Effect of skin colour and selected physical characteristics on Schistosoma mansoni dependent morbidity

Cançado, C. B.; Firmo, J. O. A.; Fernandes, S. C.; Rocha, R. S.; Costa, M. F. F. Lima e

doi:10.1590/S0036-46651995000600004

Abstracts

The effect of the colour group on the morbidity due to Schistosoma mansoni was examined in two endemic areas situated in the State of Minas Gerais, Brazil. Of the 2773 eligible inhabitants, 1971 (71.1%) participated in the study: 545 (27.6%) were classified as white, 719 (36.5%) as intermediate and 707 (35.9%) as black. For each colour group, signs and symptoms of individuals who eliminated S.mansoni eggs (cases) were compared to those who did not present eggs in the faeces (controls). The odds ratios were adjusted by age, gender, previous treatment for schistosomiasis, endemic area and quality of the household. There was no evidence of a modifier effect of colour on diarrhea, bloody faeces or abdominal pain. A modifier effect of colour on hepatomegaly was evident among those heaviest infected (> 400 epg): the adjusted odds ratios for palpable liver at the middle clavicular and the middle sternal lines were smaller among blacks (5.4 and 6.5, respectively) and higher among whites (10.6 and 12.9) and intermediates (10.4 and 10.1, respectively). These results point out the existence of some degree of protection against hepatomegaly among blacks heaviest infected in the studied areas.

Schistosomiasis mansoni; Colour; Morbidity

O efeito da cor na morbidade associada ao Schistosoma mansoni foi estudado em duas áreas endêmicas situadas no Estado de Minas Gerais, Brasil. Dos 2773 habitantes elegíveis, 1971 (71,1%) participaram do estudo: 545 (27,6%) foram classificados como brancos, 719 (36,5%) como intermediários e 707 (35,9%) como negros. Os sinais e sintomas dos indivíduos que eliminavam ovos de S. mansoni nas fezes (casos) foram comparados aos daqueles que não apresentavam ovos do parasita neste exame (controles). As razões de chance foram ajustadas por idade, gênero, tratamento anterior para a esquistossomose, área endêmica e qualidade do domicílio. Não houve evidência de um efeito modificador da cor para a ocorrência de diarréia, sangue nas fezes ou dor abdominal. Um efeito modificador da cor foi evidente entre aqueles com maiores contagens de ovos nas fezes (>400 opg), no que se refere à hepatomegalia: as razões de chances foram menores entre indivíduos classificados como negros (5,4 e 6,5 para presença de fígado palpável nas linhas hemiclavicular e médio esternal, respectivamente) e maiores entre aqueles classificados como brancos (10,6 e 12,9, respectivamente) e intermediários (10,4 e 10,1, respectivamente). Estes resultados apontam para a existência de algum grau de proteção em relação à hepatomegalia entre indivíduos classificados como negros nas áreas endêmicas estudadas.

SCHISTOSOMIASIS

Effect of skin colour and selected physical characteristics on Schistosoma mansoni dependent morbidity

Efeito da cor da pele e certas características físicas na morbidade dependente de Schistosoma mansoni

C. B. Cançado^I; J. O. A. Firmo^I; S. C. Fernandes^I; R. S. Rocha^I; M. F. F. Lima e Costa^I,II

^ICentro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil

^IIDepartamento de Medicina Preventiva e Social, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil

^{Correspondence to} Correspondence to: Dra. Maria Fernanda Lima e Costa Departamento de Epidemiologia e Antropologia Médica, Centro de Pesquisas Réne Rachou, Fundação Oswaldo Cruz Av. Augusto de Lima 1715 30190-002 Belo Horizonte, MG, Brazil

SUMMARY

The effect of the colour group on the morbidity due to Schistosoma mansoni was examined in two endemic areas situated in the State of Minas Gerais, Brazil. Of the 2773 eligible inhabitants, 1971 (71.1%) participated in the study: 545 (27.6%) were classified as white, 719 (36.5%) as intermediate and 707 (35.9%) as black. For each colour group, signs and symptoms of individuals who eliminated S.mansoni eggs (cases) were compared to those who did not present eggs in the faeces (controls). The odds ratios were adjusted by age, gender, previous treatment for schistosomiasis, endemic area and quality of the household. There was no evidence of a modifier effect of colour on diarrhea, bloody faeces or abdominal pain. A modifier effect of colour on hepatomegaly was evident among those heaviest infected (> 400 epg): the adjusted odds ratios for palpable liver at the middle clavicular and the middle sternal lines were smaller among blacks (5.4 and 6.5, respectively) and higher among whites (10.6 and 12.9) and intermediates (10.4 and 10.1, respectively). These results point out the existence of some degree of protection against hepatomegaly among blacks heaviest infected in the studied areas.

