Predisposition to urinary tract epithelial metaplasia in Schistosoma haematobium infection.

S L Hodder Department of Medicine, Case Western Reserve University and University Hospitals of Cleveland, Ohio 44106-4983, USA.

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A A Mahmoud Department of Medicine, Case Western Reserve University and University Hospitals of Cleveland, Ohio 44106-4983, USA.

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K Sorenson Department of Medicine, Case Western Reserve University and University Hospitals of Cleveland, Ohio 44106-4983, USA.

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D M Weinert Department of Medicine, Case Western Reserve University and University Hospitals of Cleveland, Ohio 44106-4983, USA.

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R L Stein Department of Medicine, Case Western Reserve University and University Hospitals of Cleveland, Ohio 44106-4983, USA.

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J H Ouma Department of Medicine, Case Western Reserve University and University Hospitals of Cleveland, Ohio 44106-4983, USA.

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D Koech Department of Medicine, Case Western Reserve University and University Hospitals of Cleveland, Ohio 44106-4983, USA.

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C H King Department of Medicine, Case Western Reserve University and University Hospitals of Cleveland, Ohio 44106-4983, USA.

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DOI:
https://doi.org/10.4269/ajtmh.2000.63.133
Volume/Issue:
Volume 63: Issue 3
Page(s):
133–138
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Although there is strong epidemiologic evidence linking Schistosoma haematobium infection with carcinoma of the bladder, the utility of cytologic screening for urinary tract cancer has not been critically evaluated in S. haematobium-endemic populations. The present cross-sectional study examined urine cytology findings among 1,014 residents (ages 1 to 91) of the S. haematobium-endemic Msambweni area of Coast Province, Kenya. Among 705 evaluable cytology specimens, prevalence of inflammation (39%), hyperkeratosis (30%), metaplasia (33%), and frank atypia (0.4%) was notably higher than in previously studied, non-endemic populations. Overall, S. haematobium infection was strongly associated with increased risk for cytologic abnormality (> 2.8-fold relative risk of metaplasia or hyperkeratosis; P < 0.001). Age-group analysis confirmed parallel increases in metaplasia and S. haematobium infection prevalence early in life (from age I to 15 for both boys and girls). However, above age 20, metaplasia prevalence persisted at 33-45% prevalence despite a decline in infection prevalence and intensity. Prevalence of advanced (moderate or severe) metaplasia showed two age-related peaks: the first at 10-14 years of age (at the time of peak infection), and the second among subjects > or = 60 years old. No cancers were detected in the study population either on cytology or on follow-up ultrasound examination. These data suggest an age-dependent progression of cellular abnormalities in the urinary epithelium that is associated with chronic S. haematobium infection, which becomes independent of concurrent infection intensity as subjects grow older. Implications for cancer screening are discussed.

Published Online:
Sep 2000
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
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