Praziquantel in the treatment of hepatosplenic schistosomiasis: biochemical disease markers indicate deceleration of fibrogenesis and diminution of portal flow obstruction

Serological indicators for disease activity and portal vein obstruction and/or deviation were assessed in 23 patients with hepatosplenic schistosomiasis before, and up to 18 months after, praziquantel treatment, as well as in 25 matched local controls. Cessation of egg-induced immunopathology was reflected by the return to normal of serum procollagen-III-propeptide and neopterin concentrations. Reversibility of portal vein pathology was indicated by normal clearance of cholylglycine in cases without signs of decompensating portal hypertension. In most patients with a history of ascites and/or haemorrhage, serum cholylglycine concentration remained pathological. The results provide evidence that the fibrogenic process ceases after specific chemotherapy, and that portal vein pathology regresses in a substantial proportion of hepatosplenic schistosomiasis cases.

Tumour necrosis factor in hepatosplenic schistosomiasis

Periportal fibroplasia is the dominating feature of hepatosplenic schistosomiasis. Since monokines play an important role in the regulation of fibroplasia, tumour necrosis factor (TNF) and interleukin 1 beta (IL-1 beta) were assessed in sera and cell culture supernatants from patients with intestinal and hepatosplenic schistosomiasis before and 3-6 months after treatment with praziquantel. Uninfected controls were from the study area in Alagoas, Brazil. TNF was measured using an L-M mouse fibroblast bioassay and radioimmunoassays specific for TNF-alpha. Whereas TNF-alpha was elevated threefold in the patients' sera, three- to five-fold reductions of TNF were observed by radioimmunoassay and bioassay, respectively, in cell culture supernatants of hepatosplenic schistosomiasis patients. Significant deviations, in opposite directions, from TNF levels in control sera and supernatants are most plausible in the event of a sequestration of TNF-alpha-producing cells from the circulation. This process may be disease stage-specific since a dichotomy between incipient and advanced cases of hepatosplenic schistosomiasis became apparent in the amplitude and kinetics of changes during the follow-up after treatment.

[Acute hepatic lesion caused by Giardia lamblia]

A study was made of 20 rats infested by Giardia muris in which a histologic study was made of the liver, as well as of 25 patients with giardiasis and elevated alanine-aminotransferase levels. Patients with positive A or B hepatitis markers, cholelithiasis or history of drug or alcohol use were excluded. Tests of liver function and liver biopsy were performed and antiparasite therapy was given during three months of follow-up, after which the liver biopsy was repeated. Humoral alterations were compared to those of 30 patients with acute viral hepatitis (15 type A and 15 type B) over the same periods of time. In 20% of the rats, nonspecific liver lesions were found. In the patients liver enzymes and the thymol test normalized a month after treatment and serum bile acids became normal in the third month. The liver biopsy demonstrated hepatic damage in 94% of the patients (in 20 cases cell lesions and in 12 cases inflammatory lesions) which regressed in the third month, the follow-up biopsy being normal after eradication of the parasite was confirmed. The comparative study with viral hepatitis showed highly significant differences in all the variables studied during the follow-up stage. Emphasis is placed on the importance of this lesion and its differential diagnosis to prevent its progression to chronic liver disease.

Hypoprothrombinemia in the compensated form of hepatosplenic schistosomiasis: further studies

Coagulation abnormality is frequently observed in schistosomiasis patients but its pathophysiology has not been established. We measured, by immunodiffusion. the prothrombin-antigen concentration in 56 individuals; of these 19 with demonstrated compensated form of hepatosplenic schistosomiasis, 17 with cirrhosis and 20 were control subjects. Transaminases, albumin, transthyretin, prothrombin time, antithrombin III, factor VII, and fibrinogen were also evaluated. All parameters were altered in the cirrhotic group but only albumin, prothrombin and antithrombin III levels were altered in the schistosomiasis group. Ninety percent of the patients with cirrhosis and sixty percent of the patients with schistosomiasis had abnormal plasma levels of albumin, transthyretin, prothrombin-antigen, and/or antithrombin III; an impaired hepatic synthesis was responsible for these results. Conversely forty percent of the schistosomiasis patients with normal plasma concentrations of both albumin and transthyretin had decreased mean plasma levels of both prothrombin and antithrombin III. These results suggest that either proth rombin and antithrombin III are more sensitive markers of impaired hepatic synthesis in schistosomiasis than are levels of albumin and transthyretin combined, or a low grade chronic consumption of clotting proteins also occurs. Considering the latter hypothesis it is possible that the thrombin formed would be inhibited by antithrombin III with the complexed thrombin-antithrombin III being cleared by the liver. Consequently the plasma levels of both prothrombin and antithrombin would be decreased, but the level of fibrinogen would be preserved.

