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Ehsan NA, Elsabaawy MM, Sweed DM, Karman EA, Abdelsameea E, Mohamed AA. Role of liver biopsy in management of liver diseases without hepatic nodules following end of the interferon era: experience of a tertiary referral center. Clin Exp Med 2023; 23:97-105. [PMID: 35262836 PMCID: PMC9939494 DOI: 10.1007/s10238-022-00797-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/20/2022] [Indexed: 11/27/2022]
Abstract
Liver biopsy (LB) is the cornerstone in the management of patients with liver diseases. However, a lot of queries had emerged about its role following the end of the interferon era. The aim of this study was to re-evaluate the current role of LB in the diagnosis of liver diseases. All patients who had underwent LB at the Department of Hepatology, National Liver Institute, from January 2015 through December 2018 were recruited. Indications for LB, pathology reports and medical records of all cases were retrieved, reviewed and statistically analyzed. A total of 275 liver biopsies were collected, 191 males and 84 females with mean age 41.22 ± 13.36 years. Etiological diagnosis made by histopathological evaluation was 48 drug-induced liver injury (DILI), 42 nonalcoholic fatty liver disease (NAFLD), 34 chronic hepatitis B, or C with cholestasis, 29 autoimmune hepatitis, 34 primary sclerosing cholangitis, 13 primary biliary cholangitis, 7 autoimmune overlap syndrome, 13 active bilharziasis and 10 Wilson's disease. Minor number of cases was diagnosed by different other etiologies. Initial diagnosis was made by liver biopsy and confirmed by clinical response and laboratory findings. Liver biopsy is still considered as the gold standard diagnostic measure of different liver diseases representing an integral component of management decisions in hepatology.
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Affiliation(s)
- Nermine A Ehsan
- Department of Pathology, National Liver Institute, Menoufia University, Shebeen El-Koom, Egypt
| | - Maha M Elsabaawy
- Hepatology and Gasteroenterology, National Liver Institute, Menoufia University, Shebeen El-Koom, 32511, Egypt
| | - Dina M Sweed
- Department of Pathology, National Liver Institute, Menoufia University, Shebeen El-Koom, Egypt
| | - Esraa A Karman
- Department of Pathology, National Liver Institute, Menoufia University, Shebeen El-Koom, Egypt
| | - Eman Abdelsameea
- Hepatology and Gasteroenterology, National Liver Institute, Menoufia University, Shebeen El-Koom, 32511, Egypt.
| | - Anwar A Mohamed
- Hepatology and Gasteroenterology, National Liver Institute, Menoufia University, Shebeen El-Koom, 32511, Egypt
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2
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Hashim A, Berzigotti A. Noninvasive Assessment of Schistosoma-Related Periportal Fibrosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2273-2287. [PMID: 33448437 DOI: 10.1002/jum.15623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 06/12/2023]
Abstract
Schistosomiasis affects nearly 250 million individuals in the world. Hepatosplenic schistosomiasis (HSS) results in periportal fibrosis (PPF) and portal hypertension (pHTN). Ultrasound has been extensively used for the diagnosis of Schistosoma-related PPF and a number of staging methods have been validated for this purpose such as Strickland classification and Niamey protocol. Nevertheless, the application of noninvasive techniques, particularly elastography modalities, has not been well explored. In this review, we describe the various noninvasive diagnostic tools for assessment of Schistosoma-related PPF including US parameters, serum biomarkers, and US-based elastography techniques. While elastography techniques have demonstrated value in the evaluation of HSS, the evidence remains limited with most studies recruiting a small number of patients. Longitudinal studies with larger sample size are required in order to devise robust criteria to accurately assess the performance of noninvasive techniques in the prediction of both regression and progression of the degree of PPF and identify their cost-effectiveness in community screening.
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Affiliation(s)
- Ahmed Hashim
- Hepatology Department, Royal Free Hospital, London, UK
| | - Annalisa Berzigotti
- University of Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
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Vellere I, Mangano VD, Cagno MC, Gobbi F, Ragusa A, Bartoloni A, Biancofiore G, De Simone P, Campani D, Bruschi F, Zammarchi L. Imported human Schistosoma japonicum: A report on two cases in Filipino migrants present in Italy and a systematic review of literature. Travel Med Infect Dis 2019; 36:101496. [PMID: 31561021 DOI: 10.1016/j.tmaid.2019.101496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Schistosoma japonicum is endemic in the Philippines, China, and Indonesia, and is the third-most common schistosoma species. The infection can be asymptomatic for years but, if left untreated, can lead to irreversible complications. METHOD We report the results of a systematic review of the literature on imported S. japonicum infection and describe two previously unpublished cases diagnosed in Filipino migrants in Italy. RESULTS Twenty-five imported cases of S. japonicum schistosomiasis were retrieved. All patients but one were migrants. Most subjects acquired the infection in Philippines (n = 18, 72%). Median age at diagnosis was 46 years. Median period of residence in non-endemic countries before diagnosis was 14.5 years. Cases of prevalent hepatosplenic involvement were 10 (40%), those with prevalent intestinal involvement were 10 (40%), whereas five (20%) had overlapping manifestations. Ten patients suffered from cirrhosis; two underwent liver transplantation. Three patients presented with acute abdomen due to intestinal complications, leading to explorative laparotomy. In all cases, but one, the diagnosis was based on a histological examination of biopsy specimen, revealing S. japonicum ova. Seventeen patients were treated with praziquantel, and in three of them, possible treatment failures occurred. CONCLUSIONS S. japonicum infection is uncommonly reported in non-endemic areas, but is probably underestimated because of a low threshold awareness of clinicians and unavailability of specific diagnostic tools. Viable S. japonicum adults may persist for decades, indicating that migrants or travellers previously exposed in areas with high-risk areas can harbour viable worms and deserve treatment.
