Rapid appraisal of liver diseases using transient elastography, abdominal ultrasound, and microbiology in Côte d'Ivoire: A single-center study.

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. Methodology: 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. Principal findings: 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 microbiological 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/Significance: 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. Author summary: At a global scale, chronic liver diseases such as liver fibrosis or cirrhosis are increasing. Causes and risk factors vary from one setting to another. In Europe, alcohol abuse, viral hepatitis, and fatty liver disease are the leading causes. Neglected tropical diseases, especially infections with parasites such as Schistosoma mansoni, are known to cause liver damage in low- and middle-income countries. Precise data on the relevance of infections with S. mansoni compared to other causes of liver fibrosis are scarce. In this study, we aimed to elucidate the infectious diseases etiology of chronic liver diseases in a schistosomiasis-endemic setting of Côte d'Ivoire. We screened residents from four villages in the southern part of Côte d'Ivoire with transient elastography, a non-invasive method that detects liver fibrosis or -cirrhosis by liver stiffness. Participants were tested for schistosomiasis and viral hepatitis, and a questionnaire was used to collect sociodemographic data. We found that liver fibrosis was common (17%), with S. mansoni being the most detected pathogen (30%). Liver diseases have a high morbidity and mortality, resulting in liver cancer or gastrointestinal haemorrhage. Schistosomiasis and hepatitis C, in particular, can be treated effectively today, so a screening program with transient elastography and subsequent treatment could prevent complications of liver disease. [ABSTRACT FROM AUTHOR]