Relationship between eosinophil cationic protein and infection intensity in a schistosomiasis endemic community in Ghana

Background: Recent studies have shown the urine filtration and Kato-Katz techniques to significantly underestimate infection intensity in Schistosoma haematobium and Schistosoma mansoni infections, respectively. Infection intensity determination by these methods improves only with increasing number of samples collected per participant. This implies tedious and lengthy periods of sample processing and analysis by microscopy examination, hence the increased chances of experimental errors. This study sought to determine the relationship between levels of eosinophil cationic protein (ECP) and infection intensity by egg count both in S. haematobium and S. mansoni single and coinfections. Methods: This was a cross-sectional study carried out in Pakro, a periurban community in Ghana, involving a total of 308 participants. Each provided urine and stool samples, which were processed using the filtration and Kato-Katz techniques, respectively. Processed samples were examined by microscopy. Aliquots of urine from 73 participants were analyzed for levels of ECP using an ECP enzyme-linked immunosorbent assay kit. Results: Of the 308 urine samples examined, 59 (19.15%) were positive for S. haematobium. Significant association was observed between sex and S. haematobium infection intensity by egg count (P < 0.05) as well as between age and infection intensity (P < 0.001). Mean ECP levels were higher in S. haematobium-positive samples than in S. haematobium-negative samples (P < 0.001). There was also positive correlation between ECP and infection intensity (Spearman's r=0.73, P < 0.001). Conclusion: This study showed that ECP levels are positively associated with infection intensity by egg count in Schistosomiasis infections, even after multivariate adjustment.