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Query: UMLS:C0038002 (splenomegaly)
 9,873 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diseases presenting with splenomegaly, fever and pancytopenia require intensive differential diagnostic considerations. These diseases include lymphoproliferative and autoimmune diseases, but also chronic infections like mansonian schistosomiasis or visceral leishmaniasis (kala-azar). Diagnosis for the latter is usually performed by testing for the presence of antileishmanial antibodies using the immunofluorescence test (IFT) or the enzyme-linked immunosorbent assay (ELISA) technique. Here, we report on patients who displayed positive antileishmanial antibody titres in the IFT and/or ELISA, but did not develop kala-azar and were eventually diagnosed as having one of the non-kala-azar diseases listed above. These false-positive sera proved to be seronegative when tested on a Leishmania immunoblot. Our studies lead us to recommend the immunoblot technique as a confirmatory test in cases with doubtful IFT or ELISA antibody titres.
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PMID:Immunoblotting as a valuable tool to differentiate human visceral leishmaniasis from lymphoproliferative disorders and other clinically similar diseases. 151 53

We have identified specific ultrasonographic changes in Schistosoma japonicum-infected patients associated with serologic indicators of general liver function. An ultrasonographic examination concomitant with hematologic and biochemical serum analyses was performed on 102 patients at the Schistosomiasis Hospital in Leyte, The Philippines. The ultrasonographic liver images were classified into four patterns, according to the development of periportal fibrosis and the patterns of echogenic bands. Eleven cases with a long-term infection showed typical septal formation (network pattern). Other ultrasonographic changes in the portal system, such as the severity of splenomegaly, did not correlate with the age of the study patients or the duration of their infection; however, the production of collateral vessels was clear in the group of older patients. Among various hematologic and biochemical serum indicators of liver damage, the serum levels of total bile acid (TBA) and procollagen-III-peptide (P-III-P) strongly correlated with the development of hepatic fibrosis and protal hypertension. These findings suggest that the ultrasonographic liver patterns classified here, along with the changes in serum levels of TBA and P-III-P, provide useful indicators for field monitoring of S. japonicum infection.
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PMID:Ultrasonographic and serologic abnormalities in Schistosoma japonicum infection in Leyte, the Philippines. 153 90

In the Zaria region of northern Nigeria, which is endemic for malaria and schistosomiasis, laparotomy was performed for traumatic rupture of the spleen in 27 children, 10 of whom had splenomegaly. Eleven of the children were pedestrians knocked down by motor vehicles while crossing the road and six were boys who fell off mango or guava trees. Using suture techniques, 17 ruptured spleens were repaired and one was partially resected: eight of them were enlarged. Total splenectomy was performed in nine cases. Five of the children in the splenic conservation group died within 4 days of surgery owing to severe associated injuries. It is concluded that splenorrhaphy is quite feasible in both normal-sized and enlarged spleens and should be encouraged in similar tropical countries where splenomegaly is a common response to endemic malaria and schistosoma.
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PMID:Conservation of the ruptured spleen in children: an African series. 170 68

The relationship between intensity of Schistosoma mansoni infection and the degree of related morbidity was suspected to differ locally within the Machakos district of Kenya. To test this possibility, prevalences of hepatomegaly and splenomegaly among 1483 school children were compared between 2 areas, Kangundo and Kambu, within this district. These areas, which were similar in many geographical and economic respects and populated by the same tribe (Akamba), had comparable levels of S. mansoni infection and no S. haematobium infection. A relationship was observed between the prevalence of hepatomegaly and intensity of S. mansoni infection, which showed no consistent difference between the 2 areas. In contrast, a relationship between the prevalence of splenomegaly and intensity of S. mansoni infection was observed only in the Kambu schools, and not in the Kangundo schools where the overall prevalence of splenomegaly was much lower. It was possible that part of the splenomegaly observed in Kambu was due to malaria. However, the observation that malaria and schistosomiasis in 2 Kambu schools were not positively correlated allowed approximations to be made of the relative contributions of each to the prevalence of splenomegaly. It was concluded that, in a school close to the river that formed the main transmission site of S. mansoni, schistosomiasis-related hepatosplenomegaly was present in at least 17% of children. The reason for the high prevalence in Kambu of hepatosplenic schistosomiasis remains uncertain, but it could include a synergistic interaction of schistosome infection with malaria.
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PMID:Differences in the rate of hepatosplenomegaly due to Schistosoma mansoni infection between two areas in Machakos District, Kenya. 175 56

