Hepatic and intestinal schistosomiasis: review

Abstract

Schistosomiasis is an endemic disease in Egypt caused by the trematode Schistosoma which has different species. Hepatic schistosomiasis represents the best known form of chronic disease with a wide range of clinical manifestations. The pathogenesis of schistosomiasis is related to the host cellular immune response. This leads to granuloma formation and neo angiogenesis with subsequent periportal fibrosis manifested as portal hypertension, splenomegaly and esophageal varices. Intestinal schistosomiasis is another well identified form of chronic schistosomal affection. Egg deposition and granuloma formation eventually leads to acute then chronic schistosomal colitis and is commonly associated with polyp formation. It frequently presents as abdominal pain, diarrhea, tenesmus and anal pain. Definite diagnosis of schistosomiasis disease depends on microscopy and egg identification. Marked progress regarding serologic diagnosis occurred with development of recent PCR techniques that can confirm schistosomal affection at any stage. Many antischistosomal drugs have been described for treatment, praziquantel being the most safe and efficient drug. Still ongoing studies try to develop effective vaccines with identification of many target antigens. Preventive programs are highly needed to control the disease morbidity and to break the cycle of transmission.

Keywords: Hepatic schistosomiasis; Intestinal schistosomiasis; Portal hypertension; Praziquantel.

Fig. 1

Schistosomal granuloma in liver. Granuloma surrounding schistosomal egg in the liver. (http://www.path.cam.ac.uk/~schisto/schistosoma/schisto_pathology_granuloma).

Fig. 2

Schistosomal colonic polyp. Colonic polyp with numerous calcified Schisosome eggs beneath the lamina propria. In (http://www.gastrohep.com/images/image.asp?id=1152).

Fig. 3

Periportal fibrosis detected by ultrasonography. Thickened portal tracts seen in the liver by abdominal ultrasonography .