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Affiliation(s)
- Iacopo Vellere
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | | | | | - Federico Gobbi
- Department of Infectious-Tropical Diseases and Microbiology, I.R.C.C.S., Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy.
| | - Andrea Ragusa
- Department of Infectious-Tropical Diseases and Microbiology, I.R.C.C.S., Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy.
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Referral Center for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
| | | | - Paolo De Simone
- Hepatobiliary Surgery and Liver Transplantation Unit, University of Pisa Medical School Hospital, Pisa, Italy.
| | - Daniela Campani
- Department of Surgical, Medical and Molecular Pathology, Pisa University Hospital, Pisa, Italy.
| | - Fabrizio Bruschi
- Department of Translational Research, University of Pisa, Pisa, Italy; Department of Laboratory Medicine, Pisa University Hospital, Pisa, Italy.
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Referral Center for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
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Carvalho Santos J, Dória Batista A, Maria Mola Vasconcelos C, Souza Lemos R, Romão de Souza Junior V, Dessein A, Dessein H, Maria Lucena Montenegro S, Pessoa Almeida Lopes E, Lúcia Coutinho Domingues A. Liver ultrasound elastography for the evaluation of periportal fibrosis in schistosomiasis mansoni: A cross-sectional study. PLoS Negl Trop Dis 2018; 12:e0006868. [PMID: 30444885 PMCID: PMC6267962 DOI: 10.1371/journal.pntd.0006868] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/30/2018] [Accepted: 09/22/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND ARFI elastrography has been used as a noninvasive method to assess the severity of liver fibrosis in viral hepatitis, although with few studies in schistosomiasis mansoni. We aimed to evaluate the performance of point shear wave elastography (pSWE) for predicting significant periportal fibrosis (PPF) in schistosomotic patients and to determine its best cutoff point. METHODOLOGY/PRINCIPAL FINDINGS This cross-sectional study included 358 adult schistosomotic patients subjected to US and pSWE on the right lobe. Two hundred two patients (62.0%) were women, with a median age of 54 (ranging 18-92) years. The pSWE measurements were compared to the US patterns of PPF, as gold standard, according to the Niamey classification. The performance of pSWE was calculated as the area under the ROC curve (AUC). Patients were further classified into two groups: 86 patients with mild PPF and 272 patients with significant PPF. The median pSWE of the significant fibrosis group was higher (1.40 m/s) than that of mild fibrosis group (1.14 m/s, p<0.001). AUC was 0.719 with ≤1.11 m/s as the best cutoff value for excluding significant PPF. Sensitivity and negative predictive values were 80.5% and 40.5%, respectively. Whereas, for confirming significant PPF, the best cutoff value was >1.39 m/s, with specificity of 86.1% and positive predictive value of 92.0%. CONCLUSIONS/SIGNIFICANCE pSWE was able to differentiate significant from mild PPF, with better performance to predict significant PPF.
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Affiliation(s)
- Joelma Carvalho Santos
- Postgraduate Program in Tropical Medicine, Centro de Ciências da Saúde, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Andrea Dória Batista
- Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | | | - Roberto Souza Lemos
- Postgraduate Program in Tropical Medicine, Centro de Ciências da Saúde, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | | | - Alain Dessein
- Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | - Hélia Dessein
- Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | | | - Edmundo Pessoa Almeida Lopes
- Postgraduate Program in Tropical Medicine, Centro de Ciências da Saúde, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
- Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Ana Lúcia Coutinho Domingues
- Postgraduate Program in Tropical Medicine, Centro de Ciências da Saúde, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
- Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
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Baekby M, Glerup H, Stribolt K, Tarp B. Hepatosplenic schistosomiasis: playing hide-and-seek with an elusive parasite. BMJ Case Rep 2017; 2017:bcr-2017-219437. [PMID: 28814579 DOI: 10.1136/bcr-2017-219437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
A 27-year-old man of Eritrean origin presented with persistent left-sided abdominal pain. Initial investigation showed signs of liver fibrosis, portal hypertension and splenomegaly. A diagnosis of hepatosplenic schistosomiasis was suspected on grounds of elevated total IgE, grey area antischistosomiasis antibodies and the high endemic status of his native country. However, repeated microscopy of faecal and urine samples, as well as rectal biopsies, failed to demonstrate schistosomal eggs. Finally, the diagnosis of hepatosplenic schistosomiasis was established through demonstration of a Schistosoma mansoni egg in a liver biopsy taken in an attempt to clarify the cause of the above findings. The patient had recently been treated for uncomplicated malaria. Lowered schistosomiasis worm/egg burden and hence reduced sensitivity of classic microscopy-based schistosomiasis testing was attributed to the antischistosomal activity of the antimalarial chemotherapy.
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Affiliation(s)
- Martin Baekby
- Department of Clinical Microbiology, Aarhus Universitetshospital, Aarhus N, Denmark
| | - Henning Glerup
- Department of Internal Medicine, Regionshospitalet Silkeborg, Silkeborg, Denmark
| | - Katrine Stribolt
- Department of Pathology, Regionshospitalet Randers, Randers, Midtjylland, Denmark
| | - Britta Tarp
- Department of Internal Medicine, Regionshospitalet Silkeborg, Silkeborg, Denmark
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