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.

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.

SuperSUS como recurso para inovar a comunicação em saúde / SuperSUS as a resource to innovate health communication / SuperSUS como recurso para innovar la comunicación en salud

Considerando que o conhecimento do direito à saúde de toda a população deve ser estimulado no público jovem com a finalidade de fortalecer as políticas públicas dessa área, este artigo baseia-se em uma pesquisa que buscou analisar o potencial do jogo SuperSUS, por meio de sua utilização por jovens de escolas públicas, como recurso para atingir esse objetivo. A pesquisa exploratória, com abordagem qualitativa, foi realizada em duas escolas estaduais da Região Nordeste do Brasil, no período de agosto de 2019 a março de 2020. Seus resultados desvelaram aposteriori cinco categorias temáticas e 11 subcategorias, que destacam elementos do SuperSUS que facilitam a comunicação acerca do Sistema Único de Saúde (SUS). Foram evidenciados os limites e as possibilidades do uso do jogo SuperSUS para fortalecer o Sistema Único de Saúde como política pública. Em suma, ele se mostrou dialógico, interativo e elementar para a aquisição de conhecimentos, pelo público jovem, acerca da saúde e das práticas de comunicação necessárias para o seu fortalecimento, confirmando assim que as tecnologias digitais como os serious games podem contribuir para o êxito desse processo.

Considering that the knowledge of the right to health of the entire population should be stimulated among young people, with the purpose of strengthening health policies, in this area, this article bases on research that sought to analyse the potential of the SuperSUS (a serious game), through its use by young people from public schools, as a resource to achieve this goal. The exploratory research, with a qualitative approach, was carried out in two state schools in the Northeast Region of Brazil, from August 2019 to March 2020. Its results revealed a posteriori five thematic categories and 11 subcategories, which highlight some elements of the SuperSUS that facilitate communication about the SUS - Sistema Único de Saúde (Unified Health System). The limits and possibilities of using the SuperSUS to strengthen the Sistema Único de Saúde as a public policy were evidenced. In short, it proved to be dialogic, interactive, and elementary for the acquisition of knowledge, by the young people, about the public health system and the indispensable communication practices for its strengthening, thus confirming that digital technologies such as serious games can contribute to the success of this process.

Considerando que el conocimiento del derecho a la salud de toda la población debe ser fomentado entre los jóvenes, con el objetivo de fortalecer las políticas públicas en esta área, este artículo se basa en una investigación que buscó analizar el potencial del juego SuperSUS, a través de su uso por jóvenes de escuelas públicas, como recurso para lograr este objetivo. La investigación exploratoria, con enfoque cualitativo, fue realizada en dos escuelas públicas de la Región Nordeste de Brasil, de agosto de 2019 a marzo de 2020. Sus resultados revelaron aposteriori cinco categorías temáticas y 11 subcategorías, que destacan algunos elementos del SuperSUS que facilitan la comunicación sobre el SUS - Sistema Único de Saúde (Sistema Único de Salud). Se destacaron los límites y las posibilidades de utilizar el juego SuperSUS para fortalecer el Sistema Único de Saúde como política pública. En síntesis, el juego demostró ser dialógico, interactivo y imprescindible para la adquisición de conocimientos, por parte del público joven, sobre el sistema público de salud y las prácticas de comunicación necesarias para su fortalecimiento, confirmando así que las tecnologías digitales como los serious games pueden contribuir para el éxito de este proceso

MicroRNA dysregulation in schistosomiasis-induced hepatic fibrosis: a systematic review.

BACKGROUND: MicroRNAs are involved in gene regulation in several common liver diseases and may play an essential role in activating hepatic stellate cells. The role of these post-transcriptional regulators in schistosomiasis needs to be further studied in populations from endemic areas for a better understanding of the disease, the development of new therapeutic approaches, and the use of biomarkers for the prognosis of schistosomiasis. AREAS COVERED: We performed a systematic review to describe the main human microRNAs identified in non-experimental studies associated with aggravation of the disease in people infected with Schistosoma mansoni (S. mansoni) and Schistosoma japonicum (S. japonicum). Structured searches were carried out in PubMed, Medline, Science Direct, Directory of Open Access Journals, Scielo, Medcarib, and Global Index Medicus databases without time and language restrictions. This is a systematic review following the guidelines of the PRISMA platform. EXPERT OPINION: The miR-146a-5p, miR-150-5p, let-7a-5p, let-7d-5p, miR-92a- 3p, and miR-532-5p are associated with liver fibrosis in schistosomiasis caused by S. japonicum, revealing that these miRNAs that have been shown to be associated with liver fibrosis are good targets for new studies that evaluate their potential as a biomarker or even treating liver fibrosis in schistosomiasis.

