Dr Valentina Marchese (Hamburg / DE), Dr Tojo Rémi Rafaralahivoavy (Fianarantsoa / MG), Prof Soloniaina Hélio Razafimahefa (Fianarantsoa / MG), DR Philipp Klein (Hamburg / DE), Dr Tiana Randrianarisoa (Fianarantsoa / MG), Dr Joaquim Richter (Berlin / DE), Prof. Jürgen May (Hamburg / DE), Dr. Daniela Fusco (Hamburg / DE), prof Rivo Andry Rakotoarivelo (Fianarantsoa / MG)
Abstract text
Introduction
Ultrasound (US) is crucial for the assessment of hepatosplenic schistosomiasis morbidity (HSS), although it is still poorly implemented in endemic countries, such as Madagascar. HSS is therefore mostly detected with complications (i.e., variceal bleeding, ascites) when praziquantel treatment is not effective, while some regression has been shown in lower degrees of periportal fibrosis.
Objectives
The overall objective is to describe US patterns and clinical presentation among patients with hepatosplenic schistosomiasis in a highly endemic area of Madagascar in order to advocate for the need of US implementation in Madagascar for both early detection and morbidity control of chronic schistosomiasis.
Materials & methods
In a descriptive design we aim at recruiting 60 patients among all adult patients attending primary health care, pre-screened using urine based rapid diagnostic test regardless symptom presentation. Recruitment is currently ongoing. Morbidity is assessed following WHO guidelines for image pattern (IP) classification: no fibrosis (A), borderline aspect/ incipient portal fibrosis (B) (both no fibrosis group), moderate peripheral fibrosis (C), moderate central fibrosis (D) (moderate fibrosis group), and severe fibrosis (Dc, E, Ec,-F). Bleeding risk (BR) is assessed with SMS score using IP classification and portal vein quotient. Those presenting an SMS score > 2 undergo EGDS and additional lab tests for further management.
All patients are tested for chronic viral hepatitis, HIV antibodies, transaminases, blood count, albumin and creatinine. Praziquantel 40 mg/kg is administered once or for three days based on BR. US classification will be validated by two external experienced sonographers through imaging evaluations.
Results
Up to December 2022, eight patients (six women, age range 21-73 years, no viral infections) underwent US evaluation, with the following results: three severe forms (one Dc pattern, two F patterns, one of them with portal thrombosis), four moderate fibrosis (three C pattern, one D pattern) and one patient with no fibrosis. With the exception of one patient with severe fibrosis, none of them referred previous history of gastric bleeding, nor severe symptoms.
Conclusion
Our preliminary results show advanced fibrosis in patients without severe symptoms, supporting the need for early identification of HSS, for which US evaluation remains the first diagnostic tool.