Kato-Katz slide preservation technique: Extension of viability and the benefits for schistosomiasis control programs.

The World Health Organization recommends the use of the Kato-Katz method in the procedures of schistosomiasis control programs. Studies show the importance of a fast reading of the slides due to the decline of their viability, with the appearance of fungi or desiccation of the sample, which hinders diagnosis. It is necessary to establish a procedure to improve the long-term preservation of these Kato-Katz slides in order to accomplish the following: (1) preserve the slides for future quality control procedures and readings; (2) allow for the production of durable materials for training; and (3) train health professionals involved in diagnosing schistosomiasis. Therefore, this study aims to test a slide preservation methodology for these purposes. The results showed that the modifications made to the experimental slides demonstrated that egg loss was within the expected range and the limit accepted by quality control standards, as well as improved the diagnostic durability of the slides during the preservation times tested. We concluded that the application of the preservation technique to the slides promoted stabilization and permanence for long-term storage.

Spinal neuroschistosomiasis caused by Schistoma mansoni: cases reported in two brothers.

BACKGROUND: Spinal neuroschistosomiasis (SN) is one of the most severe clinical presentations of schistosomiasis infection and an ectopic form of the disease caused by any species of Schistosoma. In Brazil, all cases of this clinical manifestation are related to Schistosoma mansoni, the only species present in the country. Although many cases have been reported in various endemic areas in Brazil, this is the first time in the literature that SN is described in two brothers. CASE PRESENTATION: Two cases of SN were accidentally diagnosed during an epidemiological survey in an urban area endemic for schistosomiasis transmission. Both patients complained of low back pain and muscle weakness in the lower limbs. Sphincter dysfunction and various degrees of paresthesia were also reported. The patients' disease was classified as hepato-intestinal stage schistosomiasis mansoni at the onset of the chronic form. A positive parasitological stool test for S. mansoni, clinical evidence of myeloradicular damage and exclusion of other causes of damage were the basic criteria for diagnosis. After treatment with praziquantel and corticosteroid, the patients presented an improvement in symptoms, although some complaints persisted. CONCLUSIONS: It is important to consider SN when patients come from areas endemic for transmission of schistosomiasis mansoni. Clinical physicians and neurologists should consider this diagnostic hypothesis, because recovery from neurological injuries is directly related to early treatment. As, described here in two brothers, a genetic predisposition may be related to neurological involvement. Primary care physicians should thus try to evaluate family members and close relatives in order to arrive at prompt schistosomiasis diagnosis in asymptomatic individuals and propose treatment in an attempt to avoid progression to SN.

Spatial risk analysis on occurrences and dispersal of Biomphalaria straminea in and endemic area for schistosomiasis.

BACKGROUND & OBJECTIVES: : Schistosomiasis is a rural endemic disease that has been expanding to urban and coastal areas in the state of Pernambuco, Brazil. The aim of this study was to characterize the distribution of breeding sites of the causative vector, Biomphalaria straminea in an endemic municipality for schistosomiasis and to present the predictive models for occurrences and dispersal of this vector snail to new areas. METHODS: : A malacological survey was conducted during January to December 2015 in the municipality of São Lourenço da Mata, Pernambuco, Brazil to identify the breeding sites of Biomphalaria. Faecal contamination was determined by means of the Colitag™ diagnostic kit. Rainfall data were collected, and correlated with snail distribution data. Kernel density estimation, kriging and maximum entropy (MaxEnt) modeling were used for spatial data analysis, by means of the spatial analysis software packages. RESULTS: : Out of the 130 demarcated collection points, 64 were classified as breeding sites for B. straminea. A total of 5,250 snails were collected from these sites. Among these 64 sites, four were considered as foci of schistosomiasis transmission and 54 as potential transmission foci. An inverse relationship between rainfall and snail density was observed. Kernel spatial analysis identified three areas at higher risk of snail occurrence, which were also the areas of highest faecal contamination and included two transmission foci. Kriging and MaxEnt modeling simulated the scenarios obtained through the kernel analyses. INTERPRETATION & CONCLUSION: : Use of geostatistical tools (Kriging and MaxEnt) is efficient for identifying areas at risk and for estimating the dispersal of Biomphalaria species across the study area. Occurrence of B. straminea in the study area is influenced by the rainy season, as it becomes more abundant during the period immediately after the rainy season, increasing the risk of dispersal and the appearance of new transmission foci.

