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Detection of Early Liver Fibrosis in Patients with Intestinal Schistosomiasis: Sonographic and Histologic Findings in Schistosoma mansoni Infection

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Abstract

Background:

Ultrasound (US) is a quite economical and noninvasive technique for morbidity assessment in intestinal schistosomiasis and it is widely used in order to detect organspecific schistosomiasis-associated changes even if it may be invalidated by low reproducibility of measurements and high interobserver variance. Reports on histological assessment in patients with intestinal schistosomiasis mansoni are unusual because liver biopsy is not commonly feasible in endemic areas and it is not warranted for ethical reasons. This short report is a retrospective analysis of sonographic and histologic findings in patients with early liver pathology, in view of the pathogenesis and morbidity assessment of intestinal schistosomiasis, in a European hospital setting.

Patients and Methods:

Seven immigrants from Madagascar with chronic diarrhea or Schistosoma mansoni egg detection in feces were admitted to our department. All of them were subjected to clinical, biochemical and ultrasound examination following current World Health Organization (WHO) guidelines. Each patient underwent percutaneous liver biopsy.

Results:

Abdominal ultrasonography showed schistosomiasis image patterns or US signs of liver involvement only in one out of seven patients while histological findings showed dense discrete fibrous tissue formation in five out of seven patients. In three out of seven patients liver biopsy also showed inflammatory infiltration of eosinophils and macrophages with periportal granulomas with S. mansoni eggs. Considering the mean egg intensity of three stool specimens as the gold standard, US showed a sensitivity of 16% with a negative predictive value (NPV) of 16% and a specificity of 100% with a positive predictive value (PPV) of 100%. Liver biopsy showed a sensitivity of 83% with a NPV of 50% and a specificity of 100% with a PPV of 100%.

Conclusion:

In our small study, US seemed to underestimate hidden liver fibrosis in intestinal schistosomiasis. In some European clinical settings, histological evaluation by liver biopsy may be a useful tool to detect early liver pathology in schistosomiasis mansoni. These findings could provide additional information for studies from endemic areas where US is commonly used for morbidity assessment.

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References

  1. Tiemersma EW, Bronzwaer SL, Lyytikainen O, Degener JE, Schrijnemakers P, Bruinsma N, Monen J, Witte W, Grundman H: Methicillin-resistant Staphylococcus aureus in Europe, 1999–2002. Emerg Infect Dis. 2004; 10: 1627–1634.

    PubMed  Google Scholar 

  2. Chaberny IF, Ziesing S, Mattner F, Barwolff S, Brandt C, Eckmanns T, Ruden H, Sohr D, Weist K, Gastmeier P: The burden of MRSA in four German university hospitals. Int J Hyg Environ Health. 2005; 208: 447–453.

    Article  PubMed  Google Scholar 

  3. Kim T, Oh PI, Simor AE: The economic impact of methicillin-resistant Staphylococcus aureus in Canadian hospitals. Infect Control Hosp Epidemiol. 2001; 22: 99–104.

    Article  PubMed  CAS  Google Scholar 

  4. Nathwani D: Impact of methicillin-resistant Staphylococcus aureus infections on key health economic outcomes: does reducing the length of hospital stay matter?. J Antimicrob Chemother. 2003; 51: ii37–ii44.

    PubMed  CAS  Google Scholar 

  5. Plowman R, Graves N, Griffin MA, Roberts JA, Swan AV, Cookson B, Taylor L: The rate and cost of hospital-acquired infections occurring in patients admitted to selected specialties of a district general hospital in England and the national burden imposed. J Hosp Infect. 2001; 47: 198–209.

    Article  PubMed  CAS  Google Scholar 

  6. Abramson MA, Sexton DJ: Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs?. Infect Control Hosp Epidemiol. 1999; 20: 408–411.

    Article  PubMed  CAS  Google Scholar 

  7. Cosgrove SE, Qi Y, Kaye KS, Harbarth S, Karchmer AW, Carmeli Y: The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol. 2005; 26: 166–174.

    Article  PubMed  Google Scholar 

  8. Cosgrove SE, Sakoulas G, Perencevich EN, Schwaber MJ, Karchmer AW, Carmeli Y: Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis. 2003; 36: 53–59.

    Article  PubMed  Google Scholar 

  9. Engemann JJ, Carmeli Y, Cosgrove SE, Fowler VG, Bronstein MZ, Trivette SL, Briggs JP, Sexton DJ, Kaye KS: Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis. 2003; 36: 592–598.

    Article  PubMed  Google Scholar 

  10. Whitby M, McLaws ML, Berry G: Risk of death from methicillin-resistant Staphylococcus aureus bacteraemia: a meta-analysis. Med J Aust. 2001; 175: 264–267.

    PubMed  CAS  Google Scholar 

  11. Tomic V, Svetina Sorli P, Trinkaus D, Sorli J, Widmer AF, Trampuz A: Comprehensive strategy to prevent nosocomial spread of methicillin-resistant Staphylococcus aureus in a highly endemic setting. Arch Intern Med. 2004; 164: 2038–2043.

    Article  PubMed  Google Scholar 

  12. Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, Farr BM: SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol. 2003; 24: 362–386.

    Article  PubMed  Google Scholar 

  13. National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing: Fourteenth Informational Supplement. NCCLS document M100. 2004:14.

