Urogenital schistosomiasis in Cabo Delgado, northern Mozambique: baseline findings from the SCORE study.

BACKGROUND: The results presented here are part of a five-year cluster-randomised intervention trial that was implemented to understand how best to gain and sustain control of schistosomiasis through different preventive chemotherapy strategies. This paper presents baseline data that were collected in ten districts of Cabo Delgado province, northern Mozambique, before treatment. METHODS: A cross-sectional study of 19,039 individuals was sampled from 144 villages from May to September 2011. In each village prevalence and intensity of S. haematobium were investigated in 100 children first-year students (aged 5-8 years), 100 school children aged 9-12 years (from classes 2 to 7) and 50 adults (20-55 years). Prevalence and intensity of S. haematobium infection were evaluated microscopically by two filtrations, each of 10 ml, from a single urine specimen. Given that individual and community perceptions of schistosomiasis influence control efforts, community knowledge and environmental risk factors were collected using a face-to-face interview. Data were entered onto mobile phones using EpiCollect. Data summary was made using descriptive statistics. Chi-square and logistic regression were used to determine the association between dependent and independent variables. RESULTS: The overall prevalence of urogenital schistosomiasis was 60.4% with an arithmetic mean intensity of infection of 55.8 eggs/10 ml of urine. Heavy infections were detected in 17.7%, of which 235 individuals (6.97%) had an egg count of 1000 eggs/10 ml or more. There was a significantly higher likelihood of males being infected than females across all ages (62% vs 58%; P < 0.0005). Adolescents aged 9-12 years had a higher prevalence (66.6%) and mean infection intensity (71.9 eggs/10 ml) than first-year students (63.1%; 58.2 eggs/10 ml). This is the first study in Mozambique looking at infection rates among adults. Although children had higher levels of infection, it was found here that adults had a high average prevalence and intensity of infection (44.5%; 23.9 eggs/10 ml). Awareness of schistosomiasis was relatively high (68.6%); however, correct knowledge of how schistosomiasis is acquired was low (23.2%) among those who had heard of the disease. Schistosomiasis risk behaviour such as washing (91.3%) and bathing (86.7%) in open water sources likely to be infested with host snails was high. CONCLUSIONS: Urogenital schistosomiasis is widespread in Cabo Delgado. In addition, poor community knowledge about the causes of schistosomiasis and how to prevent it increases the significant public health challenge for the national control program. This was the first study in Mozambique that examined infection levels among adults, where results showed that S. haematobium infection was also extremely high. Given that this controlled trial aims to understand the impact of different combinations of schistosomiasis control through treatment of communities, schools, and treatment holidays over a five-year period, these findings highlight the importance of examining the impact of different treatment approaches also in adults. TRIAL REGISTRATION: The trials have been registered with the International Standard Randomised Controlled Trial registry under ISRCT 14117624 Mozambique (14 December 2015).

Schistosomal appendicitis in pregnancy.

Acute appendicitis is the most common acute surgical infection during pregnancy. Although usually pyogenic in origin, parasitic infections account for a small percentage of cases. Despite the relatively high prevalence of acute appendicitis in our environment, it is not commonly associated with schistosomiasis. We report here the association of pregnancy and appendicitis caused by Schistosoma haematobium. Schistosomiasis is very common complication of pregnancy in hyperendemic areas. Schistosome egg masses can lodge throughout the body and cause acute inflammation of the appendix, liver and spleen. Congestion of pelvic vessels during pregnancy facilitates passage of eggs into the villi and intervillous spaces, causing an inflammatory reaction. Tourism and immigration make this disease a potential challenge for practitioners everywhere.

Schistosomiasis of the urinary bladder in an African immigrant to North Carolina.

A 30-year-old black man came to the emergency department with gross hematuria, prostatitis, and urethritis 4 months after immigrating to this country from the Sudan in Africa. Urinalysis revealed hematuria and no ova or parasites. An intravenous urogram showed normal kidneys and ureters. The patient had cystoscopy with biopsies of an inflamed and ulcerated bladder mucosa. The nematode Schistosoma haematobium and schistosome eggs were identified without evidence of urothelial malignancy. The patient was treated with praziquantel and is currently asymptomatic. Over 200 million people are infected with schistosomiasis worldwide, yet this disease is rarely encountered in this country. The differential diagnosis and assessment of patients must include exposure to uncommon diseases that are endemic to other geographic regions.

Human bilharzial ureters: I. Fine structure of eggs deposited in the submucosa and muscularis.

