Pathogenesis of Hepato-splenic Manifestation of Schistosoma

Infection

Penetration of intact skin withinfective cercariae

Ova in the portal blood

Ova lodge at the presinusoidal sites

Hepatomegaly

Presinusoidal portal blockage

Hemodynamic changes

GRANULOMA formationGRANULOMA formation

Recruitment of host’s inflammatory cells SplenomegalyPortosystemic collaterals

HLA Type I & II

genetics

Varices at the lower end of esophagus and

other sites

Portal hypertension

Compensatory arterialization

Retention of hepatocyte perfusion

N liver function tests

FIBROSISFIBROSIS

T-lymphocytes - fibroblast series interaction

cytokines (IL-2, IL-4, IL-1, TGF-B)

>>>IFN-γ, IL-12

Liver function deteriorationAscites, hypoalbuminemia

defects in coagulation

Periportal(Symmers’ clay pipe-stem fibrosis)Diffuse

CIRRHOSIS