Schistosomiasis Among Female Migrants in Non-endemic Countries: Neglected Among the Neglected? A Pilot Study.

Background: Schistosomiasis among migrant populations in Europe is an underdiagnosed infection, yet delayed treatment may have serious long-term consequences. In this study we aimed to characterize the clinical manifestations of Schistosoma infection among migrant women, and the degree of underdiagnosis. Methods: We carried out a prospective cross-sectional study among a migrant population living in the North Metropolitan Barcelona area and coming from schistosomiasis-endemic countries. We obtained clinical, laboratory and socio-demographic data from electronic clinical records, as well as information about years of residence and previous attendance at health services. Blood sample was obtained and schistosomiasis exposure was assessed using a specific ELISA serological test. Results: Four hundred and five patients from schistosomiasis-endemic regions were screened, of whom 51 (12.6%) were female. Seropositivity prevalence was 54.8%, but considering women alone we found a prevalence of 58.8% (30 out of 51). The median age of the 51 women was 41.0 years [IQR (35-48)] and the median period of residence in the European Union was 13 years [IQR (10-16)]. Schistosoma-positive women (N = 30) showed a higher prevalence of gynecological signs and symptoms compared to the seronegative women (96.4 vs. 66.6%, p = 0.005). Among seropositive women, the median number of visits to Sexual and Reproductive Health unit prior to diagnosis of schistosomiasis was 41 [IQR (18-65)]. Conclusion: The high prevalence of signs and symptoms among seropositive women and number of previous visits suggest a high rate of underdiagnosis and/or delayed diagnosis of Schistosoma infection, particularly female genital schistosomiasis, among migrant females.

An Update on the Epidemiological Features of Imported Schistosomiasis and Cystic Echinococcosis in Kuwait, 2010-2018.

OBJECTIVE: Kuwait is considered a non-endemic country for most parasitic infections. However, ∼70% of 4.7 million residents in Kuwait are expatriates from Asian and African countries, which are endemic for parasitic infections. Results of microbiological investigations for schistosomiasis and cystic echinococcosis (CE) performed in a reference national laboratory were retrospectively collected and analyzed to provide an insight on the epidemiology of these 2 neglected tropical diseases in Kuwait. SUBJECTS AND METHODS: Schistosoma infection in fecal and urine specimens from suspected patients was detected by microscopy. Schistosoma and CE infections were also detected by indirect hemagglutination assays (IHAs) using blood specimens. Patients' epidemiological data were extracted from the laboratory records. RESULTS: The overall prevalence rates of schistosomiasis and CE were 19.0 and 5.8%, respectively. Almost all schistosomiasis cases were seen among Egyptians, especially among males, and a significantly higher prevalence (p < 0.05) was seen for CE cases among the Syrian residents. A decreasing annual trend was observed for both the parasitic infections over time in Kuwait. CONCLUSIONS: This study confirmed that schistosomiasis is not autochthonous in Kuwait, as all cases were detected among expatriates from Schistosoma-endemic countries. Our data also showed that CE remains endemic among humans and livestock in Kuwait as is also seen in other Middle Eastern countries.

Human and livestock trematode infections in a mobile pastoralist setting at Lake Chad: added value of a One Health approach beyond zoonotic diseases research.

Background: At Lake Chad in Central Africa, mobile pastoralists face economic losses due to livestock trematodiases. Fasciola gigantica and Schistosoma bovis-trematodes that affect livestock-share transmission ecology traits with Schistosoma haematobium and S. mansoni that cause human schistosomiasis. This project aimed at assessing treatment strategies and elucidating the predictive potential of human and livestock trematode infections. Methods: Schistosomiasis and fascioliasis were investigated concurrently in humans and cattle by repeated cross-sectional surveys. Urine and stool samples from humans and faecal samples from cattle were examined for trematode eggs. Treatment strategies were assessed by means of focus group discussions and in-depth interviews. Results: Mobile pastoralists of four ethnic groups participated. Prevalence of human schistosomiasis and livestock trematodiases showed considerable heterogeneity from one ethnic group to another, but correlated within ethnic groups. Effective trematocidal drugs were not available in the study area. Conclusions: Mutual predictive potential of human schistosomiasis and livestock fascioliasis relates to distinct livestock husbandry practices. Introducing efficacious strategic treatment against human schistosomiasis and livestock fascioliasis might improve human and animal health and well-being. Our research provides evidence for the benefits of a One Health approach targeting diseases that share specific ecological traits.