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.

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.

Evaluation of SmITS1-LAMP performance to diagnosis schistosomiasis in human stool samples from an endemic area in Brazil.

Schistosomiasis is a life-threatening infectious disease categorized by the World Health Organization as a public health issue. New molecular diagnostic alternatives for intestinal schistosomiasis caused by Schistosoma mansoni, such as the loop-mediated isothermal amplification (LAMP), a fast and simple amplification technique, have been proposed for control of this NTD in low-endemicity locations. A LAMP assay was performed to detect the internal transcribed spacer 1 ribosomal gene of S. mansoni (SmITS1-LAMP) in 322 DNA extracted from stool samples from schistosomiasis endemic area in Brazil. Kato-Katz analysis of human stool samples was used as the gold standard test, detecting 144 positive samples. SmITS1-LAMP detection limit achieved a maximum analytical sensitivity of 10 fg/µL using S. mansoni genomic DNA, subsequently detecting 17/144 (11.8%) positive samples. SmITS1-LAMP sensitivity and specificity were 12% (95%CI: 7%-18%) and 93% (95%CI: 89%-96%), respectively. Positive predictive value (PPV) and negative predictive value (NPV) were 59% (95%CI: 39% - 76%); and 57% (95%CI: 51% - 62%), respectively. Most cases involved men (61.8%), predominantly young adults (20-39 years old) in cases diagnosed by Kato-Katz and adults (40-59 years old) in cases diagnosed by LAMP. The low number of eggs per gram of stool (1-99 EPG) was the most frequently identified by both Kato-Katz and LAMP. Further studies are needed to evaluate the applicability of SmMIT-LAMP on Schistosoma mansoni diagnosis and surveillance of schistosome infections.

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.

Spatiotemporal analysis of bubonic plague in Pernambuco, northeast of Brazil: Case study in the municipality of Exu.

Along with other countries in America, plague reached Brazil through the sea routes during the third pandemic. A brief ports phase was followed by an urban phase that took place in smaller inland cities and finally, it attained the rural area and established several foci where the ecological conditions were suitable for its continued existence. However, the geographic dispersion of plague in Brazil is still poorly studied. To better understand the disease dynamics, we accessed satellite-based data to trace the spatial occurrence and distribution of human plague cases in Pernambuco, Northeastern Brazil and using the municipality of Exu as study case area. Along with the satellite data, a historical survey using the Plague Control Program files was applied to characterize the spatial and temporal dispersion of cases in the period of 1945-1976. Kernel density estimation, spatial and temporal clusters with statistical significance and maximum entropy modeling were used for spatial data analysis, by means of the spatial analysis software packages. The use of geostatistical tools allowed evidencing the shift of the infection from the urban to the wild-sylvatic areas and the reemergence of cases after a period of quiescence, independent of the reintroduction from other plague areas.

Outbreak of autochthonous cases of malaria in coastal regions of Northeast Brazil: the diversity and spatial distribution of species of Anopheles.

BACKGROUND: Brazil has the fourth highest prevalence of malaria of all countries in the Americas, with an estimated 42 million people at risk of contracting this disease. Although most cases occur in the Amazon region, cases of an autochthonous nature have also been registered in the extra-Amazonian region where Anopheles aquasalis and An. albitarsis are the mosquito species of greatest epidemiological interest. In 2019, the municipality of Conde (state of Paraíba) experienced an epidemic of autochthonous cases of malaria. Here we present preliminary results of an entomological and case epidemiology investigation, in an attempt to correlate the diversity and spatial distribution of species of Anopheles with the autochthonous cases of this outbreak of malaria. METHODS: Case data were collected using case report forms made available by the Conde Municipal Health Department. The entomological survey was carried out from July to November 2019. The various methods of capture included the use of battery-powered aspirators, mouth aspirators, Shannon traps, BG-Sentinel traps (with and without dry ice) and CDC light traps. Captured mosquitoes were separated, packaged and sent to the laboratory for sexing and molecular identification of the various species of anophelines. The data were tabulated and analyzed using Microsoft Excel. Spatial analysis of the data was performed using ArcGis 10 software. RESULTS: In 2019, 20 autochthonous cases and one imported case of malaria caused by Plasmodium vivax were diagnosed, with three cases of relapses. A total of 3713 mosquitoes were collected, of which 3390 were culicines and 323 were anophelines. Nine species of genus Anopheles were identified, with the most abundant being An. aquasalis (38.9%), followed by An. minor (18.2%) and An. albitarsis (9.0%). Spatial analysis of the data showed that the area could be considered to be at risk of malaria cases and that there was a high prevalence of Anopheles. CONCLUSIONS: The results presented indicate that this extra-Amazonian region has an environment conducive to maintenance of the malaria transmission cycle owing to the wide diversity of Anopheles species. This environment in combination with the high influx of people from endemic areas to the study area provides a perfect setting for the occurrence and maintenance of malaria.

