Schistosomiasis: Clinical management of liver disease

Abstract

Infection with hepatitis C virus (HCV) has become the most important public health problem in Egypt. In Egypt, viral hepatitis along with infection with Schistosoma mansoni is the major cause of chronic liver disease and liver cirrhosis. Although HCV infection is highly prevalent in Egypt, very little information is available on the distribution of the different genotypes of HCV. Our aims in this study were first to determine the prevalence of viral and parasite infections in patients with chronic liver disease and then to assess the distribution of HCV genotypes in these patients. In the present study, 151 individuals (50 with chronic liver disease, 51 with chronic diseases of organs other than the liver, and 50 apparently healthy persons) were investigated. The last 2 groups served as control groups. These individuals were subjected to routine liver function tests and detection of serum antibodies to bilharziasis, hepatitis B surface antigen (HBsAg), and HCV. Furthermore, the presence of hepatitis G virus (HGV) and HCV in the serum samples were tested for by a reverse transcription polymerase chain reaction (RT-PCR). Prevalence of different genotypes of HCV in patients positive for HCV were determined by RT-PCR using type-specific primers. Results of the study revealed that 84, 74, 12, and 20% of patients with chronic liver disease were positive for Schistosoma mansoni, HCV, HBsAg, and HGV, respectively, as compared to 51, 43.1, 2, and 4% of patients with other chronic diseases and 22, 6, 0, and 0% of apparently healthy individuals. One hundred percent of patients with chronic liver disease, 72.5% of those with other diseases, and 26% of normal controls were shown to have at least one of the studied infectious agents. Two or more of the agents were highly coincident in patients with chronic liver disease. In Egypt, HCV genotype 4a is highly prevalent, where it contributed 85% of the tested samples in comparison to 10, 2.5, and 2.5% for subtypes 1b, 2a, and 3a, respectively. In conclusion, these results suggest that in Egypt, HCV along with schistosomal parasite infection is the major risk factor for chronic liver disease. In most Egyptian patients, HCV genotype 4 is highly prevalent. Hepatitis C virus (HCV) has been identified as the major causative agent of posttransfusion and sporadic community-acquired non-A, non-B hepatitis (NANBH). 1,2 Hepatitis C virus is a single-stranded RNA virus closely related to pes-tiviruses and flaviviruses. The viral RNA has 2 short non-translational regions at the 5 and 3 ends enclosing a single large open reading frame. Individual proteins, the core (C), envelope (E1 and E2), and nonstructural proteins (NS1-NS5) 3,4 are cleaved from the polyprotein by host and viral protease. Hepatitis C virus is highly prevalent in Egypt, where its antibodies were detected in 10-30% of the Egyp-tian population. 5-8 Recently, HCV infection was concluded to be the main cause of chronic liver disease in Egypt, where this infection is largely associated with schistosomiasis (Gandin C and others, ...

The Advances in Molecular and New Point-of-Care (POC) Diagnosis of Schistosomiasis Pre- and Post-praziquantel Use: In the Pursuit of More Reliable Approaches for Low Endemic and Non-endemic Areas

“…Evaluation of drug response by parasitological methods at the community level in LEAs is unreliable for a long time (9, 13, 28–30, 43). More than a decade has passed since studies pointed out the progressive loss of sensitivity in parasitological methods with decreasing prevalence and an associated difficult in measuring treatment efficacy (44).…”

“…However, the limitations of conventional methods are not restricted to transmission areas. At institutional settings in non-endemic areas, both diagnosis and clinical management of individuals with a history of exposure to contaminated water could be a problem (43). For example, the diagnosis of acute schistosomiasis during the prepatent period, with low parasite burden or an absence of egg excretion during chronic infection in travelers, immigrants and refugees often leads to misdiagnoses (23).…”

“…Also, during chronic infections, low parasite burden can remain unnoticed in asymptomatic individuals. However, in individuals with advanced disease and/or atypical presentations, parasitological tests and even tissue sample analysis can miss active infections (43). As a result, schistosomiasis diagnosis by egg detection in particular groups—like travelers, immigrants and refugees—is underdiagnosed and clinical management becomes restricted.…”

Liver ultrasound elastography for the evaluation of periportal fibrosis in schistosomiasis mansoni: A cross-sectional study

“…Furthermore, liver biopsy is invasive, usually unsuitable for long-term follow-up and not applicable in the field, indicating that there is no gold standard for schistosomal portal fibrosis available [7]. Therefore, imaging techniques, such as ultrasound (US) scan, have been proven valuable for liver morbidity assessment and its complications in endemic areas [1,8,9]. Hence, US is considered a complementary tool often used to assist the diagnosis of the S. mansoni infection, mainly on the study of the liver damage caused by the chronic infection [10].…”

Diagnosis of coinfection by schistosomiasis and viral hepatitis B or C using 1H NMR-based metabonomics

“…Moreover, the presence of periportal fibrosis in mainly established by imaging methods such as ultrasonography (US), CT scan and MR scan [ 2 ]. US is considered as the primary modality of choice and plays an integral role in the diagnosis of liver involvement in schistosomiasis, since it can show fibrosis around the periportal spaces, splenomegaly, enhanced portal vein dimensions, and the presence of collateral vessels [ 5 , 9 ]. However, US is a subjective procedure, examiner-dependent and the liver parenchymal heterogeneity caused by viral infection might hamper visualization of periportal fibrosis in some patients [ 10 ].…”