LACK OF ULTRASONOGRAPHIC EVIDENCE FOR SEVERE HEPATOSPLENIC MORBIDITY IN SCHISTOSOMIASIS-MANSONI IN MALI

The inhabitants of four villages endemic for Schistosoma mansoni in ce ntral Mall (n = 1,106 of both sexes, age range 2-80 years) and of two nonendemic villages in another part of the country were examined paras itologically and ultrasonographically to establish the prevalence of p eriportal liver fibrosis (PF) and other features of hepatosplenic schi stosomiasis. The prevalence of S. mansoni infection ranged from 36% to 93% in the endemic villages. A severe infection (> 400 eggs/g of stoo l) was found in 16% of the infected individuals. No case of grade III PF (echogenic bands usually > 10 mm in diameter around the central par t and major branches of the portal vein and streak-like fibrous bands that extended into the periphery of the liver) and only eight cases of grade II PF (echogenic bands usually > 10 mm in diameter around the c entral part and major branches of the portal vein) were found; no othe r signs of severe hepatosplenic disease were encountered. However, gra de I PF (echogenic bands usually > 4 mm in diameter that were best vis ible in the area of the portal vein bifurcation and gall bladder neck) was detected in 21% of all individuals, mainly in adults. In the none ndemic villages, the prevalence of grade I PF in adults was 9%. Genera lly, there was no significant correlation between the grade of PF and S. mansoni egg output. In one village with a high endemicity level, ho wever, the prevalence of grade PF I increased with the intensity of in fection. Morphometric data revealed no significant influence of S. man soni infection on portal vein stem diameter and spleen size. It is con cluded that schistosomiasis mansoni did not progress to severe hepatos plenic disease in the examined villages; grade I PF was prevalent, esp ecially in adults, but seemed to be related to factors other than schi stosomiasis.