Hepatic Schistosomiasis

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Most common cause of liver disease among communities where Schistosoma mansoni is endemic

Cause

• Inflammatory and fibrotic reaction to eggs laid by Schistosoma parasites and transported to the liver through the veins from the intestine

Clinical features

• Upper gastrointestinal bleeding due to varices or portal hypertensive gastropathy
• Splenomegaly and ruptured spleen
• Thrombocytopenia
• Portal vein thrombosis
• Bloody diarrhoea, anaemia and stunting

Investigations

• Liver ultrasound features: periportal fibrosis patterns and portal vein thickening as described by World Health Organization Niamey ultrasound protocol
• Screen for varices with endoscopy

ManagementTreatment

• Refer to a specialist
• Praziquantel 40 mg/kg single dose if schistosoma eggs are detected
• Correct anaemia as appropriate
• Surveillance for oesophageal varices with endoscopy
• Primary and secondary prevention of bleeding oesophageal varices with propranolol, endoscopic band ligation
• Treat acute upper gastrointestinal bleeding