Morbidity assessment in urinary schistosomiasis infection through ultrasonography and measurement of eosinophil cationic protein (ECP) in urine

In a Schistosoma haematobium-endemic village in western Madagascar we evalu ated ultrasonography and Eosinophil Cationic Protein (ECP) in urine as mean s to detect the associated urinary tract pathology 192 individuals were mat ched according to age and sex, and grouped intro infected persons with blad der and, if present, kidney pathology (n = 96); infected persons without pa thology (n = 48) and noninfected persons without pathology (n = 48). The me dian urinary egg count was significantly higher in individuals with ultraso nographically detectable urinary tract pathology (115 eggs/10 ml urine) tha n in infected persons without (45 eggs/10 ml of urine). At 136 ng/ml, the m edian ECP level was significantly higher in the 144 infected individuals th an in the 48 noninfected persons (0.35 ng/ml). Egg excretion correlated pos itively with ECP level. The median ECP level was significantly higher in th e group with ultrasonographically detectable urinary trace pathology than i n the group without (183 ng/ml vs. 67 ng/ml). The results suggest that mino r degrees of pathology, particularly at an early stage of infection with S. haematobium, might be overlooked by ultrasonography despite the presence o f marked inflammation, as indicated by markedly increased urinary ECP level s in infected individuals without ultrasonographically detectable urinary t race pathology. ECP may therefore provide important information on the evol ution of S. haematobium-associated urinary tract morbidity.