Efficacy of sodium metaperiodate (SMP)-ELISA for the serodiagnosis of schistosomiasis mekongi.

Schistosomiasis mekongi is an important public health issue in endemic countries. In this study, we evaluated an indirect immunodiagnostic ELISA method using Schistosoma mekongi soluble egg antigen. Sodium metaperiodate (SMP)-ELISA was utilized in order to remove the glycosylated epitopes responsible for false positive reactions and the results using this method were compared with those using conventional ELISA (conv-ELISA). Forty-two serum samples from schistosomiasis mekongi egg-positive patients and 100 serum samples from schistosomiasis-negative Cambodian subjects were tested using both ELISA methods. The ranges of ELISA values for positive and negative sera were distinct on SMP-ELISA, but the ranges of the two groups of sera overlapped on conv-ELISA. Therefore, diagnostic criteria may be established based on the highest ELISA value on negative sera and the lowest ELISA value on positive sera. In the present study, both the sensitivity and specificity of SMP-ELISA reached 100% using the criteria in which an ELISA value > or = 0.2 was positive.

Identification and differentiation of human schistosomes by polymerase chain reaction.

Recent increasing number of travelers, immigrants and foreign workers from schistosomiasis endemic area has thus resulted in the importation of schistosomiasis to non-endemic countries. To avoid ova-induced pathogenicity, sensitive and specific diagnostic means at an early stage of infection are therefore crucial. In this study, we developed polymerase chain reaction (PCR) primers specific for human schistosome species. The PCR products were obtained in a species-specific manner (479 bp, Schistosoma mansoni; 365 bp, S. haematobium; 614 bp, S. japonicum; 303 bp, S. mekongi) and were detectable from 0.01 pg of total worm DNA (S. haematobium, S. japonicum, S. mekongi). The primer sets were also available for multiplex use. Although some difficulties were experienced in amplifying the parasite DNA from the infected animals, schistosome DNA could be detected from one day post infection. The PCR method described herein will therefore be beneficial to detect human schistosomiasis, after some improvements in this method.

The evaluation of control measures against Schistosoma mekongi in Cambodia by a mathematical model.

We constructed a mathematical model for the transmission of Schistosoma mekongi in Cambodia. The simulation of the model will be instrumental in planning schistosomiasis control measures. The model includes two definitive hosts, humans and dogs, as animal reservoirs. Dogs are recognized to play an important role in schistosomiasis transmission in Cambodia. For the purpose of dealing with age-specific prevalence and intensity of infection, the human population was classified into eight age categories in the model. To describe the seasonal fluctuation of the intermediate host population of S. mekongi, the "Post-Spate Survival" hypothesis was adopted for the population dynamics of Neotricula aperta present in the Mekong River. We carried out simulations to evaluate the effect of universal treatment (UT) and targeted mass treatment (TT) with praziquantel on the reduction in prevalence of S. mekongi. The simulations indicated that biyearly UT for 8 years or yearly TT for 5 years after three courses of yearly UT could reduce the prevalence to below 5% when a UT or TT coverage of 85% of inhabitants was achieved. The simulation suggested that the suppression of S. mekongi in Cambodia would be possible by UT or TT with a high coverage rate.

Schistosoma mekongi and Schistosoma japonicum: Differences in the distribution of eggs in the viscera of mice.

The difference in the distribution of Schistosoma eggs in the viscera has not been clearly elucidated in the two closely related species Schistosoma japonicum and Schistosoma mekongi. In this study, we quantitatively compared the distribution of eggs in mice infected with the two species. In S. mekongi-infected mice, 56.6% to 69.4% of total eggs were found in the distal small intestine 9 to 15 weeks after infection, while in S. japonicum-infected mice, 48.8% to 71.8% of eggs were found in the proximal small intestine during the same period. There were significantly more eggs in the liver in mice infected with S. japonicum than in those infected with S. mekongi. The number of adult worms recovered did not differ between the two species during the study period. The total number of eggs laid in the tissues also did not differ between the two species at 12 to 15 weeks postinfection, but in the earlier period the total number of eggs was significantly fewer in S. mekongi-infected than in S. japonicum-infected mice, suggesting the delayed maturation of the former compared with the latter. These results clearly show that S. japonicum and S. mekongi exhibit different oviposition behavior in their hosts.

