The impact of single versus mixed schistosome species infections on liver, spleen and bladder morbidity within Malian children pre- and post-praziquantel treatment.
BACKGROUND
In the developing world co-infections and polyparasitism within humans appear to be the rule rather than the exception, be it any combination of inter-specific and/or inter- and intra-Genera mixed infections. Mixed infections might generate synergistic or antagonistic interactions and thereby clinically affect individuals and/or impact parasite epidemiology.


METHODS
The current study uniquely assesses both Schistosoma mansoni- and Schistosoma haematobium-related morbidity of the liver and the bladder as assessed by ultrasound as well as spleen and liver morbidity through clinical exams. The impact of praziquantel (PZQ) treatment on such potential inter-specific schistosome interactions and resulting morbidity using uniquely detailed longitudinal data (pre- and one year post-PZQ treatment) arising from the National Schistosomiasis Control Program in three areas of Mali: Ségou, Koulikoro and Bamako, is also evaluated. At baseline, data were collected from up to 2196 children (aged 7-14 years), 844 of which were infected with S. haematobium only, 124 with S. mansoni only and 477 with both. Follow-up data were collected from up to 1265 children.


RESULTS
Results suggested lower liver morbidity in mixed compared to single S. mansoni infections and higher bladder morbidity in mixed compared to single S. haematobium infections. Single S. haematobium or S. mansoni infections were also associated with liver and spleen morbidity whilst only single S. haematobium infections were associated with bladder morbidity in these children (light S. haematobium infection OR: 4.3, p < 0.001 and heavy S. haematobium infection OR: 19, p < 0.001). PZQ treatment contributed to the regression of some of the forms of such morbidities.


CONCLUSIONS
Whilst the precise biological mechanisms for these observations remain to be ascertained, the results illustrate the importance of considering mixed species infections in any analyses of parasite-induced morbidity, including that for the proposed Disability Adjusted Life Years (DALYs) revised estimates of schistosomiasis morbidity.
Koukounari
Artemis
A
Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, UK. artemis.koukounari@imperial.ac.uk
Donnelly
Christl A
CA
Sacko
Moussa
M
Keita
Adama D
AD
Landouré
Aly
A
Dembelé
Robert
R
Bosqué-Oliva
Elisa
E
Gabrielli
Albis F
AF
Gouvras
Anouk
A
Traoré
Mamadou
M
Fenwick
Alan
A
Webster
Joanne P
JP
D000293:Adolescent; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D002648:Child; D015897:Comorbidity; D005260:Female; D006801:Humans; D008099:Liver / Q000469:parasitology / Q000473:pathology*; D008297:Male; D008302:Mali; D011223:Praziquantel / Q000627:therapeutic use*; D012548:Schistosoma haematobium / Q000302:isolation & purification*; D012550:Schistosoma mansoni / Q000302:isolation & purification*; D012552:Schistosomiasis / Q000188:drug therapy* / Q000469:parasitology / Q000473:pathology; D013154:Spleen / Q000469:parasitology / Q000473:pathology*; D001743:Urinary Bladder / Q000469:parasitology / Q000473:pathology*
D000871:Anthelmintics; D011223:Praziquantel