ISSN (Print) 0023-4001 ISSN (Online) 1738-0006 Korean J Parasitol Vol. 53, No. 5: 545-551, October 2015 ▣ ORIGINAL ARTICLE http://dx.doi.org/10.3347/kjp.2015.53.5.545 Schistosoma mansoni-Related Hepatosplenic Morbidity in Adult Population on Kome Island, Sengerema District, Tanzania 1 2 1 3, 4 5 Godfrey M. Kaatano , Duk-Young Min , Julius E. Siza , Tai-Soon Yong *, Jong-Yil Chai , Yunsuk Ko , Su-Young Chang5, John M. Changalucha1 , Keeseon S. Eom6, Han-Jong Rim7 1National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania; 2Department of Immunology and Microbiology, Eulji University School of Medicine, Daejeon 34824, Korea; 3Department of Environmental Medical Biology, Institute of Tropical Medicine and Arthropods of Medical Importance Resource Bank, Yonsei University College of Medicine, Seoul 03722, Korea; 4Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, Seoul 03080, Korea; 5Good Neighbors International, Tanzania Western Chapter, P.O. Box 367, Mwanza, Tanzania; 6Department of Parasitology, Medical Research Institute and Parasite Resource Bank, Chungbuk National University School of Medicine, Cheongju 28644, Korea; 7Department of Parasitology, College of Medicine, Korea University, Seoul 02841, Korea Abstract: Schistosomiasis is one of the important neglected tropical diseases (NTDs) in Tanzania, particularly in Lake Vic- toria zone. This baseline survey was a part of the main study of integrated control of schistosomiasis and soil-transmitted helminths (STHs) aimed at describing morbidity patterns due to intestinal schistosomiasis among adults living on Kome Island, Sengerema District, Tanzania. Total 388 adults from Kome Islands (about 50 people from each village) aged be- tween 12 and 85 years, were examined by abdominal ultrasound according to the Niamey protocol. Liver image patterns (LIPs) A and B were considered normal, and C-F as distinct periportal fibrosis (PPF). The overall prevalence of PPF was 42.2%; much higher in males than in females (47.0% in male vs 34.4% in females, P= 0.007). Abnormal increase of seg- mental branch wall thickness (SBWT) and dilated portal vein diameter (PVD) were also more common in males than in fe- males. Hepatosplenomegaly was frequently encountered; 68.1% had left liver lobe hepatomegaly and 55.2% had sple- nomegaly. Schistosoma mansoni-related morbidity is quite high among adults in this community justifying the implemen- tation of integrated control strategies through mass drug administration, improved water supply (pumped wells), and health education that had already started in the study area. Key words: Schistosoma mansoni, hepatosplenomegaly, adult, Kome Island (Tanzania) INTRODUCTION This corresponds with the annual incidence of 180,000 with hematemesis, of whom 83.3% die annually and also with liver Approximately 779 million people are at great risk (85% in failure being responsible for extra-substantial proportion of Africa) in 78 countries of which 42 are in Africa, and 207 mil- death. lion (97% in sub-Saharan Africa) are estimated to be affected Morbidity in intestinal schistosomiasis related to S. mansoni by schistosomiasis [1]. Out of estimated 201.5 million people involves the intestinal tract, manifesting with diarrhea, ab- infected in sub-Saharan Africa (both Schistosoma mansoni and dominal pain, and blood in the stools. Also infection with S. Schistosoma haematobium) [1], more than a half experience mansoni may present as hepatosplenic schistosomiasis, charac- substantial morbidity [2]. It was estimated that about 54 mil- terized by enlargement of the liver and spleen and accompa- lions are infected with S. mansoni in sub-Saharan Africa, and nied by increased firmness of the organs [3]. Many of the eggs about 0.93 millions are with hematemesis, likely having severe (about a half) excreted by S. mansoni enter the systemic circu- hepatosplenic morbidity due to intestinal schistosomiasis [2]. lation via the portal vein and lodge in the liver [4], where they give rise to vascular and inflammatory granulomatous changes Received 23 July 2015, revised 30 September 2015, accepted 30 September 2015. that can lead to periportal fibrosis, portal hypertension with • Corresponding author ([email protected]) * development of esophageal varices, and the risk of life-threat- © 2015, Korean Society for Parasitology and Tropical Medicine ening hematemesis. