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Am. J. Trop. Med. Hyg., 82(1), 2010, pp. 103-111
doi:10.4269/ajtmh.2010.09-0061;
Copyright © 2010 by The American Society of Tropical Medicine and Hygiene

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Right arrow Schistosomiasis

Use of Ultrasonography to Evaluate Schistosoma japonicum-Related Morbidity in Children, Sichuan Province, China, 2000–2007

Michelle S. Hsiang*, Elizabeth J. Carlton, Yi Zhang, Bo Zhong, Qiu Dongchuan, Pierre-Alain Cohen, Christopher C. Stewart, AND Robert C. Spear
Global Health Sciences, University of California, San Francisco, California; School of Public Health, University of California, Berkeley, California; Institute of Parasitic Disease, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, People's Republic of China; Department of Radiology, University of California, San Francisco, California; Department of Pediatrics, University of California, San Francisco, California

Liver ultrasonography is a convenient way to evaluate Schistosoma japonicum-related morbidity; however, no consensus standards exist, and data on use in Chinese children are scant. We describe 7 years of ultrasound findings in a prospective cohort of 151 children from an endemic area in Sichuan Province, China and evaluate technical aspects of the ultrasound methodology. Although prevalence of infection decreased over time, prevalence of hepatomegaly increased, which was likely caused by re-infections. The prevalence of late findings such as parenchymal fibrosis and splenomegaly were rare and did not increase over time; however, when present, they were associated with stunting. The use of adult thresholds versus height-adjusted standards underestimated pathology in children. Reliability of all measures except parenchymal grade was poor to fair. Our findings highlight the importance of early intervention and screening. We also suggest methodological refinements to improve reliability of ultrasonography for large-scale assessment of S. japonicum-related subclinical morbidity in children.

Received January 30, 2009. Accepted for publication September 28, 2009.

The authors thank the study participants and field staff in Xichang County for their participation and assistance on the project, Shifen Zhou for her assistance in performing ultrasounds for the inter-observer variance study, and Edmund Seto, John Swartzberg, and Sam C. Wang for their critical review of this manuscript.

Financial Support: This study was funded in part by a grant from the National Institutes of Health (R01 AI-50612-5) and support from Sichuan Centers for Disease Control and Prevention.

Authors' addresses: Michelle S. Hsiang, Global Health Sciences, University of California, San Francisco, CA, E-mail: hsiangm{at}globalhealth.ucsf.edu. Elizabeth J. Carlton, School of Public Health, University of California, Berkeley, CA, E-mail: ejcarlton{at}berkeley.edu. Yi Zhang, Institute of Parasitic Disease, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, People's Republic of China, E-mail: zhangxxcdept{at}163.com. Bo Zhong, Institute of Parasitic Disease, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, People's Republic of China, E-mail: zhongbo1968{at}163.com. Qiu Dongchuan, Institute of Parasitic Disease, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, People's Republic of China, E-mail: qiudongchuan{at}163.com. Pierre-Alain Cohen, Department of Radiology, University of California, San Francisco General Hospital, San Francisco, CA, E-mail: PCohen{at}sfghrad.ucsf.edu. Christopher C. Stewart, Department of Pediatrics, University of California, San Francisco General Hospital, San Francisco, CA, E-mail: CStewart{at}sfghpeds.ucsf.edu. Robert C. Spear, School of Public Health, University of California, Berkeley, CA, E-mail: spear{at}berkeley.edu.

Reprint requests: Michelle S. Hsiang, Global Health Sciences, University of California, 50 Beale Street, 12th Floor, San Francisco, CA 94105, Tel: 415-597-8180, Fax: 415-597-8299, E-mail: hsiangm{at}globalhealth.ucsf.edu.

*Address correspondence to Michelle S. Hsiang, Global Health Sciences, University of California, 50 Beale Street, 12th Floor, San Francisco, CA 94105. E-mail: hsiangm{at}globalhealth.ucsf.edu






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Copyright © 2010 by the American Society of Tropical Medicine and Hygiene.