clove and Hypertension--Portal

Portopulmonary hypertension is characterized by a chronic liver disease associated with a mean pulmonary artery pressure >25 mmHg at rest, an increased pulmonary vascular resistance and a capillary pulmonary pressure <15 mmHg with portal hypertension. Schistosomiasis may be an aetiology of this syndrome, however, few cases have been reported. We describe the first cases of portopulmonary hypertension with schistosomiasis in Malagasy patients. There were 2 men aged of 18 and 20 from hyperendemic area of schistosomiasis in Madagascar Both had a history of repeated water contact. They presented a dyspnea associated with ascites and oedema. Clinical examination showed portal and pulmonary hypertension with right ventricular heart failure. Cardiac examination revealed a systolic murmur and splint of the second heart pulmonary Pulmonary hypertension was confirmed by cardiac ultrasonogaphy Serology of bilharzias was positive. Parasitological examination showed eggs of S. mansoni. The treatment based on salt-free diet, spironolactone and praziquantel led to a better evolution of symptoms (case 1). Symptoms of right heart failure remained for the second patient even though improvement was noted. In tropical countries, schistosomiasis may be one of the cause of portopulmonary hypertension and may appear in early age. Its treatment remains difficult as the drugs recommended are not affordable.

Topics: Adolescent; Adult; Anthelmintics; Ascites; Combined Modality Therapy; Diet, Sodium-Restricted; Dyspnea; Endemic Diseases; Heart Failure; Humans; Hypertension, Portal; Hypertension, Pulmonary; Madagascar; Male; Mineralocorticoid Receptor Antagonists; Praziquantel; Schistosomiasis mansoni; Spironolactone

In a study in three neighbouring villages of southern Madagascar, where Schistosoma mansoni is hyperendemic, ultrasound examination using the Niamey protocol showed marked differences in the burden of disease from one village to another. Hepatosplenic schistosomiasis was more frequent in the village with the highest geometric mean egg counts and the earliest onset of infections, demonstrating that the morbidity induced by S. mansoni may vary greatly within a given area. True representativeness of study populations, a keystone of epidemiological studies, is mandatory to obtain a clear picture of a wide area. Ultrasound examinations in a small number of villages, or even a single one, may be a questionable approach. Using logistic regression analysis, the explanatory variables found to be significantly associated with a risk of severe hepatosplenic disease in our study were sex, age, village of residence and S. mansoni egg counts. On the other hand, a concurrent infection with an intestinal helminth seems to reduce the risk of severe hepatosplenic disease. Further studies should assess the role and possible impact of intestinal helminths on S. mansoni associated-morbidity.

Topics: Adolescent; Adult; Age Distribution; Analysis of Variance; Child; Child, Preschool; Female; Helminthiasis; Humans; Hypertension, Portal; Infant; Infant, Newborn; Likelihood Functions; Liver Diseases, Parasitic; Logistic Models; Madagascar; Male; Parasite Egg Count; Prevalence; Residence Characteristics; Risk Factors; Schistosomiasis mansoni; Splenic Diseases

Topics: Anemia; Humans; Hypersplenism; Hypertension; Hypertension, Portal; Madagascar; Schistosomiasis; Splenomegaly; Venous Pressure