University of Manchester Medical School, Manchester, M13 9PL, UK.
Red House, Guilsfield, Powys, Wales, SY21 9NH.
Trans R Soc Trop Med Hyg. 2020 Apr 8;114(4):315-322. doi: 10.1093/trstmh/traa009.
A cross-sectional survey was performed to estimate the prevalence of periportal fibrosis in children based on ultrasound examination in the Marolambo district of the Atsinanana region of Madagascar. This is a remote area known to have a high prevalence of intestinal schistosomiasis.
School-aged children (5-14 y) were selected from six villages for parasitological and sonographic examination. Circulating cathodic antigen (CCA) tests and Kato Katz (KK) stool microscopy were performed. Video-clips of liver views were recorded with a SonoSite iViz and interpreted in the UK by comparison with standardised images (WHO protocol).
The prevalence of schistosomiasis according to CCA testing was 97.8% (269/275) and 73.8% (203/275) by KK. Sonographic evidence of periportal fibrosis was observed in 11.3% (31/275). The youngest children with fibrosis were aged 6 y. Fibrosis was more common in older children (p=0.03) but was not associated with either infection intensity category (p=0.07) or gender (p=0.67).
Findings of periportal fibrosis among children in these hard-to-reach villages suggests chronic Schistosoma mansoni infection from a very young age. This may reflect other similarly remote schistosomiasis-endemic areas and reinforces the need to investigate morbidity in neglected communities to understand the true extent of disease burden in endemic countries.
本横断面研究旨在通过超声检查估计马达加斯加阿齐那那那地区马罗拉博洛区儿童门静脉周围纤维化的患病率。该地区偏远，已知肠道血吸虫病流行率较高。
从六个村庄中选择学龄儿童（5-14 岁）进行寄生虫学和超声检查。进行循环阴电荷抗原（CCA）检测和加藤氏粪便显微镜检查。使用 SonoSite iViz 录制肝脏视图的视频片段，并在英国通过与标准化图像（世界卫生组织方案）进行比较进行解释。
根据 CCA 检测，血吸虫病的患病率为 97.8%（269/275），根据 KK 检测为 73.8%（203/275）。超声检查显示门静脉周围纤维化的证据为 11.3%（31/275）。纤维化的最小年龄为 6 岁。年龄较大的儿童中纤维化更为常见（p=0.03），但与感染强度类别（p=0.07）或性别（p=0.67）无关。
这些难以到达的村庄的儿童中存在门静脉周围纤维化的发现表明，儿童很早就受到曼氏血吸虫的慢性感染。这可能反映了其他同样偏远的血吸虫病流行地区，强调需要调查被忽视社区的发病率，以了解流行国家疾病负担的真实程度。
