A. Murinello¹, N. Germano¹, P. Mendonça ¹, C. Campos ¹, A. Grácio²

Resumo

Baseados no caso de uma doente natural da ilha de São Tomé, com doença intestinal e hipertensão portal por doença hepática em resultado de infecção por Schistosoma guineensis, os autores fazem uma revisão concisa deste tipo de schistosomíase, incluindo o ciclo de vida do parasita, diagnóstico da infecção, anatomia patológica, imunopatogénese, quadro clínico, complicações da doença e terapêutica. A distribuição geográfica do Schistosoma guineensis está restringida de uma forma geral à África Central Ocidental, na região do Golfo da Guiné, e é a única espécie de Schistosoma presente na ilha de São Tomé. Habitualmente considerada uma doença relativamente ligeira da parte terminal do cólon, muitas vezes assintomática, outras vezes manifestada por disenteria schistosómica, os autores referem além do propósito, quatro casos de infecções em naturais da mesma ilha, que apresentaram problemas graves, dois com envolvimento do sistema nervoso central, um com doença hepática e envolvimento cardiopulmonar, e o caso de um adolescente com doença hepática e atraso de crescimento devido a níveis baixos de factores de crescimento insulínico 1 e 2 (IGF1 e IGF2) (antigamente chamadas somatomedinas). É importante ter conhecimento destas possibilidades evolutivas, de forma a que a terapêutica possa ser feita em tempo útil e assim se obter um bom resultado terapêutico.

Summary

Based on the case of a patient from the island of São Tomé who presented with intestinal and liver disease with portal hypertension due to infection with Schistosoma guineensis, the authors provide a concise review of this type of schistosomiasis, including the parasite life cycle, diagnosis, pathology, immunopathogenesis and the clinical picture of the infection, as well as posible complications and treatment. Schistosoma guineensis is geographically restricted to Central Western Africa and is the only Schistosoma species on the island of São Tomé. Usually considered to be a relatively minor disease of the lower bowel, the authors refer to four other cases on the same island that presented with serious problems, two with central system nervous disorders, one with a liver disorder and cardiopulmonary involvement, and one with liver disease and failure to thrive due to low levels of insulin growth factors IGF1 and IGF2 (formerly called somatomedins). It is important to be aware of the symptoms that may be found, so therapy can be given in time to obtain a good outcome.

Full text only available in PDF format

1. Vennervald B, Duanne D. Morbidity in Schistosomiasis: an update. Curr Opin Infect Dis 2004; 17:439-47.        [ Links ]

2. Chen M. Relative distribution of Schistosoma japonicum eggs in the intestine of a man: a subject of inconsistency. Acta Tropica 1991; 48: 163-71.

3. Sturrock R. The parasites and their life cycles - S. intercalatum. In: Jordan P, Webbe G, Sturrock R, eds. Human Schistosomiasis. 8^th edition. Wallingford. UK: CAB International; 1993. p. 18-19.

4. Davies A. Schistosomiasis - Ultrasonography. In: "Manson's Tropical Diseases" Cook G, Zumla A, eds. Manson's Tropical Diseases. 21rst edition. Philadelphia: Saunders; 2003. p. 1457-8.

5. Richter J. The impact of chemotherapy on morbidity due to schistosomiasis. Acta Tropica 2003; 86: 161-83.

6. Maddison S. The present status of serodiagnosis and seroepidemiology of schistosomiasis. Diagn Microbiol Infect Dis 1987; 7: 93- 105.

8. van Lieshout L, Polderman AM, Deelder AM. Immunodiagnosis of schistosomiasis by determination of the circulating antigens CAA and CCA, in particular in individuals with recent or light infections. Acta Tropica 2000; 77: 69-80.

9. Barsoum I, Kamas K, Bassily C, Deelder AM, Colley DG. Diagnosis of human schistosomiasis by detection of circulating cathodic antigen with a monoclonal antibody. J Infect Dis 1991;164: 1010-3.

10. Gow JL, Noble LR, Rollinson D, Tchuem Tchuente LA, Jines CS. High levels of the medically important freshwater snail, Bulinus forskalii (Gastropoda: Pulmonata). Journal of Molluscan Studies 2005; 71(2): 175-80.

11. Pagès JR, Southgate VR, Tchuem Tuenté LA, Jourdanne J. Experimental evidence of a hybrid breakdown between the two geographical strains of Schistosoma intercalatum. Parasitology 2002; 124: 169-75.