Keywords: Schistosomiasis mansoni; Colour; Morbidity.

RESUMO

O efeito da cor na morbidade associada ao Schistosoma mansoni foi estudado em duas áreas endêmicas situadas no Estado de Minas Gerais, Brasil. Dos 2773 habitantes elegíveis, 1971 (71,1%) participaram do estudo: 545 (27,6%) foram classificados como brancos, 719 (36,5%) como intermediários e 707 (35,9%) como negros. Os sinais e sintomas dos indivíduos que eliminavam ovos de S. mansoni nas fezes (casos) foram comparados aos daqueles que não apresentavam ovos do parasita neste exame (controles). As razões de chance foram ajustadas por idade, gênero, tratamento anterior para a esquistossomose, área endêmica e qualidade do domicílio. Não houve evidência de um efeito modificador da cor para a ocorrência de diarréia, sangue nas fezes ou dor abdominal. Um efeito modificador da cor foi evidente entre aqueles com maiores contagens de ovos nas fezes (>400 opg), no que se refere à hepatomegalia: as razões de chances foram menores entre indivíduos classificados como negros (5,4 e 6,5 para presença de fígado palpável nas linhas hemiclavicular e médio esternal, respectivamente) e maiores entre aqueles classificados como brancos (10,6 e 12,9, respectivamente) e intermediários (10,4 e 10,1, respectivamente). Estes resultados apontam para a existência de algum grau de proteção em relação à hepatomegalia entre indivíduos classificados como negros nas áreas endêmicas estudadas.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

ACKNOWLEDGEMENT

The authors would like to thank Dr. Andrew Simpsom for the critical review of the manuscript and Dr. Naftale Katz for his support throughout this project.

Recebido para publicação em 06/11/1995.

Aceito para publicação em 30/11/1995.

This project was sponsored by UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Disease, by Financiadora de Estudos e Projetos (FINEP) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).

