RESUMO
Schistosoma mansoni infection is likely to be responsible for a significant proportion of cases of myelopathy occurring in areas where schistosomiasis is endemic. The aim of this study is to describe the clinical, laboratory and therapeutic data of 23 patients with schistosomal myeloradiculopathy. The medical records of 23 patients with schistosomal myelopathy admitted to two general hospitals of Belo Horizonte (MG), in Brazil, from 1995 to 1999, were reviewed retrospectively. Seventeen patients were male (74%). The mean age for the whole group was 27 years. Lower limb weakness and associated lumbar and/or lower limb pain were reported by 20 patients (87%), and 16 (70%) were unable to walk. All individuals presented urinary retention and 19 (83%) complained of intestinal dysfunction. The treatment was based on the association of antischistosomal drugs and corticosteroids. Five patients (22%) presented a full response to treatment, 13 (57%) partial response without functional limitations and 4 (17%) partial improvement with limitations or no response. Three out of the 4 patients who stopped steroids before 45 days of treatment developed recurrence of the symptoms and signs of myelopathy. Our cases demonstrate the severe presentation of the disease and the data disclosed here suggest that treatment with steroids should be kept for months after clinical improvement.
Assuntos
Neuroesquistossomose/parasitologia , Esquistossomose mansoni/complicações , Doenças da Medula Espinal/parasitologia , Adolescente , Corticosteroides/uso terapêutico , Adulto , Animais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroesquistossomose/diagnóstico , Neuroesquistossomose/tratamento farmacológico , Estudos Retrospectivos , Esquistossomose mansoni/diagnóstico , Esquistossomose mansoni/tratamento farmacológico , Esquistossomicidas/uso terapêutico , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/tratamento farmacológico , Esteroides/uso terapêutico , Resultado do TratamentoRESUMO
A combined clinical and sonographic classification of hepatosplenic schistosomiasis mansoni to be used in field-based studies is proposed herein. Seven hundred forty one individuals out of 892 (83%), living in an area endemic for schistosomiasis in Brazil, have been submitted to clinical and ultrasound examinations. Based on two stool examinations the overall prevalence for schistosomiasis in this area was 73%. Abdominal palpation was performed with patients in dorsal decubit, during deep breath, by two experienced physicians and a portable ultrasound was used for the evaluation of liver fibrosis, portal collaterals and spleen size. Four groups of individuals were identified using data obtained by abdominal palpation and ultrasound examination: (1) palpable spleen and intense periportal thickening in 9 individuals (1.2%); (2) spleen not palpable and intense periportal thickening in 15 (2%); (3) palpable spleen with light to moderate periportal thickening in 32 (4.3%), and (4) palpable spleen with a normal liver on ultrasound in 30 (4%). The definition of hepatosplenic schistosomiasis in field-based studies as the finding of Schistosoma mansoni eggs in the stools in an individual with splenomegaly is not acceptable anymore. Abdominal ultrasound should be combined with clinical examination to accurately identify hepatosplenics in endemic areas for schistosomiasis.
Assuntos
Hepatopatias Parasitárias/diagnóstico , Esquistossomose mansoni/diagnóstico , Esplenopatias/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Hepatopatias Parasitárias/diagnóstico por imagem , Hepatopatias Parasitárias/epidemiologia , Masculino , Pessoa de Meia-Idade , Palpação , Prevalência , Esquistossomose mansoni/diagnóstico por imagem , Esquistossomose mansoni/epidemiologia , Esplenopatias/diagnóstico por imagem , Esplenopatias/epidemiologia , UltrassonografiaRESUMO
Parasitic diseases which during their course in the host switch the immune system from a T helper 1 to a T helper 2 response may be detrimental to the host, contributing to granuloma formation, eosinophilia, hyper-IgE, and increased susceptibility to bacterial and fungal infections. Patients and animals with acute schistosomiasis and hyper-IgE in their serum develop pyogenic liver abscess in the presence of bacteremia caused by Staphylococcus aureus. The Salmonella-S. mansoni association has also been well documented. The association of tropical pyomyositis (pyogenic muscle abscess) and pyogenic liver abscess with Toxocara infection has recently been described in the same context. In tropical countries that may be an interesting explanation for the great morbidity of bacterial diseases. If the association of parasitic infections and pyogenic abscesses and/or fungal diseases are confirmed, there will be a strong case in favor of universal treatment for parasitic diseases to prevent or decrease the morbidity of superinfection with bacteria and fungi.
