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Şistosomiyazis ve pulmoner hipertansiyon

Şistosomiyazis ve pulmoner hipertansiyonŞistosomiyazis dünyada en sık görülen paraziter hastalıklardan biridir. Dünya üzerinde yetmişten fazla ülkede endemik olup, 200 milyondan fazla kişi şistosoma ile infektedir. Pulmoner hipertansiyon (PHT) şistosomiyazisin kronik komplikasyonlarından biridir. Şistosoma ilişkili PHT (Ş-PHT)'nin patogenezi tam olarak bilinmemekle birlikte parazitik arter embolizasyonu, pulmoner arteriopati ve portopulmoner hipertansiyon gibi birkaç mekanizmanın rol oynadığı düşünülmektedir. Ş-PHT'de pulmoner damarlardaki patolojik değişiklikler idiyopatik pulmoner arteriyel hipertansiyon (İPAH) ile benzer bulunmuştur. Şistosomiyazisin, özellikle gelişmekte olan ülkelerde, pulmoner arteriyel hipertansiyon (PAH)'un en sık nedenlerinden biri olması hastalık hakkında bilgilerimizi artırmanın önemini vurgulamaktadır. PAH tedavisindeki gelişmeler son yirmi yılda prognozda iyileşme, yaşam beklentisi ve yaşam kalitesinde anlamlı artışa neden olmuş ve Ş-PHT'nin önemi daha da artmıştır. Şistosomiyazis pirazikuantel ile tedavi edilir. Bununla birlikte bu tedavinin PHT için etkin olduğu yönünde çok az kanıt vardır. Antihelmintik ilaçlar hastalıkta anlamlı bir iyileşmeye neden olmamakla birlikte, yararlı etkileri vardır ve progresyon hızını yavaşlatabilirler. Şistosoma ilişkili PAH (Ş-PAH)'lı hastalarda PAH spesifik tedavilerin kullanımı prognozu iyileştirebilir. Bununla birlikte klinik çalışmaların yetersizliği ve hastalığın endemik olduğu bölgelerdeki kısıtlı kaynaklar bu pahalı ilaçların geniş çapta kullanımlarına olanak tanımamaktadır. Bu tedavilerin etkinliğinin belirlenmesi için daha fazla çalışmalara gereksinim vardır

Schistosomiasis and pulmonary hypertension

Schistosomiasis and pulmonary hypertensionSchistosomiasis is one of the most prevelant parazitic diseases in the world. It is endemic in more than 70 countries, and more than 200 million people worldwide are infected with Schistosoma. Pulmonary hypertension (PHT) is one of the chronic complications of schistosomiasis. The exact pathogenesis of schistosomiasisassociated pulmonary hypertension (S-PHT) remains unclear, although several mechanisms such as parazitic arterial embolisation, pulmonary arteriopathy, and portopulmonary hypertension have been suggested. Pathological pulmonary vascular changes in S-PHT were found similar to those in idiopathic pulmonary arterial hypertension (IPAH). The fact that schistosomiasis is one of the most common causes of pulmonary arterial hypertension (PAH), particularly in the developing countries, underlines the importance of enhancing our knowledge on this disease. Developments in the treatment of PAH have resulted in improved prognosis and significant increase in life expectancy and quality of life in the last two decades, which has enhanced the importance of S-PHT. Schistosomiasis is treated with praziquantel. Nevertheless, there is limited evidence that this treatment is effective for PHT. Although antihelmintic medications do not lead to significant improvement, they have beneficial effects and may slow down disease progression. Using PAH-specific treatments in the patients with schistosomiasis-associated PAH (S-PAH) can improve prognosis. However, inadequate clinical studies and limited sources in the endemic regions restrict extensive usage of these expensive medications. Further studies are required to determine the efficacy of these treatment modalities

