Abstract
Continuous exposure to schistosome-infested water results in acute and chronic morbidity in all ages. We analysed occurence of organomegaly via ultrasonography and investigated a possible additive effect of dual-dose drug administration in 401 Schistosoma haematobium infected individuals from a highly endemic area in Mali. Mean intensity of infection at baseline (22.0 eggs per 10 ml) was reduced to 0.22 eggs per 10 ml 9 weeks after treatment (both treatments combined). Odds of persistent infection among those given dual-dose treatment was 41% of that in people given single dose (b = 0.41; p = 0.05; 95% CI 0.17–1.00), but after two years, 70.7% of the 157 participants, who completed the survey, were re-infected with no significant difference in prevalence and intensity of infection between treatment groups. Resolution of organomegaly occurred in all age groups after treatment. A novel association between Schistosoma haematobium infection and moderate portal vein enlargement was found in 35% (n: 55). Severe portal vein diameter enlargement was found in 3.2%. After two years, moderate hepatomegaly was present in 50.6%, moderate splenomegaly in 45.6% and moderate portal vein diameter enlargement in 19%. A subsequent dose of PZQ did not provide any additional long-term advantages.
Highlights
A national control program to reduce the burden of schistosomiasis infections was initiated in Mali in 1978, resulting in a national prevalence reduction from 58.9% to 26.8% of Schistosoma haematobium, the most prevalent schistosome species in the country [1]
Development of hepato-splenomegaly is well known in S. japonicum and S. mansoni infections where congestive splenomegaly develops from focal inflammatory lesions provoked by eggs and dead worms resulting in necrosis, obstruction of vessels and scarring [10] but is not generally accepted as a feature of S. haematobium infection
Fecal samples were collected from 291 people revealing S. mansoni/S. haematobium co-infection in 38 (13.1%)
Summary
A national control program to reduce the burden of schistosomiasis infections was initiated in Mali in 1978, resulting in a national prevalence reduction from 58.9% to 26.8% of Schistosoma haematobium, the most prevalent schistosome species in the country [1]. Programs focus on school-aged children, even though nearly half of children aged 3 months–5 years have active infections causing detrimental effects on health and development [2]. S. haematobium infection causes morbidity in the urinary tract and genital organs due to inflammation and granulomatous immunologic host responses to trapped eggs [5]. Indications of genital involvement associated with S. haematobium infection have been shown in school aged girls [7] and untreated lesions may persist leading to reproductive and sexually related illnesses in adults [8]. Development of hepato-splenomegaly is well known in S. japonicum and S. mansoni infections where congestive splenomegaly develops from focal inflammatory lesions provoked by eggs and dead worms resulting in necrosis, obstruction of vessels and scarring [10] but is not generally accepted as a feature of S. haematobium infection
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