Assuntos
Abscesso Hepático/imunologia , Doenças Parasitárias/imunologia , Adolescente , Animais , Criança , Feminino , Humanos , Imunidade Celular , Larva/imunologia , Abscesso Hepático/microbiologia , Abscesso Hepático/patologia , Masculino , Camundongos , Doenças Parasitárias/complicações , Doenças Parasitárias/patologia , Estudos Prospectivos , Esquistossomose/complicações , Células Th1 , Células Th2 , Toxocaríase/complicaçõesRESUMO
OBJECTIVES: To study the role of human toxocariasis in the pathogenesis of pyogenic liver abscess. METHODS: We compared the serology for toxocariasis and serum levels of IgE in 16 patients with pyogenic liver abscess to those in 32 matched (age and gender) controls to define the possible association between these two entities. RESULTS: The serology for toxocariasis was positive in 10 of 16 patients compared with 4 of 32 controls. The relative odds and 95% confidence interval (conditional logistic regression), comparing cases and matched controls, was significant (1.4; 95% confidence interval, 1.1-1.7) for Toxocara serology. Regarding IgE serum levels, there was no difference between cases and controls. CONCLUSIONS: Human toxocariasis can be one of the predisposing causes of pyogenic liver abscess, especially in tropical countries in which this parasitic disease is common. Treatment of human toxocariasis may prevent morbid complications like hepatic abscess and should be considered in patients with clinical and/or serological evidence of Toxocara infection.
Assuntos
Abscesso Hepático/parasitologia , Toxocaríase/complicações , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Imunoglobulina E/sangue , Abscesso Hepático/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Toxocaríase/sangue , Toxocaríase/epidemiologiaRESUMO
Previous definition of classic dengue, with or without bleeding, and of dengue hemorrhagic fever (DHF) that may evolve without bleeding and with or without dengue shock syndrome (DSS) are reviewed here. The classical approach to the diagnosis and treatment of dengue, although useful in the past, nowadays breeds confusion and adds a burden to the physician's task of decision-making regarding the treatment of patients with severe forms of the disease. The classification of dengue proposed in this paper, and summarized in a diagram, incorporates new concepts about sepsis, systemic inflammatory response syndrome (SIRS), and acute respiratory distress syndrome (ARDS). This new approach, in our view, is a useful guide to initial evaluation and treatment of the disease. It also approximates the dengue syndrome to other protocols and medical procedures routinely used in intensive care units, making it easier to be followed by the health personnel working in areas subject to epidemic bursts.
Assuntos
Dengue , Dengue/complicações , Dengue/diagnóstico , Dengue/etiologia , Dengue/fisiopatologia , Dengue/terapia , HumanosAssuntos
Abscesso/diagnóstico , Abscesso/microbiologia , Miosite/diagnóstico , Miosite/microbiologia , Staphylococcus aureus , Toxocara canis , Toxocaríase/parasitologia , Abscesso/parasitologia , Abscesso/patologia , Adolescente , Adulto , Animais , Criança , Feminino , Humanos , Masculino , Camundongos , Miosite/parasitologia , Miosite/patologia , Clima TropicalRESUMO
The literature on the assessment of morbidity due to Schistosoma mansoni infection is updated. Imaging techniques such as ultrasonography, echodoppler cardiography, computerized tomography (CT scan) and magnetic resonance imaging (MRI) introduced a new perspective, and expanded our knowledge on morbidity. Three well-defined syndromes caused by schistosomiasis mansoni have been described: the stage of invasion, acute schistosomiasis (Katayama fever), and chronic schistosomiasis. Complications of the acute and chronic syndromes have also been reported: pulmonary hypertension, neuroschistosomiasis, association with Salmonella, association with Staphylococci, viral hepatitis B, glomerulonephritis. In most individuals with hepatosplenic schistosomiasis the spleen is increased in size. Hepatosplenic schistosomiasis can, however, occur without splenomegaly. The definition of hepatosplenic schistosomiasis in endemic areas as the finding of S. mansoni eggs in the stools in an individual with hepatosplenomegaly is not satisfactory anymore. Many aspects of morbidity are expected to change after schistosomiasis control. Some are expected to change quickly (worm burden, Salmonella bacteremia, hepatosplenic schistosomiasis in children) whereas others shall remain for years (pulmonary hypertension, glomerulonephritis, neuroschistosomiasis). Intestinal schistosomiasis in individuals with low worm burdens is very difficult to diagnose and therefore laborious to control.
