Study on histopathology, ultrasonography and some special serum enzymes and collagens for 38 advanced patients of schistosomiasis japonica
Introduction
The majority of advanced patients of schistosomiasis japonica have been in a sub-clinical state but some indices indicating the disease status are not sensitive, especially for the transition from chronic to advanced stage of the disease. The clinical manifestations and indices indicating the transition are non-specific, for instance, hemorrhage and hypoproteinemia etc, by which liver fibrosis due to schistosomiasis cannot be confirmed definitely. Histologically, main pathologic alterations of schistosomiasis are granuloma formation around schistosomal eggs which deposit in the parenchyma with continuously inflammatory fibrosis, especially in the liver. It has been the project for study of schistitosomiasis as how to use physical and biochemical examination results to indicate the transition from chronic to advanced stage of the disease and the degree of lesion, especially the degree of intrahepatic fibrosis.
Now ultrasonographic examination is a practical, non-invasive and harmless technique for testing directly the degree of lesion of hepatic parenchyma and has been extensively used as a tool in studies of epidemiology and pathology of schistosomiasis. It is not only used for clinical diagnosis in hospitalized patients, but also for screening cases of schistosomiasis in communities. Many studies on ultrasonographic examination for schistosomiasis, especially for liver fibrosis, have been reported (Cautinho, 1990, Mott et al., 1992, Abdel-Wahab and Strickland, 1993, Yuan et al., 1993, Strickland and Abdel-Wahab, 1993, Bisier et al., 1995).
Publications on histopathological examination for schistosomiasis japonica, either by autopsy or via liver biopsy, are very few in the literature, especially during the recent years owing to the facts that death due to schistosomiasis has been rare after praziquentel chemotherapy became available since late 1970s, and liver biopsy is an invasive technique and sometimes harmful to patients (Chen and Mott, 1989). During 1997–1998, splenectomy was performed in the Special Hospital for Schistosomiasis in Dongzhi County, Anhui Province, China in 38 cases clinically diagnosed as advanced schistosomiasis for the surgical treatment of their splenomegaly and/or hypersplenism. Before splenectomy, ultrasonographic and biochemical examinations were carried out to compare those with histopathological data from liver biopsy during splenectomy. This study is to compare results of ultrasound examination (mainly on the liver and spleen) and some special serum enzymes and collagens tested with the results of histopathological studies on the liver and spleen in 38 advanced patients diagnosed clinically, and to analyze with emphasis on the correlation between hepatic lesions and results of ultrasonographic and serological indices so as to use ultrasonography alone or in combination with serum examination to indicate the presence of hepatic lesion and its degree, used as a background for clinical diagnosis, treatment and prognosis.
Section snippets
Patients
Thirty-eight patients in this study were all diagnosed clinically as advanced schistosomiasis with splenomegaly. For all the 38 cases, surgery treatment with splenectomy was carried out. The patients were all hospitalized in the Special Hospital of Schistosomiasis in Dongzhi County, Anhui Province.
Medical history
The medical history and clinical information for everyone were collected and recorded.
Ultrasonographic examination of the liver and spleen
Ultrasound apparatus used in this study was Haiying SJN2035 with the frequency of transducer of 3.5MHZ made in
Medical history and diagnosis
Among 38 patients, 13 were males and 25 females. Seven patients aged between 9 and 30 years and 31 cases aged more than 31 years, the oldest one being 65 years of age. Thirty-seven patients were farmers residing in endemic areas in Dongzhi County over a long period of time and had been examined for schistosomiasis many times. One child aged 9 years was a resident living in non-endemic area and had been in the endemic area only for 1 year. All the 38 patients had the symptoms and signs of portal
Conclusion
Based on the results of this study, some conclusions can be reached.
- 1
According to “The use of diagnostic ultrasound in schistosomiasis: attempts at standardization of methodology” promulgated by WHO in 1992, 38 patients in this study all have ultrasonographic features of liver fibrosis due to schistosomiasis, and in consideration of the medical history and results of relevant examination, all patients can be diagnosed definitely as advanced schistosomiasis japonica. So, ultrasonography has it
Discussion
Up to present, ultrasonography is used just as supplementary tool for diagnosis, but it has rapidly become a necessary measure in study of pathological changes for schistosomiasis. Ultrasonography has been used more and more extensively in many aspects of schistosomiasis. Homeida et al., who used earliest ultrasound examination in fields for study of schistosomiasis, brought light of specificity and sensitivity of ultrasonic examination in schistosomiasis diagnosis by comparing ultrasonic data
Acknowledgements
We would like to thank The Joint Research Management Committee (JRMC) of the World Bank Load Project for Schistosomiasis Control in China for providing funds for the study. We wish to express our special thank to Professor Chen Minggang, Institute of Parasitic Diseases, Chinese Academy of Preventive Medicine, for his help during the preparation of this manuscript. Our thanks are also due to Dr Lu Dabing, Anhui Provicial Institute of Schistosomiasis for his help in statistics. Dr Cui Jiahai, Dr
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2007, Acta TropicaCitation Excerpt :Hillyer et al. (1979) consider it more accurate in detecting infected individuals than a single stool examination and suggest its use as a standard reference. Other studies include the COPT for diagnosis of schistosomiasis (Guangjin et al., 2002), and test comparisons (Zhu et al., 2002). A positive COPT suggests an active infection, and it proves negative in 64% of the people after 12 months of praziquantel treatment from an area without transmission due to snail eradication (Alarcón de Noya et al., 1992b).