title: Hepatosplenic schistosomiasis is characterised by high blood markers of translocation, inflammation and fibrosis.
abstract: OBJECTIVE
  Cirrhosis is the main cause of portal hypertension worldwide but schistosomiasis dominates in much of the tropics. The seroprevalence of Schistosoma mansoni is up to 77% in endemic parts of Zambia. Morbidity is attributed to portal hypertension causing variceal bleeding which can be fatal. Bacterial translocation is associated with portal hypertension in cirrhosis but this is almost unexplored in hepatosplenic schistosomiasis. Liver biopsy is usually used to assess fibrosis although it is invasive and prone to sampling error. We aimed to investigate translocation, fibrosis and inflammatory makers in a case-control study of schistosomiasis at the University Teaching Hospital, Lusaka, Zambia.
  
  
  METHODS
  Patients had oesophageal varices, but were negative for human immunodeficiency virus, hepatitis B and C viruses. Plasma lipopolysaccharide binding protein was used as a marker of translocation while hyaluronan and laminin measured liver fibrosis. Inflammatory markers were measured in blood. Controls were patients with non-specific abdominal pain who had normal endoscopy.
  
  
  RESULTS
  Median (interquartile range) lipopolysaccharide binding protein was elevated in patients [44.3 ng/ml (35.7, 57.1)] compared to controls [30.7 ng/ml (30.4, 35.5), P < 0.0001]. Hyaluronan was higher in patients [111.6 ng/ml (39.1, 240.3)] compared to controls [21.0 ng/ml (12.4, 37.6), P < 0.0001] and so was laminin [2.2 μg/ml (1.0, 3.7)] compared to controls [0.9 μg/ml (0.7, 1.2), P = 0.0015]. Inflammatory markers, except C-reactive protein, were elevated in patients.
  
  
  CONCLUSIONS
  These data suggest that the bacterial translocation contributes to systemic inflammation in hepatosplenic schistosomiasis. Elevated fibrotic markers suggest they may be useful in diagnosing and monitoring periportal fibrosis.
authors.affiliation: Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia.|Tropical Gastroenterology & Nutrition Group, Department of Medicine, University of Zambia, Lusaka, Zambia.
authors.forename: Edford
authors.initials: E
authors.lastname: Sinkala
authors.affiliation: Tropical Gastroenterology & Nutrition Group, Department of Medicine, University of Zambia, Lusaka, Zambia.|Biological Sciences Department, School of Natural Sciences, University of Zambia, Lusaka, Zambia.
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Kapulu
authors.affiliation: Tropical Gastroenterology & Nutrition Group, Department of Medicine, University of Zambia, Lusaka, Zambia.
authors.forename: Ellen
authors.initials: E
authors.lastname: Besa
authors.affiliation: Tropical Gastroenterology & Nutrition Group, Department of Medicine, University of Zambia, Lusaka, Zambia.
authors.forename: Kanekwa
authors.initials: K
authors.lastname: Zyambo
authors.affiliation: Paediatric Centre of Excellence Laboratory, University Teaching Hospital, Lusaka, Zambia.
authors.forename: Ng'andu J
authors.initials: NJ
authors.lastname: Chisoso
authors.affiliation: Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, UK.
authors.forename: Graham R
authors.initials: GR
authors.lastname: Foster
authors.affiliation: Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia.|Tropical Gastroenterology & Nutrition Group, Department of Medicine, University of Zambia, Lusaka, Zambia.|Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Kelly
mesh_terms: D000209:Acute-Phase Proteins; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002352:Carrier Proteins / Q000097:blood*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood*; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology*; D007249:Inflammation / Q000097:blood; D007797:Laminin / Q000097:blood*; D008103:Liver Cirrhosis / Q000097:blood / Q000209:etiology* / Q000473:pathology; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood*; D008875:Middle Aged; D012555:Schistosomiasis mansoni / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D013223:Statistics as Topic; D015024:Zambia / Q000453:epidemiology; D000099231:Lipopolysaccharide-Binding Protein
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D002352:Carrier Proteins; D006820:Hyaluronic Acid; D007797:Laminin; D008562:Membrane Glycoproteins; D000099231:Lipopolysaccharide-Binding Protein
keywords: bacterial translocation; fibrosis; inflammation; schistosomiasis