Schistosoma mansoni co-infection in tuberculosis patients with or without human immunodeficiency virus and factors associated with treatment outcomes: a prospective cohort study

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BACKGROUND: Tuberculosis (TB) has resurfaced as the leading cause of death by an infectious agent after the COVID-19 pandemic. The fight against TB needs to consider factors associated with mycobacterial reactivation and treatment of TB disease. Recent findings showed that Schistosoma mansoni co-infection leads to a Th2/Th1 profile that results in an immune modulation that favors the escape of the Mycobacteria. Schistosoma mansoni may contribute to tuberculosis (TB) incidence in endemic regions. We aimed to determine the co-infection rate and treatment outcomes. METHODS: A prospective cohort study was conducted between 2020 and 2022 at the University Clinical Research Center (UCRC). We included culture-confirmed pulmonary TB patients who were tested for Schistosoma mansoni in stools using Kato-Katz. S. mansoni co-infection was determined at baseline. Patients were classified into two -groups: TB/S. mansoni co-infected and TB-mono-infected. Univariable and multivariable logistic regression were performed to identify factors associated with the co-infection. RESULTS: We analyzed data from 174 tuberculosis-confirmed patients tested with Kato-Katz technique. Schistosoma mansoni co-infection among TB patients was 28.7%. The death rate was 18.0% in the co-infection group versus 5.6% in TB-mono-infected. Death was associated with bilateral lung opacities [aOR = 4.29 (2.98–18.74), p = 0.038]. TB/S. mansoni co-infection represented a high risk of death [aOR = 4.31 (1.17–15.90), p = 0.029]. However, HIV infection was not associated with death [aOR = 1.29 (0.18–9.20), p = 0.799]. CONCLUSIONS: Schistosoma mansoni co-infection was found in one-third of active TB patients, 2.5-fold higher than that of HIV. The co-infection was associated with death, and bilateral lung opacities were associated with a higher risk of death.

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