Use of ultrasonography to evaluate Schistosoma japonicum-related morbidity in children, Sichuan Province, China, 2000-2007

Liver ultrasonography is a convenient way to evaluate Schistosoma japonicum-related morbidity; however, no consensus standards exist, and data on use in Chinese children are scant. We describe 7 years of ultrasound findings in a prospective cohort of 151 children from an endemic area in Sichuan Province, China and evaluate technical aspects of the ultrasound methodology. Although prevalence of infection decreased over time, prevalence of hepatomegaly increased, which was likely caused by re-infections. The prevalence of late findings such as parenchymal fibrosis and splenomegaly were rare and did not increase over time; however, when present, they were associated with stunting. The use of adult thresholds versus height-adjusted standards underestimated pathology in children. Reliability of all measures except parenchymal grade was poor to fair. Our findings highlight the importance of early intervention and screening. We also suggest methodological refinements to improve reliability of ultrasonography for large-scale assessment of S. japonicum-related subclinical morbidity in children.