Risk analysis for occurrences of schistosomiasis in the coastal area of Porto de Galinhas, Pernambuco, Brazil.

BACKGROUND: Manson's schistosomiasis continues to be a severe public health problem in Brazil, where thousands of people live under the risk of contracting this parasitosis. In the Northeast of Brazil, schistosomiasis has expanded from rural areas to the coast of Pernambuco State, where the intermediate host is Biomphalaria glabrata snails. This study aims at presenting situational analyses on schistosomiasis at the coastal locality of Porto de Galinhas, Pernambuco, Brazil, by determining the risk factors relating to its occurrence from the epidemiological and spatial perspectives. METHODS: In order to gather prevalence data, a parasitological census surveys were conducted in 2010 in the light of the Kato-Katz technique. Furthermore, malacological surveys were also conducted in the same years so as to define the density and infection rates of the intermediate host. Lastly, socioeconomic-behavioral survey was also conducted to determine the odds ratio for infection by Schistosoma mansoni. Based on these data, spatial analyses were done, resulting in maps of the risk of disease transmission. To predict the risk of schistosomiasis occurrence, a multivariate logistic regression was performed using R 2.13 software. RESULTS: Based on prevalence, malacological and socioeconomic-behavioural surveys, it was identified a prevalence of 15.7% in the investigated population (2,757 individuals). Due to the malacological survey, 36 breeding sites were identified, of which 11 were classified as foci of schistosomiasis transmission since they pointed out snails which were infected by Schistosoma mansoni. Overall, 11,012 snails (Biomphalaria glabrata) were collected. The multivariate regression model identified six explanatory variables of environmental, socioeconomic and demographic nature. Spatial sweep analysis by means of the Bernoulli method identified one statistically significant cluster in Salinas (RR = 2.2; p-value < 0.000), the district with the highest occurrence of cases. CONCLUSIONS: Based on the resulting information from this study, the epidemiological dimensions of this disease are significant and severe, within the scenario of schistosomiasis in Pernambuco state. The risk factors which were identified in the predictive model made it clear that the environmental and social conditions influence on the schistosomiasis occurrences.

Malacological, socio-environmental evaluation, and evidence of local transmission and maintenance of schistosomiasis in an urban area of Northeast Brazil.

To present the current epidemiological scenario of schistosomiasis related to urban transmission through an epidemiological risk assessment in Porto de Galinhas, a coastal area of Pernambuco, Brazil. Malacological and parasitological surveys were performed between the years 2018 and 2020. Snails were identified taxonomically and examined to confirm infection by Schistosoma mansoni, and so to identify Schistosomiasis Transmission Foci (STF) by the artificial light exposure technique. Stool samples were examined using the Kato-Katz method to identify schistosomiasis cases. Socioeconomic, environmental, behavioural and health data were collected by a questionnaire applied to participates in the survey and used to predict the schistosomiasis risk occurrence by multivariate logistic regression. In all, a total of 6466 snails of Biomphalaria glabrata were collected and 36 breeding sites were identified, of which 25 % were STF. A total of 2236 individuals took part of the survey which identified 187 cases of schistosomiasis, registering a positivity percentage of 8.36 %. The surveys identified the neighbourhoods with the highest risk for transmission while the socioenvironmental analysis identifies other risk factors for disease occurrence, such as gender, age range, level of education and absence of water drainage. We found that areas with poor sanitation, flooding during winter periods and dwellings located near mangroves should be treated by health authorities as priority areas for health interventions to minimize disease transmission. In addition, efforts to improve the population's educational level could certainly contribute to the adoption of measures to prevent and control this neglected tropical disease.

Factors associated with severe forms and deaths from schistosomiasis and application of probabilistic linkage in databases, state of Pernambuco, Brazil, 2007-2017. / Fatores associados às formas graves e aos óbitos por esquistossomose e aplicação do linkage probabilístico nas bases de dados, Pernambuco, 2007­2017.

