Eosinophil granule proteins ECP and EPX as markers for a potential early-stage inflammatory lesion in female genital schistosomiasis (FGS).

Charles Emile Ramarokoto,Vololomboahangy Elisabeth Ravaoalimalala,Peter Leutscher,Eyrun Floerecke Kjetland,Bodo Sahondra Randrianasolo,Birgitte Jyding Vennervald,Pascaline Ravoniarimbinina,Anna Overgaard Kildemoes

doi:10.1371/journal.pntd.0002974

Abstract

BackgroundGenital granulomas induced by Schistosoma haematobium eggs can manifest as different lesion types visible by colposcopy; rubbery papules (RP), homogenous sandy patches (HSP) and grainy sandy patches (GSP). Pronounced tissue eosinophilia is a candidate marker for active S. haematobium pathology, as viable schistosome egg granulomas often are eosinophil rich. Here it was investigated whether eosinophil granule proteins ECP (eosinophil cationic protein) and EPX (eosinophil protein-X) in urine and genital lavage can be used as markers for active FGS lesions.MethodsUro-genital samples from 118 Malagasy women were analysed for ECP and EPX by standard sandwich avidin/biotin amplified ELISA.Principal findingsThe women with RP lesions had significantly higher levels of ECP and EPX in both lavage and urine. Furthermore, women with RP lesions were significantly younger than those with GSP. This could indicate that RP lesions might be more recently established and thus represent an earlier inflammatory lesion stage.ConclusionECP in genital lavage might be a future tool aiding the identification of FGS pathology at a stage where reversibility remains a possibility following praziquantel treatment.

Highlights

eosinophil cationic protein (ECP) in genital lavage might be a future tool aiding the identification of female genital schistosomiasis (FGS) pathology at a stage where reversibility remains a possibility following praziquantel treatment
The poverty associated disease uro-genital schistosomiasis caused by Schistosoma haematobium affects millions of people in the Sub-Saharan region resulting in a substantial morbidity burden ranging from subtle to severe in individuals [1]
This study aimed to investigate the potential of ECP and/or Eosinophil protein X (EPX) as candidate markers for distinct FGS lesion pathology in the lower genital tract

Summary

Introduction

The poverty associated disease uro-genital schistosomiasis caused by Schistosoma haematobium affects millions of people in the Sub-Saharan region resulting in a substantial morbidity burden ranging from subtle to severe in individuals [1]. A number of population-based epidemiological studies investigating genital manifestations of schistosomiasis in women, known as female genital schistosomiasis (FGS), have been carried out in various Sub-Saharan regions. These studies have demonstrated prevalence of FGS as high as 50% in S. haematobium endemic areas [8]. Pronounced tissue eosinophilia is a candidate marker for active S. haematobium pathology, as viable schistosome egg granulomas often are eosinophil rich It was investigated whether eosinophil granule proteins ECP (eosinophil cationic protein) and EPX (eosinophil protein-X) in urine and genital lavage can be used as markers for active FGS lesions

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Conclusion