Authors

Discussion

Introduction Schistosomiasis is a three-stage disease caused by trematode worms of the genus Schistosoma. Organ-specific morbidity, according to the infecting Schistosoma spp., can develop in chronic stages. Clinical manifestations are caused by inflammatory response of the host to the accumulation of parasite eggs in vessels and organs. Vascular complications of Schistosomiasis are less described than the involvement of other organs or systems. Damage can occur by direct lesion of vessels walls or to contiguity with a focus of inflammation in surrounding tissues. Among vessel lesions, aneurysms have been described.  

Aims and methods Aim of our study was to analyse the occurrence of   aneurysm lesions in patients with   Schistosomiasis, through a review of case reports in literature.

Results 12 cases were included in our review. The mean age of patients was 41.3±14.9 years (range 18-66), 7 male and 5 females. More frequently reported comorbidities were cardiovascular, including hypertension, previous aortic dissection and pulmonary valvular steno-insufficiency in 3 cases. Oesophageal varices, previous smoke and alcohol consumption have also been reported.  

A previous history of Schistosomiasis was known in 7 cases. In the majority of cases an intestinal or hepato-splenic involvement was reported (7 cases), followed by pulmonary Schistosomiasis (5 cases) and urinary or testicular (2 cases). Pain (refereed to chest, hypochondrium or lumbar region) was the most frequently reported symptom (6 cases), followed by dyspnoea (in 5 cases). Fever, hoarseness, hyper-eosinophilia, syncope/cardiogenic shock and anaemia were reported in a minority of cases.

Lesion in pulmonary artery was reported in 5 cases. Aortic arch, thoraco-abdominal aorta, hepatic, renal, splenic artery and portal involvement were also  reported. Aortic rupture on previous aortic graft occurred once.

In four cases no surgical treatment was performed: in 2 because of patients refusal, in one because of exitus and in 1 for unspecified reason. Among performed treatments 1 splenectomy, 1 aneurysmectomy with renal reimplantation, in aneurysmectomy of aortic arch and one  reintervention on aortic graft have been reported.

Follow-up data were available for 6 patients. 3 survived. In one case, post splenectomy  portal vein partial thrombosis  complicated occurred, but resolved at 4 years follow up. Exitus occurred in three cases, and was due to post-operatory cardiogenic shock in aortic reintervention for aortic rupture; pulmonary embolism in pulmonary aneurysm (refused treatment) and for ruptured pulmonary artery aneurysm with cardiac tamponade.

Conclusions Aneurysms may occur in patients with Schistosomiasis. Given the   high burden of this  neglected  tropical disease in endemic regions, and  the  high morbidity and  mortality of  vascular  conditions there is a need for studies that will  better define physiopathology  and  guide  clinicians.