Evolution of Schistosoma haematobium-related pathology over 24 months after treatment with praziquantel among school children in southeastern Tanzania
Evolution of Schistosoma haematobium-related pathology over 24 months after treatment with praziquantel among school children in southeastern Tanzania
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DOI：
10.4269/ajtmh.1998.59.775
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发表时间：
1998-11-01
影响因子：
3.3
通讯作者：
Tanner, M
中科院分区：
文献类型：
--
作者：
Hatz, CF;Vennervald, BJ;Tanner, M
关于治疗后血吸虫病病理动态的了解甚少。流行地区的公共卫生当局需要此类信息来确定治疗时间和再治疗方案。目前在坦桑尼亚东南部一个中高传播地区的两所学校开展了一项使用超声评估埃及血吸虫所致病理损害清除和再现率的研究。基线数据收集发现，533名儿童中有67%存在泌尿系统病理改变。膀胱病变与虫卵阳性和微量血尿显著相关。埃及血吸虫导致的主要膀胱病变的归因分数估计为75%。在一项队列研究中，对224名感染儿童进行了超声检查，然后用标准剂量的吡喹酮（40毫克/千克体重）进行治疗。在治疗后的2、4、6、12、18和24个月对他们进行了复查。治疗前，76%的儿童有泌尿系统病理损害。在治疗后的头几个月，出现病变的比例急剧下降，到6个月时降至11%。在24个月时，57%的儿童检测到病变，11%的儿童出现了新的严重病理改变。在15例病例中，整个研究过程中一直存在病理改变，34例在整个研究过程中未出现任何病理改变。这项研究首次详细报告了社区层面埃及血吸虫感染所致泌尿系统病理的演变情况。研究结果将有助于制定治疗和再治疗方案，并且更广泛地说，将为中高传播地区的控制策略设计提供依据。
Little is known about the dynamics of pathology due to schistosomiasis following treatment. Public health authorities in endemic areas require such information to decide on the timing of treatment and re-treatment schedules. A study to assess the rate of clearance and reappearance of pathologic lesions due to Schistosoma haematobium using ultrasound has now been carried out in two schools in southeastern Tanzania, an area of moderate-to-high transmission. Baseline data collection found urinary tract pathology in 67% of 533 children. Lesions of the bladder were significantly associated with egg positivity and microhematuria. The attributable fraction estimate of major bladder lesions due to S. haematobium was 75%. In a cohort study, 224 infected children were examined by ultrasound and then treated with a standard dose of 40 mg of praziquantel/kg of body weight. They were re-examined at two, four, six, 12, 18, and 24 months after treatment. Before treatment, 76% had pathologic lesions of the urinary tract. The proportion showing lesions decreased sharply during the first months after treatment to 11% at six months. At 24 months, lesions were detected in 57%, and 11% had developed new severe pathology. In Is cases, pathology was present throughout, and 34 did not show any pathology throughout the study. This study provides the first detailed report on the evolution of urinary tract pathology due to S. haematobium infections at the community level. The results will help in making decisions on treatment and re-treatment schedules and more generally will provide a basis for designing control strategies in areas of moderate-to-high transmission.