Assuntos
Controle de Doenças Transmissíveis , Esquistossomose mansoni/epidemiologia , Brasil/epidemiologia , Doenças do Sistema Nervoso Central/diagnóstico , Doenças do Sistema Nervoso Central/parasitologia , Glomerulonefrite/complicações , Hepatite B/complicações , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/diagnóstico , Enteropatias/diagnóstico , Enteropatias/parasitologia , Hepatopatias/diagnóstico , Hepatopatias/parasitologia , Imageamento por Ressonância Magnética , Morbidade , Infecções por Salmonella/complicações , Esquistossomose mansoni/complicações , Esquistossomose mansoni/diagnóstico , Esplenopatias/diagnóstico , Esplenopatias/parasitologia , Infecções Estafilocócicas/complicações , Tomografia , UltrassonografiaRESUMO
We describe a case of visceral larva migrans syndrome complicated by liver abscess, pericardial effusion and ascites. To our knowledge, these findings have not been reported previously. The structural and immunological alterations caused by visceral larva migrans are thought to lead to the development of visceral abscesses.
Assuntos
Larva Migrans Visceral/complicações , Abscesso Hepático/complicações , Toxocara canis , Animais , Ascite/complicações , Pré-Escolar , Humanos , Larva Migrans Visceral/diagnóstico , Abscesso Hepático/parasitologia , Masculino , Derrame Pericárdico/complicaçõesRESUMO
The association between hepatic abscesses and schistosomiasis mansoni was confirmed by clinical and experimental studies. Other parasites may cause systemic immunologic changes and local structural alterations in the affected organs that can facilitate the seeding of these areas by bacteria. Tropical pyomyositis, pyogenic liver and renal abscesses are frequent diseases in tropical areas. The visceral larva migrans syndrome is caused by the presence, in the human body, of larvae of worms that have other animals as their definitive host, most commonly being caused by Toxocara canis. The larvae migrate to various body organs leading to many inflammatory reactions in the form of granuloma and tissue necrosis. In this review we discuss the possible host-parasite-bacteria interactions that would favour the formation of abscesses in the organs involved by the larva of T. canis and present preliminary results of a clinical and experimental study undertaken during the last four years to define the role of this parasite in the pathogenesis of the abscesses.
Assuntos
Abscesso/etiologia , Nefropatias/etiologia , Larva Migrans Visceral/complicações , Abscesso Hepático/etiologia , Doenças Musculares/etiologia , Toxocara canis , Abscesso/diagnóstico , Abscesso/epidemiologia , Abscesso/parasitologia , Abscesso/terapia , Animais , Interações Hospedeiro-Parasita , Humanos , Nefropatias/diagnóstico , Nefropatias/epidemiologia , Nefropatias/parasitologia , Nefropatias/terapia , Larva Migrans/parasitologia , Larva Migrans Visceral/diagnóstico , Larva Migrans Visceral/epidemiologia , Larva Migrans Visceral/etiologia , Larva Migrans Visceral/terapia , Abscesso Hepático/diagnóstico , Abscesso Hepático/epidemiologia , Abscesso Hepático/parasitologia , Abscesso Hepático/terapia , Doenças Musculares/diagnóstico , Doenças Musculares/epidemiologia , Doenças Musculares/parasitologia , Doenças Musculares/terapia , PrognósticoRESUMO
The medical records of patients with AIDS admitted to a general hospital in Brazil from 1989 to 1997 were reviewed retrospectively with the aim at defining the frequency and etiology of fever of undetermined origin (FUO) in HIV-infected patients of a tropical country and to evaluate the usefulness of the main diagnostic procedures. 188 (58.4%) out of 322 patients reported fever at admission to hospital and 55 (17.1%) had FUO. Those with FUO had a mean CD4+ cell count of 98/ml. A cause of fever was identified for 45 patients (81.8%). Tuberculosis (32.7%), Pneumocystis carinii pneumonia (10.9%), and Mycobacterium avium complex (9.1%) were the most frequent diagnoses. Other infectious diseases are also of note, such as cryptococcal meningitis (5.5%), sinusitis (3.6%), Salmonella-S. mansoni association (3.6%), disseminated histoplasmosis (3.6%), neurosyphilis (1.8%), and isosporiasis (1.8%). Four patients had non-Hodgkin's lymphoma (7.3%). We conclude that an initial aggressive diagnostic approach should be always considered because biopsies (lymph node, liver and bone marrow) produced the highest yield in the diagnosis of FUO and the majority of the diagnosed diseases are treatable. The association of diseases is common and have contributed to delay the final diagnosis of FUO in most cases. In our study area the routine request of hemocultures for Salmonella infection and the investigation of cryptococcal antigen in the serum should be considered.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Febre de Causa Desconhecida/etiologia , Infecções Oportunistas Relacionadas com a AIDS/complicações , Adolescente , Adulto , Idoso , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções por Salmonella/complicaçõesRESUMO
We report a case of tropical pyomyositis in a boy who presented with a severe febrile illness associated with diffuse erythema, and swelling in many areas of the body which revealed on operation extensive necrotic areas of various muscles that required repeated débridement. The patient gave a history of contact with dogs, and an ELISA test for Toxocara canis was positive. He also presented eosinophilia and high serum IgE levels. Staphylococcus aureus was the sole bacteria isolated from the muscles affected. We suggest that tropical pyomyositis may be caused by the presence of migrating larvae of this or other parasites in the muscles. The immunologic and structural alterations caused by the larvae, in the presence of concomitant bacteremia, would favour seeding of the bacteria and the development of pyomyositis.
