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Downs JA, de Dood CJ, Dee HE, McGeehan M, Khan H, Marenga A, Adel PE, Faustine E, Issarow B, Kisanga EF, Kisigo GA, Ngahyolerwa S, Zahoro F, Miyaye D, Magawa RG, Mngara J, Lee MH, Corstjens PLAM, van Dam GJ, Fitzgerald DW. Schistosomiasis and Human Immunodeficiency Virus in Men in Tanzania. Am J Trop Med Hyg 2017; 96:856-862. [PMID: 28167600 DOI: 10.4269/ajtmh.16-0897] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
AbstractSchistosomiasis is a parasitic worm infection that affects over 260 million individuals worldwide. Women with schistosome infections have been demonstrated to have a 4-fold increase in the odds of human immunodeficiency virus (HIV) infection compared with women without schistosome infections. A relationship between schistosome and HIV infections has not been clearly defined in men. Among 674 men aged 18-50 years living in rural Tanzania, we identified 429 (63.6%) who had a schistosome infection as defined by serum positivity for schistosome circulating anodic antigen, visualization of parasite eggs in urine or stool, or both. HIV infection was identified in 38 (5.6%). The odds of HIV infection was 1.3 [95% confidence interval = 0.6-2.5] (P = 0.53) among men with any schistosome infection (Schistosoma haematobium or Schistosoma mansoni), and it was 1.4 [0.6-3.3] (P = 0.43) among men with S. haematobium infection. Men with S. haematobium infection were significantly more likely to report the symptom of hemospermia than men without S. haematobium infection. We conclude that schistosome infections appear to have little to no association with HIV infection in men.
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Affiliation(s)
- Jennifer A Downs
- Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania.,Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York
| | - Claudia J de Dood
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hannah E Dee
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York
| | - Megan McGeehan
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York
| | | | | | - Patrick E Adel
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Edward Faustine
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Benson Issarow
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | | | | | - Frank Zahoro
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Donald Miyaye
- National Institute for Medical Research-Mwanza Research Centre, Mwanza, Tanzania
| | - Ruth Gideon Magawa
- National Institute for Medical Research-Mwanza Research Centre, Mwanza, Tanzania
| | - Julius Mngara
- National Institute for Medical Research-Mwanza Research Centre, Mwanza, Tanzania
| | - Myung Hee Lee
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York
| | - Paul L A M Corstjens
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Daniel W Fitzgerald
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York
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Galappaththi-Arachchige HN, Amlie Hegertun IE, Holmen S, Qvigstad E, Kleppa E, Sebitloane M, Ndhlovu PD, Vennervald BJ, Gundersen SG, Taylor M, Kjetland EF. Association of Urogenital Symptoms with History of Water Contact in Young Women in Areas Endemic for S. haematobium. A Cross-Sectional Study in Rural South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13111135. [PMID: 27854250 PMCID: PMC5129345 DOI: 10.3390/ijerph13111135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 10/24/2016] [Accepted: 11/07/2016] [Indexed: 11/25/2022]
Abstract
Female genital schistosomiasis is a neglected tropical disease caused by Schistosoma haematobium. Infected females may suffer from symptoms mimicking sexually transmitted infections. We explored if self-reported history of unsafe water contact could be used as a simple predictor of genital schistosomiasis. In a cross-sectional study in rural South Africa, 883 sexually active women aged 16–22 years were included. Questions were asked about urogenital symptoms and water contact history. Urine samples were tested for S. haematobium ova. A score based on self-reported water contact was calculated and the association with symptoms was explored while adjusting for other genital infections using multivariable logistic regression analyses. S. haematobium ova were detected in the urine of 30.5% of subjects. Having ova in the urine was associated with the water contact score (p < 0.001). Symptoms that were associated with water contact included burning sensation in the genitals (p = 0.005), spot bleeding (p = 0.012), abnormal discharge smell (p = 0.018), bloody discharge (p = 0.020), genital ulcer (p = 0.038), red urine (p < 0.001), stress incontinence (p = 0.001) and lower abdominal pain (p = 0.028). In S. haematobium endemic areas, self-reported water contact was strongly associated with urogenital symptoms. In low-resource settings, a simple history including risk of water contact behaviour can serve as an indicator of urogenital schistosomiasis.
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Affiliation(s)
- Hashini Nilushika Galappaththi-Arachchige
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Postboks 4956 Nydalen, Oslo 0450, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo 0312, Norway.
| | - Ingrid Elise Amlie Hegertun
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Postboks 4956 Nydalen, Oslo 0450, Norway.
| | - Sigve Holmen
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Postboks 4956 Nydalen, Oslo 0450, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo 0312, Norway.
| | - Erik Qvigstad
- Institute of Clinical Medicine, University of Oslo, Oslo 0312, Norway.
- Department of Gynaecology, Women and Children's Division, Ullevaal University Hospital, Oslo 0450, Norway.
| | - Elisabeth Kleppa
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Postboks 4956 Nydalen, Oslo 0450, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo 0312, Norway.
| | - Motshedisi Sebitloane
- Discipline of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban 4001, South Africa.
| | | | - Birgitte Jyding Vennervald
- Section for Parasitology and Aquatic Diseases, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark.
| | - Svein Gunnar Gundersen
- Research Unit, Sorlandet Hospital, Kristiansand 4615, Norway.
- Department of Global Development and Planning, University of Agder, Kristiansand 4630, Norway.
| | - Myra Taylor
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa.
| | - Eyrun Floerecke Kjetland
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Postboks 4956 Nydalen, Oslo 0450, Norway.
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa.
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Baird S, Hicks JH, Kremer M, Miguel E. Worms at Work: Long-run Impacts of a Child Health Investment. THE QUARTERLY JOURNAL OF ECONOMICS 2016; 131:1637-1680. [PMID: 27818531 PMCID: PMC5094294 DOI: 10.1093/qje/qjw022] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
This study estimates long-run impacts of a child health investment, exploiting community-wide experimental variation in school-based deworming. The program increased labor supply among men and education among women, with accompanying shifts in labor market specialization. Ten years after deworming treatment, men who were eligible as boys stay enrolled for more years of primary school, work 17% more hours each week, spend more time in nonagricultural self-employment, are more likely to hold manufacturing jobs, and miss one fewer meal per week. Women who were in treatment schools as girls are approximately one quarter more likely to have attended secondary school, halving the gender gap. They reallocate time from traditional agriculture into cash crops and nonagricultural self-employment. We estimate a conservative annualized financial internal rate of return to deworming of 32%, and show that mass deworming may generate more in future government revenue than it costs in subsidies.
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O'Hara GA, Elliott AM. HIV and Helminths - Not All Worms Created Equal? Trends Parasitol 2016; 32:916-918. [PMID: 28029560 DOI: 10.1016/j.pt.2016.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 09/19/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Geraldine A O'Hara
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Alison M Elliott
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda.
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Affiliation(s)
- Jennifer A Downs
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA; Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania.
| | - Daniel W Fitzgerald
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
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Kroidl I, Saathoff E, Maganga L, Makunde WH, Hoerauf A, Geldmacher C, Clowes P, Maboko L, Hoelscher M. Effect of Wuchereria bancrofti infection on HIV incidence in southwest Tanzania: a prospective cohort study. Lancet 2016; 388:1912-1920. [PMID: 27495354 DOI: 10.1016/s0140-6736(16)31252-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/08/2016] [Accepted: 07/13/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND The past decades have seen an ongoing controversial debate about whether the immune activation induced by helminths has an effect on the susceptibility of individuals to HIV. In view of this, we assessed the effect of lymphatic filariasis, a chronic helminth disease elicited by Wuchereria bancrofti, on HIV incidence in southwest Tanzania. METHODS In this population-based cohort study, we enrolled a geographically stratified randomly chosen sample of about 10% of the households in nine distinct sites in southwest Tanzania. All household members present were followed up and tested for HIV and circulating filarial antigen, an indicator of W bancrofti adult worm burden. Our main outcome of interest was HIV incidence in participants with or without lymphatic filariasis. FINDINGS Between May 29, 2006, and June 16, 2011, we enrolled 4283 households with roughly 18 000 participants. Of these, 2699 individuals from Kyela district participated in at least one round of the EMINI study. In the 1055 initially HIV-negative adolescents and adults with clearly defined lymphatic filariasis status, 32 new HIV infections were observed in 2626 person-years. HIV incidence in lymphatic filariasis-positive participants (1·91 cases per 100 person-years) was significantly higher than the incidence in lymphatic filariasis-negative participants (0·80 cases per 100 person-years). The age-adjusted and sex-adjusted incidence rate ratio was 2·17 (95% CI 1·08-4·37, p=0·0300). Lymphatic filariasis status remained an independent and significantly relevant risk factor for HIV infection when controlled for other known risk factors such as sexual behaviour and socioeconomic factors. INTERPRETATION To our knowledge, this is the first prospective study demonstrating a significantly increased risk of acquiring HIV for lymphatic filariasis-infected individuals. Immunological studies and interventional treatment studies that eliminate the adult worms and not only the microfilariae are needed to follow up on the results presented. FUNDING European Union as part of EuropAid; German Federal Ministry of Education and Research; German Center for Infection Research.
