Diagnosing schistosomiasis-induced liver morbidity: implications for global control.
BACKGROUND
Subclinical morbidity due to schistosomiasis was evaluated in 565 patients, and the enhanced liver fibrosis (ELF) test was assessed for the first time as a potential screening tool for disease.


METHODS
The prevalence and intensity of infection were determined by Kato-Katz thick smear stool examination at baseline and 2 years after curative treatment. The degree of hepatic fibrosis was assessed by ultrasound. Non-invasive serum biomarkers of hepatic fibrosis were also evaluated.


RESULTS
The baseline human prevalence and infection intensity were found to be moderately high at 34% and 123 eggs per gram, respectively. However, hepatic parenchymal fibrosis occurred in 50% of subjects, with grade II fibrosis in 19% and grade III in 6%. The ELF score and higher serum levels of tissue inhibitor of metalloproteinase 1 (TIMP-1) and hyaluronic acid (HA) correlated with the grade of liver fibrosis.


CONCLUSIONS
The findings of this study demonstrated that praziquantel treatment had a short-term impact on both the prevalence and intensity of infection, but less of an impact on established morbidity. Higher TIMP-1 and HA serum levels, and an ELF cut-off score of 8 were found to be correlated with the grade of liver fibrosis; these values may, therefore, assist physicians in identifying individuals at greater risk of disease.
Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
David U
DU
Olveda
Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; Research Institute for Tropical Medicine, Department of Health, Manila, the Philippines.
Marianette
M
Inobaya
Research Institute for Tropical Medicine, Department of Health, Manila, the Philippines.
Remigio M
RM
Olveda
Research Institute for Tropical Medicine, Department of Health, Manila, the Philippines.
Marilyn L
ML
Vinluan
Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
Shu-Kay
SK
Ng
QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
Kosala
K
Weerakoon
QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
Donald P
DP
McManus
QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia.
Grant A
GA
Ramm
Center for Tropical and Emerging Global Health Diseases, University of Georgia, Athens, Georgia, USA.
Donald A
DA
Harn
QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; Hunan Institute of Parasitic Diseases, WHO Collaborating Center for research and Control of Schistosomiasis, Yueyang, Hunan, China.
Yuesheng
Y
Li
Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
Alfred K
AK
Lam
Research Institute for Tropical Medicine, Department of Health, Manila, the Philippines.
Jerric R
JR
Guevarra
Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
Allen G
AG
Ross
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010679:Philippines; D011223:Praziquantel / Q000627:therapeutic use; D015995:Prevalence; D012552:Schistosomiasis / Q000150:complications* / Q000188:drug therapy; D012554:Schistosomiasis japonica / Q000188:drug therapy; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000097:blood; D014463:Ultrasonography; D055815:Young Adult
D015415:Biomarkers; D019715:Tissue Inhibitor of Metalloproteinase-1; D011223:Praziquantel; D006820:Hyaluronic Acid
Liver fibrosis; Morbidity; Schistosomiasis; Serum makers; Ultrasound