title: Hepatosplenic schistosomiasis in field-based studies: a combined clinical and sonographic definition.
abstract: 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.
authors.affiliation: Serviço de Doenças Infecciosas e Parasitárias, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, 30130-100, Brasil. lamber@net.em.com.br
authors.forename: J R
authors.initials: JR
authors.lastname: Lambertucci
authors.forename: G F
authors.initials: GF
authors.lastname: Cota
authors.forename: R A
authors.initials: RA
authors.lastname: Pinto-Silva
authors.forename: J C
authors.initials: JC
authors.lastname: Serufo
authors.forename: R
authors.initials: R
authors.lastname: Gerspacher-Lara
authors.forename: S
authors.initials: S
authors.lastname: Costa Drummond
authors.forename: C M
authors.initials: CM
authors.lastname: Antunes
authors.forename: V
authors.initials: V
authors.lastname: Nobre
authors.forename: A
authors.initials: A
authors.lastname: Rayes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008109:Liver Diseases, Parasitic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010173:Palpation; D015995:Prevalence; D012555:Schistosomiasis mansoni / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D013158:Splenic Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D014463:Ultrasonography