Open Access Open Badges Research article

The impact of single versus mixed schistosome species infections on liver, spleen and bladder morbidity within Malian children pre- and post-praziquantel treatment

Artemis Koukounari1*, Christl A Donnelly2, Moussa Sacko3, Adama D Keita4, Aly Landouré3, Robert Dembelé5, Elisa Bosqué-Oliva1, Albis F Gabrielli6, Anouk Gouvras1, Mamadou Traoré3, Alan Fenwick1 and Joanne P Webster1

Author Affiliations

1 Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, UK

2 MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, UK

3 Institut National de Recherche en Santé Publique, Ministère de la Santé, Bamako, Mali

4 Service de la Radiologie, Hôpital National du Point G, Bamako, Mali

5 Programme National de Lutte contre la Schistosomiase et les Géohelminthiases, Direction Nationale de la Santé, Ministère de la Santé, Bamako, Mali

6 Department of Control of Neglected Tropical Diseases, World Health Organization, CH-1211 Geneva 27, Switzerland

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BMC Infectious Diseases 2010, 10:227  doi:10.1186/1471-2334-10-227

Published: 29 July 2010



In the developing world co-infections and polyparasitism within humans appear to be the rule rather than the exception, be it any combination of inter-specific and/or inter- and intra-Genera mixed infections. Mixed infections might generate synergistic or antagonistic interactions and thereby clinically affect individuals and/or impact parasite epidemiology.


The current study uniquely assesses both Schistosoma mansoni- and Schistosoma haematobium-related morbidity of the liver and the bladder as assessed by ultrasound as well as spleen and liver morbidity through clinical exams. The impact of praziquantel (PZQ) treatment on such potential inter-specific schistosome interactions and resulting morbidity using uniquely detailed longitudinal data (pre- and one year post-PZQ treatment) arising from the National Schistosomiasis Control Program in three areas of Mali: Ségou, Koulikoro and Bamako, is also evaluated. At baseline, data were collected from up to 2196 children (aged 7-14 years), 844 of which were infected with S. haematobium only, 124 with S. mansoni only and 477 with both. Follow-up data were collected from up to 1265 children.


Results suggested lower liver morbidity in mixed compared to single S. mansoni infections and higher bladder morbidity in mixed compared to single S. haematobium infections. Single S. haematobium or S. mansoni infections were also associated with liver and spleen morbidity whilst only single S. haematobium infections were associated with bladder morbidity in these children (light S. haematobium infection OR: 4.3, p < 0.001 and heavy S. haematobium infection OR: 19, p < 0.001). PZQ treatment contributed to the regression of some of the forms of such morbidities.


Whilst the precise biological mechanisms for these observations remain to be ascertained, the results illustrate the importance of considering mixed species infections in any analyses of parasite-induced morbidity, including that for the proposed Disability Adjusted Life Years (DALYs) revised estimates of schistosomiasis morbidity.