Cardiopulmonary Manifestations of Hepatosplenic Schistosomiasis

Background— Schistosomiasis is a highly prevalent disease with >200 million infected people. Pulmonary hypertension is one of the pulmonary manifestations in this disease, particularly in its hepatosplenic presentation. The aim of this study was to determine the prevalence of pulmonary hypertension in schistosomiasis patients with the hepatosplenic form of the disease. Methods and Results— All patients with hepatosplenic schistosomiasis followed up at the gastroenterology department of our university hospital underwent echocardiographic evaluation to search for pulmonary hypertension. Patients presenting with systolic pulmonary artery pressure >40 mm Hg were further evaluated through right heart catheterization. Our study showed an 18.5% prevalence of patients with elevated systolic pulmonary artery pressure at echocardiography. Invasive hemodynamics confirmed the presence of pulmonary hypertension in 7.7% (95% confidence interval, 3.3 to 16.7) of patients, with a prevalence of precapillary (arterial) pulmonary hypertension of 4.6% (95% confidence interval, 1.5 to 12.7). Conclusions— Our study reinforces the role of echocardiography as a screening tool in the investigation of pulmonary hypertension, together with the need for invasive monitoring for a proper diagnosis. We conclude that hepatosplenic schistosomiasis may account for one of the most prevalent forms of pulmonary hypertension worldwide, justifying the development of further studies to evaluate the effect of specific pulmonary hypertension treatment in this particular form of the disease.

[1]  M. Gladwin,et al.  Prevalence and risk factors for pulmonary artery systolic hypertension among sickle cell disease patients in Nigeria , 2008, American journal of hematology.

[2]  G. Simonneau,et al.  Prevalence of HIV-related pulmonary arterial hypertension in the current antiretroviral therapy era. , 2008, American journal of respiratory and critical care medicine.

[3]  J. Coura,et al.  A thirty years follow-up study on Schistosomiasis mansoni in a community of Minas Gerais, Brazil. , 2007, Memorias do Instituto Oswaldo Cruz.

[4]  A. Sanyal,et al.  Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis , 2007, The American Journal of Gastroenterology.

[5]  J. Bousquet,et al.  Pulmonary hypertension: from an orphan disease to a public health problem. , 2007, Chest.

[6]  J. McMurray,et al.  An epidemiological study of pulmonary arterial hypertension , 2007, European Respiratory Journal.

[7]  Vandana Sachdev,et al.  Hemodynamic and functional assessment of patients with sickle cell disease and pulmonary hypertension. , 2007, American journal of respiratory and critical care medicine.

[8]  J Bousquet,et al.  Global Alliance against Chronic Respiratory Diseases , 2007, European Respiratory Journal.

[9]  Luc Kestens,et al.  Human schistosomiasis , 2006, The Lancet.

[10]  P. Tauil,et al.  An analysis of the impact of the Schistosomiasis Control Programme in Brazil. , 2006, Memorias do Instituto Oswaldo Cruz.

[11]  M. Humbert,et al.  Pulmonary arterial hypertension in France: results from a national registry. , 2006, American journal of respiratory and critical care medicine.

[12]  R. Souza,et al.  [Clinical characteristics of pulmonary hypertension patients in two reference centers in the city of Sao Paulo]. , 2006, Revista da Associacao Medica Brasileira.

[13]  M. Humbert,et al.  Deleterious effects of beta-blockers on exercise capacity and hemodynamics in patients with portopulmonary hypertension. , 2006, Gastroenterology.

[14]  F. Carrilho,et al.  Assessment of Portal Hemodynamics by Doppler Ultrasound and of Liver Morphology in the Hepatosplenic and Hepatointestinal Forms of Schistosomiasis Mansoni , 2006, Digestive Diseases and Sciences.

[15]  M. Humbert,et al.  Early detection of pulmonary arterial hypertension in systemic sclerosis: a French nationwide prospective multicenter study. , 2005, Arthritis and rheumatism.

