Intensity of Schistosoma Mansoni, Hepatitis B, Age, and Sex Predict Levels of Hepatic Periportal Thickening/Fibrosis (PPT/F): A Large-Scale Community-Based Study in Ethiopia

Abstract

To elucidate determinants of morbidity in schistosomiasis mansoni, a community-based study was undertaken involving 2,451 subjects (mean age, 18.8 ± 15.3 [SD] years) from four endemic sites in Ethiopia. Overall prevalence of infection was 65.9%, reported blood in stools was 35.8%, and schistosomal periportal thickening/fibrosis (PPT/F) was 4.6%. Similarly, 43.2% were positive for at least one marker of hepatitis B virus (HBV), 5.3% were HBsAg positive, and 1.3% were anti-hepatitis C virus (HCV) positive. Prevalence of PPT/F increased significantly with increasing community prevalence and intensity of S. mansoni infection. In a multiple logistic regression analysis, intensity of egg excretion, markers of HBV infection, age, and male sex were significantly associated with PPT/F, whereas co-infection with other intestinal helminths was associated with lower odds for PPT/F. HCV was not associated with S. mansoni infection or with schistosomal PPT/F. In conclusion, integrated helminth control targeting school-aged children, who have the highest burden infection, should be used to substantially reduce the risk of periportal fibrosis.

Association between Schistosomiasis mansoni and hepatitis C: systematic review

“…2,9,19,29,30 Among the 13 articles included in the fi nal step of the review, ten were cross-sectional studies, 8,9,19,29,30,36,37,39,40,45 one was a retrospective cases series, 6 one was a prospective cases series 2 and the other was a cases series with an external control group. 32 Five studies 6,32,39,40,45 were conducted in Brazil, fi ve in Egypt, 2,9,19,29,30 two in Sudan, 36,37 one in Ethiopia 8 and one in Kenya. 9 A higher prevalence of HCV infection was found in the SM population of Egypt, compared to the other countries (Table 1).…”

“…2,9,19,30,32,36 The most commonly chosen technique of HCV diagnosis was 3 rd generation anti-HCV ELISA, utilized in fi ve studies. 8,9,36,37,45 Four other studies utilized 2 nd generation anti-HCV ELISA. 2,19,29,30 The quantifi cation of the viral titers was performed by HCV RNA PCR in seven studies.…”

“…Four studies did not fi nd any association between SM infection and an increased risk of acquiring HCV. 8,30,36,37 …”

“…6,29 The high percentage of HCV infection in schistosomiasis populations of different countries caught the attention of the scientifi c community for the variable prevalence of disease association rates. 8,19,36,37,40,45 The rates ranged from 10 to 50% in Egypt, 2,9,19,29,30 mainly due the mass treatment of the schistosomiasis infected population in the 1970s. This public policy was not adopted in other countries and similar prevalence rates cannot be observed.…”

“…This public policy was not adopted in other countries and similar prevalence rates cannot be observed. 8,36,37 There is a lack of a relationship between the high prevalence of HCV infection in schistosomiasis endemic areas and risk factors, although many of them were.…”