What is the role of periportal fibrosis in the pathophysiology of chronic schistosomiasis (bilharzia)?

Updated: Sep 20, 2018
  • Author: Shadab Hussain Ahmed, MD, AAHIVS, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Heavy infestations are more likely to produce hepatic disease. Eventually, severe periportal fibrosis in a characteristic pipestem pattern (Symmers pipestem fibrosis) may occur. Although hepatocellular function is spared, periportal fibrosis can lead to portal hypertension with the usual potential sequelae, including splenomegaly, ascites, esophageal variceal bleeding, and development of portosystemic collaterals. Through these collaterals (or directly from the inferior vena cava in the case of bladder wall schistosomiasis), eggs can reach the pulmonary circulation. The resulting pulmonary granulomatosis and fibrosis can lead to pulmonary hypertension and frank cor pulmonale with a high mortality rate.


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