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Affiliation(s)
- Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany; National Institute of Medical Research, Mbeya Medical Research Centre, Mbeya, Tanzania; German Center for Infection Research (DZIF), partner site Munich, Munich, Germany.
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany; German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Lucas Maganga
- National Institute of Medical Research, Mbeya Medical Research Centre, Mbeya, Tanzania
| | | | - Achim Hoerauf
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital of Bonn, Bonn, Germany; German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn-Cologne, Germany
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany; German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Petra Clowes
- National Institute of Medical Research, Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Leonard Maboko
- National Institute of Medical Research, Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany; National Institute of Medical Research, Mbeya Medical Research Centre, Mbeya, Tanzania; German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
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Yirenya-Tawiah DR, Ackumey MM, Bosompem KM. Knowledge and awareness of genital involvement and reproductive health consequences of urogenital schistosomiasis in endemic communities in Ghana: a cross-sectional study. Reprod Health 2016; 13:117. [PMID: 27655032 PMCID: PMC5031356 DOI: 10.1186/s12978-016-0238-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 09/14/2016] [Indexed: 11/21/2022] Open
Abstract
Background The World Health Organization, in the year 2009, renamed Schistosomiasis haematobium disease, urinary schistosomiasis, as urogenital schistosomiasis. This study, sought to determine whether urogenital schistosomiasis endemic community members were aware of the broadened scope of the disease and associated certain reproductive health related signs and symptoms to S. haematobium infection. Method This is a cross-sectional study in which 2,585 respondents aged 15–49 years from 30 riparian communities along the lower arm of the Volta lake were interviewed using a structured questionnaire; 24 focus group discussions were also conducted. Descriptive statistics were used to determine the frequency of responses for each question posed and Chi squared tests used to determine the associations between demographic variables and variables of interest. Binary logistic regression was used to predict the probability of a reported symptom as an indicator of urogenital schistosomiasis. Thematic analysis was used to examine narratives. Result Ninety four percent of male respondents and 88.7 % of female respondents acknowledged schistosomiasis as a water-borne disease. Only 207 out of 1,096 subjects (18.9 %) responding to questionnaire agreed to the knowledge that urogenital schistosomiasis can have reproductive health implications. A significant difference in variation in this knowledge was found between males (14.5 %) and females (7.2 %) (p = 0.001). The study also found that, although knowledge on HIV was high, only 12.3 % of respondents knew that urogenital schistosomiasis could facilitate the acquisition of HIV. Women who reported to have ever suffered schistosomiasis were 1.3 and 1.5 times more likely to report vaginal discharge and vaginal itch. Sexual dysfunction (11.1 %) and urethral discharge (10.6 %) were the most frequently reported symptoms among males. Conclusion The study finds very limited knowledge on the reproductive health consequences of the disease among endemic communities. It is recommended that health education on urogenital schistosomiasis should also include issues on symptoms of the disease, reproductive health consequences and HIV transmission.
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Affiliation(s)
- Dzidzo R Yirenya-Tawiah
- Institute of Environment and Sanitation Studies, University of Ghana, P.O Box 209, Legon, Accra, Ghana.
| | - Mercy M Ackumey
- School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Kwabena M Bosompem
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
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Kigen G, Edwards G. Intracellular accumulation of Praziquantel in T lymphoblastoid cell lines, CEM (parental) and CEMVBL(P-gp-overexpressing). BMC Pharmacol Toxicol 2016; 17:37. [PMID: 27522191 PMCID: PMC4983413 DOI: 10.1186/s40360-016-0079-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 07/19/2016] [Indexed: 11/10/2022] Open
Abstract
Background Praziquantel (PZQ) is an antihelminthic drug whose P-glycoprotein (P-gp) substrate specificity has not been conclusively characterized. We investigated its specificity by comparing its in vitro intracellular accumulation in CEM (parental), and CEMvbl cells which over express P-gp, a drug efflux transporter. Saquinavir (SQV), a known substrate of efflux transporters was used as control. Methods A reversed phase liquid chromatography method was developed to simultaneously quantify PZQ and SQV in cell culture media involving involved a liquid - liquid extraction followed by ultra-high performance liquid chromatography using a Hypurity C18 column and ultraviolet detection set at a wavelength of 215 nm. The mobile phase consisted of ammonium formate, acetonitrile and methanol (57:38:5 v/v). Separation was facilitated via isocratic elution at a flow rate of 1.5 ml/min, with clozapine (CLZ) as internal standard. This was validated over the concentration range of 1.6 to 25.6 μM for all analytes. Intracellular accumulation of SQV in CEMvbl was significantly lower compared to that in CEM cells (0.1 ± 0.031 versus 0.52 ± 0.046, p = 0.03 [p <0.05]). Results Accumulation of PZQ in both cell lines cells were similar (0.05 ± 0.005 versus 0.04 ± 0.009, p = 0.4) suggesting that it is not a substrate of P-gp in CEM cells. In presence tariquidar, a known inhibitor of P-gp, the intracellular accumulation of SQV in CEMvbl cells increased (0.52 ± 0.068 versus 0.61 ± 0.102, p = 0.34 in CEM cells and 0.09 ± 0.015 versus 0.56 ± 0.089, p = 0.029 [p < 0.05] in CEMvbl cells). PZQ did not significantly affect the accumulation of SQV in either CEM (0.52 ± 0.068 versus 0.54 ± 0.061, p = 0.77), or in CEMvbl cells (0.09 ± 0.015 versus 0.1 ± 0.031, p = 0.89) cells compared to tariquidar, implying that PZQ is not an inhibitor of P-gp in CEMvbl cells. Conclusions PZQ is neither a substrate nor an inhibitor of the efflux drug transporter P-gp in T-lymphoblastoid cells, CEM and CEMvbl. We also report a simple, accurate and precise method for simultaneous quantification of PZQ and SQV.
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Affiliation(s)
- Gabriel Kigen
- Department of Pharmacology and Toxicology, Moi University School of Medicine, P.O. Box 4606, 30100, Eldoret, Kenya. .,Department Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, L69 3GE, UK.
| | - Geoffrey Edwards
- Department Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, L69 3GE, UK
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Richardson ST, Franklin AL, Rome ES, Simms-Cendan JS. Global Health: Urogenital Schistosomiasis in the Adolescent Girl. J Pediatr Adolesc Gynecol 2016; 29:326-32. [PMID: 26173381 DOI: 10.1016/j.jpag.2014.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 07/11/2014] [Accepted: 07/16/2014] [Indexed: 11/28/2022]
Abstract
Urogenital schistosomiasis affects millions of women in sub-Saharan Africa. Infection by the causative organism, Schistosoma hematobium, commonly occurs during childhood and adolescence and can lead to anemia from hematuria, inflammation on the cervix which can increase risk of HIV transmission, and pelvic infection leading to infertility. Fortunately treatment is not costly, but early diagnosis is important to reduce long-term morbidity. Our objective is to review the epidemiology, pathophysiology, and diagnosis of urogenital schistosomiasis as well as treatment to improve the reproductive health of girls where this infection is endemic.
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Affiliation(s)
- Sharise T Richardson
- Department of Obstetrics & Gynecology, University of Miami, Miller School of Medicine, Miami, FL
| | - Ashley L Franklin
- Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando, FL
| | - Ellen S Rome
- Cleveland Clinic Lerner College of Medicine, Center for Adolescent Medicine, Cleveland, OH
| | - Judith S Simms-Cendan
- Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando, FL.