The internal fine structure of the partially calcified Schistosoma haematobium eggs in the lower ureteral segments of Saudi patients with chronic urinary schistosomiasis is described. The egg shell is penetrated by cribriform pores and consists of the three previously described layers: outer microspinous, middle intermediately dense, and inner dense layers. The space between the egg shell and the developing embryo is partitioned by three layers. An outer acellular Reynolds' layer of unknown origin and function consists of a fibrillar material mixed with a finely granular matrix extending to the egg-shell pores via racimose channels. The middle von Lichtenberg's envelope consists of a single layer of flattened epithelial cells containing several mitochondria in other previously described Schistosoma eggs suggesting an active, and perhaps selective, transport in or out of the egg shell. The inner fluid filled cavity, or Lehman's lacuna, between the von Lichtenberg's envelope and the embryo contains numerous lipoid bodies suggesting a relation to vitelline cells. - Four systems (out of eight previously described for the free, mature Schistosoma miracidium) have been recognized for the first time in the developing miracidium within S. haematobium eggs and include: 1) ciliated epidermal plates representing the epithelial system, 2) an outer circular and an inner longitudinal muscle layers forming the musculatures, 3) lateral penetration glands, and 4) ciliated flame cells representing the excretory system.

[Sterility as a sequela of tubal schistosomiasis]. / Sterilität als Folge einer tubaren Schistosomiasis.

A 21-year old african women presented with primary sterility in the outpatient department of our university hospital. Screening examinations, including ultrasound, demonstrated a tumour of 5.8 x 4.1 cm diameter on the left ovary. While performing laparotomy to extirpate this tumour, bilateral occlusion of the tubes was discovered by chromopertubation.This diagnosis led us to perform bilateral salpingostomy and reimplantation of the Fallopian tubes. In addition to the ovarian tumour (dermoid), fragments of the Fallopian tubes were sent for histological examination, which revealed eggs of schistosomes probably of the species Schistosoma haematobium. Since tourism to and immigration from endemic areas is increasing, schistosomiasis should be considered when it is not possible to elucidate the cause of sterility by classical means.

Human bilharzial ureters: IV. Ultrastructural interaction between multinucleate giant cells and the parasite eggs.

The ultrastructural interaction between multinucleate giant cells (MGCs) and the Schistosoma haematobium eggs is described at the transmission electron microscopy (TEM) level, in granulomas of the lower ureteral segments of Saudi patients. The MGCs were found only within the parasite empty egg-shells which were embedded in the ureter submucosa and muscularis. For the first time, two morphologically different types of MGCs were recognized: the moderate to electron-dense type I contained two types of 8-12 nuclei and cytoplasm poor in cell organelles which appeared non-functional. Type 1 MGCs were considered to be "old" and non-active cells. The electron-lucent to moderately dense type II MGCs contained 3-4 nuclei of one type, and cytoplasm rich in cell organelles. According to the performance of their organelles, type II MGCs were considered to be "young" and highly active cells. The human type II MGCs did not form the cytoplasmic membranous labyrinths previously described for the free moving MGCs obtained from experimental mice, and were suggested to be involved in the cell motility. As in murine MGCs, type II cells were incorporated in exocytic and endocytic activities aimed the degradation of the inner soft layer of the egg-shell. This study shows that individual macrophages were responsible for eliminating the outer and possibly the middle hard layers of the egg-shell.

Schistosoma haematobium (Egyptian strain) transmission microscopy of normal and praziquantel treated worms.

The ultrastructure of the tegument and subtegumental structures of S. haematobium worms was examined by TEM. The effect of praziquantel on residual worms which remained after a curative dose was also studied. The male S. haematobium worms were characterized by deep tortuous pits and sharp apically directed spines. Spherical and elliptical bodies were also observed. The esophageal tegument was described. The effect of praziquantel on the male worms revealed flattening of spines and their disappearance in some regions as well as disruption and vacuolization of the tegument in others.

Scanning electron microscopy of normal and praziquantel treated S. haematobium worms (Egyptian strain).

The ultrastructure of the tegument of S. haematobium was examined before and after treatment with Praziquantel using scanning electron microscopy. The surface of the adult male worms prior to treatment showed numerous tubercles with apically directed spines and the lateral border showed highly pitted folds. The oral and ventral suckers showed well developed spines. Praziquantel administration caused various structural changes in the various groups studied. Blebs and spine deformities appeared as early as half an hr. after administration. Changes were also observed when the drug was administered prior to worm maturation resulting in generalized deformities in the worms which survived treatment, loss of spines and tegumental swellings.

[Genital schistosomiasis--diagnosis and therapy]. / Genitale Schistosomiose--Diagnostik und Therapie.

The authors describe prevalence, diagnosis and treatment of genital schistosomiasis. Schistosomiasis is one of the most common parasitoses in tropical and subtropical developing countries. Genital schistosomiasis is caused by Schistosoma haematobium. By microscopical examination of abradates, operation material and coni schistosoma eggs could be detected in 29.2 per cent of all cases.

Schistosomiasis in a cystic teratoma of the ovary.

The authors report the case of an ovarian teratoma infected by the eggs of the trematode Schistosoma haematobium. In consideration of the rare observation, bearing a paradigmatic value, they briefly discuss the particular tropism that the parasite demonstrated towards some tumoral structures and they also outline the immunological mechanisms activated by the Schistosoma.