Does schistosomiasis interfere with application of knodell score for assessment of chronic hepatitis C?

Schistosoma mansoni [SM] is a significant etiology of liver disease in many countries. Chronic hepatitis C is a major health problem worldwide. Association of schistosomiasis and chronic hepatitis C is not uncommon especially in areas where the two diseases are prevalent. The possible synergistic relationship between both conditions is a point of controversy. Also, the assessment of degree of necroinflammatory injury and stage of fibrosis in patients with mixed schistosomiasis and chronic hepatitis C is not a settled issue. The present study is a trial to highlight this problem. 185 individuals [25] pure schistosomal affection, [100] pure HCV, and [60] mixed HCV and schistosomal [HCV+S] were included. These were selected from 222 biopsied patients with chronic liver disease attending the liver unit of Internal Medicine Department, Mansoura University July 1999-May 2000. They were subjected to rectal snip and serological test for schistosomiasis, liver functions, HBV, HCV serological markers, serum qualitative PCR and liver biopsy. .Masson trichrome stain was performed to assess fibrosis. Immunohistochemical staining for HBsAg and HBcAg were performed. Modified Knodell score was applied to assess the biopsy. Five out of the 25 pure schistosomal and only 2 of the mixed group revealed schistosomal granuloma. 30% of pure HCV and 33% of mixed [HCV+S] patients were found to be cirrhotic. No significant statistical difference was identified between the two groups as regard necroinflammatory injury and Knodell score [p= 0.81]. Also, no significant difference was identified as regard stage of fibrosis [p=0.77]. Schistosomal hepatic affection does not lead to more severe or progressive disease in patients with chronic hepatitis C. Also, it does not interfere with assessment of necroinflammatory injury or fibrosis stage as determined by Knodell score