SCHISTOSOMA-MANSONI AND S-HAEMATOBIUM INFECTIONS IN EGYPT .3. EXTRA-HEPATIC PATHOLOGY
SCHISTOSOMA-MANSONI AND S-HAEMATOBIUM INFECTIONS IN EGYPT .3. EXTRA-HEPATIC PATHOLOGY
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DOI：
10.4269/ajtmh.1978.27.55
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发表时间：
1978-01-01
影响因子：
3.3
通讯作者：
SIPPEL, JE
中科院分区：
文献类型：
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作者：
CHEEVER, AW;ISMAIL;SIPPEL, JE
在埃及开罗，对400例连续尸检中的曼氏葡萄球菌和嗜血杆菌感染进行了定量研究。病理结果与血吸虫感染的存在或不存在以及感染的强度相关。梗阻性尿路疾病(输尿管积水或肾积水)患者血结核杆菌感染强度明显高于无梗阻性尿路疾病患者，但轻度或重度梗阻性尿路疾病患者感染强度相似，即梗阻性尿路疾病的存在而不是程度与感染强度有关。在严重梗阻性尿路病变的发病机制中，局灶性病变的存在比输尿管或膀胱内虫卵的浓度更重要。血吸虫性梗阻性尿路病最严重的原因是输尿管狭窄、输尿管结石或输尿管开口扭曲。肾盂肾炎在血吸虫病患者和非血吸虫病患者中的发生率相似。肾盂肾炎多见于膀胱出口梗阻或输尿管开口扭曲的患者。在没有这些病变的情况下，输尿管积水不容易发生肾盂肾炎。肾小球肾炎与嗜血杆菌感染无正相关。曼氏血吸虫感染引起3例严重感染的血吸虫性结肠息肉。曼氏假单胞菌和嗜血杆菌引起的息肉病较少。沙门氏菌感染很少见，与血吸虫病的相关性不大。在本组病例中，血吸虫病在患者中很少见。9岁。在9岁的病例中，9.2%的感染者(占所有病例的6.2%)被认为是血吸虫病的死因。在感染病例中，2.5%的死亡归因于血吸虫病梗阻性尿路疾病，2.4%归因于与血吸虫病相关的膀胱癌，3.1%归因于综合征肝纤维化，0.8%归因于血吸虫病结肠息肉，0.4%归因于沙门氏菌病与血吸虫病。尽管没有经过深思熟虑地选择用于研究的病例，但任何以医院为基础的系列研究都收集了一组高度精选的患者。结果应非常谨慎地应用于其他感染人群。病理学研究集中在严重的解剖病变上，不能准确评估其他重要病变的影响，如血吸虫性膀胱炎，这些病变会产生相当大的发病率。
S. mansoni and S. haematobium infections were studied quantitatively in 400 consecutive autopsies in Cairo, Egypt. Pathological findings were correlated with the presence or absence of schistosome infection as well as with the intensity of infection. The intensity of S. haematobium infection was much greater in cases with obstructive uropathy (hydroureter or hydronephrosis) than in those without, but infection intensity was similar in cases with mild or severe obstructive uropathy; i.e., the presence, not the degree, of obstructive uropathy was related to infection intensity. The presence of focal lesions was more important in the pathogenesis of severe obstructive uropathy than was the concentration of eggs in the ureters or bladder. The most severe cases of schistosomal obstructive uropathy were usually caused by ureteral stenosis, ureteral stones or distortion of the ureteral orifices. Pyelonephritis was of similar frequency in cases with and without schistosomiasis. Pyelonephritis occurred most often in patients with bladder outlet obstruction or distortion of the ureteral orifices. In the absence of these lesions, hydroureter did not predispose to pyelonephritis. Glomerulonephritis was not positively associated with S. haematobium infection. S. mansoni infection caused severe schistosomal colonic polyposis in 3 heavily infected individuals. S. mansoni and S. haematobium caused less marked polyposis. Salmonella infections were infrequent and not significantly associated with schistosomiasis. In this series, schistosomiasis was rare in patients .ltoreq. 9 yr old. Among cases > 9 yr of age, schistosomiasis was considered the cause of death in 9.2% of infected cases (6.2% of all cases). Among infected cases, 2.5% of deaths were ascribed to schistosomal obstructive uropathy, 2.4% to bladder cancer associated with schistosomiasis, 3.1% to Symmers'' fibrosis of the liver, 0.8% to schistosomal colonic polyposis and 0.4% to salmonellosis associated with schistosomiasis. Although no deliberate selection of cases for study was made any hospital-based series gathers a highly selected group of patients. Results should be applied to other infected populations with great caution. Pathologic studies concentrate on serious anatomic lesions and cannot accurately evaluate the effects of other important lesions such as schistosomal cystitis, which produce considerable morbidity.