Ultrasound in tropical and parasitic diseases.

CONTEXT

Migration and worldwide travel mean that western clinicians and radiologists more and more face imported tropical diseases. Diseases with unclear signs and symptoms are likely to be investigated with ultrasound. Many tropical diseases have particular ultrasonographic features that are not familiar to the examiner and which may lead to further unnecessary or even harmful diagnostic investigations. In developing countries, ultrasound machines are becoming more widely distributed and are fairly cheap. Portable devices allow field use of ultrasound for population studies and individual diagnosis of tropical diseases.

STARTING POINT

Recently, WHO introduced a standardised classification of ultrasonographic images of cystic echinococcosis (Acta Trop 2003; 85: 253-61), to obtain comparable results in patients worldwide and to link disease status with each morphological type of echinococcosis cyst. WHO also defined guidelines for the puncture, aspiration, injection of ethanol, and re-aspiration of such cysts. Ultrasound allows diagnosis of schistosomiasis-induced periportal fibrosis and bladder abnormalities. Liver abscesses can be differentiated from other focal lesions such as cysts or neoplasms. For amoebic abscesses, invasive procedures are usually not required. In doubtful cases ultrasound-guided puncture can give adequate material for microscopy and culture. Helminths (eg, ascaris), flukes, and filariae can be seen directly with ultrasound. Filaria-induced damage also includes hypoechogenic splenic foci and ultrasonographic abnormalities due to tropical hypereosinophilia. WHERE NEXT? Classification of cysts and procedures that are less invasive than conventional surgery are being developed further for cystic echinococcosis. Novel methods are needed for the assessment of polycystic and alveolar echinococcosis. Ultrasound protocols for schistosomiasis are being evaluated for interobserver reliability, relation to clinical disease status, and power to predict complications. A WHO expert-group is also developing a standardised protocol for Asian schistosomiasis. International consensus on an algorithm for managing amoebic liver abscesses is needed.