OBJECTIVE: To verify the agreement of data on severe forms and deaths from schistosomiasis recorded in the Brazilian Notifiable Diseases Information System and the Mortality Information System, sociodemographic variables with the occurrence of severe forms and deaths, and the temporal trend of the disease in the state of Pernambuco, Brazil. METHODS: This is an ecological, descriptive, time series study with data on severe forms and deaths from schistosomiasis in Pernambuco, from 2007 to 2017. For the linkage between databases, a function was developed in python programming language, using the Soundex method. To identify sociodemographic and health factors that correlated with the dependent variables, Pearson's correlation test was applied. For trend analysis, linear regression was applied. RESULTS: We identified 9,085 severe cases, 1,956 deaths, and 186 cases in the linkage. The correlation between the average positivity rate with the general water supply and waste collection was 0.22 and 0.26 respectively. We verified a correlation of the average cumulative mortality rate with water supply by well or spring (r=0.27), water supply by the general network (r=0.3), waste collection (r=0.42), and road urbanization (r=0.29). We found 3,153 severe forms in 2007 with a decrease trend and 205 deaths in 2010, without a trend pattern. CONCLUSION: There is a need for greater investments in disease control and in the quality of information, especially in the record of severe forms, considering that, due to the pathophysiology of the disease, death only occurs when the individual develops the chronic form, and its notification on the Notifiable Diseases Information System is imperative.

OBJETIVO: Verificar a concordância dos dados relacionados às formas graves e aos óbitos por esquistossomose registrados no Sistema de Informação de Agravos de Notificação e no Sistema de Informação Sobre Mortalidade, as variáveis sociodemográficas com a ocorrência das formas graves e óbitos e a tendência temporal da doença em Pernambuco. MÉTODOS: Trata-se de um estudo ecológico, descritivo, de série temporal com dados referentes às formas graves e aos óbitos por esquistossomose em Pernambuco, de 2007 a 2017. Para o linkage entre as bases de dados, foi desenvolvida uma função em linguagem python de programação, utilizando o método soundex. Para identificar fatores sociodemográficos e sanitários que se correlacionaram com as variáveis dependentes, foi aplicado o teste de correlação de Pearson. Para a análise de tendência, aplicou-se a regressão linear. RESULTADOS: Identificaram-se 9.085 casos graves, 1.956 óbitos e 186 casos no linkage. A correlação entre a taxa média de positividade com o abastecimento hídrico rede geral e coleta de lixo foi 0,22 e 0,26 respectivamente. Houve correlação da taxa média de mortalidade acumulada com abastecimento hídrico por poço ou nascente (r=0,27), abastecimento hídrico por rede geral (r=0,3), coleta de lixo (r=0,42), urbanização das vias (r=0,29). Ocorreram 3.153 formas graves em 2007, com tendência a redução, e 205 óbitos em 2010, sem um padrão de tendência. CONCLUSÃO: Há necessidade de maiores investimentos no controle da doença e na qualidade da informação, especialmente no registro das formas graves, pois, dada a fisiopatologia da doença, o óbito só ocorre quando o indivíduo desenvolve a forma crônica, sendo imperativo sua notificação no Sistema de Informação de Agravos de Notificação.

FioSchisto's expert perspective on implementing WHO guidelines for schistosomiasis control and transmission elimination in Brazil.

The World Health Organization (WHO) recognizes schistosomiasis as one of the Neglected Tropical Diseases targeted for global elimination in the 2030 Agenda of the Sustainable Development Goals. In Brazil, schistosomiasis mansoni is considered a public health problem, particularly prevalent among vulnerable populations living in areas with poor environmental and sanitary conditions. In 2022, the WHO published a Guideline encompassing recommendations to assist national programs in endemic countries in achieving morbidity control, eliminating schistosomiasis as a public health problem, and advancing towards interrupting transmission. The perspectives presented here, collectively prepared by members of the Oswaldo Cruz Foundation's (Fiocruz) Schistosomiasis Translational Program (FioSchisto), along with invited experts, examine the feasibility of the WHO recommendations for the Brazilian settings, providing appropriate recommendations for public health policies applicable to the epidemiological reality of Brazil, and suggests future research to address relevant issues. In Brazil, the provision of safe water and sanitation should be the key action to achieve schistosomiasis elimination goals. The agencies involved in measures implementation should act together with the Primary Care teams for planning, executing, monitoring, and evaluating actions in priority municipalities based on their epidemiological indicators. Host snails control should prioritize judicious ecological interventions at breeding sites. The Information, Education, and Communication (IEC) strategy should be associated with water and sanitation and other control actions, actively involving school community. To identify infected carriers, FioSchisto recommends a two-stage approach of immunological and molecular tests to verify transmission interruption during the intervention and beyond. Praziquantel administration should be done under medical supervision at the Primary Care level. MDA should be considered in exceptional settings, as a measure of initial attack strategy in locations presenting high endemicity, always integrated with water and sanitation, IEC, and snail control. To assist decision-making, as well as the monitoring and evaluation of strategic actions, there is a need for an Information System. FioSchisto considers this systematization essential to make investments in strategic research to support the improvement of schistosomiasis control actions. Efforts toward schistosomiasis elimination in Brazil will succeed with a paradigm shift from the vertical prescriptive framework to a community-centered approach involving intersectoral and interdisciplinary collaboration.

