Human schistosomiasis and anemia: the relationship and potential mechanisms.

The public health significance of hookworm disease is briefly reviewed. The latest evidence confirms that blood loss caused by the worms' feeding activity in the gut is a contributing factor in the development of poor iron status leading to iron-deficiency anaemia. The World Health Organization has identified adolescent girls and women of child-bearing age as high-risk groups regarding the impact of hookworm disease. The merits of treating pregnant women with anthelminthic drugs after the first trimester are discussed.

The public health importance of hookworm disease.

In the developing world, young women, pregnant women, and their infants and children frequently experience a cycle where undernutrition (macronutrient and micronutrient) and repeated infection, including parasitic infections, lead to adverse consequences that can continue from one generation to the next. Among parasitic infections, malaria and intestinal helminths coexist widely with micronutrient deficiencies and contribute importantly to anemia and this cycle of retarded growth and development. In somewhat more limited or focal geographic settings, other parasitic diseases (e.g., schistosomiasis, filariasis) contribute similarly to this cycle. It is undoubtedly much better to enter a pregnancy free of infection and nutritionally replete than the various alternatives. Existing intervention strategies for micronutrient support and for the control of common parasitic infections before or during pregnancy, particularly malaria and intestinal helminths, should be followed. However, further research to identify barriers and priority approaches to achieving this goal remain very important in resource-poor settings where targeted public health efforts are required.

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Pregnancy, nutrition and parasitic diseases.

A Jonam fishing community at Panyagoro, West Nile District, Uganda, was studied and the 235 people examined showed a very high infection rate with S. mansoni . The mean egg output of males over 5 years old was 1112 eggs/g. and of females was about half this level. High egg output levels were maintained into old age. Diarrhoea with blood and abdominal pain were extremely frequent. Hepatosplenomegaly, eosinophilia and anaemia were common and particularly occurred together in people who looked ill and had marked abdominal distension and ascites. Malaria was endemic but other possible causes of these findings were largely absent. Much disease is probably due to S. mansoni which is here causing disease of public health importance in sub-Saharan Africa.

The epidemiology and consequences of Schistosoma mansoni infection in West Nile, Uganda: I. Field studies of a community at Panyagoro

This article reviews studies that examine the negative effects of urinary and intestinal schistosomiasis on the following nutritional parameters in humans: urinary and faecal blood and iron loss, anaemia and haemoglobin levels, proteinuria, child growth and adult protein-energy status, physical fitness, physical activity, appetite and symptomatology. The conclusions reached are (1) that community-level treatment and control of schistosomiasis in areas where the infection, protein-energy malnutrition, and anaemia are common are to be encouraged and are likely to improve child growth, appetite, physical fitness and activity levels and to decrease anaemia and symptoms of the infection, and (2) that further studies are needed to determine how much and by what means decreases in and treatment of schistosomal infection may improve nutritional status, cognitive and school performance and attendance, and work capacity and productivity in communities with different amounts of parasitism and malnutrition.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0031182000075545

The impact of schistosomiasis on human nutrition.

The mean daily blood and iron losses in 7 patients with proved bilharzial colonic and rectal polypi were measured by the 51Cr-tagged red cell technique. The daily blood loss ranged from 7·5 to 25·9 ml. (mean 12·5 ml.) and the daily iron loss ranged from 0·6 to 6·7 mg. (mean 3·3 mg.). Surgical removal of a large polyp in one patient resulted in cessation of blood loss. In spite of continued blood loss, 3 patients with severe iron deficiency anaemia responded rapidly, clinically and haematogically, to oral iron treatment.

Blood loss in chronic Schistosoma mansoni infection in Egyptian farmers.

https://www.bmj.com/content/bmj/2/5506/153.full.pdf

Z. Farid

Papers

Blood loss in chronic Schistosoma mansoni infection in Egyptian farmers.

Biharzial splenomegaly and refractory anaemia.