Correia E I, Martinelli R P, Rocha H
Departamento de Medicina, Universidade Federal da Bahia, Salvador, BA.
Rev Soc Bras Med Trop. 1997 Jul-Aug;30(4):341-3. doi: 10.1590/s0037-86821997000400012.
Hepatosplenic form of S. mansoni infection may be accompanied by a glomerulopathy in 12-15% of cases, manifested in the majority by a nephrotic. This type of renal involvement is becoming a rare occurrence in our University Hospital (Hospital Universitário Prof. Edgard Santos) a typical general hospital in an endemic state for this parasitic disease. To investigate this fact, autopsied cases with patients with hepatosplenic form of schistosomiasis mansoni during two decades in our Hospital-1960-70, (before a therapeutic intervention in endemic areas with oxamniquine) and 1980-1990 (after the intervention) were compared in reference to number of cases and the finding of glomerulonephritis by histological examination. Even though there was a striking decrease in number of patients with advanced forms of this disease (140 as compared to 31 autopsies in these two decades), the prevalence of glomerulonephritis diagnosed was 11.4 (16 cases) in the first and 12.9 (4 cases) in the second. As there was no change in pattern of attendance in this Hospital, the drastic decrease in number of severe forms of this parasitic infection following massive therapy of the endemic population with oxamniquine is the most likely explanation not only for the decrease in number of hepatosplenic cases but, also, and as a consequence, the scarcity of cases of the schistosomal glomerulopathy observed.
曼氏血吸虫感染的肝脾型在12% - 15%的病例中可能伴有肾小球病,多数表现为肾病综合征。在我们大学医院(埃德加德·桑托斯教授大学医院),这种肾脏受累类型正变得罕见,这是一家处于该寄生虫病流行状态的典型综合医院。为了探究这一情况,我们比较了1960 - 1970年(在流行地区使用奥沙尼喹进行治疗干预之前)和1980 - 1990年(干预之后)这两个十年间在我院进行尸检的曼氏血吸虫病肝脾型患者的病例数量以及通过组织学检查发现的肾小球肾炎情况。尽管这种疾病晚期患者的数量显著减少(这两个十年间分别为140例尸检和31例尸检),但诊断出的肾小球肾炎患病率在第一个十年为11.4%(16例),在第二个十年为12.9%(4例)。由于我院的就诊模式没有变化,那么在流行人群中使用奥沙尼喹进行大规模治疗后,这种寄生虫感染严重形式的数量急剧下降,这很可能不仅是肝脾型病例数量减少的原因,也是导致观察到的血吸虫性肾小球病病例稀缺的原因。