Treatment of human and livestock helminth infections in a mobile pastoralist setting at Lake Chad: Attitudes to health and analysis of active pharmaceutical ingredients of locally available anthelminthic drugs.

Mobile pastoralists face challenges in accessing quality health care and medication for managing human and animal diseases. We determined livestock disease priorities, health seeking behaviour of people bearing helminthiases and - placing particular emphasis on trematode infections - treatment strategies and outcome satisfaction among mobile pastoralists of four ethnic groups in the Lake Chad area using focus group discussions. People suffering from schistosomiasis were interviewed about symptoms, health seeking behaviour and their satisfaction with respect to the provided treatment. Anthelminthic drugs for human and veterinary use obtained from various health care structures were analysed for active pharmaceutical ingredients (API) and quantity, using high pressure liquid chromatography-UV and liquid chromatography combined with tandem mass spectrometry. Most people suffering from schistosomiasis sought treatment at health care centres. Yet, they also consulted informal providers without medical training. Regarding animal health, self-mediated therapy was common to manage suspected livestock fascioliasis. Self-reported treatment satisfaction for human schistosomiasis and trematodiasis treatment outcome in livestock were low. Mobile pastoralists perceived the purchased drugs to be of low quality. Among 33 products locally sold as anthelminthic drugs for human or veterinary use, 27 contained albendazole or mebendazole, varying between 91% and 159% of the labelled amount. Six products were sold loosely with incomplete information and their API could not be identified. No counterfeit anthelminthic drugs were detected. None of the samples contained praziquantel or triclabendazole, the drugs of choice against schistosomiasis and fascioliasis, respectively. The perceived unsatisfactory treatment outcomes in humans and animals infected with trematodes are most likely due to empiric diagnosis and the resulting use of inadequate therapy for human schistosomiasis and the lack of efficacious drugs against livestock fascioliasis.

Perianal lesions after return from Togo: An isolated cutaneous manifestation of schistosomiasis.

Isolated perianal lesions in a returned traveller from Togo were observed. Eosinophilia was the lead to schistosomiasis, although no systemic symptoms were reported. This case report of cutaneous schistosomiasis demonstrates the importance of a travel history, especially geographic and exposure features, and treats the differential diagnosis of eosinophilia in a returned traveller with skin lesions.

Failure of repeated treatment with praziquantel and arthemeter in four patients with acute schistosomiasis.

Schistosomiasis is on the rise but still difficult to treat in international travelers; it should be suspected in patients returning from endemic areas. Praziquantel (PZQ) is not effective and may aggravate symptoms. More recently, combination treatment with artemisinin derivatives have shown promising results. We report four cases of acute schistosomiasis (AS) in which several courses of combined therapy had been necessary to obtain negative serology.

Tropical diseases screening in immigrant patients with human immunodeficiency virus infection in Spain.

Latent parasitic infections can reactivate because of immunosuppression. We conducted a prospective observational study of all human immunodeficiency virus (HIV)-infected immigrants who visited the Infectious Diseases Department of the Hospital Universitari Vall d'Hebron, Barcelona, Spain, during June 2010-May 2011. Screening of the most prevalent tropical diseases (intestinal parasitosis, Chagas disease, leishmaniasis, malaria, schistosomiasis, and strongyloidiasis) was performed according to geographic origin. A total of 190 patients were included: 141 (74.2%) from Latin America, 41 (21.6%) from sub-Saharan Africa, and 8 (4.2%) from northern Africa. Overall, 36.8% (70 of 190) of the patients had at least one positive result for any parasitic disease: 5 patients with positive Trypanosoma cruzi serology, 11 patients with positive Schistosoma mansoni serology, 35 patients with positive Strongyloides stercoralis serology, 7 patients with positive Leishmania infantum serology, intestinal parasitosis were detected in 37 patients, malaria was diagnosed in one symptomatic patient. We propose a screening and management strategy of latent parasitic infections in immigrant patients infected with HIV.

Genetic analysis of human predisposition to hepatosplenic disease caused by schistosomes reveals the crucial role of connective tissue growth factor in rapid progression to severe hepatic fibrosis.

