Baseline Liver Ultrasound Findings in Preschool Children From the Praziquantel in Preschoolers Trial in Lake Albert, Uganda

Abstract

Background: Periportal fibrosis is a late-stage manifestation of chronic infection with Schistosoma mansoni. Praziquantel (PZQ), the only drug available for the treatment of schistosomiasis, has limited effect in treating established morbidity. Preschool-aged children (PSAC) are not considered to be an at-risk population for severe morbidity. However, the prevalence of periportal fibrosis in PSAC in S. mansoni endemic settings is unknown. Methods: As part of a phase II clinical trial comparing different dosing regimens of PZQ in children age 12–47 months infected with S. mansoni in Uganda (“praziquantel in preschoolers” trial), we present baseline results assessing liver ultrasound (US) findings as per the WHO Niamey Protocol. Results: A total of 7/347 (2%) PSAC had Image Pattern C with pipe stems and echogenic rings suggestive of periportal fibrosis, 29/347 (8%) had Image Pattern B and 58 (17%) had evidence of periportal thickening There were higher adjusted odds of periportal thickening with older age [odds ratio (OR): 1.04; 95% confidence interval (CI): 1.00–1.07], primary maternal education (OR: 1.04; 95% CI: 1.00–1.07) and being taken to the lake weekly (OR: 3.02; 95% CI: 1.19–7.63). A further 44/347 children (13%) had a rounded caudal liver edge which was associated with high S. mansoni infection intensity (adjusted OR: 3.31; 95% CI: 1.46–7.51). Conclusions: Incipient schistosomiasis-related liver morbidity was detected in young children enrolled in the praziquantel in preschoolers trial. Adequate age-adjusted reference measurements for liver ultrasound findings in very small children are lacking but urgently needed. Schistosomiasis-related fibrosis may be delayed or averted with early and repeated PZQ treatment.