Edford Sinkala1,2, Melissa C Kapulu2,3, Ellen Besa2, Kanekwa Zyambo2, Ng'andu J Chisoso4, Graham R Foster5, Paul Kelly1,2,5. 1. Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia. 2. Tropical Gastroenterology & Nutrition Group, Department of Medicine, University of Zambia, Lusaka, Zambia. 3. Biological Sciences Department, School of Natural Sciences, University of Zambia, Lusaka, Zambia. 4. Paediatric Centre of Excellence Laboratory, University Teaching Hospital, Lusaka, Zambia. 5. Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, UK.
Abstract
BACKGROUND & AIMS: Cirrhosis is the main cause of portal hypertension worldwide but schistosomiasis dominates in much of the tropics. The seroprevalence of Schistosoma mansoni is up to 77% in endemic parts of Zambia. Morbidity is attributed to portal hypertension causing variceal bleeding which can be fatal. Bacterial translocation is associated with portal hypertension in cirrhosis but this is almost unexplored in hepatosplenic schistosomiasis. Liver biopsy is usually used to assess fibrosis although it is invasive and prone to sampling error. We aimed to investigate translocation, fibrosis and inflammatory makers in a case-control study of schistosomiasis at the University Teaching Hospital, Lusaka, Zambia. METHODS: Patients had oesophageal varices, but were negative for human immunodeficiency virus, hepatitis B and C viruses. Plasma lipopolysaccharide binding protein was used as a marker of translocation while hyaluronan and laminin measured liver fibrosis. Inflammatory markers were measured in blood. Controls were patients with non-specific abdominal pain who had normal endoscopy. RESULTS: Median (interquartile range) lipopolysaccharide binding protein was elevated in patients [44.3 ng/ml (35.7, 57.1)] compared to controls [30.7 ng/ml (30.4, 35.5), P < 0.0001]. Hyaluronan was higher in patients [111.6 ng/ml (39.1, 240.3)] compared to controls [21.0 ng/ml (12.4, 37.6), P < 0.0001] and so was laminin [2.2 μg/ml (1.0, 3.7)] compared to controls [0.9 μg/ml (0.7, 1.2), P = 0.0015]. Inflammatory markers, except C-reactive protein, were elevated in patients. CONCLUSIONS: These data suggest that the bacterial translocation contributes to systemic inflammation in hepatosplenic schistosomiasis. Elevated fibrotic markers suggest they may be useful in diagnosing and monitoring periportal fibrosis.
BACKGROUND & AIMS:Cirrhosis is the main cause of portal hypertension worldwide but schistosomiasis dominates in much of the tropics. The seroprevalence of Schistosoma mansoni is up to 77% in endemic parts of Zambia. Morbidity is attributed to portal hypertension causing variceal bleeding which can be fatal. Bacterial translocation is associated with portal hypertension in cirrhosis but this is almost unexplored in hepatosplenic schistosomiasis. Liver biopsy is usually used to assess fibrosis although it is invasive and prone to sampling error. We aimed to investigate translocation, fibrosis and inflammatory makers in a case-control study of schistosomiasis at the University Teaching Hospital, Lusaka, Zambia. METHODS:Patients had oesophageal varices, but were negative for human immunodeficiency virus, hepatitis B and C viruses. Plasma lipopolysaccharide binding protein was used as a marker of translocation while hyaluronan and laminin measured liver fibrosis. Inflammatory markers were measured in blood. Controls were patients with non-specific abdominal pain who had normal endoscopy. RESULTS: Median (interquartile range) lipopolysaccharide binding protein was elevated in patients [44.3 ng/ml (35.7, 57.1)] compared to controls [30.7 ng/ml (30.4, 35.5), P < 0.0001]. Hyaluronan was higher in patients [111.6 ng/ml (39.1, 240.3)] compared to controls [21.0 ng/ml (12.4, 37.6), P < 0.0001] and so was laminin [2.2 μg/ml (1.0, 3.7)] compared to controls [0.9 μg/ml (0.7, 1.2), P = 0.0015]. Inflammatory markers, except C-reactive protein, were elevated in patients. CONCLUSIONS: These data suggest that the bacterial translocation contributes to systemic inflammation in hepatosplenic schistosomiasis. Elevated fibrotic markers suggest they may be useful in diagnosing and monitoring periportal fibrosis.
Authors: Michael J Vinikoor; Lloyd Mulenga; Alice Siyunda; Kalo Musukuma; Roma Chilengi; Carolyn Bolton Moore; Benjamin H Chi; Mary-Ann Davies; Matthias Egger; Gilles Wandeler Journal: Trop Med Int Health Date: 2016-08-30 Impact factor: 2.622
Authors: Patrick Kaonga; Evans Kaimoyo; Ellen Besa; Kanekwa Zyambo; Edford Sinkala; Paul Kelly Journal: Am J Trop Med Hyg Date: 2017-11 Impact factor: 2.345
Authors: Edford Sinkala; Kanekwa Zyambo; Ellen Besa; Patrick Kaonga; Bright Nsokolo; Violet Kayamba; Michael Vinikoor; Rabison Zulu; Martin Bwalya; Graham R Foster; Paul Kelly Journal: Am J Trop Med Hyg Date: 2018-02-08 Impact factor: 2.345
Authors: Briana D Furch; Simutanyi Mwakamui; Sandie Sianongo; Kanekwa Zyambo; Douglas C Heimburger; John R Koethe; Paul Kelly Journal: Trans R Soc Trop Med Hyg Date: 2022-02-01 Impact factor: 2.455
Authors: Edford Sinkala; Michael Vinikoor; Alice Miyanda Siyunda; Kanekwa Zyambo; Ellen Besa; Bright Nsokolo; Gilles Wandeler; Graham R Foster; Paul Kelly Journal: Heliyon Date: 2020-07-28
Authors: Edford Sinkala; Michael Vinikoor; Kanekwa Zyambo; Ellen Besa; Bright Nsokolo; Paul Kelly Journal: Am J Trop Med Hyg Date: 2020-04 Impact factor: 2.345