Liver involvement in human schistosomiasis mansoni. Assessment by immunological and biochemical markers

In 20 patients with hepatic or hepatosplenic schistosomiasis and 82 individuals infected with S. mansoni, but without liver enlargement, serum parameters reflecting the fibrotic process and hemodynamic alterations as well as immunomodulation were examined. Included as controls were 35 age- and sex-matched healthy individuals from the study region in Northeast Brazil. Peripheral blood cholylglycine levels in patients with hepatomegaly, reflecting the spillover of portal blood into the systemic circulation, were elevated 12-fold over values of patients without liver involvement. Procollagen-III-peptide, a cleavage product of collagen synthesis, was elevated in patients with hepatomegaly (P less than 0.001) but normal in uncomplicated cases. Immunomodulation was assessed by in vivo delayed hypersensitivity to recall antigens and by serum beta 2-microglobulin and neopterin, substances released in the context of lymphocyte activation. Neopterin, predominantly a macrophage product, was elevated most strikingly in hepatomegalic cases (P less than 0.001). The possible interrelation between altered immune responses and excess fibrogenesis is discussed.

Serum concentration of N-terminal procollagen peptide of collagen type III in schistosomal liver fibrosis

The major cause of mortality in human schistosomiasis is the chronic granulomatous reaction of the liver tissue to Schistosoma mansoni eggs. Liver biopsy still provides the best evaluation of the degree of liver damage. However, liver biopsy does not provide an image of the dynamic process of fibrogenesis. Variations of concentrations of procollagen type III peptide in sera have been proposed to be significant markers of liver fibrosis. Thus, liver function tests in relation to histopathological diagnosis and procollagen type III peptide concentrations were studied in patients with schistosomiasis and revealed a high correlation between the serum procollagen type III peptide and the degree of fibrosis in liver tissue.

Simultaneous radio-isotopic study of both fibrinogen and platelets in hepatic schistosomiasis

Simultaneous platelet and fibrinogen survival and turnover were studied using selenomethionine (75Se) in early and late groups of schistosomal hepatic fibrosis (SHF) and in a control group. In the control group, the mean platelet survival was 11.66 +/- 1.59 days and mean platelet turnover was 20,230 +/- 5090 platelets/microliter/day. Mean fibrinogen survival was 7.3 +/- 0.60 days and fibrinogen turnover was 0.35 +/- 0.04 mg/ml/day. In the early schistosomal group, platelet survival was shortened with an increased turnover rate and normal platelet count. The presence of a structurally abnormal fibrinogen molecule in the early group may have resulted in its shortened survival, that was compensated by the liver through increasing the turnover rate. In the late group, platelet survival was shortened with no significant increase of fibrinogen turnover, while fibrinogen concentration remained normal, suggesting the presence of extrahepatic sites of fibrinogen synthesis.

Serum immunoreactive somatomedin-C levels in growth failure and delayed puberty associated with chronic hepatosplenic schistosomiasis

Eleven patients, five males, six females, aged 14-20 years with hepatosplenic schistosomiasis (HSS), growth failure and delayed puberty were submitted to endocrine evaluation. All patients had well preserved parenchymal liver function although several changes were present in the portal system, showing a poorly vascularized liver. Bone age was retarded, thyroid function was normal, the human growth hormone response to hypoglycaemia was within the normal limits and the prolactin response to TRH was normal. LH and FSH basal levels were normal and a normal rise was observed after a provocative test with LHRH. Gonadal function, expressed as serum testosterone or oestradiol levels, was abnormally low for the chronological age. Serum somatomedin-C levels were also low (range 0.11-2.10 U/ml) for the respective Tanner stage or bone age of each individual patient. One year after a splenorenal shunting in the three patients that returned for follow-up, it was observed that sexual maturation reached Tanner stage III, linear growth increment ranged from 9.0 to 11.5 cm and serum somatomedin-C levels increased to 4.3-5.6 U/ml. We concluded that a combination of undernutrition and marked vascular changes in the liver, present in HSS, are associated with decreased serum sex steroids and somatomedin-C concentrations, resulting in growth failure and delayed puberty in these patients.

Serum glutamyl transferase and other liver function tests in Opisthorchis viverrini infection

Serum glutamyl transferase (gamma-GT), serum total protein, albumin, aspartate aminotransferase (GOT), alanine aminotransferase (GPT), alkaline phosphatase and bilirubin were measured in 55 males and 45 females suffering from O. viverrini infection and in apparently healthy non-infected individuals. A decrease in total protein, albumin and bilirubin, as well as an increase in GOT, GPT and gamma-GT was observed in males with O. viverrini infection, whereas alkaline phosphatase remained unaffected. In female patients with O. viverrini, serum total protein and albumin also decreased, GOT and GPT increased, whereas gamma-GT remained unchanged. The difference in gamma-GT alteration between females and males is discussed with regard to the possible significance of alcohol consumption and in relation to the parasitic infection and its possible implications for malignancy, associated with liver fluke infection.

Prealbumin, prekallikrein and prothrombin in hepatosplenic schistosomiasis: increased turnover of the clotting proteins?

