Nigo Maurice M, Odermatt Peter, Nigo David Wully, Salieb-Beugelaar Georgette B, Battegay Manuel, Hunziker Patrick R
Nanomedicine Translation Group, Intensive Care Unit, University Hospital Basel University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
CLINAM-European Foundation for Clinical Nanomedicine, Alemannengasse 12, P.O. Box, 4016, Basel, Switzerland.
Infect Dis Poverty. 2021 Mar 25;10(1):39. doi: 10.1186/s40249-021-00815-6.
Severe hepatosplenic complications arise in patients with chronic Schistosoma mansoni infection after heavy exposure to disease agents in endemic areas. These complications are rarely reported and, hence, underestimated.
We report on eight patients with severe morbidity associated with S. mansoni infection in Ituri Province, northeastern Democratic Republic of Congo (DRC). The patients were identified during a community-based survey in 2017; one patient was seen at the district hospital. After taking the patients' history, a clinical examination and an abdominal ultrasonographical examination were performed. S. mansoni infection was diagnosed in fecal (Kato-Katz technique) and urine (point-of-case circulating cathodic antigen test) samples. These eight patients with severe intestinal and hepatosplenic complications were identified from four villages with high S. mansoni infection prevalence and related morbidity. The patients' ages ranged from 19 to 57 years; four patients were women. Three patients reported hematemesis. Two patients were severely anemic. All patients reported non-specific abdominal symptoms, such as diarrhea (six patients), abdominal pain (seven patients), and blood in the stool (five patients), as well as weight loss (two patients). Abdominal ultrasonography revealed ascites in four patients. All patients had portal hypertension with hepatomegaly (seven patients) or splenomegaly (five patients). Of the six patients with a discernable liver parenchyma pattern, five displayed pattern F and three patient displayed pattern E. Liver parenchyma was not visible for two patients with severe ascites. An S. mansoni infection was confirmed in six patients, with infection intensity ranging from light to heavy. All S. mansoni positive patients were treated with praziquantel (40 mg/kg body weight) and referred to the district hospital for follow-up. One patient with severe ascites died two weeks after we saw her. Due to security and accessibility reasons, the villages could not be visited again and the patients were lost to follow-up.
Our observations of patients with severe schistosomiasis document the severe degree of endemicity of S. mansoni in the province and suggest an urgent need for adequate schistosomiasis control measures that target vulnerable population groups and address severe complications.
在流行地区大量接触曼氏血吸虫病病原体后，慢性曼氏血吸虫感染患者会出现严重的肝脾并发症。这些并发症很少被报道，因此被低估。
我们报告了刚果民主共和国东北部伊图里省8例与曼氏血吸虫感染相关的严重发病病例。这些患者是在2017年的一项社区调查中被发现的；1例患者在地区医院就诊。在了解患者病史后，进行了临床检查和腹部超声检查。通过粪便（加藤厚涂片法）和尿液（即时循环阴极抗原检测）样本诊断出曼氏血吸虫感染。这8例患有严重肠道和肝脾并发症的患者来自4个曼氏血吸虫感染率高且相关发病率高的村庄。患者年龄在19至57岁之间；4例为女性。3例患者报告有呕血症状。2例患者严重贫血。所有患者均报告有非特异性腹部症状，如腹泻（6例）、腹痛（7例）、便血（5例）以及体重减轻（2例）。腹部超声检查显示4例患者有腹水。所有患者均有门静脉高压，伴有肝肿大（7例）或脾肿大（5例）。在6例可辨别肝实质模式的患者中，5例表现为F型，3例表现为E型。2例有严重腹水的患者肝实质不可见。6例患者确诊为曼氏血吸虫感染，并确定感染强度从轻到重。所有曼氏血吸虫阳性患者均接受吡喹酮治疗（40mg/kg体重），并被转诊至地区医院进行随访。1例有严重腹水的患者在我们见到她两周后死亡。由于安全和交通便利等原因，无法再次访问这些村庄，患者失访。
我们对严重血吸虫病患者的观察记录了该省曼氏血吸虫病的严重流行程度，并表明迫切需要采取适当的血吸虫病控制措施，针对弱势群体并处理严重并发症。
