Barda Beatrice, Coulibaly Jean T, Hatz Christoph, Keiser Jennifer
Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.
University of Basel, CH-4003 Basel, Switzerland.
PLoS Negl Trop Dis. 2017 Feb 21;11(2):e0005400. doi: 10.1371/journal.pntd.0005400. eCollection 2017 Feb.
Schistosoma haematobium infections are responsible for significant urinary tract (UT) complications. Schistosomiasis control programs aim to reduce morbidity, yet the extent of morbidity in preschool-aged children and the impact of treatment on morbidity reduction are not well studied.
Our study was embedded in a randomized, placebo-controlled, single-blind trial in Côte d'Ivoire, which evaluated the efficacy and safety of three doses (20, 40 and 60 mg/kg) of praziquantel in school-aged (SAC) and preschool-aged (PSAC) children infected with S. haematobium. Enrolled children were invited to participate in an ultrasound examination prior and six months after treatment. At these time points 3 urine samples were collected for parasitological and clinical examinations.
162 PSAC and 141 SAC participated in the ultrasound examination at baseline, of which 128 PSAC and 122 SAC were present at follow-up. At baseline 43% (70/162) of PSAC had UT morbidity, mostly at bladder level and 7% had hydronephrosis. 67% (94/141) of SAC revealed mainly moderate UT pathology, 4% presented pseudopolyps on the bladder wall, and 6% had pyelectasis. At follow up, 45% of PSAC and 58% of SAC were S. haematobium positive, mostly harboring light infection intensities (41% and 51%, respectively). Microhematuria was present in 33% of PSAC and 42% of SAC and leukocyturia in 53% and 40% of PSAC and SAC, respectively. 50% (64/128) of PSAC and 58% (71/122) of SAC presented urinary tract morbidity, which was mainly mild. A significant correlation (p<0.05) was observed between praziquantel treatment and reversal of S. haematobium induced morbidity. Progression of UT pathology decreased with increasing praziquantel dosages. A worsening of morbidity was observed among children in the placebo group.
CONCLUSION/SIGNIFICANCE: Bladder morbidity is widespread among PSAC. Praziquantel treatment is significantly associated with the reversal of S. haematobium induced morbidity, which underscores the importance of preventive chemotherapy programs. These programs should be expanded to PSAC to prevent or decrease the prevalence of morbidity in young children. This trial is registered as an International Standard Randomized Controlled Trial, number ISRCTN15280205.
埃及血吸虫感染会引发严重的泌尿系统并发症。血吸虫病控制项目旨在降低发病率，但学龄前儿童的发病程度以及治疗对降低发病率的影响尚未得到充分研究。
我们的研究纳入了在科特迪瓦进行的一项随机、安慰剂对照、单盲试验，该试验评估了三剂（20、40和60毫克/千克）吡喹酮对感染埃及血吸虫的学龄儿童和学龄前儿童的疗效和安全性。入选儿童在治疗前和治疗后六个月被邀请参加超声检查。在这些时间点收集3份尿液样本进行寄生虫学和临床检查。
162名学龄前儿童和141名学龄儿童在基线时参加了超声检查，其中128名学龄前儿童和122名学龄儿童在随访时仍参与。基线时，43%（70/162）的学龄前儿童有泌尿系统疾病，主要在膀胱水平，7%有肾积水。67%（94/141）的学龄儿童主要表现为中度泌尿系统病变，4%在膀胱壁有假性息肉，6%有肾盂扩张。随访时，45%的学龄前儿童和58%的学龄儿童埃及血吸虫呈阳性，大多感染程度较轻（分别为41%和51%）。33%的学龄前儿童和42%的学龄儿童有镜下血尿，53%的学龄前儿童和40%的学龄儿童有白细胞尿。50%（64/128）的学龄前儿童和58%（71/122）的学龄儿童有泌尿系统疾病，主要为轻度。观察到吡喹酮治疗与埃及血吸虫所致疾病的逆转之间存在显著相关性（p<0.05）。泌尿系统病变的进展随着吡喹酮剂量的增加而减少。安慰剂组儿童的发病率有所恶化。
结论/意义：膀胱疾病在学龄前儿童中广泛存在。吡喹酮治疗与埃及血吸虫所致疾病的逆转显著相关，这凸显了预防性化疗项目的重要性。这些项目应扩展到学龄前儿童，以预防或降低幼儿的发病患病率。该试验已注册为国际标准随机对照试验，编号为ISRCTN15280205。
