Dear Editor,
It is interesting to read the review article by Ornos et al. [1]. on liver diseases in the Philippines. The authors mentioned common diseases such as NAFLD, hepatitis B, C, and alcohol liver disease as causes of chronic liver disease in the Philippines. A neglected cause of liver disease common in tropical countries such as the Philippines is schistosomiasis (bilharziasis). The World Health Organization recognizes schistosomiasis as one of the neglected tropical diseases, and in 2020, it is estimated that 240 million people worldwide are affected by this disease, together with an additional 700 million at risk of infection [2]. Schistosoma-induced liver injury results from a granulomatous inflammatory reaction around trapped Schistosoma eggs in the presinusoidal periportal spaces. Chronic infection can lead to collagen deposition in the periportal space leading to schistosomal-associated liver fibrosis, known as “Symmers’ pipestem fibrosis,” and is one of the most important causes of non-cirrhotic portal hypertension worldwide [3]. Schistosoma japonicum, the most common parasitic blood fluke in the Philippines, is endemic in 12 regions, 28 provinces, and 196 towns in the Philippines, with a 4.68% national prevalence of the disease, estimated 12.4 million Filipinos at risk and 2.7 million exposed to the infection [4,5]. Despite the decreasing mortality rate of schistosomiasis in the Philippines over the last six decades, it remains an economic and public health concern. For that reason, every January, the Philippines Department of Health leads activities related to schistosomiasis awareness and mass drug administration with the vision of “Schistosomiasis Free Philippines” [4,6]. Once fibrosis sets in, despite successful parasite elimination, Schistosoma associated coinfection or comorbidities with any of the common chronic liver disease etiologies can enhance tissue damage leading to worsening liver function and disease progression [3]. In endemic countries such as the Philippines, schistosomiasis should be considered one of the common causes of liver disease.
Declaration of interestsNone.