Schistosome worms inhabit mammalian mesenteric veins. Their eggs cause chronic inflammation, which progresses to periportal fibrosis in 5 to 30% of cases, increasing portal blood pressure and leading to esophageal varices. Episodes of bleeding cause hepatic necrosis and may ultimately lead to hepatic failure and the death of the patient. Schistosome infections can also cause pulmonary hypertension and heart failure. The mechanisms of fibrogenesis and fibrolysis are beginning to be unraveled, but it remains unclear why disease occurs only in certain subjects, as also observed for other types of chronic liver inflammation, as in hepatitis C or B. We summarize here the results that showed that fibrosis progression is determined by a genetic locus on chromosome 6. The CCN2 gene at this locus, encodes CTGF that is a crucial regulator of fibrosis. Two groups of CCN2 polymorphisms independently modulate the progression of hepatic fibrosis. These results were obtained in an Asian population, but were extended to humans living in Africa and South America and are presently tested in liver fibrosis of other etiological origins.

Acute schistosomiasis in a cluster of travelers from Rwanda: diagnostic contribution of schistosome DNA detection in serum compared to parasitology and serology.

BACKGROUND: Diagnosis of acute schistosomiasis is often elusive in travelers. Serum schistosome DNA detection is a promising new diagnostic tool. Its performance is compared with current diagnostic procedures in a cluster of travelers recently infected in Rwanda. METHODS: Recent infection with schistosomiasis was suspected in 13 Belgian children and adults, within 2 months after swimming in the Muhazi Lake, Rwanda. All were subjected to clinical examination, eosinophil count, feces parasite detection, schistosome antibody tests [enzyme-linked immunosorbent assay (ELISA) and hemagglutination inhibition assay (HAI)], and schistosome DNA detection in serum by real-time polymerase chain reaction. RESULTS: All 13 patients, between 6 and 29 years old, had a high eosinophil count (median 2,120 µL(-1) ; range 1,150-14,270). Seven of nine persons exposed for the first time developed symptoms compatible with acute schistosomiasis. Eggs of Schistosoma mansoni were found in a concentrated feces sample of 9/13 (69%), with low egg counts (median 20 eggs per gram; range 10-120). Antischistosome antibodies (ELISA and/or HAI) were present in serum of 10/13 (77%) patients. Combining schistosome antibody tests and fecal microscopy demonstrated schistosomiasis in 11/13 (85%) patients. Schistosome-specific DNA was isolated in all 13 (100%) serum samples. CONCLUSION: In this cluster of travelers with acute schistosomiasis, schistosome DNA detection in serum was able to confirm infection in all exposed persons. It clearly outperformed antibody tests and microscopic parasite detection methods as a qualitative diagnostic test.

Understanding ethnic differences in behaviour relating to Schistosoma mansoni re-infection after mass treatment.

It is now widely recognized that a decentralized approach to the control of parasitic infections in rural sub-Saharan populations allows for the design of more effective control programmes and encourages high compliance. Compliance is usually an indicator of treatment success, but cannot be used as a measure of long-term benefit since re-infection will be strongly influenced by a number of factors including the social ecology of a community. In this paper qualitative and quantitative methods are used to identify and understand the structural and behavioural constraints that may influence water contact behaviour and create inequalities with respect to Schistosoma re-infection following anti-helminth drug treatment. The research is set in a community where participant engagement has remained uniformly high throughout the course of a 10-year multidisciplinary study on treatment and re-infection, but where levels of re-infection have not been uniform and, because of variations in water contact behaviour, have varied by age, sex and ethnic background. Variations in the biomedical knowledge of schistosomiasis, socioeconomic constraints and ethnic differences in general attitudes towards life and health are identified that may account for some of these behavioural differences. The observations highlight the benefits of understanding the socio-ecology of control and research settings at several levels (both between and within ethnic groups); this will help to design more effective and universally beneficial interventions for control and help to interpret research findings.

Cyclosporine therapeutic monitoring with C(MAX) in kidney transplant recipients: racial considerations.

