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Schistosoma mansoni‐related morbidity on Ukerewe Island, Tanzania: clinical, ultrasonographical and biochemical parameters

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Abstract:

One thousand six hundred and ninety‐five inhabitants of 3 rural villages on Ukerewe Island, Lake Victoria, Tanzania, were examined by clinical, parasitological, ultrasonographic and—in part—serological means to evaluate Schistosoma (S.) mansoni‐related morbidity on a community level. Villagers frequently complained of typical colitis symptoms (abdominal pain 80.1%, bloody stools 43.1%, diarrhoea 35.1%); haematemesis, on the other hand, was rare (and reports doubtful in most cases). 16.9% of the population had been given praziquantel previously. Overall S. mansoni prevalence was 86.3%, with a median egg output of 176 eggs per gram (e.p.g.) and a maximum output of 17 984 e.p.g. Children and adolescents were infected more severely than adults, men more severely than women. Pretreated individuals excreted significantly fewer ova (median 124 vs 192e.p.g., P<0.001).

Hepatomegaly (determined by ultrasonography) was present in 35%, splenomegaly in 80%. Organomegaly was significantly related to egg output. Pretreated persons had lower rates of splenomegaly and left lobe hepatomegaly. Low‐degree periportal fibrosis was common, while severe grades of fibrosis (MANAGIL score II and III) were present in about 6%. About 10% had other abnormalities on liver sonography (irregular parenchymal texture and/or shape); these persons passed significantly more S. mansoni ova than others. Clear sonographic signs of portal hypertension were seen in 2.1%. Serum procollagen‐IV‐peptide and ‐glutamyl‐transferase levels were increased in persons with severe periportal fibrosis, irregular liver texture or portofugal collateral vessels.

Thus, S. mansoni infection in the western part of Ukerewe Island is frequent and often severe, leading to a high prevalence of gastrointestinal symptoms. Hepatosplenic involvement does occur, although symptomatic cases of portal hypertension were not identified beyond doubt. The overall level of schistosomal morbidity is thus considered intermediate. Serum procollagen‐IV‐peptide may be a promising marker of schistosomal liver disease. Our data suggest that S. mansoni infection may also be related to diffuse liver parenchyma alterations in this area.

Keywords: Schistosomiasis mansoni; Tanzania; children; epidemiology; morbidity; procollagen; ultrasonography

Document Type: Original Article

DOI: http://dx.doi.org/10.1046/j.1365-3156.1997.d01-269.x

Affiliations: 1: Children's Hospital, Medizinische Hochschule, Hannover, Germany, 2: National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania, 3: Division of Vector Borne Diseases, Ministry of Health, Entebbe, Uganda, 4: Interdisziplinäres Therapiezentrum Feldberg, Feldberg, Germany, 5: Hoechst AG, Frankfurt, Germany, 6: Prince-Leopold-Institute for Tropical Medicine, Antwerp, Belgium, 7: Children's Hospital, Charité, Berlin, Germany

Publication date: March 1, 1997

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