High susceptibility of Neotricula aperta gamma-strain from Krakor and Sdau in Cambodia to Schistosoma mekongi from Khong Island in Laos.

Neotricula aperta gamma-strain snails collected from Krakor and Sdau in Cambodia were found to have the same or higher susceptibility to Schistosoma mekongi as N. aperta originally isolated from Khong in Laos. Infection rates of N. aperta gamma-strain snails exposed to 3 miracidia at week 8 were: Khong gamma-strain, 22.6%; Krakor gamma-strain, 33.3%; and Sdau gamma-strain, 67.4%. At week 10, the Sdau gamma-strain showed the highest infection rate of 83.3%. We thus found significantly high susceptibility of the Sdau gamma-strain to S. mekongi originally isolated from Khong. However, in another experiment, susceptibility of the Sdau gamma-strain was rather comparable to that of Khong and Krakor gamma-strain. We also found no significant differences in infection and survival rates between the Khong and Krakor gamma-strain when the snails were exposed to 3 or 6 miracidia. This is the first report to confirm the high susceptibility in the laboratory of N. aperta gamma-strain snails from endemic areas in Cambodia to S. mekongi originally isolated from Laos. The high susceptibility of N. aperta gamma-strain snails to S. mekongi in distant areas may be an important factor in the endemic transmission of human schistosomiasis.

Enhancement of splenic glucose metabolism during acute malarial infection: correlation of findings of FDG-PET imaging with pathological changes in a primate model of severe human malaria.

In the current study, to elucidate the clinical features of severe malaria, we performed whole-body positron emission tomography (PET) with (18)F-fluorodeoxyglucose (FDG) of Plasmodium coatneyi-infected acute-phase Japanese macaques. The infected monkeys clearly exhibited increase in splenic FDG uptake indicating marked enhancement of glucose metabolism. The standardized uptake values (SUVs) of the spleen in the infected monkeys were significantly higher than those in the uninfected monkey. At autopsy, splenomegaly was clearly present in all infected monkeys, and histopathologic findings included hyperplasia of lymphoid follicles in white pulp, a large number of activated macrophage, and congestion of parasitized red blood cells (PRBCs) and malaria pigments in red pulp. We suggest that increase in splenic glucose uptake may thus be closely related to activation of splenic clearance system against blood-stage malarial parasites.

Modeling the dynamics and control of Schistosoma japonicum transmission on Bohol island, the Philippines.

We have investigated a mathematical model for the transmission of Schistosoma japonicum in the infested region of northeastern Bohol island in the Philippines. The development of transmission models is important for planning control strategies. Since S. japonicum has a complicated mode of transmission, the rates of transmission among its hosts cannot be measured directly by field observation. Instead, they have been estimated through model analysis. The model takes into account the seasonal variations and includes a function of control measures. In 1981, a project to eliminate schistosomiasis started on Bohol island. The prevalence decreased dramatically and has kept low level less than 1%. The simulations based on the model predicted that there is little probability of resurgence of an epidemic in the northeastern endemic villages of Bohol island due to the fact that the project has attained a high coverage of selective mass treatment based on stool examination accompanied by a successful snail control operation.

Effects of repeated praziquantel treatment on schistosomiasis mekongi morbidity as detected by ultrasonography.

Schistosomiasis mekongi is endemic in the Mekong River basin; about 80,000 people are at risk of infection in Cambodia. We conducted ultrasonographic studies of patients with schistosomiasis mekongi in Kratie province, Cambodia, focusing especially on the relationship between the frequency of praziquantel treatment and findings of ultrasonographic imaging. The frequency of praziquantel treatment in the period from 1995 to 2002 was classified into four groups: 1-2, 3-4, 5-6, and 7-8 times. Ultrasonographic images were examined to determine the presence of thickening of the portal vein wall and formation of meandering collateral circulation of the splenic vein. We selected these parameters because they are unaffected by interobserver bias. The results showed that thickening of the portal vein wall may have potential to improve with frequent praziquantel treatment. On the other hand, established hard splenomegaly and meandering collateral circulation of the splenic vein, improved very little with praziquantel treatment.

Determination of the period for establishment of a liver network echogenic pattern in Schistosoma japonicum infection.