1. ARMITAGE, P. & BERRY, G. - Statistical methods in medical research. Oxford, Blackwell Scientific Publications, 1987.
2. BINA, J.C.; TAVARES-NETO, J.; PRATA, A. & AZEVEDO, E.S. - Greater resistance to development of severe schistosomiasis in Brazilian negroes. Hum. Biol., 50: 41-44, 1978.
3. BRESLOW, N.E. & DAY, E. - Statistical methods in cancer research. The analysis of case control studies. Lyon, International Agency for Research on Cancer, 1980. (IARC Scientific Publication, no. 32).
4. DEAN, A.G.; DEAN, J.A.; BURTON, A.H. & DICKER, R.C. - EPIINFO, version 5.0: a word processing, data base and statistics program for epidemiology on micro-computers. Atlanta, Centers for Disease Control, 1990.
5. DOMINGUES, A.L.C. & COUTINHO, A.D. - Reduction of morbidity in hepatosplenic schistosomiasis mansoni after treatment with praziquantel: a long term study. Rev. Soc. bras. Med. trop., 23: 101-107, 1990.
6. GREENLAND, S. - Modeling and variable selection in epidemiologic analysis. Amer. J. publ. Hlth., 79: 340-349, 1989.
7. HIATT, R.S. - Morbidity from Schistosoma mansoni infection: an epidemiologic study based on quantitative analysis of egg excretion in two highlands Ethiopian villages. Amer. J. trop. med. Hyg., 25: 808-817, 1976.
8. JORDAN, P. - Epidemiology. In: JORDAN, P. Schistosomiasis. The St. Lucia project. Cambridge University Press, 1985. p. 372-375.
9. JORDAN, P. & WEBBE, G. - Epidemiology. In: JORDAN, P.; WEBBE, G. & STURROCK, R.F. - Human Schistosomiasis. Wallingford, CAB International, 1993. p. 124.
10. KATZ, N.; CHAVES, A. & PELLEGRINO, J. - A simple device for quantitative stool thick-smear technique in schistosomiasis mansoni. Rev. Inst. Med. trop. S. Paulo, 14: 397-400, 1972.
11. KEIL, J.E.; TYROLER, H.A.; SANDIFER, S.H. & BOYLE Jr., E. - Hypertension: effects of social class and racial admixture. Amer. J. publ. Hlth., 67: 634-639, 1977.
12. LASKER, G.W. - Photoeletric measurement of skin color in a Mexico Mestizo population. Amer. J. phys. Anthropol., 12: 115-122, 1954.
13. LIMA e COSTA, M.F.F.; ROCHA, R.S.; MAGALHĂES, M.H.A. & KATZ, N. - A clinico-epitlemioiogical survey of schistosomiasis mansoni in a hyperendemic area in Minas Gerais State (Comercinho, Brazil). I. Differences in the manifestations of schistosomiasis in the town centre and in the environs. Trans. roy. Soc. trop. Med. Hyg., 79: 539-545, 1985a.
14. LIMA e COSTA, M.F.F.; ROCHA, R.S. & KATZ, N. - Morbidade da esquistossomose e sua relaçăo com a contagem de ovos de Schistosoma mansoni em uma zona hiperendęmica do Estado de Minas Gerais. Rev. Inst. Med. trop. S. Paulo, 27: 66-75, 1985b.
15. LIMA e COSTA, M.F.F.; ROCHA, R.S.; COLLEY, D.; GAZZINELLI, G. & KATZ, N. - Validity of selected clinical signs and symptoms in diagnosis of Schistosoma mansoni infection. Rev. Inst. Med. trop. S. Paulo, 33: 12-17, 1991.
16. NUNESMAIA, H.G.; AZEVEDO, E.S.; ARANDAS, E.A. & WIDMER, C.G. - Composiçăo racial e anaptoglobinemia em portadores de esquistossomose mansônica na forma hepatesplęnica. Rev. Inst. Med. trop. S. Paulo, 17: 160-163, 1975.
17. OMER, A.H.S.; HAMILTON, P.J.S.; MARSHAL, T.F.C. & DRAPER, C.C. - Infection with Schistosoma mansoni in the Geriza area of the Sudan. J. trop. Med. Hyg., 79: 151-157, 1976.
18. ONGOM, V.L. & BRADLEY, D.J. - The epidemiology and consequences of Schistosoma mansoni infection in west Nile, Uganda. I. Field studies of a community at Panyagoro. Trans. roy. Soc. trop. Med. Hyg., 66: 835-851, 1972.
19. PRATA, A. & SCHROEDER, S. - A comparison of whites and negroes infected with Schistosoma mansoni in a hyperendemic area. Gaz. méd. Bahia, 67: 93-98, 1967.
20. PROIETTI, F.A. & ANTUNES, C.M.F. - Sensitivity, specificity and positive predictive values of selected clinical signs and symptoms associated with schistosomiasis mansoni. Int. J. Epidem., 18: 680-683, 1989.
21. PROIETTI, F.A.; PAULINO, U.H.M.; CHIARI, C.A., PROIETTI, A.B.F.C. & ANTUNES, C.M.F. - Epidemiology of Schistosoma mansoni infection in a low-endemic area in Brazil: clinical and nutritional characteristics. Rev. Inst. Med. trop. S. Paulo, 34: 409-419, 1992.
²²
STATISTICAL ANALYSE SYSTEM INSTITUTE - STAT SAS User's Guide. Release 6.03. Gary, North Caroline. SAS Institute INC, 1988.
²³
STATISTICS AND EPIDEMIOLOGY RESEARCH - EGRET: Reference Manual. Seattle, USA, 1993.
24. SUKWA, T.Y.; BULSARA, M.K. & WURAPA, F.K. - Evaluation of selected symptoms in the diagnosis of Schistosoma mansoni infection. Trop. geogr. Med., 37: 248-251, 1985.
25. SWINGENBERGER, K.; RICHTER, J.; VERGETTI, J.G. & FELDMEIER, H. - Praziquantel in the treatment of hepatosplenic schistosomiasis biochemical disease markers indicate deceleration of fibrogenisis and diminution of portal flow obstruction. Trans. roy. Soc. trop. Med. Hyg., 84: 252-256, 1990.
26. TAVARES-NETO, J. & PRATA, A. - Forma hepatoesplenica da esquistossomose mansoni em relaçăo ŕ composiçăo social e ao nível sócio-econômico. Rev. Soc. bras. Med. trop., 23: 37-42, 1990.
²⁷
WORLD HEALTH ORGANIZATION - Programme for control of diarrheal diseases: household survey manual. Geneva, WHO, 1989. (CDD/SER/86.2 Rev. 1).
²⁸
WORLD HEALTH ORGANIZATION - The control of Schistosomiasis. Second report of the WHO Expert Committee. Geneva, WHO, 1993. (Technical Report Series, 830).
29. WYLER, D.J. - Why does liver fibrosis occur in schistosomiasis? Parasit. today, 8: 277-279, 1992.

