Assessment of eosinophil cationic protein levels as possible biomarker for estimating intensity of schistosomiasis before and after praziquantel treatment: a case study in Vea in the Bongo District of the Upper East Region of Ghana

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October, 2014
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Schistosomiasis is one of the most widespread of all human parasitic diseases, ranking second only to malaria in terms of its socioeconomic and public health importance in tropical and sub-tropical areas. Despite all the efforts by the World Health Organisation and for that matter Ghana Health Service to control morbidity and a possible elimination, the disease v persists in endemic areas and new transmission foci are being discovered in different parts of the country over time. This study was conducted in Vea in the Bongo District of the Upper East Region of Ghana from July 2012 to September 2012. The aim was to assess the Eosinophil cationic protein levels as possible biomarker for estimating intensity of infection before and after praziquantel treatment. Participants were examined at baseline and 8 weeks post-treatment with praziquantel. Prevalence and intensity of S. haematobium and S. mansoni for both baseline and post-treatment urine and stool samples were estimated by microscopy. The filtration method was used for urine samples and the Kato Katz concentration method for stool samples. The formol-ether concentration technique was used to ascertain the veracity of negative stool samples by the Kato Katz concentration method. The factors that contribute to the persistence of schistosomiasis were also assessed by questionnaire interviews. Three hundred and fifteen (315) participants were recruited for the study. However a total of 217 participants gave their consent for the study (Male = 106, Female = 111). Age range for participants was between the ages of 6 – 76 years. 122 (56.2%) of participants were lost to follow-up. Samples were collected from 95 participants. This was made up of 38 (40.0%0 males and 57 (60.0%) females. Microscopy estimated urinary schistosomiasis prevalence of 18.9% (41/217). For intestinal schistosomiasis microscopy estimated a prevalence of 15.7%% (34/217). 1.4 % (3/217) had mixed infection of S. haematobium and S. mansoni. Prevalence of S. haematobium and S. mansoni eight (8) weeks after treatment with praziquantel was 4.2% (4/95) and 2.1% (2/95) respectively. The highest S. haematobium prevalence of 16.4% was found amongst the 6-15 years age group. The highest S. mansoni prevalence of 13.8% occurred amongst the 6-15 years age group. More females, 10.6%, were infected with S. haematobium and 8.3% S. mansoni than males with 8.3% and 7.4% respectively. Two (2) participants were found to be infected with H. nana in the pre treatment samples. Also two individuals each were found to be infected with hookworms and H. nana respectively in the post treatment screening. Mean intensity for S. haematobium was high among the 6 – 10 year age group (191.4 eggs/10mls of urine) than the 11 – 15 years age group (63.5 eggs/10 ml of urine). For S. mansoni intensity was 103.5 epg among the 11 – 15 years age group. Serum ECP levels of infected individuals were very high compared to normal levels (82.9 ng/ ml v 15.6 ng/ ml). There was no significant difference (p= 0.39) in ECP levels between patients infected with S. mansoni and S. haematobium. There was a significant association {p= 0.01(CI: 95%, α: 0.05)} between the estimation of intensity measured by microscopy and ECP measurement. There was also a significant drop in the ECP levels (p= 0.006) in post treatment samples of schistosomiasis patients as compared to pre-treatment Levels. ECP levels however showed a weak positive correlation(r= 0.19) with increase in intensity by egg count. Knowledge of the disease among participants was quite high, 93.5 % (203/217) but water contact was still high, 99.1 %( 215/217). Most respondents could not associate some of the symptoms to the disease, for example passing of bloody stools to S. mansoni infection. In conclusion, this study suggests that serum ECP level could be a good biomarker for estimating intensity of schistosomiasis in both pre and post praziquantel treatment. However, other factors such as allergy and microbial infection could also be responsible for increased ECP levels in the blood. These conditions will affect the validity of the test results
Thesis submitted to the Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology. in partial fulfillment of the requirement for the award of Master of Philosophy Clinical Microbiology degree,