Ferritin sequestration and C-reactive protein elevation in female genital schistosomiasis in the Tolon District of Ghana: a cross-sectional study

Schistosomiasis is a neglected tropical disease with global health concerns. Schistosoma haematobium (Sh) infection causes female genital schistosomiasis (FGS), a condition leading to the deposition of parasite eggs in the female genital tract. More than 56 million women are affected with FGS on the African continent, with almost 20 million more females who could be affected in the next decade if left untreated. Schistosomiasis initiates release of inflammatory proteins (C-reactive protein and ferritin) to mediate infection. This research investigated C-reactive protein (CRP) and ferritin as additional diagnostic markers for Sh infection, especially in women with chronic Sh infection. The study was cross-sectional, conducted in the Tolon District of Ghana, where schistosomiasis is highly endemic. Serum samples taken from women (18–60 years) were analysed using the sandwich ELISA protocol as instructed by the manufacturer. In all eighty-four (84) samples were analysed (FGS positive, Sh -infected and endemic normal (uninfected)) and their absorbance measured at 450 nm wavelength. Women who tested positive for Sh were examined by a gynaecologist to assess the presence and extent of genital complications. Women with more than one complication were grouped as FGS category 2, while those with only one were referred to as FGS category 1. Participants presenting with heavy Sh infection had significantly higher CRP levels than those presenting with light or no infection ( p = 0.0115). Here again, ferritin levels were lowest in women with heavy Sh infection ( p = 0.0112), denoting overexploitation of ferritin. Ferritin and CRP levels in FGS 2 did not differ significantly. A Spearman correlation between CRP and ferritin showed a weak but significant positive correlation ( r = 0.2799, p = 0.0137). Ferritin levels were higher in individuals who had lived in the community for lesser number of years compared to those who had lived longer, with CRP levels been lower in individuals who had stayed in the endemic for lesser years. This study demonstrates a synergistic effect between ferritin and CRP levels in women with FGS, highlighting that both are acute-phase reactant proteins synthesized by the liver in response to pro-inflammatory stimuli. While ferritin and CRP are not specific markers for only schistosomiasis, its feasibility and confirmation could be integrated into protocols approved for FGS diagnosis. Future studies on CRP and ferritin should focus on cutoff values specific to FGS to improve clinical utility.