Clinical and Immunologic Evaluation of 31 Patients with Acute Schistosomiasis mansoni

Abstract

Thirty-one patients with acute schistosomiasis were evaluated clinically and immunologically. Cytokine levels were determined in peripheral blood mononuclear cell (PBMC) supernatants. Levels of total and antigen-specific IgE, tumor necrosis factor (TNF)–α, and immune complexes were measured in serum samples. Clinical findings included general symptoms, liver damage, pulmonary involvement, and pericarditis. All patients had eosinophilia. Immune complexes were detected in 55% of the patients (mean±SD, 7.8±7.6 μg Eq/mL) and were associated with cough, dyspnea, and abnormal chest radiographic findings. Levels (mean ± SD) of TNF-α (1349.3±767.6 pg/mL), interleukin (IL)–1 (2683±1270 pg/mL), and IL-6 (382 ± 52.3 pg/mL) were elevated in PBMC. Serum TNF-α levels were elevated in 87% of the patients and were associated with abdominal pain. Higher interferon-γ levels were detected in PBMC of patients with acute disease than in those of patients with chronic schistosomiasis; IL-5 levels were higher in those with chronic disease. Low IL-5 levels were associated with weight loss. Proinflammatory cytokines and immune complexes with low Th2 responses might explain the immunopathogenesis of acute schistosomiasis.