Correspondence to:

Dra. Maria Fernanda Lima e Costa

Departamento de Epidemiologia e Antropologia Médica, Centro de Pesquisas Réne Rachou, Fundação Oswaldo Cruz

Av. Augusto de Lima 1715

30190-002 Belo Horizonte, MG, Brazil

Publication Dates

Publication in this collection
22 Sept 2006
Date of issue
Dec 1995

History

Received
06 Nov 1995
Accepted
30 Nov 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ARMITAGE, P. & BERRY, G. - Statistical methods in medical research. Oxford, Blackwell Scientific Publications, 1987.

[2] 2. BINA, J.C.; TAVARES-NETO, J.; PRATA, A. & AZEVEDO, E.S. - Greater resistance to development of severe schistosomiasis in Brazilian negroes. Hum. Biol., 50: 41-44, 1978.

[3] 3. BRESLOW, N.E. & DAY, E. - Statistical methods in cancer research. The analysis of case control studies. Lyon, International Agency for Research on Cancer, 1980. (IARC Scientific Publication, no. 32).

[4] 4. DEAN, A.G.; DEAN, J.A.; BURTON, A.H. & DICKER, R.C. - EPIINFO, version 5.0: a word processing, data base and statistics program for epidemiology on micro-computers. Atlanta, Centers for Disease Control, 1990.

[5] 5. DOMINGUES, A.L.C. & COUTINHO, A.D. - Reduction of morbidity in hepatosplenic schistosomiasis mansoni after treatment with praziquantel: a long term study. Rev. Soc. bras. Med. trop., 23: 101-107, 1990.

[6] 6. GREENLAND, S. - Modeling and variable selection in epidemiologic analysis. Amer. J. publ. Hlth., 79: 340-349, 1989.

[7] 7. HIATT, R.S. - Morbidity from Schistosoma mansoni infection: an epidemiologic study based on quantitative analysis of egg excretion in two highlands Ethiopian villages. Amer. J. trop. med. Hyg., 25: 808-817, 1976.

[8] 8. JORDAN, P. - Epidemiology. In: JORDAN, P. Schistosomiasis. The St. Lucia project. Cambridge University Press, 1985. p. 372-375.

[9] 9. JORDAN, P. & WEBBE, G. - Epidemiology. In: JORDAN, P.; WEBBE, G. & STURROCK, R.F. - Human Schistosomiasis. Wallingford, CAB International, 1993. p. 124.

[10] 10. KATZ, N.; CHAVES, A. & PELLEGRINO, J. - A simple device for quantitative stool thick-smear technique in schistosomiasis mansoni. Rev. Inst. Med. trop. S. Paulo, 14: 397-400, 1972.

[11] 11. KEIL, J.E.; TYROLER, H.A.; SANDIFER, S.H. & BOYLE Jr., E. - Hypertension: effects of social class and racial admixture. Amer. J. publ. Hlth., 67: 634-639, 1977.

[12] 12. LASKER, G.W. - Photoeletric measurement of skin color in a Mexico Mestizo population. Amer. J. phys. Anthropol., 12: 115-122, 1954.

[13] 13. LIMA e COSTA, M.F.F.; ROCHA, R.S.; MAGALHĂES, M.H.A. & KATZ, N. - A clinico-epitlemioiogical survey of schistosomiasis mansoni in a hyperendemic area in Minas Gerais State (Comercinho, Brazil). I. Differences in the manifestations of schistosomiasis in the town centre and in the environs. Trans. roy. Soc. trop. Med. Hyg., 79: 539-545, 1985a.

