Schistosoma haematobium urinary tract complications in African migrants attending primary care facilities in Paris, France: A retrospective cohort study (2004-2018).

OBJECTIVES: Little is known about the burden of urogenital schistosomiasis (UGS) outside endemic areas. This study was aimed at describing urinary complications of UGS detected among African migrants in French primary care facilities. PATIENTS AND METHODS: A retrospective cohort study included patients with UGS diagnosed from 2004 to 2018 in 5 primary health centers in Paris. Cases were defined by the presence of typical Schistosoma haematobium eggs at urine microscopy. Demographic, clinical, biological and imaging data were collected. Ultrasonography (U-S) findings were classified in accordance with the WHO guidelines. RESULTS: U-S was prescribed for all patients and performed in 100/118. Sex ratio (F/M) was 2/98, and mean age 24.4 years. Patients were from West Africa (73% from Mali) and consulted 8 months (median) after their arrival. Among the 95 patients with interpretable findings, 32 (33.7%) had abnormalities related to UGS, considered as major in 6 cases (6.3%), and mostly localized at the bladder (31/32) without detection of cancer. No sociodemographic, clinical, or biological factors were found to be associated with U-S abnormalities. All 100 patients were treated by praziquantel (PZQ). Among those with abnormalities, 20/32 received two to four doses at various time intervals. Post-cure imaging control performed in 19/32 showed persistent abnormalities in 6 patients, on average 5 months after the last PZQ uptake. CONCLUSION: Urinary tract abnormalities associated with UGS were common and predominated at the bladder. U-S should be prescribed to any patient with positive urine microscopy. Schedules for PZQ uptake and U-S monitoring for patients with complications remain to be determined.

[Failure to offer parasitology screening to vulnerable migrants in France: Epidemiology and consequences]. / Défaut de proposition de dépistage parasitologique à des migrants précaires en France : facteurs épidémiologiques et conséquences.

The "Consultations de Diagnostic et d'Orientation" (CDO), created in 1998 by the Paris Health Department, are medical consultations for vulnerable populations, which are held in municipal clinics, free of charge. More than two-thirds of CDO patients come from Africa. Our study was designed to assess and analyze whether these clinics offered consulting migrants screening for intestinal parasitic and Schistosoma haematobium infections.Material and methodsThis retrospective study included all immigrants attending CDO for the first time at four Parisian municipal free clinics during 2003. Univariate and multivariate analysis adjusted for age, sex, and geographic origin were conducted. An interview with one of the CDO physicians provided qualitative data to round out the quantitative data from the record analysis.ResultsThe study included 503 migrants eligible for screening for intestinal parasitic infections because they come from regions where these infections are endemic; among them 481 were also eligible for urine screening for Schistosoma haematobium (SH). The sociodemographic characteristics for the entire sample (not significantly different from the 481-person subgroup) were: sex ratio (M/W): 4:1; more than 50% were 35 years old or younger; and more than 50% had no health insurance coverage. Overall, around 80% came from sub-Saharan Africa, around 16% from North Africa or the Middle East, and 4.5% from Asia or South America. Screening for intestinal or urinary parasitic infections was not offered to 3 out of 5 migrants from endemic areas. Screening for intestinal parasites was offered less often to migrants from regions other than sub-Saharan Africa, to those older than 35 years of age, and to those without abdominal symptoms. Schistosoma haematobium urine screening was proposed less often to those from North Africa or the Middle East, to those older than 35 years of age, and to those without either abdominal or genitourinary symptoms. Microscopic examination of urine for Schistosoma haematobium was performed for 171 patients; 22 positive results were reported, with viable SH eggs (13%). Microscopic examination of stool for ova and parasites was performed for 161 patients; 32 had positive results (20%). These included 14 cases of Entamoeba histolytica/dispar (our laboratory cannot distinguish the 2 strains).DiscussionThe failure to offer screening affects sub-Saharan Africans less than other migrants, perhaps because of a particular visibility due to their mass (they are the most prominent subgroup of migrants) or their higher frequency of abdominal/genitourinary symptoms. Nevertheless, more than 50% of them were not asked to undergo parasite screening, although they are the group with the highest rate of intestinal/urinary parasitosis. The most common and dangerous parasite found was Schistosoma haematobium; we do not know the pathogenicity of the Entamoeba found. Reasons for the frequent failure to suggest these screenings may include that physicians consider parasitosis as diseases of secondary importance, or have forgotten its symptoms, epidemiology, cycles, means of diagnosis, or treatment. Patients accepted the screening well when it was offered. Reasons during the course of consultation might have included insufficient time for pre-test counselling, some difficulties in communicating with the patient in French, or an overriding request or complaint from the patient. We propose the following strategy for parasite screening in CDO: standard "stool ova and parasite exams" proposed to any migrant in France for less than 5 years except sub-Saharan Africans, who should receive presumptive anti-parasite treatment instead; microscopic examination of urine for Schistosoma haematobium for sub-Saharan Africans from endemic regions. This detection can avoid - if treatment is early enough - severe uronephrological complications, which are rare but costly from a health care perspective (bladder tumor, renal failure). Physicians in non-tropical settings must remember to consider parasite infections when they see patients from endemic regions.