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Person B, Ali SM, A’Kadir FM, Ali JN, Mohammed UA, Mohammed KA, Rollinson D, Knopp S. Community Knowledge, Perceptions, and Practices Associated with Urogenital Schistosomiasis among School-Aged Children in Zanzibar, United Republic of Tanzania. PLoS Negl Trop Dis 2016; 10:e0004814. [PMID: 27399310 PMCID: PMC4939940 DOI: 10.1371/journal.pntd.0004814] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 06/08/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND On the Zanzibar islands, United Republic of Tanzania, elimination of urogenital schistosomiasis is strived for in the coming years. This qualitative study aimed to better understand community knowledge, perceptions, and practices associated with schistosomiasis among school-aged children on Unguja and Pemba islands, in order to inform the development of behavior change interventions contributing to eliminate urogenital schistosomiasis. METHODOLOGY In 2011, we conducted 35 children's discussion groups, 41 in-depth interviews with parents and teachers, and 5 focus group discussions with community members in Zanzibar. Using a modified-grounded theory approach, we transcribed and coded the narrative data followed by thematic analysis of the emergent themes. PRINCIPAL FINDINGS Urogenital schistosomiasis is a common experience among children in Zanzibar and typically considered a boys' disease. Children engage in multiple high-risk behaviors for acquiring schistosomiasis because of poor knowledge on disease transmission, lack of understanding on severity of disease-associated consequences, and lack of alternative options for water related activities of daily living and recreational play. Local primary school teachers had little to no training about the disease and no teaching tools or materials for students. CONCLUSIONS/SIGNIFICANCE Conducting activities in open natural freshwater contaminated by S. haematobium larvae compromises the health of school-aged children in Zanzibar. The perception of urogenital schistosomiasis as a minor illness rather than a serious threat to a child's well-being contributes to the spread of disease. Understanding community perceptions of disease along with the barriers and facilitators to risk reduction behaviors among children can inform health promotion activities, campaigns, and programs for the prevention, control, and elimination of urogenital schistosomiasis in Zanzibar.
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Affiliation(s)
- Bobbie Person
- The Schistosomiasis Consortium for Operational Research and Evaluation, University of Georgia, Atlanta, Georgia, United States of America
| | - Said M. Ali
- Public Health Laboratory—Ivo de Carneri, Chake Chake, Pemba, United Republic of Tanzania
| | - Faiza M. A’Kadir
- Zanzibar Neglected Tropical Diseases Control Program, Ministry of Health, Zanzibar Town, Unguja, United Republic of Tanzania
| | - Jamal N. Ali
- Zanzibar Neglected Tropical Diseases Control Program, Ministry of Health, Zanzibar Town, Unguja, United Republic of Tanzania
| | - Ulfat A. Mohammed
- Public Health Laboratory—Ivo de Carneri, Chake Chake, Pemba, United Republic of Tanzania
| | - Khalfan A. Mohammed
- Zanzibar Neglected Tropical Diseases Control Program, Ministry of Health, Zanzibar Town, Unguja, United Republic of Tanzania
| | - David Rollinson
- Wolfson Wellcome Biomedical Laboratories, Department of Life Sciences, Natural History Museum, London, United Kingdom
| | - Stefanie Knopp
- Wolfson Wellcome Biomedical Laboratories, Department of Life Sciences, Natural History Museum, London, United Kingdom
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Baan M, Galappaththi-Arachchige HN, Gagai S, Aurlund CG, Vennervald BJ, Taylor M, van Lieshout L, Kjetland EF. The Accuracy of Praziquantel Dose Poles for Mass Treatment of Schistosomiasis in School Girls in KwaZulu-Natal, South Africa. PLoS Negl Trop Dis 2016; 10:e0004623. [PMID: 27139497 PMCID: PMC4854411 DOI: 10.1371/journal.pntd.0004623] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 03/21/2016] [Indexed: 11/18/2022] Open
Abstract
Background More than 260 million people live with schistosomiasis and regular mass-treatment should be implemented to prevent morbidity. Praziquantel, dosed at 40 milligrams per kilogram bodyweight, is the drug of choice. During the last decades the WHO Tablet Pole–which estimates tablet need by height as representing weight–has been used as a practical and cheap tool in mass treatment. In South Africa this method could be inaccurate given the prevalence of overweight and obesity. In this study in female pupils in KwaZulu-Natal, South Africa, we explored the accuracy of the WHO Tablet Pole and the recently developed Modified Dose Pole for adults with two additional intervals and correction for body mass index (BMI). Methodology In randomly selected primary and secondary schools of schistosomiasis-endemic areas, height and weight of female pupils were measured. The WHO Tablet Pole and Modified Dose Pole were used to indicate the amount of praziquantel according to height and the dose in milligrams per kilogram bodyweight was calculated. The BMI correction was performed by adding 600 milligrams (1 tablet) to the indicated dose if a person was overweight/obese. Principal Findings 3157 female students were investigated and 35% were found to be overweight/obese. Using the WHO Tablet Pole, 73% would have received an adequate dose (range 30–60 mg/kg). When correcting for BMI, this would have been 94%. Using the Modified Dose Pole with BMI correction, 97% would have been adequately treated. Conclusions This study shows that the WHO Tablet Pole will be inaccurate in estimating the dose of praziquantel in South African girls due to high prevalence of overweight/obesity. Under-dosing of individuals who appear overweight/obese could be largely prevented by adding an extra praziquantel tablet to the recommended dose. Further research must be done to explore if subjective weight estimates are reliable. Schistosomiasis is an acute and chronic parasitic disease caused by Schistosoma worms, contributing to morbidity and mortality in 261 million people, mainly in poor, rural communities. In an effort to control schistosomiasis, the World Health Organization advocates for regular mass treatment to at-risk populations, administering free praziquantel (40mg/kg). The WHO Tablet Pole, which estimates the number of tablets for each individual by height, is recommended for the dosing of praziquantel. A Modified Dose Pole with two additional height intervals has been developed for adults. In addition, the developers of the Modified Dose Pole suggest to add an extra tablet to the indicated dose if the person appears to be overweight/obese (“correction for body mass index (BMI)”). This study explored the accuracy of these dose pole programmes in 3157 school-girls in schistosomiasis-endemic KwaZulu-Natal, South Africa. Overweight or obesity was found in 35% of the study population. With the WHO Tablet Pole, only 73% would have received an acceptable dose (30-60mg/kg), whereas when correcting for overweight/obesity almost all the girls would have been adequately treated. We suggest adding one tablet to the dose recommended by the WHO Tablet Pole if a person appears to be overweight/obese to prevent under-dosing of these individuals.
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Affiliation(s)
- Marije Baan
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
- Faculty of Health, Medicine and Life Science, Maastricht University, Maastricht, The Netherlands
| | - Hashini Nilushika Galappaththi-Arachchige
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Silindile Gagai
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Christine G. Aurlund
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Birgitte J. Vennervald
- Section for Parasitology and Aquatic Diseases, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Myra Taylor
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Eyrun F. Kjetland
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- * E-mail:
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Christinet V, Lazdins-Helds JK, Stothard JR, Reinhard-Rupp J. Female genital schistosomiasis (FGS): from case reports to a call for concerted action against this neglected gynaecological disease. Int J Parasitol 2016; 46:395-404. [PMID: 27063073 DOI: 10.1016/j.ijpara.2016.02.006] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 02/06/2023]
Abstract
In recent years, control of neglected tropical diseases has been increasingly gaining momentum and interventions against schistosomiasis are being progressively scaled-up through expansion of donated praziquantel and preventive chemotherapy campaigns. However, the public health importance of female genital schistosomiasis is not fully recognised nor its control is adequately addressed. Taking a clinical and anatomopathological perspective, we evaluated the available literature to highlight the importance of female genital schistosomiasis and its connections with two sexually transmitted infections of global importance, Human Immunodeficiency Virus (HIV) and Human Papilloma Virus. Outside the long list of clinical descriptive reports beginning in 1899, there is presently a shocking gap in epidemiological assessment and a significant underestimation of the burden of FGS remains. The scarcity of integrated approaches to address female genital schistosomiasis calls for more concerted action in its detection, treatment and prevention alongside other concomitant women's health issues, otherwise female genital schistosomiasis will remain a neglected gynaecological disease.
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Affiliation(s)
- Vanessa Christinet
- Centre International de Recherches, d'Enseignements et de Soins en Milieu Tropical (CIRES), Akonolinga, Cameroon
| | | | - J Russell Stothard
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
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Holmen S, Galappaththi-Arachchige HN, Kleppa E, Pillay P, Naicker T, Taylor M, Onsrud M, Kjetland EF, Albregtsen F. Characteristics of Blood Vessels in Female Genital Schistosomiasis: Paving the Way for Objective Diagnostics at the Point of Care. PLoS Negl Trop Dis 2016; 10:e0004628. [PMID: 27073857 PMCID: PMC4830560 DOI: 10.1371/journal.pntd.0004628] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 03/23/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The mucosal changes associated with female genital schistosomiasis (FGS) encompass abnormal blood vessels. These have been described as circular, reticular, branched, convoluted and having uneven calibre. However, these characteristics are subjective descriptions and it has not been explored which of them are specific to FGS. METHODS In colposcopic images of young women from a schistosomiasis endemic area, we performed computerised morphologic analyses of the cervical vasculature appearing on the mucosal surface. Study participants where the cervix was classified as normal served as negative controls, women with clinically diagnosed FGS and presence of typical abnormal blood vessels visible on the cervical surface served as positive cases. We also included women with cervical inflammatory conditions for reasons other than schistosomiasis. By automating morphological analyses, we explored circular configurations, vascular density, fractal dimensions and fractal lacunarity as parameters of interest. RESULTS We found that the blood vessels typical of FGS are characterised by the presence of circular configurations (p < 0.001), increased vascular density (p = 0.015) and increased local connected fractal dimensions (p = 0.071). Using these features, we were able to correctly classify 78% of the FGS-positive cases with an accuracy of 80%. CONCLUSIONS The blood vessels typical of FGS have circular configurations, increased vascular density and increased local connected fractal dimensions. These specific morphological features could be used diagnostically. Combined with colourimetric analyses, this represents a step towards making a diagnostic tool for FGS based on computerised image analysis.