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) Tanzania is among the 7 countries (Burkina Faso, Mali, Sier- which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ra Leon, Ghana, Mozambique, Tanzania, and Madagascar) 545 546 Korean J Parasitol Vol. 53, No. 5: 545-551, October 2015 most severely affected with schistosomiasis, classified as high The sources of water for drinking, washing, and other chores prevalence setting [5]. Intestinal schistosomiasis, due to S. are Lake Victoria, natural wells, and streams. The lake harbours mansoni, is a serious public health problem which is endemic the snail intermediate hosts for schistosomes mainly Biomphal- in many parts of Tanzania [6]. About 19% of the population aria choanomphala and Biomphalaria sudanica [6,12]. Occupa- in Tanzania is constantly exposed to S. mansoni infection espe- tionally most of the people are engaged in peasant farming cially in rural and peri-urban areas [7]. In Tanzania, extensive and fishing activities. They grow cassava, maize, and sweet po- transmission of S. mansoni occurs along the shores of the Great tatoes as food crops and cotton as a cash crop. Livestock in- Lakes [6] and areas of Lake Victoria basin including the lake clude cattle, goats, chickens, ducks, and a few pigs. All the oc- shores and its associated islands are the most affected areas in cupational as well as recreational activities have obvious bear- Tanzania. For instance among adults from randomly selected ing to acquisition and transmission of intestinal schistosomia- villages in Ukerewe islands, Kardoff et al. [8] and Malengan- sis, soil-transmitted helminths (STHs), and other parasitic dis- isho et al. [9] found a prevalence of 86% in Galu and Muriti eases like malaria and amebiasis in the study area. villages and 78% in Musozi village, respectively. Of those ex- amined adults, about 41.5% in Musozi village and 30.0% in Study design and sampling procedure Miriti and Galu villages had periportal fibrosis [8,9]. There is A cross sectional study was conducted on Kome Island in also evidence that the level of S. mansoni transmission is in- February 2009 to obtain baseline data on S. mansoni infection creasing also in the northeastern and western parts of Lake status and S. mansoni-related hepatosplenic morbidity using Victoria shore that previously was regarded as low level or free ultrasonography before implementation of intervention. Be- of transmission areas [10]. fore the survey, meetings were held in each village and the Although it is quite clear that, in S. mansoni endemic areas, purpose of the study was explained. About 50 adult partici- children and young adolescents exhibit the highest prevalence pants in each 8 villages (all villages in Kome Island) were ran- and intensity of infection [11]; however, severe late-stage con- domly selected and recruited to participate in this study. A sub- sequences are likely during the adulthood, despite generally sample of older (12 years and above) schoolchildren (13 in lower intensities of infection. In order to determine the S. Lugata Secondary School and 20 in Kabaganga Primary mansoni-related hepatosplenic morbidity, the present study School) were also recruited. targeted on the adult community for collecting morbidity baseline data as mass drug administration (MDA) and other Data collection, materials and methods interventions in this control programme targeting all commu- Participants were given a container to collect stool speci- nity members of 4 year and above. mens. The cllected stools were processed by the Kato-Katz technique using a 42.7 mg template, and microscopic exami- MATERIALS AND METHODS nation of the prepared Kato’s slides for S. mansoni eggs was carried out in the field. The mean intensity of S. mansoni eggs Study area and population was determined by taking the average number of eggs in each Kome Island is a 5th largest island (after Ukerewe, Rubon- slide and then multiplying by 24 to obtain the number of eggs do, Ukara, and Mwaisome) out of 48% portion of Lake Victo- per gram (epg) of feces, which is referred as the intensity of in- ria surface controlled by Tanzania. The island is in Sengerema fection. District and is situated at longitudinal 32024” and 32024 east Ultrasound examination was performed using a portable ul- and latitude 2014’ and 2025. According to the 2002 National trasound, according to standard guidelines proposed by Nia- census, Kome Island had a population of 38,062 with an aver- mey working group [13]. A portable ultrasound scanner age growth rate of 2.9%. Administratively, it has 2 wards, 9 vil- equipped with a 3.5 MHz curved array transducer was used. lages and 53 sub-villages. It is served by 1 health centre and 2 The size of the liver (left and right lobes) and spleen was mea- dispensaries. It has 10 primary schools and 2 secondary sured and their height adjusted according to the reference schools in each ward, with almost each village