Schistosoma mansoni Infections in young children: when are schistosome antigens in urine, eggs in stool and antibodies to eggs first detectable?
BACKGROUND
in uganda, control of intestinal schistosomiasis with preventive chemotherapy is typically focused towards treatment of school-aged children; the needs of younger children are presently being investigated as in lakeshore communities very young children can be infected. In the context of future epidemiological monitoring, we sought to compare the detection thresholds of available diagnostic tools for Schistosoma mansoni and estimate a likely age of first infection for these children.


RESULTS
a total of 242 infants and preschool children (134 boys and 108 girls, mean age 2.9 years, minimum 5 months and maximum 5 years) were examined from Bugoigo, a well-known disease endemic village on Lake Albert. Schistosome antigens in urine, eggs in stool and host antibodies to eggs were inspected to reveal a general prevalence of 47.5% (CI(95) 41.1-54.0%), as ascertained by a positive criterion from at least one diagnostic method. Although children as young as 6 months old could be found infected, the average age of infected children was between 3¼-3¾ years, when diagnostic techniques became broadly congruent.


CONCLUSIONS
whilst different assays have particular (dis)advantages, direct detection of eggs in stool was least sensitive having a temporal lag behind antigen and antibody methods. Setting precisely a general age of first infection is problematic but if present Ugandan policies continue, a large proportion of infected children could wait up to 3-4 years before receiving first medication. To better tailor treatment needs for this younger ageclass, we suggest that the circulating cathodic antigen urine dipstick method to be used as an epidemiological indicator.
Wolfson Wellcome Biomedical Laboratories, Department of Zoology, Natural History Museum, London, United Kingdom. r.stothard@nhm.ac.uk
J Russell
JR
Stothard
Jose Carlos de
JC
Sousa-Figueiredo
Jose C
JC
Sousa-Figuereido
Martha
M
Betson
Moses
M
Adriko
Moses
M
Arinaitwe
Candia
C
Rowell
Fred
F
Besiyge
Narcis B
NB
Kabatereine
D000818:Animals; D000909:Antibodies, Helminth / Q000097:blood*; D000947:Antigens, Helminth / Q000652:urine*; D002675:Child, Preschool; D005243:Feces / Q000469:parasitology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012550:Schistosoma mansoni / Q000302:isolation & purification*; D012555:Schistosomiasis mansoni / Q000175:diagnosis* / Q000453:epidemiology*; D012680:Sensitivity and Specificity; D014454:Uganda / Q000453:epidemiology
D000909:Antibodies, Helminth; D000947:Antigens, Helminth
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