Assuntos
Larva Migrans Visceral/complicações , Miosite/complicações , Infecções Estafilocócicas/complicações , Toxocara canis , Adolescente , Animais , Seguimentos , Humanos , Larva Migrans Visceral/diagnóstico , Larva Migrans Visceral/tratamento farmacológico , Masculino , Miosite/diagnóstico , Miosite/tratamento farmacológico , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/isolamento & purificaçãoRESUMO
Two young men with Salmonella bacteraemia, active schistosomiasis and the acquired immunodeficiency syndrome are reported. The clinical presentation comprised nonspecific signs and symptoms, such as fatigue, malaise, weight loss, diarrhoea, prolonged fever, and hepatosplenomegaly. In one patient, liver biopsy showed poorly formed granulomata around Schistosoma mansoni eggs and hepatitis. Treatment of schistosomiasis alone induced consistent clinical improvement with eventual cure of both Salmonella and S. mansoni infections. Recognition of the Salmonella-S. mansoni association in patients with AIDS is important because treatment of schistosomiasis makes a difference, improving the prognosis of this otherwise, recurrent, potentially fatal bacteraemia.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções por Salmonella/complicações , Esquistossomose mansoni/complicações , Adulto , Humanos , Masculino , Oxamniquine/uso terapêutico , Infecções por Salmonella/diagnóstico , Infecções por Salmonella/tratamento farmacológico , Esquistossomose mansoni/diagnóstico , Esquistossomose mansoni/tratamento farmacológico , Esquistossomicidas/uso terapêuticoRESUMO
In hospital-based series viral hepatitis B has been frequently described in association with schistosomiasis whilst in field-based studies the association has not been confirmed. The association between schistosomiasis and Salmonella bacteraemia has been well documented. More recently, acute schistosomiasis has been shown to be a facilitating factor in the genesis of pyogenic liver abscesses caused by Staphylococcus aureus. New evidences indicate an interaction between the acquired immunodeficiency syndrome (AIDS) and schistosomiasis. In this paper, data on the association of schistosomiasis with other infections are updated.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Hepatite B/complicações , Abscesso Hepático/complicações , Infecções por Salmonella/complicações , Esquistossomose/complicações , Infecções Estafilocócicas/complicações , Animais , HumanosAssuntos
Esquistossomose mansoni/diagnóstico , Esquistossomose mansoni/epidemiologia , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Criança , Pré-Escolar , Doenças Endêmicas , Fezes/parasitologia , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Morbidade , Contagem de Ovos de Parasitas , Prevalência , População Rural , Esquistossomose mansoni/diagnóstico por imagem , UltrassonografiaRESUMO
This study was undertaken to determine the accuracy of splenic palpation for the diagnosis of splenomegaly, and to determine whether the frequency of individuals with a palpable spleen in an endemic area can be considered as an index of morbidity of schistosomiasis. For the clinical diagnosis of splenomegaly, two criteria have been tested: (A) presence of a palpable spleen and (B) presence of a palpable spleen whose border could be felt more than 4 cm below the costal margin. In an area of high prevalence of the disease (66.3%) 285 individuals aged 18 years or more have been submitted to abdominal ultrasonography and physical examination. Splenomegaly was defined as a splenic length greater than 120 mm by ultrasound and the sensitivity, specificity, positive and negative predictive values of criterion A were 72.2%, 90.5%, 35.1% and 97.8%. The values for criterion B were 27.8%, 98%, 50% and 95%, respectively. In an non endemic area, 517 individuals were submitted to the same protocol and 22 individuals had a palpable spleen, but no patient fulfilled criterion B for splenomegaly, and only one met the ultrasonographic criterion for splenomegaly. The authors concluded that abdominal palpation is a poor method for the diagnosis of splenomegaly.
