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Case–Control Study of Posttreatment Regression of Urinary Tract Morbidity Among Adults in Schistosoma haematobium–Endemic Communities in Kwale County, Kenya

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  • Department of Radiology, Kenyatta National Hospital, Nairobi, Kenya; Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Pediatrics, University Hospitals of Cleveland, Cleveland, Ohio; Kenya Medical Research Institute, Nairobi, Kenya; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya; Department of Environmental Sciences, Emory University, Atlanta, Georgia

Previous population-based studies have examined treatment impact on Schistosoma-associated urinary tract disease among children, but much less is known about longer-term treatment benefits for affected adult populations in areas where risk of recurrent infection is high. In communities in Msambweni, along the Kenya coast, we identified, using a portable ultrasound, 77 adults (aged 17–85) with moderate-to-severe obstructive uropathy or bladder disease due to Schistosoma haematobium. Treatment response was assessed by repeat ultrasound 1–2 years after praziquantel (PZQ) therapy and compared with interval changes among age- and sex-matched infected/treated control subjects who did not have urinary tract abnormalities at the time of initial examination. Of the 77 affected adults, 62 (81%) had improvement in bladder and/or kidney scores after treatment, 14 (18%) had no change, and one (1.3%) had progression of disease. Of the 77 controls, 75 (97%) remained disease free by ultrasound, while two (3%) had apparent progression with abnormal findings on follow-up examination. We conclude that PZQ therapy for S. haematobium is effective in significantly reducing urinary tract morbidity from urogenital schistosomiasis among adult age groups, and affected adults stand to benefit from inclusion in mass treatment campaigns.

Author Notes

* Address correspondence to Charles H. King, Center for Global Health and Diseases, Biomedical Research Building, Room 422, Case Western Reserve University School of Medicine, 2109 Adelbert Road, Cleveland, OH 44106. E-mail: chk@cwru.edu

Financial support: This research was supported by grants from the National Institutes of Health under grants AI-45473 (National Institute of Allergy and Infectious Diseases) and TW/ES01543 (Fogarty International Center).

Authors' addresses: Philip Magak, City X-Ray Services, Nairobi, Kenya, E-mail: magakpw@yahoo.com. Alicia Chang-Cojulun, Unidad De Oncologia Pediatrica (UNOP), Guatemala City, Guatemala, E-mail: aliciachc18@gmail.com. Hilda Kadzo, Kenyatta National Hospital, Nairobi, Kenya, E-mail: hildakadzo@yahoo.com. Edmund Ireri, Kenya Medical Research Institute, Nairobi, Kenya, E-mail: eikareko@hotmail.com. Eric Muchiri, Meru University of Science and Technology, Meru, Kenya, E-mail: ericmmuchiri@gmail.com. Uriel Kitron, Department of Environmental Sciences, Emory University, Atlanta, GA, E-mail: ukitron@emory.edu. Charles H. King, Center for Global Health and Diseases, CWRU School of Medicine, Cleveland, OH, E-mail: chk@cwru.edu.

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