Schistosomiasis is caused by infection with Schistosoma haematobium, S. mansoni, S. japonicum, or S. mekongi. S. japonicum infection results in liver cirrhosis at the final stage. A "network" (NW) echogenic pattern on hepatic ultrasonography appears to be specific to S. japonicum infection. The principal aim of the present study was to determine the exact year(s) or even month(s) required for the establishment of the liver NW echogenic pattern from the initial infection in young patients with schistosomiasis japonica since there are few data on this important point. We conducted yearly ultrasonographic, serologic, coprologic, and physical examinations of schistosomiasis patients in the Philippines from 1996 up to the present. During that period, the total number of patients examined was approximately 2,000, among whom we selected 2 patients for determination of the duration required for NW establishment, when they were 10 years old. Although the exact time of initial exposure to schistosomes cannot be determined, the duration for the establishment of NW was definitively confirmed in patient no. 1 to be between 19-24 months based on the results of serologic and coprologic examinations. For patient no. 2, the circumstantial evidence suggested that the establishment of a NW might require 5 to 6 years at maximum. To the best of our knowledge, this is the first evidence-based report on the determination of the period required for the establishment of a liver NW echogenic pattern in S. japonicum infection in the Philippines.

A rapid and simplified ELISA using whole blood samples of Schistosoma japonicum-infected rabbits.

A rapid and simplified ELISA using whole blood samples of Schistosoma japonicum-infected rabbits was compared with a conventional ELISA. This whole-blood ELISA has advantages. The volume of crude egg antigens, whole blood samples, and conjugates was only 0.05 ml. The incubation time was shortened to 5 minutes. Wells were washed three to five times with PBS-Tween after each procedure. Optical density values were measured in 10 minutes after transfer of 0.1 ml of substrate. Constant temperature was not necessary. The entire procedure took only 20-30 minutes.

Development of the rapid and simple elisa (whole blood-ELISA) using coconut water-tween as a wash solution for whole blood sample from Schistosoma japonicum-infected rabbit and human.

PBS-Tween as a wash solution, prepared with distilled water, is used in ELISA. In areas where schistosomiasis is endemic, however, distilled water is hard to come by. We have modified a WHOLE BLOOD-ELISA test to use coconut water-Tween as a wash solution, because coconut water is easy to come by and cheap in the tropics. We applied the test to whole blood samples from rabbits and humans infected with Schistosoma japonicum. This modified WHOLE BLOOD-ELISA was confirmed to be a rapid, simple, and cost-effective method.

Development of the rapid and simplified ELISA (WHOLE BLOOD-ELISA) using samples of Schistosoma japonicum-infected human whole blood.

An ELISA technique was developed using samples of Schistosoma japonicum-infected human whole blood based on the conventional ELISA. In this study, the following were demonstrated. 1) Whole blood samples could be used. 2) The volume of whole blood and conjugate could be reduced to 0.05 ml. 3) The incubation time was shortened to 5 minutes. 4) The optical density could be measured at 10 minutes after transferring the substrate and the volume was reduced to 0.1 ml. 5) It did not require a fixed temperature setting. 6) The operation time was as short as 20 to 30 minutes. 7) The optical density values were almost the same as the conventional ELISA and were not influenced by other common intestinal helminthic infections. 8) The observed variations from day to day including effects of sampling in stool examination were negated by the results of this ELISA technique. 9) Based on correlation with stool examination results, criteria can be formulated in which optical density values of 0.3 and above as positive, 0.1 to less than 0.3 as doubtful, and less than 0.1 as negative. Whenever an immunological field survey is necessary, before and after a selective or a mass treatment control program, this WHOLE BLOOD-ELISA, which was shown to be rapid and simple, is recommended.

Therapeutic effect of subcurative dose praziquantel on Schistosoma mansoni infected mice and resistance to challenge infection after treatment.

The therapeutic effect of a subcurative dosage of praziquantel (PZQ) on Schistosoma mansoni infected mice and resistance to challenged worm infection after treatment were assessed and compared with conventional treatment using a curative dosage of PZQ. S. mansoni infected mice were treated with PZQ at a curative dosage (600 mg kg(-1)) or a subcurative dosage (300 mg kg(-1)) at 9 weeks after infection. Untreated mice and non-infected mice were added as controls. The therapeutic effect of the drug was evaluated in terms of the mortality of mice after treatment, and the parasitological and pathological findings in mice sacrificed at 1 week, 1 month, or 3 months after treatment. Another sample of mice was not killed but challenged with S. mansoni cercariae at 1 week, 1 month, or 3 months after treatment. Resistance to re-infection was evaluated by the extent of challenged worm reduction. In conclusion, there was no significant difference in mortality, or parasitological and pathological findings between mice treated with PZQ at the two dosages. However, resistance to challenged worm infection was more sustained in the group treated with subcurative dose PZQ, especially at 3 months after treatment.