BACKGROUND: The aim of the study was to assess whether the C(2) level is a good parameter to predict a drug's maximal concentration C(MAX) values in Egyptian kidney transplant recipients (KTR). METHODS: Fifty stable kidney transplant recipients (KTR) with a previously confirmed diagnosis of schistosomal infection compared to KTR (n = 50) without schistosomal infection regarding CsA concentrations at time 0 (trough), 1.5, 2, 2.5, 3, and 3.5 h post-CsA. Statistical significance of linear regression between different CsA time concentrations and drug dosages was calculated. RESULTS: Patients in schistosomal group, had significantly lower C(2) levels (511 +/- 118 ng/ml) compared with control group (669 +/- 213 ng/ml) (P < 0.05), whereas C(2.5) level was significantly higher (730 +/- 215 and 527 +/- 129 ng/ml, respectively; P < 0.05). Only C(2.5) in schistosomal group had a significant linear regression relationship with both morning cyclosporine (CsA) dose and CsA dose expressed as mg/kg/day (P = 0.0123, r = 0.573018). CONCLUSIONS: Egyptian patients have special characteristics in drug absorption and metabolism, mostly due to schistosomal infection, and they may need the use of C(2.5) for monitoring of CsA. If confirmed by subsequent larger experience, these findings may have a significant impact on our management of CyA immunosuppression in clinical renal transplantation in certain ethnicities.

Cyclosporine therapeutic monitoring with Cmax in kidney transplant recipients: does it fit for all populations?

BACKGROUND: We sought to assess whether the single cyclosporine concentration taken 2 hours after administration (C2) is a good parameter to predict a drug's maximal concentration (Cmax) value in Egyptian kidney transplant recipients. MATERIALS AND METHODS: Fifty stable Egyptian kidney transplant recipients with a previously diagnosed schistosomal infection were compared with 50 Egyptian kidney transplant recipients without a schistosomal infection regarding cyclosporine concentrations at time 0 (trough), and then at 1.5, 2, 2.5, 3, and 3.5 hours after a dose of cyclosporine. We used a linear regression analysis to assess any statistically significant differences between the different cyclosporine time concentrations and drug dosages. RESULTS: Patients in the schistosomal group had significantly lower C2 levels (511 -/+ 118 nmol/L) compared with those in the nonschistosomal (control) group (669 -/+ 213 nmol/L) (P < .05), whereas the C2.5 level was significantly higher (730 -/+ 215 and 527 -/+ 129 nmol/L, respectively; P < .05). A significant linear regression relation was determined for only C2.5 in the schistosomal group with both morning cyclosporine dose and cyclosporine dose expressed as mg/kg/d (P = .0123, r = .573018). CONCLUSIONS: Egyptian patients have special characteristics with regard to drug absorption and metabolism, mostly owing to schistosomal infection, and they may need the use of C2.5 to monitor cyclosporine. If confirmed by subsequent, larger studies, our findings may have a significant effect on our understanding and management of cyclosporine immunosuppression in clinical renal transplants with persons of different ethnicities.

Intergenerational representations of schistosomiasis in endemic area, Jaboticatubas, Minas Gerais

The analysis of the intergenerational process of disease/health representations constitutes a requisite for the construction of projects and health education interventions. The objective of this work is to describe the meaning attributed to schistosomiasis in the family context. Twenty-one residents of an endemic area were interviewed. The interviews were submitted to content analysis. The results demonstrated different representations of the disease by the children, parents and grandparents. This paper discusses the differences in these representations and its impact in schistosomiasis control programs.

Undiagnosed and potentially lethal parasite infections among immigrants and refugees in Australia.

Intestinal parasite infections are a major cause of ill health in many resource-poor countries. This study compares the types and rates of these infections and their risk factors in recently arrived and long-term immigrants in Australia. Cross-sectional surveys of 127 East African and 234 Cambodian immigrants and refugees were undertaken in 2000 and 2002, respectively, to assess the burden of intestinal parasites and collect demographic information. Serum samples were assessed for eosinophilia and Strongyloides stercoralis and Schistosoma antibodies, and feces examined for ova, cysts, and parasites. Intestinal parasites were identified in 77/117 fecal samples from East African and in 25/204 samples collected from Cambodian participants. Eleven percent (14/124) of East Africans and 42% (97/230) of Cambodians had positive or equivocal serology for S stercoralis. Schistosoma serology was positive or equivocal in 15% (19/124) of East African participants. Potentially serious intestinal parasite infections are common among recent and longer term immigrants despite multiple visits to health care providers. Immigrants and refugees from high-risk countries would benefit from comprehensive health checks soon after resettlement.

Intergenerational representations of schistosomiasis in endemic area, Jaboticatubas, Minas Gerais.

The analysis of the intergenerational process of disease/health representations constitutes a requisite for the construction of projects and health education interventions. The objective of this work is to describe the meaning attributed to schistosomiasis in the family context. Twenty-one residents of an endemic area were interviewed. The interviews were submitted to content analysis. The results demonstrated different representations of the disease by the children, parents and grandparents. This paper discusses the differences in these representations and its impact in schistosomiasis control programs.

