Hepatosplenic schistosomiasis

Peter Hotez and colleagues (Aug 14, p 496)1 describe the need for drugs to treat schistosomiasis in Africa. But we believe that their Comment significantly understates the problem by not emphasising the severe effects of portal hypertension and variceal bleeding. Although splenomegaly is an important indicator of Schistosoma infection, it is the blood loss that is debilitating and often fatal. We have made observations on a hyperendemic focus of Schistosoma mansoni infection in Africa. We noted that many patients with oesophageal varices were coming for endoscopy from one area of northwestern Zambia, so we did two consecutive surveys. We estimated first the proportion of adults who had a lifetime history of haematemesis, then in the second round the proportion of such adults who had S mansoni ova in stool samples. In the first round we interviewed 70 female heads of household to obtain information on 178 adults, 15 (8%) of whom were reported to have had haematemesis. In the second round we obtained a single stool sample from 68 adults with a lifetime history of haematemesis, and 45 (66%) of these had ova by means of the Kato-Katz technique. Given that the use of heads of household as reporters will underestimate the prevalence of gastrointestinal bleeding, this community is clearly severely affected by hepatosplenic schistosomiasis. There might be other communities in Africa similarly affected, and we concur fully that the need for mass praziquantel treatment for this neglected infection is very urgent.