No plasma de 20 doentes portadores da forma hepatesplênica da esquistossomose mansônica, assim como no de 18 indivíduos normais, foram avaliados pré-albumina, precalicreína (atividade amidolítica) e protrombina-antígeno. Os valores da concentração plasmática de pré-albumina obtidos no grupo controle permitiram que se estabelecesse um intervalo de referência (0,5 — 99,5%) de 97 — 389 mg/I. Valores anormalmente diminuídos de pré-albumina encontrados em 2 dos doentes indicaram nestes uma disfunção hepatocítica de síntese protêica. Nos 18 doentes restantes a média da pré-albumina (232 ± 13 mg/l) não diferiu (p > 0,05) da do grupo controle (243 ± 11 mg/l) enquanto as médias da atividade de pró-calicreina (34 ± 1 μKat/l) e protrombina (81 ± 3,0 mg/l) estavam significativamente diminuídos no grupo de esquistossomóticos (p < 0,01). Estes dados não excluem a possibilidade da pré-calicreina ou da protrombina-antígeno serem marcadores de síntese protêica pelo hepatócito mais sensíveis que a pré-albumina; se entretanto a concentração plasmática normal desta proteína indicar preservação desta função, a diminuição de fatores de coagulação poderá ser secundária a um "turnover" aumentado dos fatores de coagulação na forma hepatesplênica da esquistossomose.

Comparative study of Schistosoma mansoni isolated from patients with hepatosplenic and intestinal clinical forms of schistosomiasis

Six Schistosoma mansoni isolates obtained from the same endemic area were compared experimentally; three were from patients with the hepatosplenic form and three from patients with the intestinal form of schistosomiasis. The following features were analyzed in mice: body weight, liver and spleen weights, mortality, infectivity, number of S. mansoni eggs/female worm, egg distribution in the viscera, and hemogram. Three groups of mice, used as controls, were infected with the LE strain of S. mansoni which is routinely maintained in the laboratory. The group of isolates from patients with the hepatosplenic form of schistosomiasis did not show important differences in relation to those from nonhepatosplenic patients; in almost all features analyzed the differences among these six isolates were within the variation limits observed with the LE strain of S. mansoni.

Changes in blood cellular components, serum proteins and serum enzyme activities in pigs naturally infected with Cysticercus tenuicollis

A study was made of blood cellular components, serum proteins and serum enzymes in 48 pigs naturally infected with Cysticercus tenuicollis. Twenty-five healthy pigs were studied for comparison. Affected animals showed a reduction in total erythrocyte count, packed cell volume and haemoglobin content and an increase in mean corpuscular volume and total leucocyte count. Significantly higher activities of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and isocitric dehydrogenase serum enzymes were recorded in all affected pigs. Total protein, albumin and globulin values of affected pigs remained unchanged when compared with healthy controls.

Radioimmunoassay of serum conjugated cholic acid in hepatic murine schistosomiasis

Cholylglycine levels were measured by radioimmunoassay in sera from 10 control CFI female mice and 22 CFI female mice experimentally infected with Schistosoma mansoni. Cholylglycine was significantly elevated in sera of all but one of the chronically infected animals. Serum aspartate transaminase was within normal limits in all the infected animals; while five infected mice had elevated serum alkaline phosphatase and all these five also had high levels of serum cholylglycine. Marked hepatic histopathological changes were demonstrated in all the infected animals. The data suggest that serum cholylglycine is a highly sensitive index for hepatic dysfunction in chronic hepatic schistosomiasis mansoni.

Experimental induction of a toxemia-like syndrome in the pregnant beagle

A toxemia-like syndrome was induced in pregnant beagles by intraperitoneal inoculation of concentrates prepared from placentas of patients with preeclampsia-eclampsia and hydatidiform mole, which contained an agent, Hydatoxi lualba, that stained in a unique fashion with toluidine blue-O-. The pregnant dogs inoculated with either of these concentrates progressively developed hypertension, eyeground changes consistent with hypertensive retinopathy, proteinuria, disseminated intravascular coagulation, and hepatic dysfunction in addition to intrauterine growth retardation and intrauterine fetal death. Hepatic periportal hemorrhage and glomeruloendotheliosis, lesions usually seen in preeclampsia-eclampsia, were also noted to occur in pregnant beagles inoculated with these concentrates. A significant increased sensitivity to angiotensin II infusion was also noted. The toxemia-like syndrome did not develop in pregnant beagles when inoculated in a similar fashion with concentrates prepared from placentas from normal term pregnancies which were free of Hydatoxi lualba or in nonpregnant beagles inoculated with concentrates containing Hydatoxi lualba. Although the agent was not injected in pure form, the inoculation of concentrates containing Hydatoxi lualba appears to be required for the manifestation of the toxemia-like syndrome.

Pathophysiology of Mesocestoides corti infection in the mouse

Liver histology and serum enzyme and protein changes were studies in two strains of mice showing different initial susceptibilities to infection with Mesocestoides corti. The results show an increase in ALT and AST levels during the period of invasion and proliferation in the liver and a decrease in the levels of these two enzymes following encapsulation of the parasite in the liver and liver regeneration. A progressive loss of albumin was accompanied by increases in the levels of the beta- and gamma-globulins. These changes are discussed in the light of our knowledge of the effects of this parasite upon its host.