12. Pagès JR, Durand P, Southgate VR, Tchuem Tchuenté LA, Jourdane J. Molecular arguments for splitting of Schistosoma intercalatum, in two different species. Parasitol Res 2001; 87:: 57-62.

13. Pagès JR, Southgate VR, Tchuem Tchuenté LA. Reconaissance de deux espèces jumelles au sein du taxon Schistosoma intercalatum Fisher, 1934, agent de la schistosomose humaine rectale en Afrique. Description de Schistosoma guineensis n.sp. In: Combes C and Jourdane J, eds. Taxonomie, écologie et evolution des métazoaires parasites.Tome ll (Livre homage à Louis Euzet). Perpignan. France. Presses Universitaires de Perpignan . France (French); 2003. p. 139-46; p. 319-337.

14. Kane RA, Southgate VR, Rollinson D, Littlewood DT, Lockyer AE, Pagès JR, et al. A phylogeny based on three mithocondrial gene supports the division of Schistosoma intercalatum into two separate species. Parasitology 2003; 127: 131-7.

15. Jourdanne J, Southgate V, Pagès J, Southgate VR, Durand P, Tchuenté LA. Recent studies on Schistosoma intercalatum: taxonomic status, puzzling distribution and transmission pattern revisited. Memorias do Instituto Oswaldo Cruz 2001; 96: Suppl 45-8

16. Raoult D, Tilton R. Schistosomiasis. In: Raoult D, Tilton R eds. Dictionary of Infectious Diseases1rst edition. Amsterdam: Elsevier; 2003. p. 926

18. Davies S, Lim K, Blank R, Kim JH, Lucas KD, Hernandez DC, Sedgwick JD, McKerrow JH. Involvement of TNF in limiting liver pathology and promoting parasite survival during schistosoma infection. Int J Parasitol 2004; 34: 27-36.

19. Markell E, John D, Krotowski W. Schistosoma intercalatum. In: Markell E, John D, KroowskiW, eds. Markell and Voges' Medical Parasitology. 7th edition. Philadelphia: Saunders; 1999. p. 214.

20. Muller R, Taylor M. On the use of the Ziehl-Neelsen technique for specific identification of Schistosoma eggs. J Helmintology 1972;46:139-42.

21. Richard-Lenoble D, Kombila M, Duong T, Gendrel D. Bilharziasis caused by Schistosoma intercalatum, a recent and forgotten form of schistosomiasis . Rev Prat (French) 1993; 43: 432-9.

22. Fisher A. Astudy of the schistosomiasis of the Stanley Ville District of the Belgian Congo. Trans Roy Soc Trop Med Hyg 1934; 28:277-306.

23. Symmers W. Note on a new form of liver cirrhosis due to the presence of the ova of Bilharzia haematobia. J Pathol Bacteriol 1904;9: 237-9.

24. Cunha A. Esquistossomose mansoni. In: Cunha A, ed. Esquistossomose Mansoni. 1rst edition. S. Paulo: Sarvier. Editora Universidade de S. Paulo (Portuguese); 1970. p. 99-110.

25. van Wijk H, Elias H. Hepatic and rectal pathology in Schistosoma intercalatum infection. Trop Geog Med 1975; 27: 237-48.

26. Farid Z. Infection with S. intercalatum. In: Jordan P, Webbe G, Março/Abril 2006 LIVER DISEASE DUE TO SCHISTOSOMA GUINEENSIS - A REVIEW 103

* The Clinical Report was presented as Posters in: a) Scientific Meeting on "Medicine and Health in the Tropics", in Marseille, France, 11-15 Set. 05, during the "XVIth International Congress for Tropical Medicine and Malaria, IVth European Congress on Tropical Medicine and International Health, VIIe Congrès International de la Societé de Pathologie Exotique", and on the date of the "Centenaire de L' Institute de Médecine Tropicale du Service de anté des Armés (L'Ècole du Pharo)"; b) "5as Jornadas de Actualização em Doenças Infecciosas", of the Hospital Curry Cabral, in Lisbon, Portugal, winning the first prize "ex-equo" for Poster presentations.

(1) Hospital de Curry Cabral, Divisions of Internal Medicine 1 and Pathology, Lisboa, Portugal.

(2) Instituto de Higiene e Medicina Tropical, Helmintology Department Lisboa. Portugal.

Recebido para publicação: 26/09/2005

Aceite para publicação: 15/02/2006