DIAGNOSIS OF FEMALE GENITAL SCHISTOSOMIASIS BY INDIRECT DISEASE MARKERS - DETERMINATION OF EOSINOPHIL CATIONIC PROTEIN, NEOPTERIN AND IGA IN VAGINAL FLUID AND SWAB ELUATES

Based on assumptions about the pathophysiology of egg-related lesions in the lower reproductive tract, putative indirect disease markers wer e investigated in vaginal fluids from 54 Malawi adolescent girls and w omen infected with S. haematobium. These women received a careful gyne cological examination during which biopsies were taken from the cervix , and, if present, also from suspicious lesions in the vagina and the vulva. If the biopsies, either in wet crushed preparations or in histo logical sections, contained eggs the patients were considered to have female genital schistosomiasis (FGS; n=33). The remainder (n=21) were classified as having urinary schistosomiasis only. Eosinophil cationic protein (ECP), a cytotoxic granule protein of eosinophils, neopterin, a second messenger molecule generated during the activation of macrop hages, and IEA as an Indicator of local B-cell activation were quantit atively determined in vaginal fluid. To clarify the origin of ECP, thi s protein was also looked for in histological sections by an immunohis tochemical method. in order to explore whether such disease markers ca n be detected after absorption to a tampon-like material, ECP and IgA were also assessed after elution from a non-porous, polypropylene fibr e web impregnated with vaginal fluid. The concentration of ECP in vagi nal fluid and the degree of immunohistochemical staining in histologic al sections were significantly higher in patients with FGS than in wom en with urinary schistosomiasis only. The amount of ECP detected in hi stological sections correlated to the number of eggs/mm(2) of compress ed genital tissue (rho=0.36, P=0.02), and the concentration of ECP in vaginal fluid correlated to the concentration of neopterin as well as to that of IgA (rho=0.52, P=0.004 and rho=0.37, P=0.02, respectively). Median neopterin concentration in vaginal fluid was also higher in th e FGS group, but the difference was not statistically significant. ECP could also be detected in eluates from impregnated fibre webs, but th e concentration was approximately one power of la less than in the ori ginal vaginal fluid. These results demonstrate that indicators of immu nological mechanisms related to the egg-granuloma might be useful as i ndirect disease markers for women with FGS if assessed in vaginal wash ings or swab eluates.