Blood Flukes and Arterial Damage: A Review of Aneurysm Cases in Patients with Schistosomiasis

Table 1

Summary of cases.

N	Author, year	Age, sex	Geographic region	Schistosoma species	Comorbidities and c.v. risk factors in anamnesis	Schistosomiasis details	Clinical presentation	Vascular findings	Pharmacological treatment of schistosomiasis
1	Salah, 1997	27, M	Egypt	n.a.	Smoke	Previous urinary andintestinal schistosomiasis, normal lung parenchima	Cardio-vocal Ortner’s syndrome; exertional dyspnoea (2 months), pulmonary hypertension	Pulmonary artery-aneurysmand schistosomal, cor pulmonale	Previous treatment with praziquantel for intestinal and urinary schistosomiasis
2	Vanker, 1986	19, F	South-Africa	Schistosoma mansoni (stool and rectal mucosa)	None	Pulmonary shistosomiasis	Haemoptysis; left chest pain, hoarseness, absent left brachial pulse (1 month), haematuria	Aortic arch pseudoaneurysm (7 x 2 cm)	Not reported
3	Mucenic, 2002	45, M	Lived for 17 years in Schistosoma endemic area	Negative (stool and rectal biopsy)	No other	Previous hepatosplenic schistosomiasis (hematemesis, enterorrhagia, oesophageal varices)	Abdominal continuous pain (left hypochondrium)	Right portal branch aneurysm (5 x 4 x 4 cm)	No previous treatment with praziquantel
4	Lambertucci, 2010	66, F	Brazil	n.a.	No other	Chronic hepato-splenic schistosomiasis (esophago-gastric varices; hematemesis)	Routine assessment for hepato-splenic schistosomiasis	Saccular aneurysm of the splenic artery; intrahepatic shunt between right portal branch and right hepatic vein	Beta-blockers as gastroenteric haemorrhage prophylaxis
5	Piveta, 2012	41, F	Brazil	n.a.	Alcoholic hepatitis waiting for liver transplant	Hepato-splenic schistosomiasis	Intermittent chest pain; pulmonary hypertension; intrapulmonary shunt	Pulmonary a. aneurysm (8.3 cm)	Not reported
6	Genzini, 2014	48, M	Brazil	n.a.	Hypertension, thrombo-cytopenia	Advanced hepatosplenic schistosomiasis	Right lumbar pain	Right renal artery aneurysm 2.5 cm	Not reported
7	Ramadan, 2015	55, M	Lower-Egypt	Schistosoma mansoni (lung biopsy)	Ex-smoker	History of intestinal and hepato-splenic schistosomiasis. Pulmonary granuloma, positive serology S. mansoni	Dyspnoea (one month); fever (2 months) cough and mucoid sputum (10 days) left atrial compression; pleural effusion	Right pulmonary artery aneurysm (17 x 11 cm)	Previous treatment for intestinal schistosomiasis (20 years previously). Anticoagulation
8	Abdelnaby, 2018	50, F	Egypt	n.a.	n.a.	Bilharziasis since early childhood	Chest pain (recurrent); exertional dyspnoea	Right and left pulmonary a. aneurysm (6.5 cm) and atrial mural thrombus	Anticoagulation
9	Athanazio, 2018	n.a., M	Brazil	Schistosoma mansoni (lung, testis, liver, and large bowl)	n.a.	Testicular, intestinal and lung schistosomiasis	Spontaneous aorto-cutaneous fistula	Thoraco-abdominal aortic aneurysm; spontaneous aorto-cutaneous fistula	n.a.
10	Gavilanes, 2018	38, M	Brazil	n.a.	n.a.	Chronic schistosomiasis, pulmonary artery hypertension	Palpitations; dyspnoea; exertional syncope	Giant pulmonary artery aneurysm; aorta and left coronary artery compression	n.a.
11	De Oliveira, 2019	48, M	Brazil	n.a.	Type A aortic dissection ascending aorta substitution (dacron); biological valve	Hepato-splenic schistosomiasis	Fever Porphyromonas pogonae sepsis	Aortic graft infection and aortic rupture	Antibiotics for associated bacteria
12	Dyer, 2020	18, F	Australia	Schistosoma Ag EIA	n.a	Serology positive for schistosomiasis	Fever; right upper quadrant pain; liver abscess Fasciola hepatica infestation	Hepatic artery pseudoaneurysm; acute bleeding from the ampulla of Vater	Praziquantel
13	Abdelnaby, 2020	38, F	Egypt	n.a.		History of bilharzias	Dyspnoea (5 years) and hoarseness (1 year)	Pulmonary artery aneurysm (PAA) with dilatation of both branches and hoarseness	Anticoagulation

Anagraphic details, geographic region of patient’s origin/residency, schistosomiasis details, clinical presentation, vascular findings, and pharmacological management are included. M = male; F = female; Ag EIA = antigen enzyme-linked immunosorbent essay; n.a = not available; c.v. = cardiovascular. The most frequently involved arterial district was the pulmonary artery, followed by aortic lesions which included one recurrent lesion on previous aortic surgery and abdominal visceral vessels aneurysms (specifically in splenic, hepatic artery, right portal branch, and renal artery).