Abstract
BackgroundCalprotectin is a calcium-binding cytoplasmic protein found in neutrophils and increasingly used as a marker of bowel inflammation. Fecal occult blood (FOB) is also a dependable indicator of bowel morbidity. The objective of our study was to determine the applicability of these tests as surrogate markers of Schistosoma mansoni intestinal morbidity before and after treatment with praziquantel (PZQ).Methods216 children (ages 3–9 years old) from Buliisa District in Lake Albert, Uganda were examined and treated with PZQ at baseline in October 2012 with 211 of them re-examined 24 days later for S. mansoni and other soil transmitted helminths (STH). POC calprotectin and FOB assays were performed at both time points on a subset of children. Associations between the test results and infection were analysed by logistic regression.ResultsFecal calprotectin concentrations of 150–300 µg/g were associated with S. mansoni egg patent infection both at baseline and follow up (OR: 12.5 P = 0.05; OR: 6.8 P = 0.02). FOB had a very strong association with baseline anemia (OR: 9.2 P = 0.03) and medium and high egg intensity schistosomiasis at follow up (OR: 6.6 P = 0.03; OR: 51.3 P = 0.003). Both tests were strongly associated with heavy intensity S. mansoni infections. There was a significant decrease in FOB and calprotectin test positivity after PZQ treatment in those children who had egg patent schistosomiasis at baseline.ConclusionsBoth FOB and calprotectin rapid assays were found to correlate positively and strongly with egg patent S. mansoni infection with a positive ameloriation response after PZQ treatment indicative of short term reversion of morbidity. Both tests were appropriate for use in the field with excellent operational performance and reliability. Due to its lower-cost which makes its scale-up of use affordable, FOB could be immediately adopted as a monitoring tool for PC campaigns for efficacy evaluation before and after treatment.
Highlights
With over 207 million people worldwide infected with schistosomiasis, mostly in sub-Saharan Africa, there is still a pressing need to optimize field-appropriate tools for morbidity staging and monitoring of clinical disease [1]
This holds true for intestinal schistosomiasis, mainly caused by two different species of the genus Schistosoma: S. japonicum and S. mansoni, in which the clinical diagnostic gold-standard for bowel morbidity is a colonoscopy
The primary objective of the present study was an investigation of point-of-care (POC) chromatographic Fecal occult blood (FOB) detection and fecal calprotectin with S. mansoni infection status as a proxy for intestinal morbidity
Summary
With over 207 million people worldwide infected with schistosomiasis, mostly in sub-Saharan Africa, there is still a pressing need to optimize field-appropriate tools for morbidity staging and monitoring of clinical disease [1]. Part of the difficulty is due to the variability of schistosomiasis-related clinical manifestations that are often non-specific and species dependent. This holds true for intestinal schistosomiasis, mainly caused by two different species of the genus Schistosoma: S. japonicum and S. mansoni, in which the clinical diagnostic gold-standard for bowel morbidity is a colonoscopy. This has limited applicability in resource limited settings owing to logistic constraints [5]. The objective of our study was to determine the applicability of these tests as surrogate markers of Schistosoma mansoni intestinal morbidity before and after treatment with praziquantel (PZQ)
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