School non-enrollment and its relation with health and schistosomiasis knowledge, attitudes and practices in rural Egypt.

Children who are not enrolled in school are deprived of schistosomiasis treatments delivered through school health programmes. We explored perceptions of barriers to school enrolment and health and schistosomiasis knowledge, attitude and practices among 58 enrolled and 41 non-enrolled children and 80 adults in a village in El-Fayoum governate, Egypt. Economic factors, cultural factors and the school system were perceived as barriers. Maternal education had a significant role in enrolment. Non-enrolled children were more anaemic and had more signs of vitamin deficiency. Enrolled children had better schistosomiasis knowledge and attitudes, but not practice; both groups had high Schistosoma mansoni infection rates (51.7% enrolled and 65.8% non-enrolled). Education and health policies should tackle perceived barriers. Introduction

[Urogenital bilharziasis: imaging diagnosis]. / Bilharziose urogénitale: diagnostic par imagerie.

Urogenital bilharziasis is a well-known disease that seldom is encountered in western countries. Therefore, bilharziasis usually only is considered after tuberculosis, the main differential diagnosis, has been excluded. Using this case, we will discuss the value of different imaging techniques (especially that of CT combined with transrectal US) for diagnosing bilharziasis and review specific criteria to more easily distinguish both pathologies.

Long-term follow-up after liver transplantation in Egyptians transplanted abroad.

OBJECTIVE: To study the long-term outcome after liver transplantation (LT) in Egyptian patients who underwent LT outside Egypt. METHODS: Between May 1993 and February 2004, over 150 Egyptians underwent LT outside Egypt. Data of 67 recipients were collected in Egypt through personal communications with the Overseas Liver Transplant Centers and through the records of the Egyptian Liver Transplant Association. RESULTS: Most patients underwent LT in Europe (73.1%), few in the United State of America (17.9%) and in Japan (9%). Sixty-one patients underwent cadaveric LT and the remaining 6 patients underwent living related liver transplantation (LDLT). The male to female ratio was 58:9. Median age was 45 (3-63 years). Hepatitis C virus (HCV) cirrhosis whether alone or mixed with schistosomiasis was the main indication for LT. Out of those 67 recipients, 52 (77.6%) survived after a median follow-up period of 4.6 years (rang 1-10.5 years). Deaths were due to primary non-function in 3 patients, postoperative bleeding in one patient, recurrent hepatitis C virus (HCV) in 10 patients, and chronic rejection in one patient. CONCLUSION: Egyptians underwent LT abroad showed a good long-term outcome. Due to the high prevalence of HCV, we expect a growing need for LT in Egypt. Although LDLT has been introduced recently in Egypt, cadaveric liver donation is still not legalized by the government. Efforts should be directed to expanding LDLT, legalizing cadaveric LT and also to the prevention and control of HCV infection in Egypt in order to avoid its devastating effect on the society as well as its enormous negative impact on Egypt's economy and future development.

Full results of the genome-wide scan which localises a locus controlling the intensity of infection by Schistosoma mansoni on chromosome 5q31-q33.

Three hundred million individuals are at risk of infection by schistosomes, and thousands die each year of severe hepatic disease. Previous studies have shown that the intensity of infection by Schistosoma mansoni in a Brazilian population is controlled by a major gene, denoted as SM1. We report here the full results of a genome-wide search that was performed on this population to localise SM1. Two hundred and forty-six microsatellites were used for the primary map, and only one region in 5q31-q33 provided significant evidence of linkage. SM1 was subsequently mapped to this region, which contains several genes encoding cytokines or cytokine receptors which are involved in protection against schistosomes. Three additional regions, 1p22.2, 7q36 and 21q22-22-qter, yielded promising, although not significant, lod-score values. These regions contain candidate genes encoding cytokines or molecules relevant to anti-schistosome immunity.

Ultrasound appearance of schistosomiasis of the testis.

Schistosomiasis of the testis is rare and its ultrasound findings have not previously been documented in the English medical literature. This case report describes the ultrasound appearances of a case of schistosomiasis of the testis in a 33-year-old male who had recently travelled to Egypt. The ultrasound findings are those of a solid testicular mass with a heterogeneous echotexture identical to that of most testicular malignancies.