Hepatitis B virus infection in schistosomiasis mansoni

Abstract

Schistosomiasis and hepatitis B virus (HBV) infection are very common in Brazil but the interrelationships between the two infections are poorly understood. We have undertaken a detailed serological study of the prevalence of HBV markers in 189 Brazilian patients with chronic schistosomiasis mansoni, 46 with hepatointestinal (HIS) and 143 with hepatosplenic (HSS) schistosomiasis, 12 of the latter having decompensated liver disease (HSSD), and in 50 control patients. Sera were tested for HBsAg, anti-e, anti-HBc, anti-HBs and HBV-DNA. Eighty-three (44%) of the 189 schistosoma patients had at least one marker of HBV infection, 18 of whom (10%) were seropositive for HBsAg. All the controls were HBsAg negative, but ten (20%) had anti-HBc and anti-HBs. There was no significant difference in the frequency of these markers between HIS (14/46, 30.4%), HSSC (43/131, 34.5%), and the controls. Among the HBsAg-positive patients, one had HIS (HBV-DNA negative), seven had HSSC (one HBV-DNA positive) and ten had HSSD (six HBV-DNA positive), a significant association of HBV carriage with HSSD (P << 0.001). Mean (+/- SD) ALT values were significantly (P < 0.001) higher in HBsAg-positive HSSD patients (70.7 +/- 18 IU/liter) than in those with HSSC (29.5 +/- 15 IU/liter). Liver biopsies were performed in 12 HBsAg-positive patients (one with HIS, three with HSSC, and eight with HSSD) and in 50 HBsAg-negative HSSC patients. Seven of the eight HSSD patients had chronic active hepatitis with cirrhosis, and one had inactive cirrhosis. All three patients with HSSC and the one with HIS had chronic persistent hepatitis, with periportal fibrosis in three.(ABSTRACT TRUNCATED AT 250 WORDS)

Reciprocal Immunomodulation in a Schistosome and Hepatotropic Virus Coinfection Model

“…This suggests that the inflammatory cells in the granulomas did not facilitate early virus replication in the liver by comprising an infection-susceptible cell population for the virus to target; but rather that the hepatocytes surrounding the granulomas appeared to have become more susceptible to virus infection than hepatocytes in singly infected mice. This mirrors findings made in schistosome/HBV coinfection, in which examination of liver wedge biopsy specimens showed HBV replication to be localized to hepatocytes outside the granulomas (44). Notably, we did not observe any enhancement of LCMV replication in the context of S. mansoni infection in areas of liver tissue devoid of egg deposition; likewise although viral titers in the liver of coinfected mice were 3 logs higher than those in mice infected with LCMV only on day 7 p.i., viral clearance from the spleen was only slightly delayed.…”

“…In one schistosome/HCV coinfection study in Egypt, the hepatic viral burden in coinfected individuals was shown to be 10-fold higher than in individuals infected with HCV only; likewise other studies also suggest that schistosome infection impairs control of HBV and HCV (26,27,(42)(43)(44). Similarly, in mice coinfected with schistosomes and vaccinia virus, liver viral titers were increased and clearance was significantly delayed, with virus replicating preferentially in granulomas (25).…”

Prognosis of schistosomiasis mansoni patients infected with hepatitis B virus

“…Lyra et al (1976) in Brazil and Bassily et al (1979) in Egypt emphasized the high frequency of markers for hepatitis B infection in patients hospitalized with the uncontrolled hepatosplenic form. However, Pereira et al (1994) suggested that in order to avoid bias, patient samples with severe chronic hepatic lesions not be included in studies.…”

Duplex sonography study in schistosomiasis portal hypertension: characterization of patients with and without a history of variceal bleeding

“…Since patients in endemic areas often present mixed forms of liver disease due to the frequent association of schistosomiasis with chronic hepatitis, particularly due to HCV and HBV (27,28) , knowledge of these patterns with a more precise characterization of portal hypertension may be critical to the clinician caring for them, who may consider surgical therapy as part of their management.…”