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.

Does physical exercise influence in the development of neuroeschistosomiasis?

Neuroschistosomiasis is a severe form of presentation of schistosomiasis in which Schistosoma spp. affects the central nervous system. This is the first study performed to analyze whether there is any relationship between physical effort and the appearance of neuroschistosomiasis, through clinical, molecular and immunological evaluations. An experimental controlled study using 64 male Balb/c inbred mice divided into four groups according to presence or absence of S. mansoni infection and submitted to physical effort or resting was conducted. Thirteen weeks after exercise training, S. mansoni DNA was detected in the brain or spinal cord in about 30% of the infected animals moreover, only S. mansoni-positive samples showed positive labeling for S. mansoni antigens in the brain or spinal cord, with a striking reaction inside the microglia. However, the behavioral tests did not show any clinical symptoms of neuroschistosomiasis in animals submitted to physical effort or in resting. In animals with S. mansoni-positive DNA, immunohistochemical data revealed astrogliosis and microgliosis, elevated IL-10 levels and decreased TNF-α expression. This study demonstrated that isometric exercise does not promote neuroschistosomiasis, furthermore, ectopic forms of schistosomiasis in the central nervous system were largely asymptomatic and exhibited a Th2 immune response profile. More experimental studies are necessary in order to characterize the pathological process of experimental neuroschistosomiasis.

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.

Mesenteric ischemia as a cause of early death among mice infected by Schistosoma mansoni

Laboratory maintenance of the Schistosoma mansoni cycle is necessary for developing studies regarding the diagnosis, treatment and control of schistosomiasis. Within this perspective, it is paramount that mice infected by the parasite should present a minimum survival of six months. However, between October 2016 and May 2017, early deaths were observed among infected animals kept in the vivarium of the Schistosomiasis Reference Service of IAMFIOCRUZ. Therefore, the purpose of the present study was to present the results obtained after investigating the main cause of death among these animals. To achieve this, animals that died or that needed to be euthanized due to clinical distress caused by parasite infection were necropsied to investigate the cause of death and clinical condition. Fragments from the intestines, mesenteric vessels and livers were removed and were subjected to histopathological studies. In addition, mouse feces were collected and analyzed using the hydrogen peroxide reaction to detect occult blood. Over an eight-month period, 70 deaths were noted. Forty two animals presented mesenteric ischemia, a vascular insufficiency syndrome that causes a reduction in the nutrient supply to the intestinal viscera. There is, therefore, a need to reduce the infective parasite load in mice to increase their survival, reduce distress caused by the infection and ensure maintenance of the S. mansoni cycle, thus enabling continuity of scientific studies on this parasitosis.

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.

Investigação sobre os casos e óbitos por esquistossomose na cidade do Recife, Pernambuco, Brasil, 2005-2013 / Investigación sobre los casos y los óbitos por esquistosomiasis en la ciudad de Recife, Pernambuco, Brasil, 2005-2013 / Investigation of schistosomiasis cases and deaths in the city of Recife, Pernambuco, Brazil, 2005-2013

Objetivo: descrever os casos e óbitos por esquistossomose em residentes na cidade de Recife, Pernambuco, Brasil, no período 2005-2013. Métodos: estudo epidemiológico descritivo com dados do Sistema de Informações sobre Mortalidade (SIM) (2005-2013) e do Sistema de Informação de Agravos de Notificação (Sinan) (2007-2013); realizou-se a busca ativa dos familiares dos óbitos e o relacionamento probabilístico das bases de dados (2007-2013) pelo aplicativo Reclink. Resultados: no SIM, registraram-se 297 óbitos por esquistossomose no período estudado; pela busca ativa, 130 familiares foram contatados, identificando-se 20,8% de autoctonia; no Sinan, 388 casos foram registrados para residentes no Recife; pelo relacionamento probabilístico, identificaram-se 23 registros pareados entre SIM e Sinan. Conclusão: a investigação dos óbitos demonstrou que alguns indivíduos nunca viajaram para fora do Recife e evoluíram para a fase crônica da doença; 23,8% dos casos notificados no Sinan tiveram como município de infecção o Recife.

