Schistosoma mansoni-Hepatitis B co-infection among adult patients with periportal fibrosis: a cross sectional study

Abstract

Objectives: Chronic Schistosoma mansoni infection is a common cause of periportal fibrosis in Sub Saharan Africa. About 20 million people are suffering complications of chronic S. mansoni infection with an annual mortality of 0.2million people. The outcome of periportal fibrosis is highly modified by hepatitis B co-infection which may cause a rapid progression to fibrosis and decompensation. In Tanzania both S. mansoni and hepatitis B are highly endemic; however, the co-infection among patients with periportal fibrosis in the hospital setting has not been described. Methods: A cross-sectional study was done among patients with S. mansoni related periportal fibrosis at Bugando hospital. A minimum sample of 193 patients was calculated and, patients’ clinical, laboratory, ultrasound and endoscopic data were analyzed using STATA 13. The prevalence of S. mansoni-hepatitis B co-infection was calculated and its correlates were determined by logistic model. Results: In total 250 patients were analyzed in this study and, 40 (16.0%) were found to have S. mansoni-Hepatitis B co-infection who were more likely to have higher AST levels, (58 vs. 38U/L; OR: 1.03; p=0.033), higher APRI levels, (1.8 vs. 1.05; OR: 2.1; P=0.03); ascites, (OR: 2.9; p=0.049) with higher mortality, (OR: 2.9; p=0.032). Conclusions: The S. mansoni-Hepatitis B co-infection is common among patients with periportal fibrosis. The correlates found in this study, suggest that co-infected patients are more likely to have a severe liver injury with increased risk of severe fibrosis, decompensation, and mortality. Regular screening for hepatitis B and vaccination of people at-risk is highly suggested in this study. J Microbiol Infect Dis 2019; 9(3):136-143.

Keywords

• Periportal fibrosis
• Active S. mansoni
• Hepatitis B co-infection
• APRI score

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