Use of Ultrasonography to Evaluate Schistosoma japonicum-Related Morbidity in Children, Sichuan Province, China, 2000–2007

Hsiang, Michelle S.; Carlton, Elizabeth J.; Zhong, Bo; Qiu, Dongchuan; Cohen, P.; Stewart, Christopher C.; Spear, Robert C.

doi:10.4269/ajtmh.2010.09-0061

Cited by 8 publications

(10 citation statements)

References 35 publications

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“…Generalized estimating equations logistic regression with exchangeable correlation was used for all other measures. doi:10.1371/journal.pntd.0000685.t004 measures has been shown to be poor in a pediatric population, and further efforts to evaluate the accuracy of organ and vein size measurements are needed [19].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Schistosoma japonicum Infection and Treatment on Ultrasound-Detectable Morbidity: A Five-Year Cohort Study in Southwest China

et al. 2010

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BackgroundUltrasonography allows for non-invasive examination of the liver and spleen and can further our understanding of schistosomiasis morbidity.Methodology/Principal FindingsWe followed 578 people in Southwest China for up to five years. Participants were tested for Schistosoma japonicum infection in stool and seven standard measures of the liver and spleen were obtained using ultrasound to evaluate the relationship between schistosomiasis infection and ultrasound-detectable pathology, and the impact of targeted treatment on morbidity. Parenchymal fibrosis, a network pattern of the liver unique to S. japonicum, was associated with infection at the time of ultrasound (OR 1.40, 95% CI: 1.03–1.90) and infection intensity (test for trend, p = 0.002), adjusting for age, sex and year, and more strongly associated with prior infection status and intensity (adjusted OR 1.84, 95% CI: 1.30–2.60; test for trend: p<0.001 respectively), despite prompt treatment of infections. While declines in parenchymal fibrosis over time were statistically significant, only 28% of individuals with severe parenchymal fibrosis (grades 2 or 3) at enrollment reversed to normal or grade 1 within five years. Other liver abnormalities were less consistently associated with S. japonicum infection.Conclusions/SignificanceParenchymal fibrosis is an appropriate measure of S. japonicum morbidity and can document reductions in disease following control efforts. Other ultrasound measures may have limited epidemiological value in regions with similar infection levels. Because severe fibrosis may not reverse quickly following treatment, efforts to reduce exposure to S. japonicum should be considered in combination with treatment to prevent schistosomiasis morbidity.

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Section: Discussionmentioning

confidence: 99%

The Impact of Schistosoma japonicum Infection and Treatment on Ultrasound-Detectable Morbidity: A Five-Year Cohort Study in Southwest China

et al. 2010

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“…29,30 It includes assessment of expected morbidities such as splenomegaly and left lobe hepatomegaly, as well as successively more pronounced liver ultrasound changes scored as image patterns (IP) A (normal), B ("starry sky," abnormal linear opacities of unclear significance), and C through F (progressive hepatic fibrosis). These characteristic, partially reversible 31,32 schistosomiasis-associated abnormalities in adults have also been found in school-aged children, 33,34 but morbidity in PSAC using this system or ultrasound more generally is again not well characterized.…”

Section: Introductionmentioning

confidence: 99%

Morbidity Associated with Schistosomiasis Before and After Treatment in Young Children in Rusinga Island, Western Kenya

Davis¹,

Wiegand²,

Mulama³

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract. Schistosoma mansoni infection is a major cause of organomegaly and ultimately liver fibrosis in adults. Morbidity in pre-school-aged children is less defined, and they are currently not included in mass drug administration (MDA) programs for schistosomiasis control. We report results of a study of the association of schistosomiasis with organomegaly in a convenience sample of 201 children under 7 years old in Rusinga, Kenya on two cross-sectional visits, before and after praziquantel treatment. Data included stool examination and serology for schistosomiasis, the Niamey ultrasound protocol to stage hepatosplenic morbidity including organomegaly, and potential confounders including malaria. Unadjusted and adjusted Poisson regressions were performed. The baseline prevalence of schistosomiasis by antibody and/or stool was 80.3%. Schistomiasis was associated with hepatomegaly (adjusted prevalence ratio [aPR] = 1.4; 95% confidence interval [CI]: 1.0-2

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“…The impact of this sensitization on fibrosis-related outcomes as these infants acquire natural infections remains unknown. Multiple studies have shown that hepatomegaly and fibrosis associated with schistosome infection continue to affect children and adults even after initial infection is resolved (30)(31)(32). Because fibrosis is a morbidity associated with chronic schistosome infection, it is relatively rare in children (30,33,34); however, we speculate that the risk of developing schistosome-associated fibrosis following acquisition of infection may differ in individuals who were sensitized in utero to respond to schistosome antigens with a profibrotic signature.…”

Section: Discussionmentioning

confidence: 56%

Maternal Infection with Schistosoma japonicum Induces a Profibrotic Response in Neonates

et al. 2014

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fThe global burden of schistosomiasis is significant, with fibrosis a major associated morbidity and the primary cause of mortality. We have previously shown that schistosomiasis during pregnancy upregulates proinflammatory cytokines in the cord blood. In this study, we extend these findings to include a large panel of fibrosis-associated markers. We developed a multiplex beadbased assay to measure the levels of 35 proteins associated with fibrosis. Cord blood from 109 neonates born to mothers residing in an area of Schistosoma japonicum endemicity was assessed for these molecules. Ten mediators were elevated in the cord blood from schistosome-infected pregnancies, including insulin-like growth factor 1 (IGF-1), tumor growth factor ␤1 (TGF-␤1), connective tissue growth factor (CTGF), procollagen I carboxy-terminal propeptide (PICP), amino-telopeptide of type 1 collagen (ICTP), collagen VI, desmosine, matrix metalloproteinase 2 (MMP-2), tissue inhibitor of metalloproteinases 1 (TIMP-1), and TIMP-4. Many of these were also positively correlated with preterm birth (PICP, ICTP, MMP-2, TGF-␤1, desmosine, CTGF, TIMP-1). In addition, birth weight was 168 g lower for infants with detectable levels of CTGF than for those with CTGF levels below the level of detection. Maternal schistosomiasis results in upregulation of fibrosis-associated proteins in the cord blood of the neonate, a subset of which are also associated with adverse birth outcomes. As the first report of fibrosis-associated molecules altered in the newborn of infected mothers, this study has broad implications for the health of the fetus, stretching from gestation to adulthood.

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Use of Ultrasonography to Evaluate Schistosoma japonicum-Related Morbidity in Children, Sichuan Province, China, 2000–2007

Cited by 8 publications

References 35 publications

The Impact of Schistosoma japonicum Infection and Treatment on Ultrasound-Detectable Morbidity: A Five-Year Cohort Study in Southwest China

The Impact of Schistosoma japonicum Infection and Treatment on Ultrasound-Detectable Morbidity: A Five-Year Cohort Study in Southwest China

Morbidity Associated with Schistosomiasis Before and After Treatment in Young Children in Rusinga Island, Western Kenya

Maternal Infection with Schistosoma japonicum Induces a Profibrotic Response in Neonates

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