HEPATIC SCHISTOMIASIS

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

Management

  • 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