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Affiliation(s)
- Sigve Holmen
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hashini Nilushika Galappaththi-Arachchige
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Elisabeth Kleppa
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pavitra Pillay
- Department of Biomedical and Clinical Technology, Durban University of Technology, Durban, South Africa
| | - Thajasvarie Naicker
- Optics and Imaging Centre, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Myra Taylor
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Mathias Onsrud
- Department of Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Eyrun Floerecke Kjetland
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Fritz Albregtsen
- Department of Informatics, University of Oslo, Oslo, Norway
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway
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115
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Brodish PH, Singh K. Association Between Schistosoma haematobium Exposure and Human Immunodeficiency Virus Infection Among Females in Mozambique. Am J Trop Med Hyg 2016; 94:1040-4. [PMID: 26976893 DOI: 10.4269/ajtmh.15-0652] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 02/05/2016] [Indexed: 11/07/2022] Open
Abstract
Recent evidence suggests an association between human immunodeficiency virus (HIV) and female genital schistosomiasis (FGS) in sub-Saharan Africa, especially in Mozambique, South Africa, Tanzania, and Zimbabwe. Women with FGS have increased numbers of HIV target cells and cell receptors in genital and blood compartments, potentially increasing the risk of HIV transmission per sexual exposure, and the association may explain the high female:male ratio of HIV prevalence unique to sub-Saharan Africa. We investigate this association in Mozambique by linking two georeferenced, high-quality secondary data sources on HIV prevalence and Schistosoma haematobium: the AIDS Indicator Survey, and the Global Neglected Tropical Diseases (GNTD) open-source database, respectively. We construct a schistosomiasis exposure covariate indicating women reporting "unimproved" daily drinking water sources and living no more than 2-5 km from high-endemic global positioning system (GPS) coordinates in the GNTD. In logistic regression analyses predicting HIV-positive status, we show that exposure increases the odds of HIV-positive status by three times, controlling for demographic and sexual risk factors.
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Affiliation(s)
- Paul Henry Brodish
- MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kavita Singh
- MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Repurposing pharma assets: an accelerated mechanism for strengthening the schistosomiasis drug development pipeline. Future Med Chem 2016; 7:727-35. [PMID: 25996066 DOI: 10.4155/fmc.15.26] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Schistosomiasis, one of 17 diseases deemed to be neglected by the World Health Organization, has received little attention from the biopharmaceutical industry. Due to this, only a handful of drugs have been developed to treat schistosomiasis, with only one, praziquantel, used in most endemic regions. Growing concern over resistance coupled with praziquantel's incomplete efficacy across all stages of the Schistosoma platyhelminth life cycle highlights the urgent need for new drugs. The WIPO Re:Search consortium is a platform whereupon biopharmaceutical company compounds are being repurposed to efficiently and cost-effectively develop new drugs for neglected diseases such as schistosomiasis. This article summarizes recent clinical-stage efforts to identify new antischistosomals and highlights biopharmaceutical company compounds with potential for repurposing to treat schistosomiasis.
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Stroehlein AJ, Young ND, Jex AR, Sternberg PW, Tan P, Boag PR, Hofmann A, Gasser RB. Defining the Schistosoma haematobium kinome enables the prediction of essential kinases as anti-schistosome drug targets. Sci Rep 2015; 5:17759. [PMID: 26635209 PMCID: PMC4669435 DOI: 10.1038/srep17759] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/26/2015] [Indexed: 01/13/2023] Open
Abstract
The blood fluke Schistosoma haematobium causes urogenital schistosomiasis, a neglected tropical disease (NTD) that affects more than 110 million people. Treating this disease by targeted or mass administration with a single chemical, praziquantel, carries the risk that drug resistance will develop in this pathogen. Therefore, there is an imperative to search for new drug targets in S. haematobium and other schistosomes. In this regard, protein kinases have potential, given their essential roles in biological processes and as targets for drugs already approved by the US Food and Drug Administration (FDA) for use in humans. In this context, we defined here the kinome of S. haematobium using a refined bioinformatic pipeline. We classified, curated and annotated predicted kinases, and assessed the developmental transcription profiles of kinase genes. Then, we prioritised a panel of kinases as potential drug targets and inferred chemicals that bind to them using an integrated bioinformatic pipeline. Most kinases of S. haematobium are very similar to those of its congener, S. mansoni, offering the prospect of designing chemicals that kill both species. Overall, this study provides a global insight into the kinome of S. haematobium and should assist the repurposing or discovery of drugs against schistosomiasis.
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Affiliation(s)
- Andreas J. Stroehlein
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Neil D. Young
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Aaron R. Jex
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Paul W. Sternberg
- HHMI, Division of Biology, California Institute of Technology, Pasadena, California, USA
| | - Patrick Tan
- Genome Institute of Singapore, Republic of Singapore
- Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School, Republic of Singapore
| | - Peter R. Boag
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Andreas Hofmann
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
- Structural Chemistry Program, Eskitis Institute, Griffith University, Brisbane, Australia
| | - Robin B. Gasser
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
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Simon GG. Impacts of neglected tropical disease on incidence and progression of HIV/AIDS, tuberculosis, and malaria: scientific links. Int J Infect Dis 2015; 42:54-57. [PMID: 26594012 DOI: 10.1016/j.ijid.2015.11.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 10/19/2015] [Accepted: 11/07/2015] [Indexed: 01/15/2023] Open
Abstract
The neglected tropical diseases (NTDs) are the most common infections of humans in Sub-Saharan Africa. Virtually all of the population living below the World Bank poverty figure is affected by one or more NTDs. New evidence indicates a high degree of geographic overlap between the highest-prevalence NTDs (soil-transmitted helminths, schistosomiasis, onchocerciasis, lymphatic filariasis, and trachoma) and malaria and HIV, exhibiting a high degree of co-infection. Recent research suggests that NTDs can affect HIV and AIDS, tuberculosis (TB), and malaria disease progression. A combination of immunological, epidemiological, and clinical factors can contribute to these interactions and add to a worsening prognosis for people affected by HIV/AIDS, TB, and malaria. Together these results point to the impacts of the highest-prevalence NTDs on the health outcomes of malaria, HIV/AIDS, and TB and present new opportunities to design innovative public health interventions and strategies for these 'big three' diseases. This analysis describes the current findings of research and what research is still needed to strengthen the knowledge base of the impacts NTDs have on the big three.
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Affiliation(s)
- G G Simon
- Management Sciences for Health, Arlington VA, USA.
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119
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Stecher CW, Kallestrup P, Kjetland EF, Vennervald B, Petersen E. Considering treatment of male genital schistosomiasis as a tool for future HIV prevention: a systematic review. Int J Public Health 2015; 60:839-48. [PMID: 26298443 DOI: 10.1007/s00038-015-0714-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/26/2015] [Accepted: 07/03/2015] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Male genital schistosomiasis (MGS) is a neglected manifestation of Schistosoma haematobium infection with ignored implications on reproductive health and a differential diagnosis to sexually transmitted infections in endemic regions. MGS may have associations with HIV transmission and acquisition, and treatment could be a neglected chance of HIV prevention. This review summarizes current knowledge on epidemiology, clinical manifestations, diagnosis and treatment of MGS as a hypothesized risk factor for HIV transmission. Future research areas of global interest are suggested. METHODS PubMed published literature was reviewed based on the MOOSE guidelines. All publications on MGS were included regardless of publication year and study design. Furthermore, all publications were searched for information on possible HIV association. RESULTS The 40 identified publications related to MGS were dominated by case reports and observational studies. No randomized clinical trials have been conducted to date, and very scant information related to possible associations with HIV transmission was presented. CONCLUSIONS Clinical, randomized studies and epidemiological studies covering the possible association between MGS and HIV are urgently needed. Furthermore, field diagnostic tools should be developed and future mass treatment programs should include adults to reduce morbidity and prevent HIV acquisition. SYSTEMATIC REVIEW REGISTRATION NUMBER CRD42015016252.