Schistosomiasis transmission and environmental change: a spatio-temporal analysis in Porto de Galinhas, Pernambuco--Brazil.

BACKGROUND: In Brazil, schistosomiasis mansoni infection is an endemic disease that mainly affects the country's rural populations who carry out domestic and social activities in rivers and water accumulations that provide shelter for the snails of the disease. The process of rural migration to urban centers and the disorderly occupation of natural environments by these populations from endemic areas have favored expansion of schistosomiasis to locations that had been considered to be disease-free. Based on environmental changes that have occurred in consequent to an occupation and urbanization process in the locality of Porto de Galinhas, the present study sought to identify the relationship between those chances, measure by remote-sensing techniques, and establish a new endemic area for schistosomiasis on the coast of Pernambuco State--Brazil. METHODS: To gather prevalence data, two parasitological census surveys were conducted (2000 and 2010) using the Kato-Katz technique. Two malacological surveys were also conducted in the same years in order to define the density and infection rate of the intermediate host. Based on these data, spatial analyses were done, resulting in maps of the risk of disease transmission. To ascertain the environmental changes that have occurred at the locality, images from the QuickBird satellite were analyzed, thus resulting in land use maps. RESULTS: Over this 10-year period, the foci of schistosomiasis became more concentrated in the Salinas district. This area was considered to be at the greatest risk of schistosomiasis transmission and had the highest prevalence rates over this period. The study illustrated that this was the area most affected by the environmental changes resulting from the disorderly urbanization process, which gave rise to unsanitary environments that favored the establishment and maintenance of foci of schistosomiasis transmission, thereby consolidating the process of expansion and endemization of this parasitosis.

Urban schistosomiasis: An ecological study describing a new challenge to the control of this neglected tropical disease.

Background: Social and environmental vulnerabilities contribute to the persistence and increase of Schistosomiasis, which has been a public health problem in Brazil and worldwide. In this study, we aimed to monitor the entry, installation, and maintenance of schistosomiasis transmission in an urban area on the Brazilian coast over two decades (2000-2010/2010-2020). Methods: This population-based cross-sectional study was conducted in Porto de Galinhas, state of Pernambuco, Brazil, to investigate the dynamics of schistosomiasis transmission in the urban area. Through 3 malacological and parasitological surveys and using geoprocessing technologies, schistosomiasis transmission foci (STF), as well as cases of the disease were identified and quantified. Statistical and geoprocessing tools were used to analyse the data. Findings: Overall, the number of STF decreased from 15 (2000) to 11 (2010) and then to 9 (2020). Although the infection ratio of snails in 2000 has decreased from 16·1% to 5·8% in 2010, we observed an increase to 7·2% in 2020. Additionally, 6,499 individuals were analysed (2012 in 2000; 2459 in 2010, and 2028 in 2020) and the prevalence of human infection has decreased over years, from 32·5% (2000), 16·6% (2010) to 8·8% (2020). The disorderly urbanization process was directly related to the spatial distribution of STF and schistosomiasis cases, causing a new scenario where people became infected by walking on unpaved and flooded streets. Interpretation: Although we observed a decreasing in schistosomiasis cases and STF, this NTD became a health problem related to urbanization in the study area. The challenge to overcome this new sort of transmission will require a greater understanding of the disorderly migration, spatial occupation, and degradation of the environment. Funding: National Council for Scientific and Technological Development (CNPq), Ministry of Science, Technology, Innovations and Communications, Brazil.

