REVERSIBILITY OF SCHISTOSOMA MANSONI-ASSOCIATED MORBIDITY AFTER YEARLY MASS PRAZIQUANTEL THERAPY - ULTRASONOGRAPHIC ASSESSMENT

A parasitological, clinical and ultrasonographic longitudinal study wa s undertaken in 1993 in a focus hyperendemic for Schistosoma mansoni i nfection in the central highlands of Madagascar. All the inhabitants w ere systematically treated with praziquantel. A complete examination a nd treatment were repeated each year. Among the 289 villagers who unde rwent the complete 3 years' follow up, 65.9% excreted eggs at the init ial survey and the mean egg count of infected individuals was 202 eggs /g. In 1996, the prevalence of infection was 19.3% with a mean egg cou nt of 27 eggs/g and, among inhabitants aged >44 years, only one was fo und to be infected. The proportion of individuals complaining of blood y stool decreased from 24.9% in 1993 to 84% in 1996. Compared to the i nitial clinical examination, the age-adjusted prevalence of splenomega ly was significantly lower in 1996, but remained high: 62% in the 10-1 4 years age group and 59% in individuals aged >24 years. Ultrasonograp hic examination after 3 years of praziquantel therapy showed a marked decrease of the overall prevalence of schistosomal hepatic fibrosis, f rom 28% in 1993 to 10.3% in 1996. This improvement had already been ac hieved during the second year of follow-up for most subjects. Usually, the reversal of morbidity affected individuals classified as stage I at the beginning of the study. Stage 3 was not observed in the last 2 surveys. One patient's ascites disappeared during the follow-up, assoc iated with a significant reversal of periportal fibrosis. Our results indicate that repeated praziquantel therapy can lead to improvement of liver morbidity and the prevention of the development of schistosomal hepatic fibrosis, even in an old-established hyperendemic focus.