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Affiliation(s)
- Chalotte Willemann Stecher
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
- Center for Global Health (GloHAU), Aarhus University, Aarhus, Denmark.
| | - Per Kallestrup
- Center for Global Health (GloHAU), Aarhus University, Aarhus, Denmark.
| | - Eyrun Floerecke Kjetland
- Norwegian Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway.
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Birgitte Vennervald
- Department of Parasitology and Aquatic Diseases, University of Copenhagen, Copenhagen, Denmark.
| | - Eskild Petersen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
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Siza JE, Kaatano GM, Chai JY, Eom KS, Rim HJ, Yong TS, Min DY, Chang SY, Ko Y, Changalucha JM. Prevalence of Schistosomes and Soil-Transmitted Helminths and Morbidity Associated with Schistosomiasis among Adult Population in Lake Victoria Basin, Tanzania. THE KOREAN JOURNAL OF PARASITOLOGY 2015; 53:525-33. [PMID: 26537031 PMCID: PMC4635833 DOI: 10.3347/kjp.2015.53.5.525] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/30/2015] [Accepted: 10/04/2015] [Indexed: 11/23/2022]
Abstract
The objective of this study was to carry out a community survey on schistosomiais and soil-transmitted helminth (STH) infections in order to suggest feasible and effective intervention strategies in Lake Victoria basin, Tanzania. A total of 37 communities selected from 23 districts of the 4 regions in the Lake Victoria basin of Tanzania were involved in the study. From each of the selected locality, 50 adult community members, 25 males and 25 females, were recruited for the study. Each study participant was requested to submit stool and urine specimens. From each stool specimen, duplicate Kato-Katz thick smears were prepared and microscopically examined for Schistosoma mansoni and STH eggs. Urine specimens were processed by the filtration technique and microscopically examined for Schistosoma haematobium eggs. Ultrasound examination for morbidity due to schistosomiasis was performed. Mass treatment was done using praziquantel and albendazole for schistosome and STHs infections, respectively. Out of 1,606 adults who provided stool specimens, 199 (12.4%) were positive for S. mansoni, 349 (21.7%) for hookworms, 133 (8.3%) for Ascaris lumbricoides, and 33 (2.0%) for Trichuris trichiura. Out of 1,400 participants who provided urine specimens, 25 (1.8%) were positive for S. haematobium eggs. Because of the co-endemicity of these afflictions and their impact on vulnerable population groups, the helminthiasis could be simultaneously treated with 2 drugs, praziquantel for schistosomiasis and albendazole for STHs.
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Affiliation(s)
- Julius E Siza
- National Institute of Medical Research, P.O. Box 1462, Mwanza, Tanzania
| | - Godfrey M Kaatano
- National Institute of Medical Research, P.O. Box 1462, Mwanza, Tanzania
| | - Jong-Yil Chai
- Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Keeseon S Eom
- Department of Parasitology and Medical Research Institute, Chungbuk National University School of Medicine, Cheongju 28644, Korea
| | - Han-Jong Rim
- Department of Parasitology, College of Medicine, Korea University, Seoul 02841, Korea
| | - Tai-Soon Yong
- Department of Environmental Medical Biology and Institute of Tropical Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Duk-Young Min
- Department of Microbiology and Immunology, Eulji University College of Medicine, Daejeon 35233, Korea
| | - Su Young Chang
- Good Neighbors International, Tanzania Western Chapter, P.O. Box 367, Mwanza, Tanzania
| | - Yunsuk Ko
- Good Neighbors International, Tanzania Western Chapter, P.O. Box 367, Mwanza, Tanzania
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Holmen SD, Kleppa E, Lillebø K, Pillay P, van Lieshout L, Taylor M, Albregtsen F, Vennervald BJ, Onsrud M, Kjetland EF. The first step toward diagnosing female genital schistosomiasis by computer image analysis. Am J Trop Med Hyg 2015; 93:80-86. [PMID: 25918212 PMCID: PMC4497910 DOI: 10.4269/ajtmh.15-0071] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/10/2015] [Indexed: 11/07/2022] Open
Abstract
Schistosoma haematobium causes female genital schistosomiasis (FGS), which is a poverty-related disease in sub-Saharan Africa. Furthermore, it is co-endemic with human immunodeficiency virus (HIV), and biopsies from genital lesions may expose the individual to increased risk of HIV infection. However, microscopy of urine and hematuria are nonspecific and insensitive predictors of FGS and gynecological investigation requires extensive training. Safe and affordable diagnostic methods are needed. We explore a novel method of diagnosing FGS using computer color analysis of colposcopic images. In a cross-sectional study on young women in an endemic area, we found strong associations between the output from the computer color analysis and both clinical diagnosis (odds ratio [OR] = 5.97, P < 0.001) and urine microscopy for schistosomiasis (OR = 3.52, P = 0.004). Finally, using latent class statistics, we estimate that the computer color analysis yields a sensitivity of 80.5% and a specificity of 66.2% for the diagnosis of FGS.
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Affiliation(s)
- Sigve Dhondup Holmen
- Norwegian Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Microbiology, Haukeland University Hospital, Bergen, Norway; Department of Biomedical and Clinical Technology, Durban University of Technology, Durban, South Africa; Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands; Discipline of Public Health Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Department of Informatics, University of Oslo, Oslo, Norway; Parasitology and Aquatic Diseases, University of Copenhagen, Copenhagen, Denmark; Department of Gynaecology, Oslo University Hospital, Oslo, Norway
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Challenges and opportunities associated with neglected tropical disease and water, sanitation and hygiene intersectoral integration programs. BMC Public Health 2015; 15:547. [PMID: 26062691 PMCID: PMC4464235 DOI: 10.1186/s12889-015-1838-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 05/13/2015] [Indexed: 12/04/2022] Open
Abstract
Background Recent research has suggested that water, sanitation, and hygiene (WASH) interventions, in addition to mass drug administration (MDA), are necessary for controlling and eliminating many neglected tropical diseases (NTDs). Objectives This study investigated the integration of NTD and WASH programming in order to identify barriers to widespread integration and make recommendations about ideal conditions and best practices critical to future integrated programs. Methods Twenty-four in-depth, semi-structured interviews were conducted with key stakeholders in the global NTD and WASH sectors to identify barriers and ideal conditions in programmatic integration. Results The most frequently mentioned barriers to WASH and NTD integration included: 1) differing programmatic objectives in the two sectors, including different indicators and metrics; 2) a disproportionate focus on mass drug administration; 3) differences in the scale of funding; 4) siloed funding; and 5) a lack of coordination and information sharing between the two sectors. Participants also conveyed that a more holistic approach was needed if future integration efforts are to be scaled-up. The most commonly mentioned requisite conditions included: 1) education and advocacy; 2) development of joint indicators; 3) increased involvement at the ministerial level; 4) integrated strategy development; 5) creating task forces or committed partnerships; and 6) improved donor support. Conclusions Public health practitioners planning to integrate NTD and WASH programs can apply these results to create conditions for more effective programs and mitigate barriers to success. Donor agencies should consider funding more integration efforts to further test the proof of principle, and additional support from national and local governments is recommended if integration efforts are to succeed. Intersectoral efforts that include the development of shared indicators and objectives are needed to foster conditions conducive to expanding effective integration programs. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1838-7) contains supplementary material, which is available to authorized users.
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Sanya RE, Muhangi L, Nampijja M, Nannozi V, Nakawungu PK, Abayo E, Webb EL, Elliott AM. Schistosoma mansoni and HIV infection in a Ugandan population with high HIV and helminth prevalence. Trop Med Int Health 2015; 20:1201-1208. [PMID: 25976017 PMCID: PMC4568314 DOI: 10.1111/tmi.12545] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objectives Recent reports suggest that Schistosoma infection may increase the risk of acquiring human immunodeficiency virus (HIV). We used data from a large cross‐sectional study to investigate whether Schistosoma mansoni infection is associated with increased HIV prevalence. Methods We conducted a household survey of residents in island fishing communities in Mukono district, Uganda, between October 2012 and July 2013. HIV status was assessed using rapid test kits. Kato‐Katz (KK) stool tests and urine‐circulating cathodic antigen (CCA) were used to test for Schistosoma infection. Multivariable logistic regression, allowing for the survey design, was used to investigate the association between S. mansoni infection and HIV infection. Results Data from 1412 participants aged 13 years and older were analysed (mean age 30.3 years, 45% female). The prevalence of HIV was 17.3%. Using the stool Kato‐Katz technique on a single sample, S. mansoni infection was detected in 57.2% (719/1257) of participants; urine CCA was positive in 73.8% (478/650) of those tested. S. mansoni infection was not associated with HIV infection. [KK (aOR = 1.04; 95% CI: 0.74–1.47, P = 0.81), CCA (aOR = 1.53; 95% CI: 0.78–3.00, P = 0.19)]. The median S. mansoni egg count per gram was lower in the HIV‐positive participants (P = 0.005). Conclusions These results add to the evidence that S. mansoni has little effect on HIV transmission, but may influence egg excretion.