The endemisation of schistosomiasis in Porto de Galinhas, Pernambuco, Brazil, 10 years after the first epidemic outbreak.

In 2000, after heavy rains and floods in Porto de Galinhas, Pernambuco, Brazil, an outbreak of schistosomiasis was recorded, of which 62.2% (412 cases) were of the acute clinical form. Between 2001-2009, occasional findings of Biomphalaria snails parasitised by Schistosoma mansoni indicated that disease transmission was still occurring. This motivated a new epidemiological survey between August-December 2010 to provide an update of the occurrence of this health hazard and to investigate the process of disease endemisation at this locality. This survey gathered parasitological, clinical and malacological data. The results of this survey, compared with data from the year 2000 survey, showed the following: (i) over these 10 years, there were declines in the total percentage of cases and the percentage of acute forms, (ii) the acute clinical form now represents 23.3% in contrast with the 62.2% detected in 2000 and (iii) the current prevalence of schistosomiasis is 15.7%, while in 2000 32.1% of the individuals were diagnosed as parasitised. Today, the chronic clinical form represents 76.7% of the total number of cases diagnosed, thus showing that over the 10-year period the occurrences of clinical forms became inverted. These findings, together with visual observation of insalubrious environmental conditions, indicate that schistosomiasis has become endemic in Porto de Galinhas.

Gas chromatography-mass spectrometry (GC/MS) reveals urine metabolites associated to light and heavy infections by Schistosoma mansoni in mice.

High-throughput profiling of metabolites has been used to identify metabolic changes in murine models as a response to the infection by the parasitic trematode Schistosoma. These investigations have contributed to our understanding on the pathogenesis of this tropical neglected disease, with a potential of helping diagnosis. Here, our study aimed to investigate the application of gas chromatography-mass spectrometry (GC/MS) on the profiling of urine metabolites from mice carrying infections by Schistosoma mansoni. Two larval infection doses created distinctive infection intensities in mice, whereby the heavily infected animals were found to release 25 times more eggs in faeces than lightly infected animals. Over 200 urine metabolites were identified from these animals by GC/MS, following two complementary derivatisation methods. A list of 14 individual metabolites with altered relative abundances between groups were identified. Most of the altered metabolites showed a trend of increased abundances in response to infection intensity, indicating host-specific metabolic alterations as a result of the disease. Hippurate, a metabolite which concentration is intimately modulated by the gut microbiota, was found to be highly correlated to infection intensity. Our study showed that urine metabolic profiling by GC/MS can distinguish non-infected animals from those carrying light and heavy infections by S. mansoni, revealing metabolites associated to the infection and providing insights on the pathogenesis of schistosomiasis.

Current epidemiological status of schistosomiasis in the state of Pernambuco, Brazil.

Uncontrolled peripheral urbanisation coupled with environmental degradation has affected the status of schistosomiasis in Pernambuco (PE), Brazil. This endemic disease continues to perpetuate its transmission in rural areas and has also become a cause for concern in coastal towns of the state. The lack of basic infrastructure (sanitation and health programmes) to support the new urban areas leads to faecal contamination of natural aquatic environments, resulting in consequent infection of vector snails and the emergence of new sources of schistosomiasis transmission. In the present paper, we discuss the current epidemiological status of schistosomiasis in PE. We have consolidated and analysed information from parasitological, malacological and morbidity surveys undertaken by the group of researchers at the Laboratory of Schistosomiasis, Centro de Pesquisas Aggeu Magalhães-Fiocruz. The results of our analysis show: (i) the maintenance of the levels of schistosomiasis in the rural Zona da Mata, PE, (ii) the record of the human cases of schistosomiasis and the foci of infected snails detected along the coast of PE through 2007, (iii) the high record of the severe clinical form of schistosomiasis in the metropolitan region of Recife (RMR) and (iv) new breeding sites of schistosomiasis vector snails that were identified in a 2008 survey covering the RMR and the coastal localities of PE.

The prevalence of schistosomiasis in school-aged children as an appropriate indicator of its prevalence in the community.