  14. Harmsen D, Claus H, Witte W, Rothganger J, Turnwald D, Vogel U: Typing of methicillin-resistant Staphylococcus aureus in a university hospital setting by using novel software for spa repeat determination and database management. J Clin Microbiol. 2003; 41: 5442–5448.

    Article  PubMed  CAS  Google Scholar 

  15. Lina G, Piemont Y, Godail-Gamot F, Bes M, Peter MO, Gauduchon V, Vandenesch F, Etienne J: Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis. 1999; 29: 1128–1132.

    Article  PubMed  CAS  Google Scholar 

  16. Jernigan JA, Pullen AL, Flowers L, Bell M, Jarvis WR: Prevalence of and risk factors for colonization with methicillin-resistant Staphylococcus aureus at the time of hospital admission. Infect Control Hosp Epidemiol. 2003; 24: 409–414.

    Article  PubMed  Google Scholar 

  17. Lucet JC, Chevret S, Durand-Zaleski I, Chastang C, Regnier B: Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit: results of a multicenter study. Arch Intern Med. 2003; 163: 181–188.

    Article  PubMed  Google Scholar 

  18. Sax H, Harbarth S, Gavazzi G, Henry N, Schrenzel J, Rohner P, Michel JP, Pittet D. Prevalence and prediction of previously unknown MRSA carriage on admission to a geriatric hospital. Age Ageing. 2005.

  19. von Baum H, Schmidt C, Svoboda D, Bock-Hensley O, Wendt C: Risk factors for methicillin-resistant Staphylococcus aureus carriage in residents of German nursing homes. Infect Control Hosp Epidemiol. 2002; 23: 511–515.

    Article  Google Scholar 

  20. Holmes A, Ganner M, McGuane S, Pitt TL, Cookson BD, Kearns AM: Staphylococcus aureus isolates carrying Panton-Valentine leucocidin genes in England and Wales: frequency, characterization, and association with clinical disease. J Clin Microbiol. 2005; 43: 2384–2390.

    Article  PubMed  CAS  Google Scholar 

  21. Gillet Y, Issartel B, Vanhems P, Fournet JC, Lina G, Bes M, Vandenesch F, Piemont Y, Brousse N, Floret D, Etienne J: Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients. Lancet. 2002; 359: 753–759.

    Article  PubMed  CAS  Google Scholar 

  22. Chini V, Petinaki E, Foka A, Paratiras S, Dimitracopoulos G, Spiliopoulou I: Spread of Staphylococcus aureus clinical isolates carrying Panton-Valentine leukocidin genes during a 3-year period in Greece. Clin Microbiol Infect. 2006; 12: 29–34.

    Article  PubMed  CAS  Google Scholar 

  23. Bocchini CE, Hulten KG, Mason EO Jr, Gonzalez BE, Hammerman WA, Kaplan SL: Panton-Valentine leukocidin genes are associated with enhanced inflammatory response and local disease in acute hematogenous Staphylococcus aureus osteomyelitis in children. Pediatrics. 2006; 117: 433–440.

    Article  PubMed  Google Scholar 

  24. Tsuji BT, Rybak MJ, Cheung CM, Amjad M, Kaatz GW: Community- and health care-associated methicillin-resistant Staphylococcus aureus: a comparison of molecular epidemiology and antimicrobial activities of various agents. Diagn Microbiol Infect Dis. 2007; 58: 41–47.

    Article  PubMed  CAS  Google Scholar 

  25. Weber SG, Gold HS, Hooper DC, Karchmer AW, Carmeli Y: Fluoroquinolones and the risk for methicillin-resistant Staphylococcus aureus in hospitalized patients. Emerg Infect Dis. 2003; 9: 1415–1422.

    PubMed  Google Scholar 

  26. Charbonneau P, Parienti JJ, Thibon P, Ramakers M, Daubin C, du Cheyron D, Lebouvier G, Le Coutour X, Leclercq R: Fluoroquinolone use and methicillin-resistant Staphylococcus aureus isolation rates in hospitalized patients: a quasi experimental study. Clin Infect Dis. 2006; 42: 778–784.

    Article  PubMed  CAS  Google Scholar 

  27. Pittet D, Safran E, Harbarth S, Borst F, Copin P, Rohner P, Scherrer JR, Auckenthaler R: Automatic alerts for methicillin-resistant Staphylococcus aureus surveillance and control: role of a hospital information system. Infect Control Hosp Epidemiol. 1996; 17: 496–502.

    Article  PubMed  CAS  Google Scholar 

  28. Witte W: [The MRSA situation in Germany 2005 and 2006]. Epidemiol Bull. 2007; 6: 41–6.

    Google Scholar 

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Authors and Affiliations

  1. Infectious Disease Unit, “S. Caterina Novella” Hospital, 73013, Galatina Lecce, Italy

    R. Chiavaroli, P. Grima & P. Grima

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  1. R. Chiavaroli
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  2. P. Grima
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Correspondence to R. Chiavaroli.

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Chiavaroli, R., Grima, P. & Grima, P. Detection of Early Liver Fibrosis in Patients with Intestinal Schistosomiasis: Sonographic and Histologic Findings in Schistosoma mansoni Infection. Infection 36, 585–589 (2008). https://doi.org/10.1007/s15010-008-7202-4

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  • DOI: https://doi.org/10.1007/s15010-008-7202-4

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