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Affiliation(s)
- Richard E Sanya
- Medical Research Council/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Lawrence Muhangi
- Medical Research Council/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Margaret Nampijja
- Medical Research Council/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | | | | | | | - Emily L Webb
- London School of Hygiene & Tropical Medicine, London, UK
| | - Alison M Elliott
- Medical Research Council/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.,London School of Hygiene & Tropical Medicine, London, UK
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Rush to judgment: the STI-treatment trials and HIV in sub-Saharan Africa. J Int AIDS Soc 2015; 18:19844. [PMID: 25990095 PMCID: PMC4438085 DOI: 10.7448/ias.18.1.19844] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 03/24/2015] [Accepted: 04/13/2015] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The extraordinarily high incidence of HIV in sub-Saharan Africa led to the search for cofactor infections that could explain the high rates of transmission in the region. Genital inflammation and lesions caused by sexually transmitted infections (STIs) were a probable mechanism, and numerous observational studies indicated several STI cofactors. Nine out of the ten randomized controlled trials (RCTs), however, failed to demonstrate that treating STIs could lower HIV incidence. We evaluate all 10 trials to determine if their design permits the conclusion, widely believed, that STI treatment is ineffective in reducing HIV incidence. DISCUSSION Examination of the trials reveals critical methodological problems sufficient to account for statistically insignificant outcomes in nine of the ten trials. Shortcomings of the trials include weak exposure contrast, confounding, non-differential misclassification, contamination and effect modification, all of which consistently bias the results toward the null. In any future STI-HIV trial, ethical considerations will again require weak exposure contrast. The complexity posed by HIV transmission in the genital microbial environment means that any future STI-HIV trial will face confounding, non-differential misclassification and effect modification. As a result, it is unlikely that additional trials would be able to answer the question of whether STI control reduces HIV incidence. CONCLUSIONS Shortcomings in published RCTs render invalid the conclusion that treating STIs and other cofactor infections is ineffective in HIV prevention. Meta-analyses of observational studies conclude that STIs can raise HIV transmission efficiency two- to fourfold. Health policy is always implemented under uncertainty. Given the known benefits of STI control, the irreparable harm from not treating STIs and the likely decline in HIV incidence resulting from STI control, it is appropriate to expand STI control programmes and to use funds earmarked for HIV prevention to finance those programmes.
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Breugelmans B, Ansell BRE, Young ND, Amani P, Stroehlein AJ, Sternberg PW, Jex AR, Boag PR, Hofmann A, Gasser RB. Flatworms have lost the right open reading frame kinase 3 gene during evolution. Sci Rep 2015; 5:9417. [PMID: 25976756 PMCID: PMC4894443 DOI: 10.1038/srep09417] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 02/26/2015] [Indexed: 01/08/2023] Open
Abstract
All multicellular organisms studied to date have three right open reading frame kinase genes (designated riok-1, riok-2 and riok-3). Current evidence indicates that riok-1 and riok-2 have essential roles in ribosome biosynthesis, and that the riok-3 gene assists this process. In the present study, we conducted a detailed bioinformatic analysis of the riok gene family in 25 parasitic flatworms (platyhelminths) for which extensive genomic and transcriptomic data sets are available. We found that none of the flatworms studied have a riok-3 gene, which is unprecedented for multicellular organisms. We propose that, unlike in other eukaryotes, the loss of RIOK-3 from flatworms does not result in an evolutionary disadvantage due to the unique biology and physiology of this phylum. We show that the loss of RIOK-3 coincides with a loss of particular proteins associated with essential cellular pathways linked to cell growth and apoptosis. These findings indicate multiple, key regulatory functions of RIOK-3 in other metazoan species. Taking advantage of a known partial crystal structure of human RIOK-1, molecular modelling revealed variability in nucleotide binding sites between flatworm and human RIOK proteins.
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Affiliation(s)
- Bert Breugelmans
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Brendan R E Ansell
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Neil D Young
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Parisa Amani
- Structural Chemistry Program, Eskitis Institute, Griffith University, Brisbane, Australia
| | - Andreas J Stroehlein
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Paul W Sternberg
- HHMI, Division of Biology, California Institute of Technology, Pasadena, California, USA
| | - Aaron R Jex
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Peter R Boag
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Andreas Hofmann
- 1] Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia [2] Structural Chemistry Program, Eskitis Institute, Griffith University, Brisbane, Australia
| | - Robin B Gasser
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
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126
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Kildemoes AO, Kjetland EF, Zulu SG, Taylor M, Vennervald BJ. Schistosoma haematobium infection and asymptomatic bacteriuria in young South African females. Acta Trop 2015; 144:19-23. [PMID: 25623258 DOI: 10.1016/j.actatropica.2015.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 12/19/2014] [Accepted: 01/17/2015] [Indexed: 11/29/2022]
Abstract
Schistosoma haematobium eggs can induce lesions in the urinary and genital tract epithelia, as eggs pass through or get trapped in the tissue. Local inflammatory reactions induced by S. haematobium eggs might affect the ability of bacteria to establish mucosal super-infection foci. S. haematobium infection and asymptomatic bacteriuria can both portray haematuria, proteinuria and leukocyturia. This shared set of proxy diagnostic markers could fuel routine misdiagnosis in S. haematobium endemic areas. Furthermore, S. haematobium infected individuals might be at a higher risk of contracting bacterial urinary tract infections, which could manifest either as symptomatic or asymptomatic bacteriuria. The aim of the current study was to explore whether schistosomal lesions are susceptible to super-infection by bacteria measured as asymptomatic bacteriuria. S. haematobium infection was determined by microscopy of urine samples. Furthermore, urine samples were tested with dipslides for asymptomatic bacteriuria and with dipsticks for haematuria, proteinuria and leukocytes. We found no association between asymptomatic bacteriuria and S. haematobium infection in a sample of 1040 female primary and high school students from a schistosomiasis endemic area in KwaZulu-Natal, South Africa. Furthermore, it was demonstrated that asymptomatic bacteriuria is not a bias for use of micro-haematuria as a proxy diagnostic measure for S. haematobium infection in this population.
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Affiliation(s)
- Anna Overgaard Kildemoes
- Section for Parasitology and Aquatic Diseases, Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Eyrun Floerecke Kjetland
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Siphosenkosi Gift Zulu
- Department of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Myra Taylor
- Department of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Birgitte Jyding Vennervald
- Section for Parasitology and Aquatic Diseases, Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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127
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Botelho MC, Alves H, Barros A, Rinaldi G, Brindley PJ, Sousa M. The role of estrogens and estrogen receptor signaling pathways in cancer and infertility: the case of schistosomes. Trends Parasitol 2015; 31:246-50. [PMID: 25837311 DOI: 10.1016/j.pt.2015.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 03/09/2015] [Accepted: 03/09/2015] [Indexed: 01/26/2023]
Abstract
Schistosoma haematobium, a parasitic flatworm that infects more than 100 million people, mostly in the developing world, is the causative agent of urogenital schistosomiasis, and is associated with a high incidence of squamous cell carcinoma (SCC) of the bladder. Schistosomiasis haematobia also appears to negatively influence fertility, and is particularly associated with female infertility. Given that estrogens and estrogen receptors are key players in human reproduction, we speculate that schistosome estrogen-like molecules may contribute to infertility through hormonal imbalances. Here, we review recent findings on the role of estrogens and estrogen receptors on both carcinogenesis and infertility associated with urogenital schistosomiasis and discuss the basic hormonal mechanisms that might be common in cancer and infertility.
