Hepatosplenic schistosomiasis in Zambian adults is characterized by increased liver stiffness: A nested case-control study
Edford Sinkala,
Michael Vinikoor,
Alice Miyanda Siyunda,
Kanekwa Zyambo,
Ellen Besa,
Bright Nsokolo,
Gilles Wandeler,
Graham R. Foster,
Paul Kelly
Affiliations
Edford Sinkala
Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia; Tropical Gastroenterology & Nutritional Group, Department of Internal Medicine, University of Zambia, Lusaka, Zambia; Corresponding author.
Michael Vinikoor
Department of Medicine, University of Alabama at Birmingham, Birmingham, USA; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
Alice Miyanda Siyunda
Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
Kanekwa Zyambo
Tropical Gastroenterology & Nutritional Group, Department of Internal Medicine, University of Zambia, Lusaka, Zambia
Ellen Besa
Tropical Gastroenterology & Nutritional Group, Department of Internal Medicine, University of Zambia, Lusaka, Zambia
Bright Nsokolo
Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia; Tropical Gastroenterology & Nutritional Group, Department of Internal Medicine, University of Zambia, Lusaka, Zambia
Gilles Wandeler
Institute of Social and Preventive Medicine, University of Bern, Switzerland; Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
Graham R. Foster
Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, UK
Paul Kelly
Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia; Tropical Gastroenterology & Nutritional Group, Department of Internal Medicine, University of Zambia, Lusaka, Zambia; Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, UK
Cirrhosis commonly complicates portal hypertension worldwide but in Zambia hepatosplenic schistosomiasis (HSS) dominates as the cause of portal hypertension. We need easier and non-invasive ways to assess HSS. Transient elastography (TE), a measure of liver stiffness can diagnose liver cirrhosis. TE remains unexplored in HSS patients, who generally have normal liver parenchyma. We aimed to explore liver stiffness in HSS. This nested case control study was conducted at the University Teaching Hospital, Lusaka, Zambia between January 2015 and January 2016. We enrolled 48 adults with HSS and 22 healthy controls. We assessed liver stiffness using TE while plasma hyaluronan was used to assess liver fibrosis. Plasma tumor necrosis factor receptor 1 (TNFR1) and soluble cluster of differentiation 14 (sCD14) were used to assess inflammation. The median (interquartile range) liver stiffness was higher in patients, 9.5 kPa (7.8, 12.8) than in controls, 4.7 kPa (4.0, 5.4), P < 0.0001. We noted linear correlations of hyaluronan and TNFR1 with the liver stiffness, P = 0.0307 and P = 0.0003 respectively.HSS patients seem to have higher liver stiffness than healthy controls. TE may be useful in identifying fibrosis in HSS. The positive correlations of inflammatory markers with TE suggest that HSS has both periportal and parenchymal pathophysiology.
