The egg ribonuclease SjCP1412 accelerates liver fibrosis caused by Schistosoma japonicum infection involving damage-associated molecular patterns (DAMPs).

Schistosomiasis, a parasite infectious disease caused by Schistosoma japonicum, often leads to egg granuloma and fibrosis due to the inflammatory reaction triggered by egg antigens released in the host liver. This study focuses on the role of the egg antigens CP1412 protein of S. japonicum (SjCP1412) with RNase activity in promoting liver fibrosis. In this study, the recombinant egg ribonuclease SjCP1412, which had RNase activity, was successfully prepared. By analysing the serum of the population, it has been proven that the anti-SjCP1412 IgG in the serum of patients with advanced schistosomiasis was moderately correlated with liver fibrosis, and SjCP1412 may be an important antigen associated with liver fibrosis in schistosomiasis. In vitro, the rSjCP1412 protein induced the human liver cancer cell line Hep G2 and liver sinusoidal endothelial cells apoptosis and necrosis and the release of proinflammatory damage-associated molecular patterns (DAMPs). In mice infected with schistosomes, rSjCP1412 immunization or antibody neutralization of SjCP1412 activity significantly reduced cell apoptosis and necroptosis in liver tissue, thereby reducing inflammation and liver fibrosis. In summary, the SjCP1412 protein plays a crucial role in promoting liver fibrosis during schistosomiasis through mediating the liver cells apoptosis and necroptosis to release DAMPs inducing an inflammatory reaction. Blocking SjCP1412 activity could inhibit its proapoptotic and necrotic effects and alleviate hepatic fibrosis. These findings suggest that SjCP1412 may be served as a promising drug target for managing liver fibrosis in schistosomiasis japonica.

PEDIATRIC OCULAR TOXOCARIASIS IN JIANGSU PROVINCE, EASTERN CHINA.

Ocular toxocariasis is caused by migration of a Toxocara larva through the posterior eye. We report the first case of pediatric ocular toxocariasis caused by T. canis in Jiangsu Province, eastern China. A 6-year-old girl presented to Suzhou Municipal Children's Hospital with a complaint of right eye redness, minimal white discharge, no photophobia, eye pain, visual impairment, fever or arthralgia. She was initially diagnosed as having conjunctivitis; however, a 2-month treatment with lomefloxacin 0.3% eye drops gave no improvements. The diagnosis was made based on medical history (contact with dogs), clinical features and detection of T. canis IgG antibodies with an enzyme-linked immunosorbent assay (ELISA). Anthelmintic therapy with albendazole in combination with prednisolone resulted in improvement of the ocular symptoms. Ocular toxocariasis is rarely reported in China. However, the rapid economic development in China, could mean an increase in pet dogs with the potential increased risk of contracting toxocariasis if no control measures are taken. Disposal of pet litter, deworming of infected pets, complete cooking of meats, thorough rinsing of fruits and vegetables, and good hand-washing may help prevent human infections. Ocular toxocariasis should be considered in the differential diagnosis of patients with conjunctivitis that does not resolve with treatment.

The sensitivity of artesunate against Schistosoma japonicum decreased after 10 years of use in China.

Schistosomiasis due to Schistosoma japonicum is a major public health problem in China. Since 1995, artesunate has been used to treat and prevent schistosome infections in China. Artesunate previously showed a high prophylactic efficacy against schistosome infection, with a protection rate of 100%. However, recent clinical trials and animal experiments have found that the sensitivity of many schistosomes to artesunate, including Schistosoma mekongi and Schistosoma mansoni, decreased. Whether the prophylactic efficacy of artesunate on Schistosomiasis japonica decreased after being used over 10-year period was still unknown. In the current study, we conducted a double-blind trial and found that the protection rate of artesunate was only 13.5% in the Administration I group, whose dosage schedule was identical to schedules used in previous studies. Therefore, the sensitivity of S. japonicum to artesunate was confirmed to have decreased after being using for over 10 years. Moreover, when we increased the concentration of artesunate during the first week and third week, the protection reached 74.8%.

[Clinical manifestations and treatment of schistosomiasis hematobia].

