Comportamento da esquistossomose mansÃnica forma hespatoesplÃnica em pacientes com idade acima de 60 anos

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

Schistosomiasis mansoni (SM) is one of the most common infectious and parasitary diseases in the world, because of its chronical characteristic and because it constitutes an important public health problem. In Brazil, it represents the most frequent cause of portal hypertension and includes the state of Pernambuco as one with the highest member of events, reaching a high morbid-mortality. The introducing of Special Schistosomiasis Control Program (PECE), in 1976, was important in reducing the infection and the frequency of the hepatosplenic form with a higher occurrence among aged people. The hepatosplenic form is considered as a gravidity indicator, characterized by clinical hematological and biochemical specific changes. Accurate diagnosis about the hepatic alterations is done by image methods. Two studies were done in an unusual age group: aged people. The aim of the studies was to analyse the behaviour of the patients aged 60 and up in relation to the clinical, laboratorial, endoscopic and ultrasonographic aspects. In both studies all the patients with hepatosplenic form, men and women, aged 60 and up were included when attended from February to September 2008. The patients were interviewed and did haematological, ultrasonographic and endoscopic exams after signing a document in which they expressed their awareness about the research. Ninety one patients attended at the specialized schistosomiasis Outclinic at Clinical Hospital of Federal University of Pernambuco (HC/UFPE) between March and September 2008 were analysed in the first study. There was an occurrence of 15,9% (91/571) patients with hepatosplenic form up to 60 years old. There were more patients between 60 and 70 years old in 71,5% (65/91) and female sex in 67% (61/91). Most patients had hepatosplenic compensated form and a previous treatment for schistosomiasis. Sixty-four patients had their last contact with the river more than ten years ago and more tham 50% had upper bleeding digestive episodes. Seventy-eight patients were included in the second study and they were distributed in two groups A and B, which were respectively represented by 31 splenectomized patients and 47 non-splenectomized. The average age was 67,15 years old, mainly the age group from 60 to 70 years old (75,6%) and the female sex 69,2% (54/78). Serious anaemia and thrombocytopenia occurred more frequently in B group, although there was no difference between the groups in relation to the biochemical changes, showing that the splenectomy did not cause any alteration in the function of the liver along time. Most patients showed II degree fibroses and E pattern in the ultrasonography and esophagus varices with thin caliber without gastropathy and blood spots. Although the low gravitidy which was observed in relation to the ultrasonography and endoscopic aspects, these researches also presented a high morbidity in this age group because 42, 8% showed upper bleeding digestive in the first medical appointment and 30,7% did not report any specific treatment, which could be considered a fail of the Schistosomiasis mansoni control services.

ASSUNTO(S)

elderly people periportal fibrosis idosos ciencias da saude portal hypertension hepatosplenic form esquistossomose mansÃnica forma hepatoesplÃnica fibrose peri-portal schistosomiasis mansoni

ACESSO AO ARTIGO

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