One hundred forty-four of 166 adults with acute viral hepatitis (AVH) admitted to an Egyptian fever hospital were followed for 12 months. The hepatitis B surface antigen (HBsAg) carrier rate in 95 with hepatitis B virus (HBV) hepatitis decreased from 53% at three months to 13% at 12 months. At 12 months, 22% of the male patients had persistent HBsAg compared with only 7% of the female patients. The HBsAg carrier rate was 25% at 12 months in those with schistosomiasis compared with 9% in those with only acute HBV infection. Splenomegaly persisted in those with palpable spleens at the initial examination and others developed splenomegaly. The prevalence of splenomegaly increased from 11% on admission to 20% at 12 months in those with only AVH, and from 40% to 69% in those with concomitant schistosomiasis. Patients with concomitant schistosomiasis had higher mean values for liver function test results and a greater proportion had abnormal liver function test results during hospitalization and follow-up than those with AVH only. Concomitant schistosomiasis increased the prevalence and prolonged splenomegaly and morbidity due to AVH. Both male sex and concomitant schistosomiasis prolonged the HBsAg carrier state. We propose that AVH frequently converts uncomplicated intestinal schistosomiasis to hepatosplenic schistosomiasis.
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PMID:The impact of endemic schistosomiasis on acute viral hepatitis. 176 2

This paper summarizes the results of a series of studies on the epidemiology, morbidity and transmission of Schistosoma mansoni in Burundi, and discusses their consequences for control. The main endemic area is the Imbo lowland, consisting of the Rusizi plain, the urban focus of Bujumbura, and the shores of lake Tanganyika; a small, new focus was discovered in the highlands, around lake Cohoha. Distribution studies on 5-10% population samples with duplicate 28 mg Kato smears in these 4 foci showed prevalences of 33%, 26%, 17%, 19% and mean (positive) egg loads of 110, 105, 92, 144 eggs/g, respectively. The combined population at risk was estimated to be 400,000 people, the total number of detectable cases 90,000. Prevalences and intensities varied greatly at the subregional, local and even sublocal level. The age- and sex-related prevalences and intensities of infection showed typical peaks in children and adolescents, but remained relatively high in adults in many areas; these patterns varied from one area to another and could be related to ecology and water contact. Morbidity studies showed that, in children as well as in adults, schistosomiasis-related morbidity such as (bloody) diarrhoea, hepatomealy and splenomegaly was apparent mainly in areas with prevalences over 30-40%. The intermediate hosts were Biomphalaria pfeifferi (Imbo), B. sudanica (Tanganyika marshes) and B. stanleyi (Cohoha). Population dynamic studies showed strong seasonal variations, the patterns of which were focal and even erratic in space and time. Snail densities and cercarial infection rates (0.85% overall in B. pfeifferi) were low.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The epidemiology of schistosomiasis in Burundi and its consequences for control. 178 Sep 93

Since the primary objective of mass chemotherapy in schistosomiasis control is reduction of schistosome-induced morbidity, it would be reasonable to assess the impact of a control program on the morbidity in a given population by investigating hepato-splenomegaly associated with schistosomiasis in a schistosomiasis endemic area. In this paper, the authors described the relationship between the prevalence, intensity and morbidity of Schistosoma japonicum infection in terms of stool egg count and ultrasonographically detectable hepatosplenomegaly in a community-based study. It was found that the epidemiological pattern of the infection in this study community was quite different from our usual understanding, that is, the prevalence remained relatively high (39.4%) when the intensity became lower. This unusual pattern might be resulted from intermittent and sporadic chemotherapy associated with frequent exposure of people to the infection in an area of high transmission. It was surprised to note that despite the praziquantel treatment carried out over the past years, the prevalence of hepatosplenomegaly induced by schistosomiasis in this community was still very high, suggesting that intermittent and sporadic chemotherapy might render little impact on schistosomiasis-induced morbidity. The investigation also showed that ultrasonography was a sensitive tool for assessing morbidity associated with schistosome infection.
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PMID:[Clinico-epidemiological investigation of schistosome-induced hepatosplenomegaly: a community-based study in Jishan, Xinjian County, Jiangxi]. 180 52