[16]  R. Franchis,et al.  Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. , 2005, Journal of hepatology.

[17]  R. de Franchis.  Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. , 2005, Journal of hepatology.

[18]  A. Torbicki,et al.  Diagnosis and differential assessment of pulmonary arterial hypertension. , 2004, Journal of the American College of Cardiology.

[19]  J. Zieleński,et al.  Airway inflammation and infection in congenital bilateral absence of the vas deferens. , 2004, American journal of respiratory and critical care medicine.

[20]  S. Raia,et al.  Systemic and Hepatic Hemodynamics in Hepatosplenic Manson's Schistosomiasis with and Without Propranolol , 1997, Digestive Diseases and Sciences.

[21]  B. Zilberstein,et al.  Prevalence of pulmonary hypertension in patients with hepatosplenic Mansonic schistosomiasis--prospective study. , 2003, Hepato-gastroenterology.

[22]  J. Habbema,et al.  Quantification of clinical morbidity associated with schistosome infection in sub-Saharan Africa. , 2003, Acta tropica.

[23]  Gail M. Williams,et al.  Current concepts - Schistosomiasis , 2002 .

[24]  C. Otto,et al.  Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. , 2002, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[25]  L. Chitsulo,et al.  The global status of schistosomiasis and its control. , 2000, Acta tropica.

[26]  J. Richter,et al.  Evolution of schistosomiasis-induced pathology after therapy and interruption of exposure to schistosomes: a review of ultrasonographic studies. , 2000, Acta tropica.

[27]  L. Magder,et al.  The role of parenteral antischistosomal therapy in the spread of hepatitis C virus in Egypt , 2000, The Lancet.

[28]  C. Antunes,et al.  Schistosomiasis and associated infections. , 1998, Memorias do Instituto Oswaldo Cruz.

[29]  J. Lamounier,et al.  Pulmonary hypertension in schistosomiasis mansoni. , 2006, Transactions of the Royal Society of Tropical Medicine and Hygiene.

[30]  P. Bourée,et al.  [Pulmonary arterial hypertension due to bilharziasis. Apropos of a case due to Schistosoma haematobium having been cured by praziquantel]. , 1990, Bulletin de la Societe de pathologie exotique.

[31]  Guimarães Ac.  Present state of knowledge of cardiopulmonary involvement in schistosomiasis mansoni , 1982 .

[32]  A. Guimarães.  [Present state of knowledge of cardiopulmonary involvement in schistosomiasis mansoni]. , 1982, Arquivos brasileiros de cardiologia.

[33]  J. Renambot,et al.  [Bilharzial pulmonary arterial hypertension. Clinical and hemodynamic study in 37 patients]. , 1978, Archives des maladies du coeur et des vaisseaux.

[34]  G. Rebouças,et al.  Hepatitis B surface antigen carrier state in hepatosplenic schistosomiasis. , 1976, Gastroenterology.

[35]  E. Chaves.  The pathology of the arterial pulmonary vasculature in manson's schistosomiasis. , 1966, Diseases of the chest.

[36]  E. Chaves.  [Plexiform lesions in chronic cor pulmonale in schistosomiasis]. , 1965, Hospital.

[37]  E. Chaves.  [Pathology of pulmonary endarteritis obliterans in Manson's schistosomiasis]. , 1965, Anais do Instituto de Medicina Tropical.

[38]  E. Chaves.  [PULMONARY SCHISTOSOMIASIS ARTERITIS; MORPHOLOGICAL STUDY OF 54 CASES WITH SPECIAL REFERENCE TO HYPERSENSITIVITY REACTIONS]. , 1964, Hospital.

[39]  A. Magalhães Filho.  Pulmonary lesions in mice experimentally infected with Schistosoma mansoni. , 1959, The American journal of tropical medicine and hygiene.

[40]  A. Ghareeb,et al.  The pathogenesis of pulmonary schistosomiasis in Egypt with special reference to Ayerza's disease , 1938 .