title: Hepatosplenomegaly in Kenyan schoolchildren: exacerbation by concurrent chronic exposure to malaria and Schistosoma mansoni infection.
abstract: OBJECTIVE
  Chronic exposure to malaria exacerbates Schistosoma mansoni-associated hepatosplenomegaly in school-aged children. However, residual hepatosplenomegaly after treatment of S. mansoni with concurrent mollusciciding suggests malaria could be an underlying cause of hepatosplenomegaly. We investigated the role of chronic malaria in childhood hepatosplenomegaly in the presence and absence of concurrent S. mansoni infection.
  
  
  METHODS
  Cross-sectional study of children in an study area where transmission of S. mansoni, but not malaria, is restricted to the eastern end. Clinical and ultrasound examinations were conducted, and parasitological and serological tests used to determine S. mansoni infection intensities and comparative exposure levels to malaria.
  
  
  RESULTS
  Chronic exposure to malaria, as determined by Pfs-IgG3 levels, was associated with hepatosplenomegaly even in the absence of S. mansoni infection. Children infected with S. mansoni mostly had light to moderate infection intensities but greater enlargement of the liver and spleen than children who did not have schistosomiasis, and for the left liver lobe this was S. mansoni infection intensity dependent.
  
  
  CONCLUSIONS
  Children chronically exposed to malaria but without S. mansoni infection can have hepatosplenomegaly, which even light S. mansoni infections can exacerbate in an intensity-dependent manner. Thus, concurrent chronic exposure to S. mansoni and Plasmodium falciparum can have an additive or synergistic effect on childhood morbidity.
authors: Department of Pathology, University of Cambridge, Cambridge, UK. sw320@cam.ac.uk
authors: Shona
authors: S
authors: Wilson
authors: Birgitte J
authors: BJ
authors: Vennervald
authors: Hilda
authors: H
authors: Kadzo
authors: Edmund
authors: E
authors: Ireri
authors: Clifford
authors: C
authors: Amaganga
authors: Mark
authors: M
authors: Booth
authors: H Curtis
authors: HC
authors: Kariuki
authors: Joseph K
authors: JK
authors: Mwatha
authors: Gachuhi
authors: G
authors: Kimani
authors: John H
authors: JH
authors: Ouma
authors: Eric
authors: E
authors: Muchiri
authors: David W
authors: DW
authors: Dunne
mesh_terms: D000293:Adolescent; D000818:Animals; D000871:Anthelmintics / Q000494:pharmacology / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006529:Hepatomegaly / Q000145:classification / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D016014:Linear Models; D008099:Liver / Q000000981:diagnostic imaging; D016778:Malaria, Falciparum / Q000150:complications / Q000453:epidemiology*; D008297:Male; D011223:Praziquantel / Q000627:therapeutic use; D015995:Prevalence; D012550:Schistosoma mansoni / Q000187:drug effects; D012555:Schistosomiasis mansoni / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D012720:Severity of Illness Index; D013163:Splenomegaly / Q000145:classification / Q000453:epidemiology* / Q000209:etiology; D014463:Ultrasonography
chemical_list: D000871:Anthelmintics; D011223:Praziquantel