Morbidity Associated with Schistosoma Mansoni Infection as Determined by Ultrasound: A Study in Gezira, Sudan

Mamoun HomeidaDepartment of Medicine, Faculty of Medicine, University of Khartoum

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Saad AhmedDepartment of Medicine, Faculty of Medicine, University of Khartoum

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Assim DafallaMedical Research Council, Institute of Tropical Medicine

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Suad SulimanDepartment of Parasitology, National Health Laboratory, Ministry of Health, Khartoum, Sudan

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Isam EltomDepartment of Medicine, Faculty of Medicine, University of Khartoum

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Theodore NashNational Institutes of Health, Building 5, Bethesda, Maryland 20205

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James L. BennettDepartment of Pharmacology and Toxicology, Michigan State University, East Lansing, Michigan 48824

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Previous studies demonstrated the usefulness of ultrasonography in diagnosing Symmers' periportal fibrosis. The prevalence and grade of Symmers' fibrosis was determined using ultrasonography in two villages in the Gezira region of Sudan and compared to standard clinical criteria. In El Dar 18% and Abu Jin 13% of the population had Symmers' fibrosis by ultrasonography. In contrast, only 6.3% in El Dar and 5.2% in Abu Jin with Symmers' fibrosis had splenomegaly, thus most of the population with Symmers' fibrosis would not have been diagnosed clinically. The degree of involvement was estimated by a set of previously defined criteria which ranged from mild (grade 1) to severe (grade 3). Involvement was greatest between 20–30 years and followed the age peak egg excretion rate by 5 years. The prevalence and degree of splenomegaly as well as the portal and splenic vein diameters increased with grade. The presence of hepatomegaly did not correlate with increasing grade. Ultrasonography is a much more sensitive technique than clinical evaluation in estimating the degree of Symmers' fibrosis in this population. A more accurate assessment of involvement will allow a more rational approach to the study of the pathophysiology of this complication and its eventual control.

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