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Abstract：
BACKGROUND: Liver diseases of infectious and non-infectious etiology cause considerable morbidity and mortality, particularly in low- and middle-income countries (LMICs). However, data on the prevalence of liver diseases and underlying risk factors in LMICs are scarce. The objective of this study was to elucidate the occurrence of infectious diseases among individuals with chronic liver damage in a rural setting of Côte d\'Ivoire.
METHODS: In 2021, we screened 696 individuals from four villages in the southern part of Côte d\'Ivoire for hepatic fibrosis and steatosis, employing transient elastography (TE) and controlled attenuation parameter (CAP). We classified CAP ≥248 dB/m as steatosis, TE ≥7.2 kPa as fibrosis, and did subgroup analysis for participants with TE ranging from 7.2 kPa to 9.1 kPa. Clinical and microbiologic characteristics were compared to an age- and sex-matched control group (TE <6.0 kPa; n = 109). Stool samples were subjected to duplicate Kato-Katz thick smears for diagnosis of Schistosoma mansoni. Venous blood samples were examined for hepatitis B and hepatitis C virus. Additionally, an abdominal ultrasound examination was performed.
RESULTS: Among 684 individuals with valid TE measurements, TE screening identified hepatic pathologies in 149 participants (17% with fibrosis and 6% with steatosis). 419 participants were included for further analyses, of which 261 had complete microbiologic analyses available. The prevalence of S. mansoni, hepatitis B, and hepatitis C were 30%, 14%, and 7%, respectively. Logistic regression analysis revealed higher odds for having TE results between 7.2 kPa and 9.1 kPa in individuals with S. mansoni infection (odds ratio [OR] = 3.02, 95% confidence interval [CI] = 1.58-5.76, P = 0.001), while HCV infection (OR = 5.02, 95% CI = 1.72-14.69, P = 0.003) and steatosis (OR = 4.62, 95% CI = 1.60-13.35, P = 0.005) were found to be risk factors for TE ≥9.2 kPa.
CONCLUSIONS: Besides viral hepatitis, S. mansoni also warrants consideration as a pathogen causing liver fibrosis in Côte d\'Ivoire. In-depth diagnostic work-up among individuals with abnormal TE findings might be a cost-effective public health strategy.
METHODS: In 2021, we screened 696 individuals from four villages in the southern part of Côte d\'Ivoire for hepatic fibrosis and steatosis, employing transient elastography (TE) and controlled attenuation parameter (CAP). We classified CAP ≥248 dB/m as steatosis, TE ≥7.2 kPa as fibrosis, and did subgroup analysis for participants with TE ranging from 7.2 kPa to 9.1 kPa. Clinical and microbiologic characteristics were compared to an age- and sex-matched control group (TE <6.0 kPa; n = 109). Stool samples were subjected to duplicate Kato-Katz thick smears for diagnosis of Schistosoma mansoni. Venous blood samples were examined for hepatitis B and hepatitis C virus. Additionally, an abdominal ultrasound examination was performed.
RESULTS: Among 684 individuals with valid TE measurements, TE screening identified hepatic pathologies in 149 participants (17% with fibrosis and 6% with steatosis). 419 participants were included for further analyses, of which 261 had complete microbiologic analyses available. The prevalence of S. mansoni, hepatitis B, and hepatitis C were 30%, 14%, and 7%, respectively. Logistic regression analysis revealed higher odds for having TE results between 7.2 kPa and 9.1 kPa in individuals with S. mansoni infection (odds ratio [OR] = 3.02, 95% confidence interval [CI] = 1.58-5.76, P = 0.001), while HCV infection (OR = 5.02, 95% CI = 1.72-14.69, P = 0.003) and steatosis (OR = 4.62, 95% CI = 1.60-13.35, P = 0.005) were found to be risk factors for TE ≥9.2 kPa.
