Hepatosplenic schistosomiasis in field-based studies: a combined clinical and sonographic definition

A combined clinical and sonographic classification of hepatosplenic schisto somiasis mansoni to be used in field-based studies is proposed herein. Seve n hundred forty one individuals out of 892 (83%), living in an area endemic for schistosomiasis in Brazil, have been ubmitted to clinical and ultrasou nd examinations. Based on two stool examinations the overall prevalence for schistosomiasis in this area was 73%. Abdominal palpation was performed wi th patients in dorsal decubit, during deep breath, by two experienced physi cians and a portable ultrasound was used,for the evaluation of liver fibros is, portal collaterals and spleen size. Four groups of individuals were ide ntified using data obtained by abdominal palpation and ultrasound examinati on: (1) palpable spleen and intense periportal thickening in 9 individuals (1.2%); (2) spleen not palpable and intense periportal thickening in 15 (2% ); (3) palpable spleen with light to moderate periportal thickening in 32 ( 4.3%), and (4) palpable spleen with a normal liver on ultrasound in 30 (4%) . The definition of hepatosplenic schisto-somiasis in field-based studies a s the finding of Schistosoma mansoni eggs in the stools in an individual so miasis in , with splenomegaly is not acceptable anymore. Abdominal ultrasou nd should be combined with clinical examination to accurately identify hepa tosplenics in endemic areas for schistosomiasis.