Measuring Morbidity Associated with Urinary Schistosomiasis: Assessing Levels of Excreted Urine Albumin and Urinary Tract Pathologies

Abstract

BackgroundUrinary schistosomiasis is responsible for a variety of debilitating conditions; foremost perhaps are urinary tract pathologies (UTPs). Although portable ultrasonography can be used to detect UTPs visually, there is still a need for rapid morbidity assessment (henceforth referred to as RaMA) tools that can be deployed in the field during implementation, monitoring and evaluation of control programmes. We therefore aimed to determine associations between excreted urine-albumin, as measured using a HemoCue photometer, and UTPs, as detected by ultrasonography, in children and adults from an urinary schistosomiasis endemic area in Zanzibar.Methodology/Principal FindingsIn a survey of 140 school-children of both sexes (aged 9 to 15 yr) and 47 adult males (≥16 yr) on the island of Unguja, the prevalence of egg-patent urinary schistosomiasis was 36.4% (CI95 28.5–45.0%) and 46.8% (CI95 32.1–61.9%) (P = 0.14), and that of UTPs was 39.4% (CI95 31.0–48.3%) and 64.4% (CI95 48.8–78.1%) (P = 0.006), respectively. In school-children, raised urine-albumin concentrations (>40 mg/L) were associated, albeit non-significantly, with prevalence of infection (OR = 3.1, P = 0.070), but more specifically and significantly with the prevalence of micro-haematuria (OR = 76.7, P<0.0001). In adults, elevated urine-albumin excretion was associated with UTPs, particularly lesions of the bladder wall (OR = 8.4, P = 0.013). Albuminuria showed promising diagnostic performance, especially in school-aged children with sensitivity of 63.3% and specificity of 83.1% at detecting lower UTPs, i.e. bladder-wall lesions (ultrasonography as ‘gold standard’).Conclusion/SignificanceThis study indicates that albuminuria assays could be used as a RaMA tool for monitoring UTP prevalence during control programmes, as well as a tool for selecting those with more chronic bladder-wall lesions without resorting to ultrasonography.

Identifying and Evaluating Field Indicators of Urogenital Schistosomiasis-Related Morbidity in Preschool-Aged Children

“…haematobium infection in children than using one test parameter alone, and thereby facilitating effective and timely interventions. The utility of albuminuria as a valuable indicator of schistosome-related morbidity in our study corroborates earlier findings in school-aged children by Sousa-Figueiredo and colleagues [ 34 ].…”

Comparison of novel and standard diagnostic tools for the detection of Schistosoma mekongi infection in Lao People’s Democratic Republic and Cambodia

“…These results are in accordance with published results which showed that POC-CCA prevalence was between 1.5- and up to 6-fold higher than Kato-Katz prevalence estimates in areas with low infection intensity [ 23 ]. The comparable cost levels per determination for POC-CCA and Kato-Katz [ 41 , 42 ] should not prevent the application of the rapid test in national schistosomiasis control programmes. Furthermore, people are more likely to provide urine samples than any other type of sample, leading to higher compliance.…”

A rare parasitic infection in turkey: schistosomiasis. case report

“…They range from mild symptoms such as hematuria, leukocyturia, urinary tract complaints, tender abdomen, and supra-pubic tenderness to chronic iron deficiency and anemia, scarring and deformity of the ureters and bladder, chronic bacterial superinfection, severe damage of urinary tract organs, and ultimately renal failure (2,4,5,9). The urinary bladder is the most affected area of the urogenital tract.…”