Schwartz E, Rozenman J, Perelman M
The Center for Geographic Medicine and Department of Medicine C, Sheba Medical Center, Tel Hashomer, Israel.
Am J Med. 2000 Dec 15;109(9):718-22. doi: 10.1016/s0002-9343(00)00619-7.
The clinical aspects of acute pulmonary schistosomiasis among nonimmune patients have not been well characterized.
We evaluated 8 patients who presented with pulmonary symptoms and abnormal chest radiographs after recent travel to Africa. Diagnosis was based on the detection of schistosomal eggs or positive serology.
Of 60 patients evaluated in our center for schistosomiasis during a 3-year period, 8 (6 with Schistosoma hematobium, 2 with S. mansoni) had pulmonary symptoms. These symptoms appeared 3 to 6 weeks after exposure and consisted of dry cough and shortness of breath without concurrent fever. The mean (+/- SD) eosinophil count was 4020 +/- 1400 per micromL. Chest radiography revealed multiple small nodules in 7 patients; in 1 patient, a diffuse interstitial infiltrate was also seen. Computerized tomographic scans of the chest were obtained in 4 patients; the scans confirmed the nodular pattern and detected a greater number of nodules. A transbronchial biopsy in 1 patient revealed eosinophilic pneumonia without detection of larva or eggs.
Pulmonary manifestations during the early stage of schistosomal infection may occur with either S. hematobium or S. mansoni infection. These manifestations may represent an immunologic process, as is thought to be responsible for the febrile systemic response (Katayama fever) to acute infection.
非免疫患者急性肺血吸虫病的临床特征尚未得到充分描述。
我们评估了8例近期前往非洲后出现肺部症状和胸部X线片异常的患者。诊断基于血吸虫卵的检测或血清学阳性。
在3年期间，我们中心评估的60例血吸虫病患者中，8例（6例感染埃及血吸虫，2例感染曼氏血吸虫）有肺部症状。这些症状在接触后3至6周出现，包括干咳和呼吸急促，无并发发热。嗜酸性粒细胞平均计数（±标准差）为每微升4020±1400。胸部X线检查显示7例患者有多个小结节；1例患者还可见弥漫性间质浸润。4例患者进行了胸部计算机断层扫描；扫描证实了结节状模式，并检测到更多结节。1例患者经支气管活检显示嗜酸性粒细胞性肺炎，未检测到幼虫或虫卵。
血吸虫感染早期的肺部表现可能发生在埃及血吸虫或曼氏血吸虫感染时。这些表现可能代表一种免疫过程，正如人们认为其是急性感染发热全身性反应（急性期血吸虫病发热）的原因一样。
