Case–Control Study of Posttreatment Regression of Urinary Tract Morbidity Among Adults in Schistosoma haematobium–Endemic Communities in Kwale County, Kenya

Abstract

Abstract. Previous population-based studies have examined treatment impact on Schistosoma-associated urinary tract disease among children, but much less is known about longer-term treatment benefits for affected adult populations in areas where risk of recurrent infection is high. In communities in Msambweni, along the Kenya coast, we identified, using a portable ultrasound, 77 adults (aged 17-85) with moderate-to-severe obstructive uropathy or bladder disease due to Schistosoma haematobium. Treatment response was assessed by repeat ultrasound 1-2 years after praziquantel (PZQ) therapy and compared with interval changes among age-and sex-matched infected/treated control subjects who did not have urinary tract abnormalities at the time of initial examination. Of the 77 affected adults, 62 (81%) had improvement in bladder and/or kidney scores after treatment, 14 (18%) had no change, and one (1.3%) had progression of disease. Of the 77 controls, 75 (97%) remained disease free by ultrasound, while two (3%) had apparent progression with abnormal findings on follow-up examination. We conclude that PZQ therapy for S. haematobium is effective in significantly reducing urinary tract morbidity from urogenital schistosomiasis among adult age groups, and affected adults stand to benefit from inclusion in mass treatment campaigns.

Decline in infection-related morbidities following drug-mediated reductions in the intensity of Schistosoma infection: A systematic review and meta-analysis

“…This phenomenon thus limits the overall impact of drug treatment in communities at high risk for S . haematobium infection [42–44]. Post-treatment reductions in the odds of morbidities related to intestinal infections ( S .…”

“…In endemic regions, it is believed that age is an important proxy of cumulative exposure to the parasite and the related tissue damage that it causes. As the process of infection progresses from acute injury to a more chronic forms of fibrotic scarring, it becomes proportionately more difficult to reverse Schistosoma -associated pathology [44, 48]. In addition, the meta-analysis also suggests differences between S .…”

Ultrasound Evolution of Pediatric Urinary Schistosomiasis after Treatment with Praziquantel in a Highly Endemic Area

“…This finding is surprising because age is usually considered an important proxy for cumulative parasite exposure and subsequent tissue damage, and lesions are more difficult to reverse as infection progresses to a more chronic and fibrotic stage. 13,19 One explanation may be that the older children were more receptive to health education advice, and therefore became reinfected less frequently; another reason may be that younger children in this area, compared with older ones, are usually more affected by other comorbidities such as malnutrition and anemia. 20 As praziquantel requires a competent immune system to take effect, 21 it may be less effective in these children.…”

Evaluation of a Mobile Phone-Based Microscope for Screening of Schistosoma haematobium Infection in Rural Ghana

“…Schistosomiasis, for example, affects over 200 million people worldwide with the vast majority of those affected residing in rural African settings. 2 Chronic infection with Schistosoma haematobium can result in significant morbidity from hydronephrosis, renal failure, and infertility, 3,4 in addition to mortality secondary to bladder cancer. 5,6 Schistosoma haematobium may also be a risk factor for human immunodeficiency virus acquisition.…”