Hepatosplenomegaly in Kenyan schoolchildren: exacerbation by concurrent chronic exposure to malaria and Schistosoma mansoni infection.
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.
Wilson
Shona
S
Department of Pathology, University of Cambridge, Cambridge, UK. sw320@cam.ac.uk
Vennervald
Birgitte J
BJ
Kadzo
Hilda
H
Ireri
Edmund
E
Amaganga
Clifford
C
Booth
Mark
M
Kariuki
H Curtis
HC
Mwatha
Joseph K
JK
Kimani
Gachuhi
G
Ouma
John H
JH
Muchiri
Eric
E
Dunne
David W
DW
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
D000871:Anthelmintics; D011223:Praziquantel