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Affiliation(s)
- Mónica C Botelho
- INSA, National Institute of Health Dr. Ricardo Jorge, Porto, Portugal; IPATIMUP, Institute of Pathology and Molecular Immunology of the University of Porto, Portugal.
| | - Helena Alves
- INSA, National Institute of Health Dr. Ricardo Jorge, Porto, Portugal
| | - Alberto Barros
- Centre for Reproductive Genetics Prof. Alberto Barros, Porto, Portugal; Department of Genetics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Gabriel Rinaldi
- Department of Microbiology, Immunology and Tropical Medicine, and Research Center for Neglected Tropical and Infectious Diseases, School of Medicine & Health Sciences, George Washington University, Washington, DC 20037, USA
| | - Paul J Brindley
- Department of Microbiology, Immunology and Tropical Medicine, and Research Center for Neglected Tropical and Infectious Diseases, School of Medicine & Health Sciences, George Washington University, Washington, DC 20037, USA
| | - Mário Sousa
- Department of Microscopy, Laboratory of Cell Biology, Institute of Biomedical Sciences Abel Salazar (ICBAS), Multidisciplinary Unit for Biomedical Research-UMIB, University of Porto, Porto, Portugal
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128
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Kleppa E, Klinge KF, Galaphaththi-Arachchige HN, Holmen SD, Lillebø K, Onsrud M, Gundersen SG, Taylor M, Ndhlovu P, Kjetland EF. Schistosoma haematobium infection and CD4+ T-cell levels: a cross-sectional study of young South African women. PLoS One 2015; 10:e0119326. [PMID: 25768005 PMCID: PMC4359034 DOI: 10.1371/journal.pone.0119326] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 01/14/2015] [Indexed: 01/23/2023] Open
Abstract
Schistosoma (S.) haematobium causes urogenital schistosomiasis and has been hypothesized to adversely impact HIV transmission and progression. On the other hand it has been hypothesized that HIV could influence the manifestations of schistosomiasis. In this cross-sectional study, we explored the association between urogenital S. haematobium infection and CD4 cell counts in 792 female high-school students from randomly selected schools in rural KwaZulu-Natal, South Africa. We also investigated the association between low CD4 cell counts in HIV positive women and the number of excreted schistosome eggs in urine. Sixteen percent were HIV positive and 31% had signs of urogenital schistosomiasis (as determined by genital sandy patches and / or abnormal blood vessels on ectocervix / vagina by colposcopy or presence of eggs in urine). After stratifying for HIV status, participants with and without urogenital schistosomiasis had similar CD4 cell counts. Furthermore, there was no significant difference in prevalence of urogenital schistosomiasis in HIV positive women with low and high CD4 cell counts. There was no significant difference in the number of eggs excreted in urine when comparing HIV positive and HIV negative women. Our findings indicate that urogenital schistosomiasis do not influence the number of circulating CD4 cells.
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Affiliation(s)
- Elisabeth Kleppa
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kari F. Klinge
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | | | - Sigve D. Holmen
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kristine Lillebø
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Mathias Onsrud
- Department of Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Svein Gunnar Gundersen
- Research Unit, Sorlandet Hospital, Kristiansand, Norway
- Department of Global Development and Planning, University of Agder, Kristiansand, Norway
| | - Myra Taylor
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | | | - Eyrun F. Kjetland
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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129
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Kleppa E, Holmen SD, Lillebø K, Kjetland EF, Gundersen SG, Taylor M, Moodley P, Onsrud M. Cervical ectopy: associations with sexually transmitted infections and HIV. A cross-sectional study of high school students in rural South Africa. Sex Transm Infect 2015; 91:124-9. [PMID: 25281761 PMCID: PMC4345922 DOI: 10.1136/sextrans-2014-051674] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 09/04/2014] [Accepted: 09/14/2014] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES It has been hypothesised that ectopy may be associated with increased susceptibility to sexually transmitted infections (STIs). In this cross-sectional study, we wanted to explore the association between STIs (including HIV) and cervical ectopy. METHODS We included 700 sexually active young women attending randomly selected high schools in a rural district in KwaZulu-Natal, South Africa. The district is endemic of HIV and has a high prevalence of STIs. We did computer-assisted measurements of the ectocervical area covered by columnar epithelium (ectopy) in colposcopic images and STI analyses on cervicovaginal lavage and serum samples. All participating women answered a questionnaire about sexual behaviour and use of contraceptives. RESULTS The mean age was 19.1 years. Ectopy was found in 27.2%, HIV in 27.8%, chlamydia in 25.3% and gonorrhoea in 15.6%. We found that age, parity, chlamydia and gonorrhoea, years since menarche, years since sexual debut and number of sexual partners were associated with ectopy. In multivariate analysis with chlamydia infection as the dependent variable, women with ectopy had increased odds of having chlamydia infection (adjusted OR 1.78, p=0.033). In women under 19 years of age, we found twofold higher odds of being HIV-positive for those with ectopy (OR 2.19, p=0.014). CONCLUSIONS In conclusion, cervical ectopy is associated with Chlamydia trachomatis infection and HIV in the youngest women.
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Affiliation(s)
- Elisabeth Kleppa
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sigve D Holmen
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kristine Lillebø
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Eyrun F Kjetland
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway
- School of Public Health Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal (UKZN), Durban, South Africa
| | - Svein Gunnar Gundersen
- Research Unit, Sorlandet Hospital, Kristiansand, Norway
- Department of Global Development and Planning, University of Agder, Kristiansand, Norway
| | - Myra Taylor
- School of Public Health Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal (UKZN), Durban, South Africa
| | - Prashini Moodley
- Department of Infection Prevention and Control, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, UKZN, Durban, South Africa
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130
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Price A, Verma A, Welfare W. Are health education interventions effective for the control and prevention of urogenital schistosomiasis in sub-Saharan Africa? A systematic review. Trans R Soc Trop Med Hyg 2015; 109:239-44. [PMID: 25669840 DOI: 10.1093/trstmh/trv008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An estimated 129 million people are infected with urogenital schistosomiasis in sub-Saharan Africa. Current control recommendations endorse mass administration of praziquantel. Health education is an important component of effective schistosomiasis prevention and control, but there has been limited research on its effectiveness. This paper reviews the effectiveness of health education as an intervention in the prevention and control of urogenital schistosomiasis in sub-Saharan Africa. The outcomes of interest were prevalence, incidence or transmission of schistosomiasis, behaviour change associated with infection, or changes in knowledge of the disease. The findings from this review suggest that health education has a beneficial impact on knowledge and understanding of schistosomiasis within the target groups. However, further research is needed due to the poor quality of the included studies.
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Affiliation(s)
- Amy Price
- University of Manchester Medical School
| | - Arpana Verma
- Manchester Academic Health Sciences Centre, Institute of Population Health, Stopford Building, MAHSC, University of Manchester, Manchester, M13 9PT, UK
| | - William Welfare
- Manchester Academic Health Sciences Centre, Institute of Population Health, Stopford Building, MAHSC, University of Manchester, Manchester, M13 9PT, UK
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131
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Chachage M, Geldmacher C. Immune system modulation by helminth infections: potential impact on HIV transmission and disease progression. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 828:131-49. [PMID: 25253030 DOI: 10.1007/978-1-4939-1489-0_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- Mkunde Chachage
- Department of Cellular Immunology, National Institute for Medical Research-Mbeya Medical Research Centre (NIMR-MMRC), Hospital Hill road, Mbeya, Tanzania,
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132
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Adenowo AF, Oyinloye BE, Ogunyinka BI, Kappo AP. Impact of human schistosomiasis in sub-Saharan Africa. Braz J Infect Dis 2015; 19:196-205. [PMID: 25636189 PMCID: PMC9425372 DOI: 10.1016/j.bjid.2014.11.004] [Citation(s) in RCA: 185] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 10/15/2014] [Accepted: 11/12/2014] [Indexed: 01/02/2023] Open
Abstract
Schistosomiasis, a neglected tropical disease of poverty ranks second among the most widespread parasitic disease in various nations in sub-Saharan Africa. Neglected tropical diseases are causes of about 534,000 deaths annually in sub-Saharan Africa and an estimated 57 million disability-adjusted life-years are lost annually due to the neglected tropical diseases. The neglected tropical diseases exert great health, social and financial burden on economies of households and governments. Schistosomiasis has profound negative effects on child development, outcome of pregnancy, and agricultural productivity, thus a key reason why the “bottom 500 million” inhabitants of sub-Saharan Africa continue to live in poverty. In 2008, 17.5 million people were treated globally for schistosomiasis, 11.7 million of those treated were from sub-Saharan Africa. This enervating disease has been successfully eradicated in Japan, as well as in Tunisia. Morocco and some Caribbean Island countries have made significant progress on control and management of this disease. Brazil, China and Egypt are taking steps towards elimination of the disease, while most sub-Saharan countries are still groaning under the burden of the disease. Various factors are responsible for the continuous and persistent transmission of schistosomiasis in sub-Saharan Africa. These include climatic changes and global warming, proximity to water bodies, irrigation and dam construction as well as socio-economic factors such as occupational activities and poverty. The morbidity and mortality caused by this disease cannot be overemphasized. This review is an exposition of human schistosomiasis as it affects the inhabitants of various communities in sub-Sahara African countries. It is hoped this will bring a re-awakening towards efforts to combat this impoverishing disease in terms of vaccines development, alternative drug design, as well as new point-of-care diagnostics.