Comparative studies on the pathological findings and mortality in Schistosoma mansoni infected mice after treatment with artesunate and the current antischistosomal drugs.

The effect of artesunate (ART) on the pathology and mortality rate of in Schistosoma mansoni infected mice was comparatively studied with the current drugs of choice for the treatment of schistosomiasis mansoni: praziquantel (PZQ) and oxamniquine (OX). S. mansoni experimentally infected mice were treated at 9th week of infection with ART, PZQ or OX at an oral dosage of 300 mg kg(-1), 600 mg kg(-1) and 100 mg kg(-1), respectively. Untreated, infected mice and non-infected mice were added as controls. Samples of mice were sacrificed and examined for the pathological findings at 1 week, 1 month, and 3 months after treatment. At 1 week after treatment, both gross and microscopic lesions were observed. No significant differences were noted among the infected groups. Differences were observed at 1 month after treatment. The lesions decreased more rapidly in groups treated with PZQ and OX. At 3 months after treatment, there were significant differences in the pathological findings among groups. In the groups treated with PZQ and OX, the lesions were markedly reduced and rarely found, but they were clearly observed in the group treated with ART and in the untreated, infected group. High mortality was also recorded in the group treated with ART and in the untreated, infected group. Therefore, the treatment of S. mansoni infected mice at 9 weeks of infection with ART did not reduce the pathological findings or the mortality rate compared to treatment with the current recommended schistosomicides, PZQ and OX.

Comparative studies on the internal defense system of schistosome-resistant and -susceptible amphibious snail Oncomelania nosophora 1. Comparative morphological and functional studies on hemocytes from both snails.

Two morphologically distinct blood cell types (hemocytes), Type I and Type II were found coexisting in hemolymph from two kinds of snails, Oncomelania nosophora strain, viz. from the Nirasaki strain (schistosome-resistant snail) and the Kisarazu strain (schistosome-susceptible snail). Ten min after inoculation of SRBC, the majority of Type I cells from Nirasaki strain flattened and spread over the surface of the glass plate by extending pseudopodia. In the Kisarazu strain, Type I cells adhered to the surface of substrate with spike-like filopodia, but did not form spreading lamellipodia. Type I cell from the Nirasaki strain phagocytosed SRBC but that from the Kisarazu strain did not. The starting time of recognition of foreign materials was slightly different in the Type I hemocytes from the two strains. Type II cells from both strains were round and lymphocyte-like. Ten or sixty min after incubation, Type II cells from neither strain adhered to the surface of substrate or SRBC, and did not phagocytose SRBC. Type II cells from the Nirasaki strain were quite similar to those from the Kisarazu strain. We concluded that Type I cells from the schistosome-resistant snail, Nirasaki strain, possessed higher phagocytic activity than those from the susceptible snail, Kisarazu strain, despite the morphological similarities of the hemocytes from both strains.

Efficacy of administration of praziquantel on 2 days 2 weeks apart against Schistosoma japonicum eggs in mice.

We compared a group of mice given multiple oral doses of praziquantel (PZQ) on 1 day 7 weeks after infection with Schistosoma japonicum and another group given multiple doses of PZQ over 2 days (7 and 9 weeks after infection) by examining the number of schistosome eggs and oograms in their tissues and feces. In the 1-day-protocol group (4 x 100 mg/kg x 1 day), calcified dead eggs or shells accounted for 77.4 and 70.1% of the total EPG (the total number of immature eggs, mature eggs, and calcified eggs and shells per 1 g tissue) in the liver and small intestine, respectively, 11 weeks after infection. Shells accounted for nearly half of the total EPG (54.3% liver and 46.6% small intestine). Mature eggs accounted for 8.4% (liver) and 5.1% (small intestine) of the total EPG. Only shells were found in the feces. In the 2-day-protocol group (4 x 100 mg/kg x 2 days, 2 weeks apart), dead eggs accounted for 87.2 and 89.5% of the total EPG in the liver and small intestine, respectively, 11 weeks after infection. Shells accounted for 62.5% (liver) and 75.8% (small intestine) of the total EPG. In the 2-day group, mature eggs accounted for 0.9% (liver) and 0.6% (small intestine) of the total EPG. In liver and small intestine, the EPG of immature and mature eggs in the 2-day group was significantly smaller than in the 1-day group. Especially, the tendency was clear in the case of the EPG of mature eggs. There were no schistosome eggs in the feces of the 2-day group. We found that administration of PZQ over 2 days separated by a 2-week interval was effective against S. japonicum.