School-aged children (6-15 years) from the endemic area of Pernambuco were evaluated both as a target group for and an indicator of schistosomiasis control in the community. Parasitological data were drawn from baseline stool surveys of whole populations that were obtained to diagnose Schistosoma mansoni infection. Nineteen representative localities were selected for assessing the prevalence of schistosomiasis among individuals in the following age groups: 0-5, 6-15, 16-25, 26-40 and 41-80 years. For each locality, the prevalence in each age group was compared to that of the overall population using contingency table analysis. To select a reference group, the operational difficulties of conducting residential surveys were considered. School-aged children may be considered to be the group of choice as the reference group for the overall population for the following reasons: (i) the prevalence of schistosomiasis in this age group had the highest correlation with the prevalence in the overall population (r = 0.967), (ii) this age group is particularly vulnerable to infection and plays an important role in parasite transmission and (iii) school-aged children are the main target of the World Health Organization in terms of helminth control. The Schistosomiasis Control Program should consider school-aged children both as a reference group for assessing the need for intervention at the community level and as a target group for integrated health care actions of the Unified Health System that are focused on high-risk groups.

Clinical-epidemiologic profile of the schistosomal myeloradiculopathy in Pernambuco, Brazil.

This was a retrospective descriptive study on a series of cases of schistosomal myeloradiculopathy (SMR) and the aim was to investigate the incidence of this disease and its clinical and epidemiological characteristics in cases diagnosed at three healthcare units in Pernambuco, Brazil between 1994-2006. The data were collected by reviewing the medical records from both the neurological and paediatric outpatient clinics and wards of the Hospital Clinics, Hospital of the Restoration and Pernambuco Mother and Child Institute. To gather the data, a spinal cord schistosomiasis evaluation protocol was used. The diagnoses were based on positive epidemiological evidence of schistosomiasis, clinical findings and laboratory tests (stool parasitological examination or rectal biopsies, magnetic resonance imaging findings and cerebrospinal fluid investigations). A total of 139 cases aged between 2-83 years were found. The most important determinants of SMR were male sex (66.2%), contact with fresh water (91%), origin in endemic regions (39.5%), lower-limb muscle weakness (100%), sensory level at the lower thoracic medulla (40.3%), myeloradicular form (76%) and presence of eggs in the stool parasitological examination (48%). This sample indicates the need for intervention policies guided by diagnostic standardization, thereby avoiding disease under-notification.

Mapping the risk for transmission of urban schistosomiasis in the Brazilian Northeast.

This is an analysis of the risk of schistosomiasis transmission in the city of Recife in the Northeast of Brazil based on the number of schistosomiasis cases (Schistosoma mansoni) registered for the period 2007-2017 together with data resulting from active search of breeding sites of the Biomphalaria snail intermediate host. The analyses were performed using Kernel Density Estimation (KDE), SaTScan and Map Algebra methodology using human socio-demographic data and biotic and abiotic data from the snail breeding sites. Investigating 44 breeding sites resulted in a total of 3.800 snails, 31.8% of which were positive for S. mansoni DNA. These data were considered in relation to total of 652 schistosomiasis cases. The KDE showed two high-risk and two medium-risk clusters, while three significant clusters were identified by SaTScan. Combining these data with the Map Algebra methodology showed that all high-risk neighbourhoods had breeding sites with snails positive for S. mansoni. It was concluded that schistosomiasis transmission cannot be controlled without basic sanitation and sewage management in the presence of Biomphalaria snails. The technique of Map Algebra was found to be fundamental for the analysis and demonstration of areas with a high probability of schistosomiasis transmission.

[Temporary and permanent breeding sites for Biomphalaria in Jaboatão dos Guararapes, PE]. / Criadouros de Biomphalaria, temporários e permanentes, em Jaboatão dos Guararapes, PE.