Schistosomiasis hematobia is one major human schistosomiasis. The disease is endemic in Africa and Mediterra- nean region, and is the main cause of urogenital diseases. Although only Schistosoma japonicum is spreading across the Mainland China, now more schistosomiasis hematobia cases are reported among aid projects and migrant workers to Africa, with the economy development and the increasing degree of foreign exchanges. Meanwhile, the relevant clinical data of.schistosomiasis hematobia are rare in China. This article reviews the clinical manifestations and progress in diagnosis and treatment of the disease.

[Diagnosis and treatment of one case of imported schistosomiasis haematobia].

The therapeutic process of one case of schistosomiasis haematobia indicates that the health education should be strengthened between both doctors and patients, so as to reduce the rates of missed diagnosis and misdiagnosis. The serum immunological diagnosis of schistosomiasis japonica is helpful in the diagnosis and treatment evaluation of schistosomiasis haematobia, and praziquantel treatment is efficient, but more cases are needed to be summarized for the sake of fair use.

Improving the management of imported schistosomiasis haematobia in China: lessons from a case with multiple misdiagnoses.

BACKGROUND: Human Schistosoma haematobium infection that causes urinary schistosomiasis occurs in Africa and the eastern Mediterranean, and China is only endemic for S. japonicum. In this report, we reported an imported case with S. haematobium infection returning from Angola to Shaanxi Province, northwestern China, where S. japonicum is not endemic. FINDINGS: The case was misdiagnosed as ureteral calculus, invasive urothelial carcinoma and eosinophilic cystitis in several hospitals, and was finally diagnosed by means of serological assay followed by microscopic examination of the urine sediment. The patient was then treated with praziquantel, and a satisfactory outcome was obtained. CONCLUSIONS: As S. haematobium is not indigenous to China, most Chinese doctors and medical technicians are unfamiliar with this introduced parasitic disease, therefore, they need to increase the awareness of its existence when they encounter persons who have visited or resided in endemic areas, and the techniques for detection of the parasite, so as to reduce the misdiagnosis. In addition, health education should be given to those who will go to the endemic areas to improve their knowledge and awareness on prevention and control of schistosomiasis haematobia, thereby reducing the risk of exposure to the infested freshwater.

[Clinical efficiency of tanshinone IIA-sulfonate in treatment of liver fibrosis of advanced schistosomiasis].

OBJECTIVE: To evaluate the clinical efficiency of tanshinone IIA-sulfonate (STS) in the treatment of liver fibrosis of advanced schistosomiasis. METHODS: A total of 73 advanced schistosomiasis patients were selected into a treatment group and 55 cases of advanced schistosomiasis were selected into a control group, and dipstick dye immunoassay assay (DDIA) for schistosomiasis and HBsAg of all the patients were negative. The patients in the treatment group received STS for 14 days, and all the patients in both groups received the conventional liver-protecting treatment for 14 days. All the patients in both groups received the measurements of portal vein, 4 indicators of liver fibrosis (P III P, C IV, HA, LN), and 3 indicators of serum enzyme activities (ALT, AST, gamma-GT). RESULTS: After the treatments, the inside diameters of the portal vein and the degrees of the positive results of indicators of serum enzyme activities of all the patients of both groups decreased, but there were no statistically significant differences compared with those before the treatment. In the treatment group, the degrees of the positive results of indicators of liver fibrosis decreased somewhat, but there were no statistically significant differences compared with those before the treatment except C IV. In the control group, the degrees of the positive results of indicators of liver fibrosis fluctuated. In the treatment group, the indicator of liver fibrosis, CIV improved and the 2 indicators of liver fibrosis, PIIIP and HA improved significantly, but the indicators of serum enzyme activities did not improve. CONCLUSION: STS is effective in the treatment of liver fibrosis of advanced schistosomiasis.

The efficacy and safety of entecavir in patients with advanced schistosomiasis co-infected with hepatitis B virus.