[14] 14. LIMA e COSTA, M.F.F.; ROCHA, R.S. & KATZ, N. - Morbidade da esquistossomose e sua relaçăo com a contagem de ovos de Schistosoma mansoni em uma zona hiperendęmica do Estado de Minas Gerais. Rev. Inst. Med. trop. S. Paulo, 27: 66-75, 1985b.

[15] 15. LIMA e COSTA, M.F.F.; ROCHA, R.S.; COLLEY, D.; GAZZINELLI, G. & KATZ, N. - Validity of selected clinical signs and symptoms in diagnosis of Schistosoma mansoni infection. Rev. Inst. Med. trop. S. Paulo, 33: 12-17, 1991.

[16] 16. NUNESMAIA, H.G.; AZEVEDO, E.S.; ARANDAS, E.A. & WIDMER, C.G. - Composiçăo racial e anaptoglobinemia em portadores de esquistossomose mansônica na forma hepatesplęnica. Rev. Inst. Med. trop. S. Paulo, 17: 160-163, 1975.

[17] 17. OMER, A.H.S.; HAMILTON, P.J.S.; MARSHAL, T.F.C. & DRAPER, C.C. - Infection with Schistosoma mansoni in the Geriza area of the Sudan. J. trop. Med. Hyg., 79: 151-157, 1976.

[18] 18. ONGOM, V.L. & BRADLEY, D.J. - The epidemiology and consequences of Schistosoma mansoni infection in west Nile, Uganda. I. Field studies of a community at Panyagoro. Trans. roy. Soc. trop. Med. Hyg., 66: 835-851, 1972.

[19] 19. PRATA, A. & SCHROEDER, S. - A comparison of whites and negroes infected with Schistosoma mansoni in a hyperendemic area. Gaz. méd. Bahia, 67: 93-98, 1967.

[20] 20. PROIETTI, F.A. & ANTUNES, C.M.F. - Sensitivity, specificity and positive predictive values of selected clinical signs and symptoms associated with schistosomiasis mansoni. Int. J. Epidem., 18: 680-683, 1989.

[21] 21. PROIETTI, F.A.; PAULINO, U.H.M.; CHIARI, C.A., PROIETTI, A.B.F.C. & ANTUNES, C.M.F. - Epidemiology of Schistosoma mansoni infection in a low-endemic area in Brazil: clinical and nutritional characteristics. Rev. Inst. Med. trop. S. Paulo, 34: 409-419, 1992.

[22] ²²
STATISTICAL ANALYSE SYSTEM INSTITUTE - STAT SAS User's Guide. Release 6.03. Gary, North Caroline. SAS Institute INC, 1988.

[23] ²³
STATISTICS AND EPIDEMIOLOGY RESEARCH - EGRET: Reference Manual. Seattle, USA, 1993.

[24] 24. SUKWA, T.Y.; BULSARA, M.K. & WURAPA, F.K. - Evaluation of selected symptoms in the diagnosis of Schistosoma mansoni infection. Trop. geogr. Med., 37: 248-251, 1985.

[25] 25. SWINGENBERGER, K.; RICHTER, J.; VERGETTI, J.G. & FELDMEIER, H. - Praziquantel in the treatment of hepatosplenic schistosomiasis biochemical disease markers indicate deceleration of fibrogenisis and diminution of portal flow obstruction. Trans. roy. Soc. trop. Med. Hyg., 84: 252-256, 1990.

[26] 26. TAVARES-NETO, J. & PRATA, A. - Forma hepatoesplenica da esquistossomose mansoni em relaçăo ŕ composiçăo social e ao nível sócio-econômico. Rev. Soc. bras. Med. trop., 23: 37-42, 1990.

[27] ²⁷
WORLD HEALTH ORGANIZATION - Programme for control of diarrheal diseases: household survey manual. Geneva, WHO, 1989. (CDD/SER/86.2 Rev. 1).

[28] ²⁸
WORLD HEALTH ORGANIZATION - The control of Schistosomiasis. Second report of the WHO Expert Committee. Geneva, WHO, 1993. (Technical Report Series, 830).

[29] 29. WYLER, D.J. - Why does liver fibrosis occur in schistosomiasis? Parasit. today, 8: 277-279, 1992.

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