A malacological survey of permanent and temporary breeding sites was conducted in the Piedade neighborhood of Jaboatão dos Guararapes, Pernambuco, between November 2006 and November 2007, with the aim of determining the malacological fauna at this locality, along with the potential for Schistosomiasis mansoni transmission. In addition to Biomphalaria glabrata (Say, 1818), the molluscs Drepanotrema cimex (Moricand, 1837), Pomacea sp and Melanoides tuberculatus (Muller, 1774) were collected. Among the specimens of Biomphalaria glabrata that were collected, 1,490 were found alive, and 74 (5%) were positive for Schistosoma mansoni. The largest numbers of molluscs collected, and all of the specimens that were positive for Schistosoma mansoni, were collected during the annual rainy season. The presence of larvae of other trematodes infecting the Biomphalaria glabrata molluscs was also observed. These trematodes were from the families Strigeidae and Diplostomatidae and, at first sight, they presented morphology that could lead to confusion with Schistosoma mansoni cercariae. Thus, knowledge of these trematodes becomes essential for the differential diagnosis of the etiological agent for schistosomiasis.

Fatores associados às formas graves e aos óbitos por esquistossomose e aplicação do linkage probabilístico nas bases de dados, Pernambuco, 2007-2017 / Factors associated with severe forms and deaths from schistosomiasis and application of probabilistic linkage in databases, state of Pernambuco, Brazil, 2007-2017

RESUMO Objetivo: Verificar a concordância dos dados relacionados às formas graves e aos óbitos por esquistossomose registrados no Sistema de Informação de Agravos de Notificação e no Sistema de Informação Sobre Mortalidade, as variáveis sociodemográficas com a ocorrência das formas graves e óbitos e a tendência temporal da doença em Pernambuco. Métodos: Trata-se de um estudo ecológico, descritivo, de série temporal com dados referentes às formas graves e aos óbitos por esquistossomose em Pernambuco, de 2007 a 2017. Para o linkage entre as bases de dados, foi desenvolvida uma função em linguagem python de programação, utilizando o método soundex. Para identificar fatores sociodemográficos e sanitários que se correlacionaram com as variáveis dependentes, foi aplicado o teste de correlação de Pearson. Para a análise de tendência, aplicou-se a regressão linear. Resultados: Identificaram-se 9.085 casos graves, 1.956 óbitos e 186 casos no linkage. A correlação entre a taxa média de positividade com o abastecimento hídrico rede geral e coleta de lixo foi 0,22 e 0,26 respectivamente. Houve correlação da taxa média de mortalidade acumulada com abastecimento hídrico por poço ou nascente (r=0,27), abastecimento hídrico por rede geral (r=0,3), coleta de lixo (r=0,42), urbanização das vias (r=0,29). Ocorreram 3.153 formas graves em 2007, com tendência a redução, e 205 óbitos em 2010, sem um padrão de tendência. Conclusão: Há necessidade de maiores investimentos no controle da doença e na qualidade da informação, especialmente no registro das formas graves, pois, dada a fisiopatologia da doença, o óbito só ocorre quando o indivíduo desenvolve a forma crônica, sendo imperativo sua notificação no Sistema de Informação de Agravos de Notificação.

ABSTRACT Objective: To verify the agreement of data on severe forms and deaths from schistosomiasis recorded in the Brazilian Notifiable Diseases Information System and the Mortality Information System, sociodemographic variables with the occurrence of severe forms and deaths, and the temporal trend of the disease in the state of Pernambuco, Brazil. Methods: This is an ecological, descriptive, time series study with data on severe forms and deaths from schistosomiasis in Pernambuco, from 2007 to 2017. For the linkage between databases, a function was developed in python programming language, using the Soundex method. To identify sociodemographic and health factors that correlated with the dependent variables, Pearson's correlation test was applied. For trend analysis, linear regression was applied. Results: We identified 9,085 severe cases, 1,956 deaths, and 186 cases in the linkage. The correlation between the average positivity rate with the general water supply and waste collection was 0.22 and 0.26 respectively. We verified a correlation of the average cumulative mortality rate with water supply by well or spring (r=0.27), water supply by the general network (r=0.3), waste collection (r=0.42), and road urbanization (r=0.29). We found 3,153 severe forms in 2007 with a decrease trend and 205 deaths in 2010, without a trend pattern. Conclusion: There is a need for greater investments in disease control and in the quality of information, especially in the record of severe forms, considering that, due to the pathophysiology of the disease, death only occurs when the individual develops the chronic form, and its notification on the Notifiable Diseases Information System is imperative.

Investigation of schistosomiasis cases and deaths in the city of Recife, Pernambuco, Brazil, 2005-2013. / Investigação sobre os casos e óbitos por esquistossomose na cidade do Recife, Pernambuco, Brasil, 2005-2013.