OBJECTIVE: To evaluate the efficacy and safety of entecavir (ETV) in patients with advanced schistosomiasis and hepatitis B virus (HBV) co-infection. METHODS: Sixty-seven patients with advanced schistosomiasis and HBV co-infection were enrolled in this study. The patients were randomly divided into the ETV treatment group (n=35) and the control group (n=32). The patients in the control group adopted routine supportive therapy for 52 weeks, and those in the ETV treatment group received ETV at a dose of 0.5mg once daily on the basis of routine supportive therapy for 52 weeks. Hepatic fibrosis markers (hyaluronic acid, type III procollagen, type IV collagen, laminin, and fibronectin), Ishak fibrosis score, alanine transaminase (ALT), HBV DNA, and Child-Pugh score were compared between the two groups. The intention to treat (ITT) population was used for the analysis. The measurement data and count data were analyzed by t-test and Chi-square test, respectively. RESULTS: After 52 weeks of treatment, the hepatic fibrosis markers (hyaluronic acid, type III procollagen, type IV collagen, laminin, and fibronectin) were significantly improved in the ETV treatment group compared to the control group (all p<0.05). A ≥1-point improvement in the Ishak fibrosis score was found in 25.7% (9/35) of the ETV group, and the mean change from the baseline in the Ishak fibrosis score was a 0.3-point reduction. The control group showed disease progression in the Ishak fibrosis score. More patients in the ETV group than in the control group had undetectable serum HBV DNA levels (82.9% vs. 3.1%, p<0.05) and ALT normalization (68.6% vs. 18.3%, p<0.05). The ETV treatment group demonstrated an improvement in Child-Pugh score at week 52 (-3.7 vs. 0.3, p<0.05). In addition, no obvious adverse reactions were observed during ETV treatment. CONCLUSION: ETV is safe and effective in patients with advanced schistosomiasis and HBV co-infection.

[Survey on newly-developed advanced schistosomiasis patients in schistosomiasis transmission-interrupted areas].

OBJECTIVE: To understand the status of newly-developed advanced schistosomiasis patients in schistosome transmission-interrupted areas. METHODS: The newly diagnosed advanced schistosomiasis patients confirmed by professionals at province and county levels according to the available standards were investigated. Their detailed epidemiology history and present signs/ symptoms were surveyed, and the relevant medical examinations were performed. RESULTS: There were 75 patients including 22 males and 53 females. The average age was (70.0 +/- 7.0) years and they were all infected with schistosome previously. They received anti-schistosome therapy (mean 1.85 times) and stool examinations (mean 26.24 times) continuously from 1976 to 1985, and the results of stool examination were all negative. In majority of the patients' resident areas, the last time that Oncomelania hupensis snails were found was 1976, and the latest was 1983. During this period, no patients were up to the diagnostic criteria of advanced schistosomiasis after multiple examinations, and they were diagnosed as advanced cases between 2008 and 2011. The survey indicated that liver fibrosis was found in all the patients with 82.7% showing grad III pathological change, 90.7% of them had splenomegaly, 20.0% had ascites, and 22.7% had portal vein broadening. The mean value of enzyme indexes of liver function was 31.81 U/L (ALT), 53.19 U/L (AST) and 89.28 U/L (gamma-GT), and the positive rate was 21.3%, 49.3% and 57.3%, respectively. As for the fibrosis indexes, the positive rate of HA, LN, C VI and P III P was 73.3%, 13.3%, 17.3% and 9.3%, respectively, and the mean value of HA was 3 times higher than that of the upper limit of normal standard. Conclusions Newly-developed advanced schistosomiasis patients are those who were dignosed and cured parasitologically but progressed pathologically without any chance of re-infection. Anti-fibrosis therapy is necessary as the patients show considerable progressive liver fibrosis.

[Survey of Toxoplasma gondii infection among pregnant women in Jiangsu Province, China].

OBJECTIVE: To understand the situation of Toxoplasma gondii infection among pregnant women in Jiangsu Province. METHODS: The pregnant women from 7 cities in Jiangsu Province were involved in this survey and the information was recorded according to the request of unified admission information of the case questionnaire of toxoplasmosis in Jiangsu Province. The specific antibodies IgM and IgG to Toxoplasma gondii in sera of these pregnant women were tested by ELISA. RESULTS: The specific antibody IgM to Toxoplasma gondii of all the respondents was negative. The positive rate of IgG was 3.98% (43/1 081), which was little different from the control group's 2.27% (4/176), and every city shared a similar positive rate. The positive rate of IgG of early pregnant women was 3.78%, which was also not obviously different from the 4.17% appearing in mid and late pregnant women. The respondents who previously had pathological abortions did not show positive IgG. Only 1.84% (8/435) of pregnant women had had the examinations related to Toxoplasma gondii before this survey. CONCLUSIONS: The rate of Toxoplasma gondii infection is low among pregnant women in Jiangsu Province. The situations in different areas are not far from each other. We should enhance the peri-conception tests of Toxoplasma gondii and take prevention and treatment countermeasures based on corresponding objects, and also further strengthen the healthy education.

