Co-infection with Schistosoma mansoni and Helicobacter pylori: epidemiological patterns and implications for integrated control

Co-infections with Schistosoma mansoni and Helicobacter pylori are frequently reported in low-resource endemic settings; however, their combined systemic and hematological effects in true co-endemic populations remain incompletely characterized. While S. mansoni transmission is primarily driven by exposure to agricultural water, H. pylori reflects persistent household and sanitation-related transmission, highlighting distinct yet overlapping epidemiological pathways. This study aimed to assess the association between occupational freshwater exposure and S. mansoni infection and to evaluate the clinical, hematological, and biochemical profiles associated with S. mansoni and H. pylori mono- and co-infections in a rural Egyptian population. A community-based, cross-sectional study was conducted in a rural agricultural village in Egypt. Participants were stratified into four groups: S. mansoni mono-infection (Gp1), S. mansoni-H. pylori co-infection (Gp2), H. pylori mono-infection (Gp3), and uninfected controls (Gp4). Clinical assessment, stool microscopy using the Kato-Katz thick smear technique, H. pylori coproantigen ELISA, complete blood counts, and serum biochemical analyses were performed. Comparative statistical analyses were used to evaluate group differences and associated risk factors. Occupational exposure (farm work) was strongly associated with S. mansoni infection (P S. mansoni. Co-infection did not significantly influence H. pylori antigen levels (P = 0.190), indicating limited biological interaction between the pathogens. Systemic alterations were predominantly driven by S. mansoni, including thrombocytopenia and marked eosinophilia (P P = 0.037), suggesting sustained immune activation. Other biochemical parameters showed no significant differences. In endemic rural settings, co-infection with S. mansoni and H. pylori does not demonstrate synergistic systemic effects but rather reflects overlapping transmission pathways with distinct epidemiological determinants. These findings suggest that integrated screening strategies may offer limited additional clinical benefit beyond pathogen-specific management, while still supporting coordinated control efforts targeting shared risk environments.