OBJECTIVE: to describe schistosomiasis cases and deaths among residents of the city of Recife, Pernambuco, Brazil, from 2005 to 2013. METHODS: this was a descriptive epidemiological study using data from the Mortality Information System (SIM) (2005-2013) and the Notifiable Diseases Information System (SINAN) (2007-2013); active tracing of the relatives of the dead was undertaken and probabilistic linkage of the databases (2007-2013) was performed using the Reclink program. RESULTS: 297 schistosomiasis deaths were recorded on the SIM system; through active tracing, 130 relatives were contacted and 20.8% autochthony was identified; 388 cases resident in Recife were registered on the SINAN system; through probabilistic linkage, 23 matching records were identified on SIM and SINAN. CONCLUSION: investigation of deaths showed that some individuals had never traveled outside Recife and progressed to the chronic stage of the disease; 23.8% of the cases registered on SINAN had Recife as the municipality in which infection occurred.

[Spatial analysis of Biomphalaria glabrata foci and human cases of mansoni schistosomiasis in Porto de Galinhas, Pernambuco State, Brazil, in the year 2000]. / Análise espacial dos focos de Biomphalaria glabrata e de casos humanos de esquistossomose mansônica em Porto de Galinhas, Pernambuco, Brasil, no ano 2000.

This article provides information on the spatial distribution of schistosomiasis, correlating snail foci with human cases using spatial analysis. The locations studied were Merepe III, Pantanal, Salinas, and Socó, comprising 70% of the populated area of Porto de Galinhas. Malacological and parasitological surveys by a CPqAM/ FIOCRUZ team at the location where an epidemic occurred in 2000 identified 15 foci of infected B. glabrata. Human cases were also diagnosed and recorded according to residential block. Spatial analysis was performed using the TerraView computer program and Kernel intensity estimation. Total infection rates, considering all collection stations marked out per location, varied from 15% to 32.4%. The 15 infected B. glabrata foci included 9 in Merepe, 2 in Socó, 3 in Salinas, and 1 in Pantanal. The results suggest a strong spatial trend in the risk of schistosomiais transmission in Salinas and Socó. In Merepe, with the most foci and where foci were closer together, individual focal infection rates were lower. Spatial analysis thus showed less concentration of risk as compared to other locations studied. As for human cases, two high-intensity areas were observed, shown on the map in darker colors.

Ovarian Manson's Schistosomiasis: Rare Diagnosis or Underestimated Prevalence?

The occurrence of Manson's schistosomiasis in organs of the female reproductive tract is an uncommon event, given that the etiological agent for this disease is a blood parasite that inhabits the mesenteric veins. In this case report, a 45-year-old female patient reported that her first symptoms had been strong pain in the left iliac region around two years earlier. An endovaginal pelvic ultrasonography showed that the left ovary was enlarged, and the report suggested that this finding might be correlated with clinical data and tumor markers. After being examined at several healthcare services, the patient was referred to an oncology service due to suspected neoplasia, where she underwent a left ovariectomy. The result from the histopathological examination showed the presence of granulomatous inflammatory processes surrounding both viable and calcified eggs of Schistosoma mansoni. There was no evidence of any neoplastic tissue. The patient was medicated and followed-up as an outpatient.

A ocorrência da esquistossomose mansônica em órgãos do aparelho reprodutor feminino é um evento pouco comum, tendo em vista que o agente etiológico desta doença é um parasito sanguíneo que habita as veias mesentéricas. Neste relato de caso, uma paciente de 45 anos referiu como primeira sintomatologia fortes dores na região ilíaca esquerda há cerca de 2 anos. Uma ultrassonografia pélvica endovaginal identificou aumento do ovário esquerdo, e o laudo sugeriu correlacionar tal achado com dados clínicos e marcadores tumorais. Após passar por vários serviços de saúde, a paciente foi encaminhada para um serviço de oncologia por suspeita de neoplasia, sendo submetida a uma ovariectomia à esquerda. O resultado do exame histopatológico evidenciou a presença de processos inflamatórios granulomatosos em torno de ovos viáveis e calcificados de Schistosoma mansoni. Não houve qualquer evidência de tecido neoplásico. A paciente foi medicada, e seguiu em acompanhamento ambulatorial.