Wilson Shona, Vennervald Birgitte J, Kadzo Hilda, Ireri Edmund, Amaganga Clifford, Booth Mark, Kariuki H Curtis, Mwatha Joseph K, Kimani Gachuhi, Ouma John H, Muchiri Eric, Dunne David W
Department of Pathology, University of Cambridge, Cambridge, UK.
Trop Med Int Health. 2007 Dec;12(12):1442-9. doi: 10.1111/j.1365-3156.2007.01950.x.
Chronic exposure to malaria exacerbates Schistosoma mansoni-associated hepatosplenomegaly in school-aged children. However, residual hepatosplenomegaly after treatment of S. mansoni with concurrent mollusciciding suggests malaria could be an underlying cause of hepatosplenomegaly. We investigated the role of chronic malaria in childhood hepatosplenomegaly in the presence and absence of concurrent S. mansoni infection.
Cross-sectional study of children in an study area where transmission of S. mansoni, but not malaria, is restricted to the eastern end. Clinical and ultrasound examinations were conducted, and parasitological and serological tests used to determine S. mansoni infection intensities and comparative exposure levels to malaria.
Chronic exposure to malaria, as determined by Pfs-IgG3 levels, was associated with hepatosplenomegaly even in the absence of S. mansoni infection. Children infected with S. mansoni mostly had light to moderate infection intensities but greater enlargement of the liver and spleen than children who did not have schistosomiasis, and for the left liver lobe this was S. mansoni infection intensity dependent.
Children chronically exposed to malaria but without S. mansoni infection can have hepatosplenomegaly, which even light S. mansoni infections can exacerbate in an intensity-dependent manner. Thus, concurrent chronic exposure to S. mansoni and Plasmodium falciparum can have an additive or synergistic effect on childhood morbidity.
长期接触疟疾会加重学龄儿童曼氏血吸虫病相关的肝脾肿大。然而，在用杀螺剂同时治疗曼氏血吸虫病后仍存在残余肝脾肿大，这表明疟疾可能是肝脾肿大的潜在病因。我们研究了在合并或未合并曼氏血吸虫感染的情况下，慢性疟疾在儿童肝脾肿大中的作用。
对一个研究区域的儿童进行横断面研究，该区域曼氏血吸虫的传播仅限于东端，而疟疾不传播。进行了临床和超声检查，并采用寄生虫学和血清学检测来确定曼氏血吸虫感染强度以及对疟疾的相对暴露水平。
通过Pfs-IgG3水平确定的长期接触疟疾，即使在没有曼氏血吸虫感染的情况下也与肝脾肿大有关。感染曼氏血吸虫的儿童大多感染强度为轻度至中度，但与未感染血吸虫病的儿童相比，肝脏和脾脏肿大更明显，并且对于左肝叶，这种情况与曼氏血吸虫感染强度有关。
长期接触疟疾但未感染曼氏血吸虫的儿童可能会出现肝脾肿大，即使轻度的曼氏血吸虫感染也会以强度依赖的方式使其加重。因此，同时长期接触曼氏血吸虫和恶性疟原虫可能会对儿童发病率产生相加或协同作用。