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1. Papamatheakis DG, Mocumbi AO, Kim NH, Mandel J. Schistosomiasis associated pulmonary hypertension. Pulm Circ 2014;4:596-611.
2. Graham BB, Kumar R. Schistosomiasis and the pulmonary vasculature (2013 Grover Conference series). Pulm Circ 2014;4:353-62.
3. Gavilanes F, Fernandes CJ, Souza R. Pulmonary arterial hypertension in schistosomiasis. Curr Opin Pulm Med 2016;22:408-14.
4. Simonneau G, Galiè N, Rubin LJ, Langleben D, Seeger W, Domenighetti G, et al. Clinical classification of pulmonary hypertension. J Am Coll Cardiol 2004;43(Suppl 12):S5-S12
5. Fishman AP. Clinical classification of pulmonary hypertension. Clin Chest Med 2001;22:385-91.
6. Simonneau G, Gatzoulis MA, Adatia I, Celermajer D, Denton C, Ghofrani A, et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 2013;62(Suppl 25):D34-D41.
7. Butrous G. Saudi guidelines on the diagnosis and treatment of pulmonary hypertension: schistosomiasis and pulmonary arterial hypertension. Ann Thorac Med 2014;9(Suppl): S38- S41.
8. Graham BB, Bandeira AP, Morrell NW, Butrous G, Tuder RM. Schistosomiasis-associated pulmonary hypertension: pulmonary vascular disease: the global perspective. Chest 2010;137(Suppl):S20-S29.
9. Lapa M, Dias B, Jardim C, Fernandes CJ, Dourado PM, Figueiredo M, et al. Cardiopulmonary manifestations of hepatosplenic schistosomiasis. Circulation 2009;119: 1518-23.
10. Alves JL Jr, Gavilanes F, Jardim C, Fernandes CJ, Morinaga LT, Dias B, et al. Pulmonary arterial hypertension in the southern hemisphere: results from a registry of incident Brazilian cases. Chest 2015;147:495-501.
11. Hoetle S, Figueiredo C, Dias B, Alves JL Jr, Gavilanes F, Prada LF, et al. Pulmonary artery enlargement in schistosomiasis associated pulmonary arterial hypertension. BMC Pulm Med 2015;15:118.
12. Fernandes CJ, Jardim CV, Hovnanian A, Hoette S, Dias BA, Souza S, et al. Survival in schistosomiasis-associated pulmonary arterial hypertension. J Am Coll Cardiol 2010; 56:715-20.
13. Japyassu FA, Mendes AA, Bandeira AP, Oliveira FR, Sobral Filho D. Hemodynamic profile of severity at pulmonary vasoreactivity test in schistosomiasis patients. Arq Bras Cardiol 2012;99:789-96.
14. Graham BB, Chabon J, Bandeira A, Espinheira L, Butrous G, Tuder RM. Significant intrapulmonary Schistosoma egg antigens are not present in schistosomiasis-associated pulmonary hypertension. Pulm Circ 2011;1:456-61.
15. Pedroso ER, Lambertucci JR, Greco DB, Rocha Ode C, Ferreira CS, Raso P. Pulmonary involvement in schistosomiasis mansoni. Mem Inst Oswaldo Cruz 1987;82(Suppl):S221-7.
16. Ferreira RCS, Domingues ALC, Markman B, Veras FH, Batista LJB, Albuquerque ES. Hepatopulmonary syndrome in patients with Schistosoma mansoni periportal fibrosis. Acta Trop 2009;11:119-24.
17. Boros DL, Whitfield JR. Enhanced Th1 and dampened Th2 responses synergize to inhibit acute granulomatous and fibrotic responses in murine schistosomiasis mansoni. Infect Immun 1999;67:1187-93.
18. Burke ML, Jones MK, Gobert GN, Li YS, Ellis MK, McManus DP. Immunopathogenesis of human schistosomiasis. Parasite Immunol 2009;1:163-76.
19. Kumar R, Mickael C, Chabon J, Gebreab J, Rutebemberwa A, Garcia AR, et al. The causal role of IL-4 ve IL-13 in Schistosoma mansoni pulmonart hypertension. Am J Respir Crit Care Med 2015;192:998-1008.
20. Graham BB, Chabon J, Gebreab L, Poole J, Debella E, Davis L, et al. TGF-β signaling promotes pulmonary hypertension caused by Schistosoma mansoni. Circulation 2013;128: 1354-64.
21. Hovnanian A, Hoette S, Fernandes CJ, Jardim C, Souza R. Schistosomiasis associated pulmonary hypertension. Int J Clin Pract Suppl 2010;165:25-8.
22. Fernandes CJ, Dias BA, Jardim CV, Hovnanian A, Hoette S, Morinaga LK, et al. The role of target therapies in schistosomiasis-associated pulmonary arterial hypertension. Chest 2012;141:923-8.
23. Galiè N, Corris PA, Frost A, Girgis RE, Granton J, Jing ZC, et al. Updated treatment algorithm of pulmonary arterial hypertension. J Am Coll Cardiol 2013;62(Suppl 25): D60- D72.