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Med Sci Monit. 2002 Feb;8(2):CR72-7.

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

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Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt.



Schistosoma mansoni (SM) is a significant cause of liver disease in many countries. Chronic hepatitis C (HCV) is a worldwide health problem. The association of SM and chronic HCV is not uncommon, especially in areas where both diseases occur. The possible synergistic relationship between them is controversial. Also, the degree of necroinflammatory injury and the stage of fibrosis in patients with mixed schistosomiasis and chronic HCV remains unclear.


185 individuals were studied: 25 with pure SM, 100 with pure HCV, and 60 mixed HCV and SM (HCV+S), selected from 222 biopsied patients with chronic liver disease treated at the liver unit of the 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 was performed for HBsAg and HBcAg. The Modified Knodell score was applied to assess the biopsy.


Five of the 25 pure SM and 2 of the HCV+S group revealed schistosomal granuloma. 30% of the pure HCV and 33% of the HCV+S patients were found to be cirrhotic. No statistically significant difference was identified between the groups as regards necroinflammatory injury or Knodell score, or the stage of fibrosis.


Schistosomal hepatic infection does not lead to more severe or progressive disease in patients with chronic hepatitis C.

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