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Two-year impact of praziquantel treatment for Schistosoma japonicum infection in China: re-infection, subclinical disease and fibrosis marker measurements

Li, Y.S. ; Sleigh, A.C. ; Ross, A.G.P. ; Li, Y. ; Williams, G.M. ; Tanner, M. ; McManus, D.P.

In: Transactions of The Royal Society of Tropical Medicine and Hygiene, 2000, vol. 94, no. 2, p. 191-197

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    Titre
    • Two-year impact of praziquantel treatment for Schistosoma japonicum infection in China: re-infection, subclinical disease and fibrosis marker measurements
    Auteur
    • Li, Y.S.. Tropical Health Program, Australian Centre for International and Tropical Health and Nutrition, The Queensland Institute of Medical Research and The University of Queensland, 300 Herston Road, Herston, Brisbane, Queensland 4029, Australia
    • Sleigh, A.C.. Tropical Health Program, Australian Centre for International and Tropical Health and Nutrition, The Queensland Institute of Medical Research and The University of Queensland, 300 Herston Road, Herston, Brisbane, Queensland 4029, Australia
    • Ross, A.G.P.. Tropical Health Program, Australian Centre for International and Tropical Health and Nutrition, The Queensland Institute of Medical Research and The University of Queensland, 300 Herston Road, Herston, Brisbane, Queensland 4029, Australia
    • Li, Y.. Hunan Institute of Parasitic Diseases, Huabanqiao Road, Yueyang, Hunan 414000, The People's Republic of China
    • Williams, G.M.. Tropical Health Program, Australian Centre for International and Tropical Health and Nutrition, The Queensland Institute of Medical Research and The University of Queensland, 300 Herston Road, Herston, Brisbane, Queensland 4029, Australia
    • Tanner, M.. Swiss Tropical Institute, Socinstrasse 57, P.O. Box Ch-4002, Basel, Switzerland
    • McManus, D.P.. Tropical Health Program, Australian Centre for International and Tropical Health and Nutrition, The Queensland Institute of Medical Research and The University of Queensland, 300 Herston Road, Herston, Brisbane, Queensland 4029, Australia
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Transactions of The Royal Society of Tropical Medicine and Hygiene, 2000, vol. 94, no. 2, p. 191-197. Royal Society of Tropical Medicine and Hygiene
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:302648
    Summary
    We studied a community cohort of 193 individuals exposed to endemic Schistosoma japonicum infection in the Dongting Lake region of China to assess subclinical morbidity and the 2-year benefit of curative therapy (praziquantel) administered in 1996. Prevalence and intensity of S. japonicum infection before treatment were 28% and 192 eggs per gram faeces (epg), respectively. Two years after cure, 22% of the cohort were reinfected, but with a lighter intensity (67 epg). Sixty-four subjects (37%) showed significant improvement in ultrasound parenchyma images after treatment and 51 subjects (54%) showed significant improvement of periportal fibrosis. Left-lobe enlargement also reversed (P < 0·05) and splenomegaly reversed in 6 of 8 cases and developed in only 1. Two years post-treatment a dilated portal vein became less frequent, but the decline was not significant (16% vs 11 %, P > 0·05). The serum levels of laminin and collagen IV associated with reinfection and intensity and hyaluronic acid levels correlated with ultrasound findings (P < 0·01). Overall, treatment induced a marked decrease in subclinical hepatosplenic morbidity attributable to S. japonicum although low-intensity re-infection after treatment remained relatively frequent. Stratified analysis and logistic models evaluated potential confounding factors for assessment of treatment effects on hepatic fibrosis. S. japonicum infection and moderate-heavy alcohol intake interacted: improvement in parenchymal morbidity was impeded among drinkers (P < 0·05). Chemotherapy focused on at-risk residents controls prevalent subclinical hepatic fibrosis but re-infection indicates the need for complementary control strategies