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• W2460356257 abstract "Letters to the EditorPrevalence of Hepatitis B Surface Antigenemia Among Patients with Schistosoma mansoni G. Thomas StricklandMD, PhD, DCMT G. Thomas Strickland Search for more papers by this author Published Online:1 May 1994https://doi.org/10.5144/0256-4947.1994.263SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionTo the Editor: I read the recent paper by Dr. Hussein M. Al-Freihi, “Prevalence of hepatitis B surface antigenemia among patients with Schistosoma mansoni” with interest,1 and congratulate him for using epidemiological methods, that is, the case-control study, for investigating endemic diseases.However, I believe his conclusion, “...patients with Schistosoma mansoni are exposed to a higher risk of acquiring HBV infection and ...” is reversed. It is true that farmers and males have more exposure to either infection than city dwellers and females in the Middle East; and when parenteral therapy was used to treat schistosomiasis, some patients may have been infected with HBV through contaminated needles.2 However, a recent study in Egypt, in which subjects were selected because they had acute viral hepatitis, showed that patients having concomitant Schistosoma mansoni, which was usually asymptomatic, were much more likely to become chronic HBsAg carriers than other subjects with acute viral hepatitis who did not have active S. mansoni infections.3 Among the 95 patients with acute HBV hepatitis, the HBsAg carrier rate was 25% in those with - and 9% in those without - concomitant Schistosoma mansoni, a significant (P<0.038) difference. In addition, patients with Schistosoma mansoni having acute viral hepatitis - caused by HBV, hepatitis delta virus on top of HBV infection and (probably) hepatitis C virus infection (which is prevalent in Egypt) - had greater prevalence of, and more prolonged, splenomegaly and morbidity (graded by clinical outcome and liver function tests) than others with acute viral hepatitis not having active schistosomiasis.I am unaware of any study proving patients with Schistosoma mansoni have a greater risk of HBV infection, as Dr. Al-Freihi concluded,1 although two others have shown that HBsAg carriage is prolonged in patients with both infections.4,5 This is also biologically plausible since Schistosoma mansoni infections affect the immune response in two ways that might delay clearance of viral infections. Anti-idiotype antibodies produced in patients with chronic schistosomiasis can down-regulate specific immune responses and suppress nonspecific immune responses.6 In addition, recent very interesting studies in mice and humans have shown that S. mansoni egg antigens modify subpopulations of thymus helper cells. Th2 activity and the cytokines involved with eosinophilia and IgE secretion are stimulated while Th1 activity and the cytokines, interleukin 2 and gamma interferon, as well as CD8+ cytotoxic T cells, components of the immune system that help clear viral infections, are down-regulated in BALB/c mice infected with S. mansoni.7 The immunosuppression appears specific, possibly organ (liver) associated, since schistosomiasis has not been reported to increase the prevalence of HIV infection or decrease the time from initial infection to the development of AIDS.The Annals of Saudi Medicine welcomes Letters to the Editor from its readers. They may be on any topic, though the Editor especially encourages discussion of papers published in the Annals. Letters should be no more than 100 typewritten lines in length, typed double-space, and submitted in triplicate. Letters may include one figure or brief table and up to five references. Submission of a letter constitutes permission for the Annals to use it for publication. Letters should not duplicate similar material being submitted or published elsewhere, and the Annals reserves the right to edit letters submitted. Letters referring to a recent Annals article should be received within six weeks of the article’s publication.ARTICLE REFERENCES:1. Al-Freihi HM. Prevalence of hepatitis B antigenemia among patients with Schistosoma mansoni . Ann Saudi Med. 1993; 13(2):121-5. Google Scholar2. Madwar MA, El-Tahwy M, Strickland GT. The relationship between uncomplicated schistosomiasis and hepatitis B infection . Trans R Soc Trop Med Hyg. 1989; 83:233-6. Google Scholar3. Ghaffar YA, Fattah SA, Kamel M, et al. The impact of endemic schistosomiasis on acute viral hepatitis . Am J Trop Med Hyg. 1991; 45:743-50. Google Scholar4. Lyra LD, Reboucas G, Andrade ZA. Hepatitis B surface antigen carrier state in hepatosplenic schistosomiasis . Gastroenterol. 1976; 71:641-5. Google Scholar5. Bassily S, Dunn MA, Farid Z, et al. Chronic hepatitis in patients with Schistosoma mansoni . J Trop Med Hyg. 1983; 86:67-71. Google Scholar6. Colley DG. Occurrence, roles, and uses of idiotypes and anti-idiotypes in parasitic diseases . Idiotypic Network and Diseases. In: Cerny J, Hiernaux J. Am Soc Microbiol, Washington, DC, 1990;71-105. Google Scholar7. Actor JK, Shirai M, Kullberg MC, et al. Helminth infection results in decreased virus-specific CD8+ cytotoxic T-cell and TH1 cytokine response as well as delayed virus clearance . Proc Natl Acad Sci. 1993; 90:948-52. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 14, Issue 3May-June 1994 Metrics History Published online1 May 1994 InformationCopyright © 1994, Annals of Saudi MedicineThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.PDF download" @default.
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• W2460356257 title "Prevalence of Hepatitis B Surface Antigenemia Among Patients withSchistosoma mansoni" @default.
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