title: Prevalence of schistosome antibodies with hepatosplenic signs and symptoms among patients from Kaoma, Western Province, Zambia.
abstract: BACKGROUND
  Schistosomiasis is a major cause of morbidity and mortality, with over 200 million people infected worldwide. Eighty-five percent of cases are in Africa. The hepatosplenic form develops over time by an immune reaction to trapped Schistosoma mansoni eggs in the portal system leading to liver fibrosis, portal hypertension and oesophageal varices. Most patients presenting to the University Teaching Hospital in Lusaka with oesophageal varices, come from Western province, but no formal studies have been carried out in this area assessing the burden of hepatosplenic pathology. We aimed to define the extent of the problem in Kaoma district, western Zambia, and to correlate signs and symptoms with serology.
  
  
  RESULTS
  A symptom questionnaire, demographic survey and physical examination was conducted amongst patients presenting to Kaoma district outpatient clinics. To assess the prevalence of Schistosoma mansoni infections, blood was collected and screened for the presence of Schistosoma antibodies using Enzyme linked immunosorbent assay (ELISA). Of the 110 patients screened, 97 (88%) were ELISA positive. Forty-six percent (51/110) reported haematochezia and 7% experienced haematemesis (8/110). On physical examination 27% (30/110) hepatomegaly and 17% (30/110) splenomegaly was observed amongst participants but there were few correlations between serology and signs/symptoms. On questioning 68% (75/110) of participants knew nothing about schistosomiasis transmission.
  
  
  CONCLUSIONS
  Our serological and clinical data indicate a very heavy burden of schistosomiasis-related portal hypertension. Our evidence highlights a need for mass treatment in Kaoma to address and prevent extensive pathology of hepatosplenic schistosomiasis. Safe water and health education throughout Western Province are clearly also important.
authors.affiliation: Faculty of Medicine, Imperial College London, South Kensington Campus, SW7 2AZ London, UK. larapayne@doctors.org.uk.
authors.forename: Lara
authors.initials: L
authors.lastname: Payne
authors.forename: Eleanor
authors.initials: E
authors.lastname: Turner-Moss
authors.forename: Mable
authors.initials: M
authors.lastname: Mutengo
authors.forename: Akwi W
authors.initials: AW
authors.lastname: Asombang
authors.forename: Paul
authors.initials: P
authors.lastname: Kelly
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000909:Antibodies, Helminth / Q000097:blood*; D004932:Esophageal and Gastric Varices / Q000473:pathology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006529:Hepatomegaly / Q000473:pathology; D006801:Humans; D006975:Hypertension, Portal / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012550:Schistosoma mansoni / Q000276:immunology*; D012555:Schistosomiasis mansoni / Q000453:epidemiology* / Q000276:immunology* / Q000469:parasitology / Q000473:pathology; D013163:Splenomegaly / Q000473:pathology; D011795:Surveys and Questionnaires; D015024:Zambia / Q000453:epidemiology
chemical_list: D000909:Antibodies, Helminth