[Targeted screening proposed in 6 migrant worker housing units in Paris in 2005: feasibility and impact study.]. / Dépistages ciblés proposés dans 6 foyers de migrants à Paris en 2005 : étude de faisabilité et d'impact.

Within the framework of the Mobile Radiological TB Screening Unit of the Health Department of Paris (DASES), six migrant worker housing units were selected to benefit from the presence of a health care professional on-site. This presence would ensure that following a chest X-Ray, residents would be offered the possibility of an interview with a general practitioner about Schistosoma haematobium (Sch. h.) including: collection of a urine specimen on-site (microscopic detection of eggs performed at the lab the next day), and free medical consultation (CDO) in a neighbouring municipal free clinic proposed to people expressing a health problem. The objective is to assess feasibility and impact of screenings undertaken on-site and thereafter, within free clinics. CDO have been created for precarious populations by the DASES in 1998. 97 persons received an individual interview, of which 52 have undergone Sch. h. screening. 3 cases were found (5.7%). 57 persons went to the CDO out of 75 to whom it was offered (18 no-show). In total, 33 pathologies were detected among 24 patients: HBV infection (7 cases), Sch. h. (9 cases), intestinal parasitic infection (5 cases), sexually transmitted infection (2 cases), HIV-2 infection (1 case) and fewer non infectious diseases. The treatable diseases detected have all been treated free of charge. Community health services which involve screening and assessment by going directly to those persons in migrant worker housings is worthwhile for Sch. h. (although it is less efficient on-site than in CDO) and for HBV screening. This personalized, individual, and targeted contact supports the development trust and confidence of the migrants in order to then visit a GP and a social worker in a Municipal Clinic. But the follow-up of people diagnosed with a chronic disease is uncertain and costly for patients without full social security coverage. The continuation of such prevention programmes is recommended in such housing units.

[Discovery of Chlamydia trachomatis in the throat during diagnosis of secondary syphilis in an HIV+ patient]. / Découverte de Chlamydia trachomatis dans la gorge lors d'un diagnostic de syphilis secondaire chez un sujet VIH +

INTRODUCTION: Chlamydia trachomatis (CT) pharyngitis has rarely been described in the literature. Studies in the last decade have shown a prevalence of less than 5%, with more women than men infected in the pharynx. Among homosexual men, only one study, conducted more than 5 years ago, detected the presence of CT in the throat (in one patient out of 13 tested). OBSERVATION: A 33 year-old homosexual man consulted for cutaneous lesions on the palms and the chest. Infected by HIV, he was taking antiretroviral therapy but no antibiotic prophylaxis. He admitted practising unprotected (insertive and receptive) fellatio with unknown partners. The lesions were those of secondary syphilis but the location of the chancre remained unknown. An enlarged screening for sexually transmitted infections detected the presence, through molecular amplification, of CT in the throat without further localisation (urethra, anus). After intramuscular injection of Extencillin and an 8-day-regimen of cycline, CT was no longer detected in the throat. The course of HIV infection did not appear modified by this infectious episode. COMMENTS: According to a review of the literature, the 4 most recent studies have not revealed CT in the throat of homosexuals although the bacteria was detected in the urethra of 3 to 4% of them. Chlamydia trachomatis is more frequently detected in the genital tract rather than the pharynx of women also screened in various localisations. These results must be tempered by the participant recruitment methods, diagnostic methods used, sample size and history of recent antibiotherapy. The pharyngeal mucosa might be less receptive to CT than the urethral mucosa. Association of CT pharyngitis with syphilis or its occurrence during HIV infection are not documented. The molecular amplification technique detects CT in the throat with sensitivity and specificity. A one-week regimen of cycline can cure this pharyngitis. Cost-effectiveness of screening for pharyngeal CT has not yet been assessed in persons 'at risk'.