Existence of host DNA sequences in schistosomes--horizontal and vertical transmission.

The localization of repetitive DNA sequences in the mouse genome such as mouse type 2 Alu sequence (B2) and mouse retrovirus-related sequences was shown in the body of adult Schistosoma japonicum and Schistosoma mansoni by applying an in situ PCR and hybridization technique. Using the same method, mouse major histocompatibility complex (MHC) class I sequence was also found in schistosomes. Furthermore, mouse MHC class I sequence and type A retroviral sequence were detected in S. japonicum and S. mansoni cercarial DNA by blot hybridization. These findings indicated that horizontal and vertical transmission of host DNA sequences occurred in schistosomes. The incorporation and propagation of host sequences in schistosomes and the roles played by such host sequences form the focus of this brief review.

Biological characteristics and control of intermediate snail host of Schistosoma japonicum.

Except for imported cases, we have had no new Schistosoma japonicum infection in Japan since 1977. But there are still two habitats of the intermediate snail host: Oncomelania nosophora in the previous endemic areas of Kofu Basin and Obitsu. O. nosophora from Kofu Basin and Obitsu are susceptible to Chinese and Philippine strains of S. japonicum. The number of immigrants from current endemic areas in China or the Philippines is increasing. In order to prevent re-emerging of S. japonicum infections in Japan, we should continue monitoring on those existing snail hosts and investigate an adequate quarantine system. In Japan, elimination of schistosomiasis has been mainly accomplished by control of the snail host. As measures of snail control, cement-lining of ditches and chemical mollusciciding were most effective in Japan. But the cost of this joint program is too expensive compared with health budget in almost developing countries. In endemic areas of Japan, land reformation from paddy field to fruit farm was also effective. The intermediate snail host in the Philippines, Oncomelania quadrasi is much more aquatic than O. nosophora. For control of O. quadrasi, small drainage of the water and land reclamation from swampy field to rice-field were effective. Based on biological characteristics of Oncomelania spp., we can modify the past successful snail control program in Japan to be adapted ecologically and economically to each endemic area of developing countries.

Fixed-point observation of Oncomelania nosophora in Kofu Basin--establishment of monitoring system of schistosomiasis japonica in Japan.

There are still many Oncomelania snails that inhabit the Kofu Basin, Yamanashi Prefecture, Japan, which had been declared free of schistosomiasis japonica. Due to the need to monitor the situation, a fixed-point observation system using GIS from GPS is being examined. In addition, in broad present or former endemic areas, survey areas are being managed by remote sensing with satellite images or aerial photographs. A simple and effective monitoring method by mobile GIS using PDAs was developed, risk or hazard maps were prepared and a system that would enable a response in the event of reemergence is being examined.

The schistosomiasis problem in the Philippines: a review.

A descriptive study was carried on the schistosomiasis problem in the Philippines from the time the disease was discovered in 1906 to the latter part of the 1990 s. Some research findings were reviewed including the nature of the disease itself. Based on the thrust of the control program which is centered mainly on selective mass treatment and progressed to disease stratification and mass treatment using praziquantel, a downward trend in the prevalence of the disease was observed-from an average of 10.4% in 1981-1985 to 4.1% in 1996. Recommended prospective action, among others, include the development of strategies on environmental sanitation and snail control/eradication in the thrust of the schistosomiasis control program. Other policy related concerns should be formulated subject to the results of further research activities such as on (a) chemotherapy; (b) drug delivery schemes; (c) diagnosis; (d) search for a safe, economical and effective chemical(s) for vector control; and (e) prophylaxis and vaccine production for protection against infection for disease modulation or reduction of pathology.