在乌干达农村地区反复大规模用药的背景下,门静脉周围纤维化的流行病学和当前曼氏血吸虫感染的相关性:一项基于人群的横断面研究。

IF 20.9 1区 生物学 Q1 INFECTIOUS DISEASES
Seun Anjorin, Betty Nabatte, Simon Mpooya, Benjamin Tinkitina, Christopher K Opio, Narcis B Kabatereine, Goylette F Chami
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引用次数: 0

摘要

背景:世卫组织控制和消除血吸虫病相关发病率的指导方针将当前感染作为发病率的替代指标。我们根据慢性肠血吸虫病导致的反复大量用药和肝包膜纤维化情况对这些指导方针进行了评估:我们在血吸虫病追踪队列中对从乌干达布里萨、帕克瓦赫和马尤格地区的 38 个村庄随机抽样的 1442 个家庭进行了调查。使用尼亚美方案中的超声波和图像模式 C-F,对 2834 名 5-90 岁的人进行了肝包膜纤维化诊断。通过卡托-卡茨显微镜和护理点循环阴性抗原检测诊断曼氏血吸虫的状态和强度。将血吸虫感染、合并感染和并发症作为门静脉周围纤维化的暴露因素进行了研究。以家庭为单位对SE进行了多变量逻辑回归:2022年1月6日至2月3日期间,2834名参与者中有342人(12-1%)被诊断出患有门脉周围纤维化。通过卡托-卡茨显微镜检查,2834 名参与者中有 1229 人(43-4%)受到感染。在 2834 名参与者中,有 1863 人(65-7%)在护理点循环阴性抗原检测中呈痕量阳性,高于卡托-卡茨显微镜检测的流行率;在 2834 名参与者中,有 1158 人(40-9%)在护理点循环阴性抗原检测中呈痕量阴性。个人血吸虫状态、感染强度以及感染强度低于1%和低于5%的重度感染率与肾包膜纤维化可能性或村庄感染率无关。从 5 岁到 25 岁,肝包膜纤维化可能性随年龄呈线性增长,从 26 岁到 45 岁呈非线性增长,从 46 岁到 60 岁呈减弱或保持不变,过了 60 岁则稳步下降。肝病史、艾滋病毒、超声波检测出的慢性肝炎或早期肝硬化样疾病与肝周膜纤维化可能性增加两倍以上有关:世卫组织的指南依赖于当前的血吸虫状态和强度,对于确定可能的病例或门静脉周围纤维化的社区没有参考价值。艾滋病病毒感染史和潜在的慢性肝炎或早期肝硬化样疾病是可用于肝门静脉周围纤维化监测和管理的风险因素:NDPH 泵引水基金、惠康基金会、约翰-费尔基金、罗伯逊基金会和英国研究与创新工程与物理科学研究委员会。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Epidemiology of periportal fibrosis and relevance of current Schistosoma mansoni infection within the context of repeated mass drug administration in rural Uganda: a population-based, cross-sectional study.

Background: WHO guidelines for schistosomiasis-related morbidity control and elimination rely on current infection as a proxy indicator for morbidity. We evaluated these guidelines within the context of repeated mass drug administration and periportal fibrosis attributable to chronic intestinal schistosomiasis.

Methods: We examined 1442 households randomly sampled from 38 villages in Buliisa, Pakwach, and Mayuge districts of Uganda within the SchistoTrack cohort. Periportal fibrosis was diagnosed in 2834 individuals aged 5-90 years using ultrasound and image patterns C-F from the Niamey protocol. Schistosoma mansoni status and intensity were diagnosed by Kato-Katz microscopy and point-of-care circulating cathodic antigen tests. Schistosome infection, co-infections, and comorbidities were examined as exposures for periportal fibrosis. Multivariable logistic regressions were run with SEs clustered by household.

Findings: Between Jan 6 and Feb 3, 2022, 342 (12·1%) of 2834 participants were diagnosed with periportal fibrosis. By Kato-Katz microscopy, 1229 (43·4%) of 2834 participants were infected. 1863 (65·7%) of 2834 participants had trace positive point-of-care circulating cathodic antigen tests, which was higher than prevalence by Kato-Katz microscopy, and 1158 (40·9%) of 2834 participants had trace negative point-of-care circulating cathodic antigen tests. Individual schistosome status, intensity, and prevalence of heavy intensity infections of less than 1% and less than 5% were not correlated with periportal fibrosis likelihood or village prevalence. Periportal fibrosis likelihood linearly increased with age from age 5 years to age 25 years, non-linearly increased from age 26 years to age 45 years, attenuated or remained unchanged from age 46 years to age 60 years, and steadily decreased past 60 years of age. History of liver diseases, HIV, and ultrasound-detected chronic hepatitis or early cirrhosis-like disease were associated with more than two-times increased periportal fibrosis likelihood.

Interpretation: WHO guidelines reliant on current schistosome status and intensity are uninformative for identifying probable cases or communities with periportal fibrosis. History of HIV and underlying chronic hepatitis or early cirrhosis-like disease are risk factors that could be investigated for periportal fibrosis surveillance and management.

Funding: NDPH Pump Priming Fund, Wellcome Trust, John Fell Fund, Robertson Foundation, and UK Research and Innovation Engineering and Physical Sciences Research Council.

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来源期刊
Lancet Microbe
Lancet Microbe Multiple-
CiteScore
27.20
自引率
0.80%
发文量
278
审稿时长
6 weeks
期刊介绍: The Lancet Microbe is a gold open access journal committed to publishing content relevant to clinical microbiologists worldwide, with a focus on studies that advance clinical understanding, challenge the status quo, and advocate change in health policy.
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