Periportal fibrosis, liver and spleen sizes among S. mansoni mono or co-infected individuals with human immunodeficiency virus-1 in fishing villages along Lake Victoria shores, North-Western, Tanzania

Abstract

BackgroundThe pathogenesis of S. mansoni infection involves chronic inflammatory responses to parasite eggs which can be associated with a characteristic periportal fibrosis (PPF) and the progression to severe hepatosplenic disease. The effects of HIV-1 co-infection and the influence of CD4+ cell numbers on these clinical manifestations of chronic S. mansoni are not known. To understand the effects of HIV-1 co-infection on these morbidities, we examined S. mansoni ultrasound-detectable morbidities in relation to HIV-1 infection and CD4+ cell counts, and other factors in fishing communities where the two infections are present.MethodsUltrasonographical examination was conducted during a cross-sectional study of 1,671 (aged 21–55 years) individuals in North-Western Tanzania. Blood samples were obtained for HIV-1 screening and CD4+ cell quantification. A single stool sample was examined for S. mansoni eggs using the Kato-Katz technique. A questionnaire was used to collect socio-demographic-economic information.ResultsThe prevalence of PPF (grade C-F) was 13.79% and 15.01% for the HIV-1 infected and non-infected individuals (P = 0.72). Male gender (P< 0.001), age group 21–30 years (P< 0.028) and, residential time of 11–20 (P< 0.01) and ≥21 years (P< 0.01) were associated with PPF in S. mansoni infected individuals. The height-adjusted measurements of the left liver lobe were significantly larger in HIV-1/S. mansoni co-infected compared to S. mansoni only-infected individuals (t = −2.0702, P< 0.039). Predictors of the height-adjusted measurements of the left liver lobe and spleen were age, male gender, malaria infection, fishing occupation, village of residence and heavy intensity of S. mansoni infection. After accounting for these factors, neither HIV-1 infection nor CD4+ cell counts predicted PPF, hepatosplenomegaly, measurements of the liver or spleen. Height-adjusted ultrasound measurements of the left liver lobe did not correlate with the CD4+ cells counts in co-infected individuals (r = −0.16, P = 0.084).ConclusionS. mansoni-related PPF, liver and spleen enlargement are prevalent in the study population. The intensity of S. mansoni infection was associated with the enlargement of liver, spleen and hepatosplenomegaly. The PPF grades observed were similar in both HIV-1/S. mansoni co-infected and in those only infected with S. mansoni. There was no evidence that HIV-1 infection or CD4+ cells counts were associated with these S. mansoni morbidities.

Intestinal schistosomiasis of Ijinga Island, north-western Tanzania: Prevalence, intensity of infection, hepatosplenic morbidities and their associated factors

“…Our results confirm the findings of the previous studies conducted in the same region which noted different patterns of organ morbidities in communities living along the shoreline of the lake and on islands [12,13,19,25]. The common hepatosplenic morbidities detected in the present study population were periportal fibrosis (PPF), hepatomegaly, splenomegaly, hepatosplenomegaly and gall bladder wall thickening.…”

“…Findings on the prevalence of S. mansoni infection on Ijinga Island corroborate the results of previous studies which demonstrated that communities along the southern shore line of Lake Victoria and its Islands carry the highest burden of the disease [12,13,[18][19][20]30]. Our findings noted a very high prevalence using both KK technique and POC-CCA test.…”

“…S. haematobium is not associated with periportal fibrosis therefore. It is worth noting that epidemiological and demographic factors such as duration of residence in endemic areas [11,12], involving in fishing activities [12], parasitological factors (low versus heavy infection intensities) [13], age (children versus adults) [5] and genetic factors [14] can contribute to development of hepatosplenic disease in endemic populations.…”

“…Schistosoma mansoni is focally distributed and commonly found along the large water bodies such as the Lake Victoria [5]. Indeed, multiple studies indicate, that the species S. mansoni is the by far predominant cause of schistosomiasis along the shoreline of Lake Victoria and on its islands [5,12,13,16,19,20,22,25,36]. Communities living there are disproportionally highly affected by the S. mansoni-specific pathology and a number of studies have reported a high prevalence of hepatosplenic morbidities in this region [5,12,13,18,19].…”

The Efficacy of Single-Dose versus Double-Dose Praziquantel Treatments onSchistosoma mansoniInfections: Its Implication on Undernutrition and Anaemia among Primary Schoolchildren in Two On-Shore Communities, Northwestern Tanzania

“…In particular, Schistosoma mansoni in the country is extensively distributed in the southeastern and southwestern sides of Lake Victoria and its islands [9, 11]. In these areas, it has been reported to significantly affect people, mostly schoolchildren, contributing significantly to their morbidities and mortalities [12–15]. …”