CONCLUSIONS: Besides viral hepatitis, S. mansoni also warrants consideration as a pathogen causing liver fibrosis in Côte d\'Ivoire. In-depth diagnostic work-up among individuals with abnormal TE findings might be a cost-effective public health strategy.
摘要：
背景：感染性和非感染性病因的肝脏疾病导致相当高的发病率和死亡率，特别是在低收入和中等收入国家（LMICs）。然而,关于LMIC中肝病患病率和潜在危险因素的数据很少.本研究的目的是阐明科特迪瓦农村地区慢性肝损害患者传染病的发生情况。
方法：在2021年，我们对科特迪瓦南部四个村庄的696人进行了肝纤维化和脂肪变性筛查，采用瞬态弹性成像(TE)和受控衰减参数(CAP)。我们将CAP≥248dB/m归类为脂肪变性，TE≥7.2kPa作为纤维化，并对TE范围为7.2kPa至9.1kPa的参与者进行了亚组分析.将临床和微生物学特征与年龄和性别匹配的对照组(TE<6.0kPa;n=109)进行比较。对粪便样品进行重复的Kato-Katz厚涂片检查，以诊断曼氏血吸虫。检查静脉血样本中的乙型肝炎和丙型肝炎病毒。此外,进行了腹部超声检查。
结果：在684名具有有效TE测量值的个体中，TE筛查在149名参与者中确定了肝脏病理（17％的纤维化和6％的脂肪变性）。419名参与者被纳入进一步分析，其中261个有完整的微生物分析。S.Mansoni的患病率,乙型肝炎，丙型肝炎占30%，14%,7%,分别。Logistic回归分析显示，曼氏链球菌感染患者的TE结果在7.2kPa至9.1kPa之间的几率较高（比值比[OR]=3.02，95%置信区间[CI]=1.58-5.76，P=0.001），HCV感染（OR=5.02，95％CI=1.72-14.69，P=0.003）和脂肪变性（OR=4.62，95％CI=1.60-13.35，P=0.005）是TE≥9.2kPa的危险因素。
结论：除病毒性肝炎外，曼索尼也有理由将其视为导致科特迪瓦肝纤维化的病原体。在TE异常发现的个体中进行深入的诊断检查可能是一种具有成本效益的公共卫生策略。
方法：在2021年，我们对科特迪瓦南部四个村庄的696人进行了肝纤维化和脂肪变性筛查，采用瞬态弹性成像(TE)和受控衰减参数(CAP)。我们将CAP≥248dB/m归类为脂肪变性，TE≥7.2kPa作为纤维化，并对TE范围为7.2kPa至9.1kPa的参与者进行了亚组分析.将临床和微生物学特征与年龄和性别匹配的对照组(TE<6.0kPa;n=109)进行比较。对粪便样品进行重复的Kato-Katz厚涂片检查，以诊断曼氏血吸虫。检查静脉血样本中的乙型肝炎和丙型肝炎病毒。此外,进行了腹部超声检查。
结果：在684名具有有效TE测量值的个体中，TE筛查在149名参与者中确定了肝脏病理（17％的纤维化和6％的脂肪变性）。419名参与者被纳入进一步分析，其中261个有完整的微生物分析。S.Mansoni的患病率,乙型肝炎，丙型肝炎占30%，14%,7%,分别。Logistic回归分析显示，曼氏链球菌感染患者的TE结果在7.2kPa至9.1kPa之间的几率较高（比值比[OR]=3.02，95%置信区间[CI]=1.58-5.76，P=0.001），HCV感染（OR=5.02，95％CI=1.72-14.69，P=0.003）和脂肪变性（OR=4.62，95％CI=1.60-13.35，P=0.005）是TE≥9.2kPa的危险因素。
结论：除病毒性肝炎外，曼索尼也有理由将其视为导致科特迪瓦肝纤维化的病原体。在TE异常发现的个体中进行深入的诊断检查可能是一种具有成本效益的公共卫生策略。
