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

Schistosomiasis is a water-borne parasite that infects approximately 200 million people worldwide. Schistosoma japonicum, found in Asia, causes disease by releasing eggs in the liver, leading to fibrosis, anemia, and, in children, impaired growth. Ultrasound can assess liver pathology from schistosomiasis; however more information is needed to evaluate the relevance of standard ultrasound measures. We followed 578 people for up to five years, testing for schistosomiasis infection and conducting ultrasound examinations to assess the relationship between infection and seven ultrasound measures and to evaluate the impact of treatment with anti-schistosomiasis chemotherapy (praziquantel) on morbidity. All infections were promptly treated. Fibrosis of the liver parenchyma, pathology unique to S. japonicum, was associated with schistosomiasis infection, and was most advanced in people with high worm burdens. Liver fibrosis declined significantly following treatment, but reversal of severe liver fibrosis was rare. Other ultrasound measures were not consistently related to schistosomiasis infection or treatment. These findings suggest parenchymal fibrosis can be used to measure morbidity attributable to S. japonicum and evaluate the impact of disease control efforts. Because reversal of severe fibrosis was limited, disease control efforts will be most effective if they can not only treat existing infections but also prevent new infections

Chitinase 3-Like 1 Protein Levels Are Elevated in Schistosoma haematobium Infected Children

Currently there are few studies characterising the nature and aetiology of human schistosome-related inflammatory processes. The aim of this study was to determine the relationship between Chitinase 3-like 1 (CHI3L1), also known as YKL-40, a molecule associated with inflammatory processes, and schistosome infection, morbidity and systemic cytokine levels. Methods Serological levels of CHI3L1 and a panel of cytokines (IFN-y, IL-4/5/6/9/10/13 and 17) were measured in two Zimbabwean populations resident in a high and low schistosome infection area. CHI3L1 levels were related to schistosome infection, haematuria status and cytokine levels after allowing for confounding variables. The effect of antihelminthic treatment with praziquantel on CHI3L1 levels was determined in 246 participants 6 weeks post-treatment. Results CHI3L1 levels increased with age in both areas but were significantly higher in the high infection areas compared to the low infection area. CHI3L1 levels were also higher in infected compared to uninfected individuals with this difference being significant in the youngest age group. Curative antihelminthic treatment resulted in a significant decrease in CHI3L1 levels. Of the cytokines, only IL-10 and IL-17 had a significant association with CHI3L1 levels, and this association was negative. Conclusions Serum CHI3L1 levels differ between infected and uninfected people before and after antihelminthic treatment. The greatest difference occurs in the youngest age group, in keeping with the period when schistosome-related pathological processes are initiated. Following from previous studies in non-infectious diseases showing that CHI3L1 is a biomarker for the inflammatory process, this study suggests that the potential for CHI3L1 as a biomarker for schistosome-related pathology should be explored further.World Health Organisation (www.who.org); the Wellcome Trust (http://www.wellcome.ac.uk/) [grant number WT082028MA]; the Thrasher Foundation (http://www.thrasherresearch.org/) to [FM]; and by the Medical Research Council (http://www.mrc.ac.uk) [grant number G0600818 to JEA, PhD studentship LJA-544 to LJA]

ASPECTOS ULTRA-SONOGRÁFICOS DA ESQUISTOSSOMOSE HEPATOESPLÊNICA Ultrasound findings in hepatosplenic schistosomiasis

A ultra-sonografia representa uma importante contribuição no diagnóstico da forma hepatoesplênica da esquistossomose. A ultra-sonografia permite a identificação das principais alterações, como espessamento periportal, perivesicular, aumento do lobo hepático esquerdo, redução do lobo hepático direito e esplenomegalia. Adicionalmente, os padrões hemodinâmicos podem ser avaliados com o Doppler, sendo possível a análise das veias porta, mesentérica superior e esplênica, além de facilitar o estudo dos vasos venosos colaterais. Em áreas endêmicas, a ultra-sonografia assume papel de destaque, sendo superior à avaliação clínica na identificação da hepatoesplenomegalia e possibilitando o acompanhamento dos pacientes submetidos a tratamento clínico. Neste trabalho, os autores apresentam uma revisão dos principais achados sonográficos e ao Doppler da esquistossomose hepatoesplênica, sendo demonstrada, também, a relação destes achados com os aspectos clínico-patológicos desta doença.<br>Ultrasound represents an important contribution to the diagnosis of hepatosplenic mansonic schistosomiasis. Abnormalities such as hyperechoic fibrotic bands along the portal vessels, volumetric reduction of the right hepatic lobe, enlargement of the left lobe, perivesicular fibrotic thickening and splenomegaly can be recognized. Moreover, the hemodynamic status of the portal venous system may also be evaluated by Doppler analysis, including the identification of collateral veins and portosystemic venous shunts. In endemic areas, ultrasound is of great value in the identification of hepatosplenomegaly, allowing follow-up of patients under clinical treatment. This review presents the ultrasonographic and Doppler features of hepatosplenic schistosomiasis. The relationship between these findings and the clinical and pathological characteristics of this disease are also discussed