Assuntos
Palpação/métodos , Esquistossomose mansoni/epidemiologia , Esplenomegalia/diagnóstico , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Criança , Pré-Escolar , Doenças Endêmicas , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Morbidade , Valor Preditivo dos Testes , Prevalência , Esquistossomose mansoni/complicações , Sensibilidade e Especificidade , Esplenomegalia/epidemiologia , Esplenomegalia/etiologiaRESUMO
Data on the association of schistosomiasis and hepatitis B in field-based studies are scarce. Two areas have been selected for this study: i) Queixadinha, endemic for schistosomiasis, with a population of 693 individuals, and ii) Capão, a control non-endemic area, with 515 inhabitants. Sera of all individuals in both areas were tested for hepatitis B infection, yearly, from 1994 to 1997. In the first area hepatitis B was found in 32.1% of children up to one year old and reached a peak of 68.7% in the age range of 15 to 19 years. In the control area the prevalence of hepatitis B was under 5% up to 19 years of age and the highest prevalence was observed in adults over 45. HBsAg was detected in 9.4% of the individuals living in the endemic area for schistosomiasis and in 1.4% of the controls (OR = 4.98; 95% CI = 3.7-6.7). The index of chronicity of HBsAg was not statistically different in the studied areas (8.1% x 7.3%; OR = 1.09; 95% CI = 0.42-3.03), nor was it different for people with and without schistosomiasis in Queixadinha (8.7% x 7.0%). We conclude that the Schistosoma mansoni infection has not altered the course of hepatitis B in the studied area.
Assuntos
Antígenos de Superfície da Hepatite B/sangue , Hepatite B Crônica/complicações , Esquistossomose mansoni/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Biomarcadores , Brasil/epidemiologia , Portador Sadio/sangue , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Doenças Endêmicas , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prevalência , População Rural , Esquistossomose mansoni/epidemiologiaRESUMO
The cases of five patients with unusual manifestation of acute schistosomiasis mansoni are described in this paper. One patient developed skin lesions, three displayed diverse lung involvement, and one presented pyrogenic liver abscesses caused by Staphylococcus aureus.
Assuntos
Humanos , Esquistossomose mansoni/complicações , Dermatite/parasitologia , Fígado/patologia , Pneumonia/parasitologiaRESUMO
In patients with hepatosplenic schistosomiasis, characteristic thickening of the walls of the portal vein in the hilus and its central and peripheral branches is observed. In an area of high prevalence of the disease in Brazil, 424 individuals older than 5 years have been examined by abdominal ultrasonography and 146 presented fibrosis, classified as central in 31 (21%), peripheral in 56 (38%), and both central and peripheral in 59 (40%). The mean ages of the subjects in the 3 groups were 45.7, 24.1 and 31.9 years, respectively (P < 0.05). The presence of central fibrosis was associated with the presence of peripheral fibrosis (odds ratio 10.7, P < 0.000001). Splenomegaly was found in 16% and 15% of individuals with peripheral and both central and peripheral fibrosis, respectively. No subject with central but no peripheral fibrosis and splenomegaly was identified. We conclude that central fibrosis occurs among older subjects but should not be considered a criterion for advanced disease.
Assuntos
Cirrose Hepática/diagnóstico por imagem , Hepatopatias Parasitárias/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Esquistossomose mansoni/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Cirrose Hepática/complicações , Hepatopatias Parasitárias/complicações , Masculino , Pessoa de Meia-Idade , Razão de Chances , Esquistossomose mansoni/complicações , Esplenomegalia/complicações , UltrassonografiaRESUMO
The cases of five patients with unusual manifestations of acute schistosomiasis mansoni are described in this paper. One patient developed skin lesions, three displayed diverse lung involvement, and one presented pyogenic liver abscesses caused by Staphylococcus aureus.