Noninvasive diagnosis of periportal fibrosis in schistosomiasis mansoni: A comprehensive review

Abstract

Schistosomiasis mansoni is a neglected disease and key public health problem, mainly due to its high prevalence, the scarcity of public policies, and the severity of some clinical forms. Periportal fibrosis (PPF) is the commonest complication of chronic schistosomiasis mansoni and its diagnosis requires different techniques. Even though wedge biopsy of the liver is considered the gold standard, it is not justified in non-surgical patients, and percutaneous liver biopsy may be informative but does not have sufficient sensitivity. Noninvasive PPF tests mostly include biological (serum biomarkers or combined scores) or physical assessments (imaging assessment of fibrosis pattern or tissue stiffness). Moreover, imaging techniques, such as ultrasound, computed tomography, magnetic resonance imaging, and elastography are applied not only to support the diagnosis of schistosomiasis, but also to assess and detect signs of portal hypertension and organ damage due to chronic schistosomiasis. A combination between a comprehensive history and physical examination with biomarkers for liver fibrosis and imaging methods seems to offer the best approach for evaluating these patients. In addition, understanding their strengths and limitations will allow a more accurate interpretation in the clinical context and can lead to greater accuracy in estimating the degree of fibrosis in patients with Schistosomiasis mansoni (S. mansoni) infection. This review will discuss the different noninvasive methods that are currently available for the evaluation of PPF in S. mansoni infection, and their application, advantages, and limitations in clinical practice.

Keywords: Schistosoma mansoni; Parasitic liver diseases; Liver fibrosis; Biomarkers; Elasticity imaging techniques; Ultrasonography

Core Tip: Schistosomiasis mansoni is a neglected and key public health problem and periportal fibrosis (PPF) is its commonest complication. Noninvasive PPF tests mostly include biological or physical assessments. Imaging techniques have been currently applied to assess and detect liver damage due to chronic schistosomiasis. A combination between these biomarkers, a comprehensive history and physical examination, laboratory tests, and imaging methods seems to offer the best approach for evaluating these patients. We herein discuss the different noninvasive methods that are currently available for evaluating PPF in Schistosomiasis mansoni infection, and their application, advantages, and limitations in clinical practice.