The association between both HLA-A1 and B5 antigens and chronic forms of human schistosomiasis was studied in 64 patients and 26 normal controls from a southern Brazilian hospital. No apparent correlation between the chronic forms of the disease and the expression of those antigens was detected. However, the analysis of these data together with those observed on an Egyptian sample suggests that the presence of either of the antigens and the hepatomegalic forms of schistosomiasis is significant, without heterogeneity. Conversely, the association of histocompatibility antigens with splenomegaly is consistent and significant only for HLA-B5, but not HLA-A1.
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PMID:On the association between HLA-A1 and B5 and clinical forms of schistosomiasis mansoni. 184 99

The efficacy of the highly selective antischistosomal combination chemotherapy with tubercidin (7-deazaadenosine) plus nitrobenzylthioinosine 5'-monophosphate (NBMPR-P), [el Kouni et al., Proc Natl Acad Sci USA 80: 6667-6670, 1983; el Kouni et al., Biochem Pharmacol 36: 3815-3821, 1987] was examined against chronic and advanced stages of schistosomiasis in mice. Administration of four successive daily doses of tubercidin (5 mg/kg/day) plus NBMPR-P (25 mg/kg/day) to Schistosoma mansoni-infected mice beginning 5, 6, 7 and 8 weeks post-infection and monitored for 22 weeks was very effective against the parasite. It resulted in a marked increase in survivorship of treated mice. Repetition of the dose-regimen after a 10-day rest period was even more effective. However, survivorship of infected animals decreased with the delay of therapy. Early treatment (5 weeks post-infection) resulted in 100% survival compared to 13% only for untreated animals. If therapy was instituted at 8 weeks post-infection, only 70% of the treated mice survived. Treated animals appeared healthy and were found to have less splenomegaly and hepatomegaly. Combination therapy also caused a significant reduction in the number of worms as well as the number of eggs in the liver and small intestine. However, these differences diminished as the treatment was delayed. The number of eggs in the liver was reduced from an average of 120,000 eggs per liver in untreated animals to approximately 16,000 eggs per liver when treated at 5 weeks post-infection. When treatment was delayed to 8 weeks post-infection, the reduction in liver egg count was not as dramatic (88,000 eggs per liver). Similarly, the number of eggs was reduced in the intestine from 1,759 to an average of 58 and 860 eggs per cm2 of the intestine when the mice were treated at 5 and 8 weeks post-infection respectively. However, some worms survived and resumed egg production after an extended period of recuperation. Histological examination indicated that combination therapy was effective in preventing the formation of new egg granulomas but not on pre-existing granulomas.
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PMID:Efficacy of combination therapy with tubercidin and nitrobenzylthioinosine 5'-monophosphate against chronic and advanced stages of schistosomiasis. 190 Jan 58

Thirty patients suffering from active intestinal S. mansoni infection, were classified into 3 groups. The first group: 13 cases with early active intestinal schistosomiasis without hepatosplenomegaly. The second group: 11 cases with hepatosplenomegaly and the third group: 6 cases with splenomegaly and ascites. Also 10 normal individuals were included as a normal control group. Histopathological examination of rectal mucosa showed hyperaemia with extravasation of blood in early cases and granulomatous lesions in the second group with hepatosplenomegaly. The structural changes were severe in the late ascitic group. In this group the rectal mucosal glands showed distorted irregular tubular branching in addition to the granulomatous and the fibrous reactions. Histochemical studies including periodic acid schiff, alkaline phosphatase and acetyl cholinestrase reactions were done. Using the periodic acid shiff stain, the goblet cells showed strong reaction for neutral mucin in cases of group I (early cases) and group II (late hepatosplenomegalic cases). In group III (late ascitic cases) the goblet cells were faintly stained. A notable difference was observed between the lightly and heavily infected patients of this group. No alkaline phosphatase reactivity could be identified in rectal crypts of patients and controls. Alkaline phosphatase reactivity was sharply localised in S. mansoni egg shell. There was obvious decrease in the acetyl cholinesterase stained nerve fibres in the rectal mucosa of all studied patients. The decrease was more in chronic and heavily infected cases rather than in the acute and lightly infected ones.
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PMID:Histochemical studies on rectal mucosa in active intestinal schistosomiasis. 190 99


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