Diagnostic value of connective tissue metabolites in Schistosoma mansoni related liver disease

Reliable non-invasive markers of hepatosplenic involvement in schistosomias is are needed for determination of morbidity levels in endemic populations and for diagnosis and followup of affected individuals. Serum levels of con nective tissue metabolites have been investigated as fibrosis markers in va rious hepatic disorders, but their accuracy in the detection of hepatosplen ic schistosomiasis under endemic conditions has not been fully elucidated. 206 adult inhabitants of a Tanzanian village highly endemic for schistosomi asis mansoni (prevalence 88%) underwent clinical, parasitological and sonog raphic work-up; sera were tested for aminoterminal procollagen III-peptide (PIIIP), carboxyterminal procollagen IVpeptide (NC1) and laminin. Connectiv e tissue marker levels did not correlate with the presence or intensity of infection. NC1 levels were significantly correlated with periportal liver f ibrosis (P < 0.001), splenomegaly (P < 0.002), portal vein dilatation (P < 0.004) and the presence of portosystemic collaterals (P < 0.001); for PIIIP and laminin, none of the respective relationships was significant. Due to wide overlap of NC1 levels between individuals with normal sonography findi ngs and those with advanced periportal fibrosis and portal hypertension, th e sensitivity and positive predictive value of this markers to detect these individuals were low (< 40%), although specificity and overall accuracy in the given setting were good (80-90%). It is concluded that PIIIP and lamin in are not useful as diagnostic serum markers of hepatosplenic schistosomia sis at the community level; NC1 was significantly related to various indice s of hepatosplenic involvement, but its low sensitivity precludes its use a s a screening tool under endemic conditions. (C) 1999 Elsevier Science B.V. All rights reserved.