[Diagnosis and treatment of one case of cerebral sparganosis mansoni in Jiangsu Province].

The diagnosis and treatment of one case of cerebral sparganosis suggests that stereotactic positioning operation is an effective treatment, and understanding of the spectrum of parasitic diseases is helpful for the diagnosis and differential diagnosis. However, in non-epidemic area of sparganosis, the classical epidemiological route of transmission is difficult to satisfy the explanation of the current status of the disease.

[Application of SF-36 scale among patients with advanced-schistosomiasis in Jiangsu province].

OBJECTIVE: To understand the reliability and validity on SF-36 scale and the quality of life (QoL) among patients with advanced-schistosomiasis in Jiangsu province. METHODS: Cluster sampling method was used to choose 586 advanced-schistosomiasis patients who were registered in Jiangsu province. Questionnaire including SF-36 module, was used for face to face interview on the patients. Statistical analyses were made to assess the results, including correlation analysis, reliability analysis, factor analysis, t-test and one-way ANOVA. RESULTS: The split-half reliability coefficient was 0.92, P < 0.001 and the internal consistency reliability was 0.90, with the range of Cronbach' α coefficient on each dimension was from 0.69 to 0.98. Through principal component analysis, two factors were identified, with the accumulative contribution rate as 67.37%. SF-36 showed certain discriminant validity to distinguish groups in different economic levels. Compared with the domestic norm data, the scores of SF-36 on those patients were generally lows. CONCLUSION: SF-36 had good reliability and good criterion validity, with a certain degree of discriminant validity, but with poor constructs validity. Level of QoL of patients with advanced schistosomiasis in Jiangsu was low because of being chronically ill, that called for more strategies to improve the QoL of patients.

[Serological investigation on Toxoplasma gondii infection in patients with unknown central nervous system diseases].

Totally 207 patients with unknown central nervous system diseases and 203 healthy persons were investigated for serum IgG of anti-Toxoplasma antibody assessed by ELISA. The serum IgG positive rate in 207 patients with unknown central nervous system diseases was 19.81%, and that in 203 health people was 5.42%, and there was a significant difference between them (P < 0.01). The IgG positive rates in different types of central nervous system diseases were different, which were 22.81%, 24.32%, 16.05%, and 18.75%, respectively in encephalopathy, epilepsy, mental disorder and neurasthenia. The IgG positive rate in different types of central nervous system diseases were significantly higher than that in healthy population (P < 0.01). The IgG positive rates in patients who contacted or did not contact cats or dogs were 32.97% and 9.48% respectively (P < 0.01). In conclusion, the infection rate in patients with unknown central nervous system diseases is higher than that in healthy persons; therefore, it is necessary to assay the serum IgG in them.

[Therapeutic effect of dahuangzhechong pills on advanced schistosomiasis].

OBJECTIVE: To evaluate the therapeutic effect and safety of Dahuangzhechong pills on advanced schistosomiasis. METHODS: Sixty-two patients with advanced schistosomiasis were divided randomly into two groups, a treatment group and a control group, and treated with Dahuangzhechong pills and routine therapy, respectively. The course of treatment was 52 weeks in the two groups. Before and after the 52-week treatment, the indexes of liver function and hepatic fibrosis, prothrombin time (PT), Child-Pugh scores and changes of B-type ultrasonic images were detected for all the patients. RESULTS: There were significant differences in the levels of alanine aminotransferase (ALT) and total bilirubin (TBIL), the indexes of hepatic fibrosis, portal venous inside diameters and portal venous flow between the two groups after 52 weeks treatment (P < 0.05). In addition, there were no obvious adverse effects during the treatment in the patients of the Dahuangzhechong pill group. CONCLUSION: Dahuangzhechong pill treatment is a safe and effective therapy for the patients with advanced schistosomiasis.