Objetivo: describir casos y óbitos por esquistosomiasis en residentes de la ciudad de Recife, Pernambuco, Brasil, en el período de 2005 a 2013. Métodos: estudio epidemiológico descriptivo con datos del Sistema Información sobre Mortalidad (SIM) (2005-2013) y del Sistema de Información de Agravamientos de Notificación (Sinan) (2007-2013); se realizó la búsqueda activa de los familiares de los fallecidos y la relación probabilística de los datos (2007-2013) en el aplicativo Reclink. Resultados: en el SIM, hubo 297 óbitos por esquistosomiasis; en la búsqueda activa, se identificaron 130 familiares y un 20,8% de autoctonía; en Sinan, 388 casos fueron registrados para residentes en Recife; en la relación probabilística, 23 registros pareados fueron identificados en el SIM y el Sinan. Conclusión: la investigación de los óbitos mostró que algunas personas nunca viajaron fuera de Recife y evolucionaron a la fase crónica de la enfermedad; 23,8% de los casos registrados en el Sinan tuvieron a Recife como municipio de la infección.

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.

Ovarian Manson's Schistosomiasis: Rare Diagnosis or Underestimated Prevalence? / Esquistossomose mansônica no ovário: diagnóstico raro ou prevalência subestimada?

Abstract 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.

Resumo 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 decaso, 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.

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.

Transmissão urbana da esquistossomose: novo cenário epidemiológico na Zona da Mata de Pernambuco / Urban transmission of schistosomiasis: new epidemiological situation in the forest area of Pernambuco

RESUMO: Introdução: A esquistossomose é considerada uma endemia em Vitória de Santo Antão, Pernambuco, o qual apresenta há décadas altas incidências e prevalências para essa doença. Nesse município ocorre a transmissão clássica da doença por meio do contato da população de áreas rurais com águas contaminadas durante o desenvolvimento de suas atividades de vida diárias. Recentemente surgiram indícios da presença do caramujo vetor na área urbana da cidade, o que pode configurar um novo modelo de transmissão para esquistossomose nesse município. Objetivo: Identificar novo cenário epidemiológico para ocorrência da transmissão urbana da esquistossomose em Vitória de Santo Antão, Pernambuco. Métodos: Foi conduzido um inquérito malacológico, investigando-se todas as coleções hídricas do perímetro urbano quanto à presença do caramujo vetor da esquistossomose (Biomphalaria spp.). Os caramujos coletados foram examinados para identificação taxonômica e de infecção pelo Schistosoma mansoni. Todos os criadouros (CRs) foram georreferenciados para construção de mapas de risco por meio dos software TrackMaker-Pro e ArcGIS. Resultados: Foram identificados 22 CRs da espécie Biomphalaria straminea, nos quais foram coletados 1.704 caramujos. Desses CRs, um foi identificado como foco de transmissão da doença e sete como focos potenciais para transmissão. Os mapas construídos identificaram duas áreas de risco para transmissão urbana da esquistossomose, bem como áreas de expansão dos CRs, configurando um aumento no risco de transmissão para a população. Conclusão: Os resultados constatam a existência de um novo cenário epidemiológico, no qual a possibilidade de transmissão urbana dessa doença foi confirmada.

ABSTRACT: Introduction: Schistosomiasis is considered an endemic disease in Vitória de Santo Antão, Pernambuco, a district which has presented both high incidence and prevalence of it for decades. Poor environmental conditions lead to contamination of water sources in rural areas, which are used by the population during daily activities, resulting in typical transmission. Recently, there has been evidence of vector snails in urban areas, which could set a new model for schistosomiasis transmission in this district. Objective: To identify the new epidemiological situation for the urban transmission of schistosomiasis in Vitória de Santo Antão, Pernambuco. Methods: A malacological survey was conducted in all water sources in the city limits to investigate schistosomiasis vector snails (Biomphalaria spp.). The collected snails were examined for taxonomic identification and Schistosoma mansoni infection. All breeding sites were georeferenced to build risk maps through the TrackMaker PRO program and ArcGIS software. Results: We identified 22 Biomphalaria straminea breeding sites and collected 1,704 snails. One of these breeding sites was identified as a source of transmission and seven as potential sources of transmission. The designed maps identified two risk areas of urban transmission of schistosomiasis and expansion areas for breeding sites, establishing an increased risk of transmission to the population. Conclusion: This study verified the existence of a new epidemiological situation in which the possibility of the urban transmission of the disease was confirmed.