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Affiliation(s)
- Abiola Fatimah Adenowo
- Biotechnology and Structural Biology (BSB) Group, Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa
| | - Babatunji Emmanuel Oyinloye
- Biotechnology and Structural Biology (BSB) Group, Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa; Department of Biochemistry, College of Sciences, Afe Babalola University, Ado Ekiti, Nigeria
| | - Bolajoko Idiat Ogunyinka
- Biotechnology and Structural Biology (BSB) Group, Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa
| | - Abidemi Paul Kappo
- Biotechnology and Structural Biology (BSB) Group, Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa.
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133
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Holmen SD, Kjetland EF, Taylor M, Kleppa E, Lillebø K, Gundersen SG, Onsrud M, Albregtsen F. Colourimetric image analysis as a diagnostic tool in female genital schistosomiasis. Med Eng Phys 2015; 37:309-14. [PMID: 25630808 DOI: 10.1016/j.medengphy.2014.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 11/21/2014] [Accepted: 12/21/2014] [Indexed: 11/25/2022]
Abstract
Female genital schistosomiasis (FGS) is a highly prevalent waterborne disease in some of the poorest areas of sub-Saharan Africa. Reliable and affordable diagnostics are unavailable. We explored colourimetric image analysis to identify the characteristic, yellow lesions caused by FGS. We found that the method may yield a sensitivity of 83% and a specificity of 73% in colposcopic images. The accuracy was also explored in images of simulated inferior quality, to assess the possibility of implementing such a method in simple, electronic devices. This represents the first step towards developing a safe and affordable aid in clinical diagnosis, allowing for a point-of-care approach.
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Affiliation(s)
- Sigve Dhondup Holmen
- Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
| | | | - Myra Taylor
- School of Public Health, Nelson Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | - Elisabeth Kleppa
- Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Kristine Lillebø
- Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway
| | - Svein Gunnar Gundersen
- Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway; Research Department, Sørlandet Hospital HF, Kristiansand, Norway; Institute of Development Studies, University of Agder, Kristiansand, Norway
| | - Mathias Onsrud
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Fritz Albregtsen
- Department of Informatics, University of Oslo, Oslo, Norway; Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway
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134
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Patil M, Kapdi AR, Kumar AV. Magnetically recyclable iron oxide nanoparticles for the α-cyanation of amines under acid-free conditions and the formal synthesis of praziquantel. RSC Adv 2015. [DOI: 10.1039/c5ra10552h] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Non-toxic and recyclable iron oxide nanoparticles catalyzed α-cyanation of amines and the formal synthesis of anti-schistosome drug praziquantel.
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Affiliation(s)
- Mahendra Patil
- Department of Chemistry
- Institute of Chemical Technology
- Mumbai
- India–400019
| | - Anant R. Kapdi
- Department of Chemistry
- Institute of Chemical Technology
- Mumbai
- India–400019
| | - A. Vijay Kumar
- Department of Chemistry
- Institute of Chemical Technology
- Mumbai
- India–400019
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135
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Correia da Costa JM, Vale N, Gouveia MJ, Botelho MC, Sripa B, Santos LL, Santos JH, Rinaldi G, Brindley PJ. Schistosome and liver fluke derived catechol-estrogens and helminth associated cancers. Front Genet 2014; 5:444. [PMID: 25566326 PMCID: PMC4274992 DOI: 10.3389/fgene.2014.00444] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 12/04/2014] [Indexed: 12/21/2022] Open
Abstract
Infection with helminth parasites remains a persistent public health problem in developing countries. Three of these pathogens, the liver flukes Clonorchis sinensis, Opisthorchis viverrini and the blood fluke Schistosoma haematobium, are of particular concern due to their classification as Group 1 carcinogens: infection with these worms is carcinogenic. Using liquid chromatography-mass spectrometry (LC-MS/MS) approaches, we identified steroid hormone like (e.g., oxysterol-like, catechol estrogen quinone-like, etc.) metabolites and related DNA-adducts, apparently of parasite origin, in developmental stages including eggs of S. haematobium, in urine of people with urogenital schistosomiasis, and in the adult stage of O. viverrini. Since these kinds of sterol derivatives are metabolized to active quinones that can modify DNA, which in other contexts can lead to breast and other cancers, helminth parasite associated sterols might induce tumor-like phenotypes in the target cells susceptible to helminth parasite associated cancers, i.e., urothelial cells of the bladder in the case of urogenital schistosomiasis and the bile duct epithelia or cholangiocytes, in the case of O. viverrini and C. sinensis. Indeed we postulate that helminth induced cancers originate from parasite estrogen-host epithelial/urothelial cell chromosomal DNA adducts, and here we review recent findings that support this conjecture.
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Affiliation(s)
- José M Correia da Costa
- Center for Parasite Biology and Immunology, National Health Institute Doutor Ricardo Jorge Porto, Portugal ; Center for the Study of Animal Science, Instituto de Ciências e Tecnologias Agrárias e Agroalimentares, University of Porto Porto, Portugal
| | - Nuno Vale
- Department of Chemistry and Biochemistry, Centro de Investigação em Química, University of Porto Porto, Portugal
| | - Maria J Gouveia
- Center for the Study of Animal Science, Instituto de Ciências e Tecnologias Agrárias e Agroalimentares, University of Porto Porto, Portugal ; Department of Chemistry and Biochemistry, Centro de Investigação em Química, University of Porto Porto, Portugal
| | - Mónica C Botelho
- Department of Health Promotion and Chronic Diseases, National Health Institute Doutor Ricardo Jorge Porto, Portugal
| | - Banchob Sripa
- Tropical Disease Research Laboratory, Liver Fluke and Cholangiocarcinoma Research Center, Department of Pathology, Faculty of Medicine, Khon Kaen University Khon Kaen, Thailand
| | - Lúcio L Santos
- Experimental Pathology and Therapeutics Group, Portuguese Institute for Oncology of Porto Porto, Portugal
| | - Júlio H Santos
- Center for the Study of Animal Science, Instituto de Ciências e Tecnologias Agrárias e Agroalimentares, University of Porto Porto, Portugal ; Experimental Pathology and Therapeutics Group, Portuguese Institute for Oncology of Porto Porto, Portugal
| | - Gabriel Rinaldi
- Research Center for Neglected Diseases of Poverty, Department of Microbiology, Immunology and Tropical Medicine, School of Medicine & Health Sciences, George Washington University Washington, DC, USA
| | - Paul J Brindley
- Research Center for Neglected Diseases of Poverty, Department of Microbiology, Immunology and Tropical Medicine, School of Medicine & Health Sciences, George Washington University Washington, DC, USA
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136
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Ndlovu H, Brombacher F. Role of IL-4Rα during acute schistosomiasis in mice. Parasite Immunol 2014; 36:421-7. [PMID: 24127774 PMCID: PMC4286023 DOI: 10.1111/pim.12080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 10/08/2013] [Indexed: 12/31/2022]
Abstract
Schistosomiasis is an important parasitic disease that causes major host morbidity and mortality in endemic areas. Research conducted in mouse models of schistosomiasis has provided great insights and understanding of how host protective immunity is orchestrated and key cellular populations involved in this process. Earlier studies using cytokine-deficient mice demonstrated the importance of IL-4 and IL-10 in mediating host survival during acute schistosomiasis. Subsequent studies employing transgenic mice carrying cell-specific deletion of IL-4Rα generated using the Cre/LoxP recombination system have been instrumental in providing more in-depth understanding of the mechanisms conferring host resistance to Schistosoma mansoni infection. In this review, we will summarize the contributions of IL-4/IL-13-responsive cellular populations in host resistance during acute schistosomiasis and their role in limiting tissue pathology.
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Affiliation(s)
- H Ndlovu
- Division of Immunology, International Center for Genetic Engineering and Biotechnology (ICGEB), Cape Town Component and Institute of Infectious Diseases and Molecular Medicine (IIDMM), University of Cape Town, Cape Town, South Africa
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Norseth HM, Ndhlovu PD, Kleppa E, Randrianasolo BS, Jourdan PM, Roald B, Holmen SD, Gundersen SG, Bagratee J, Onsrud M, Kjetland EF. The colposcopic atlas of schistosomiasis in the lower female genital tract based on studies in Malawi, Zimbabwe, Madagascar and South Africa. PLoS Negl Trop Dis 2014; 8:e3229. [PMID: 25412334 PMCID: PMC4238986 DOI: 10.1371/journal.pntd.0003229] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 08/29/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Schistosoma (S.) haematobium is a neglected tropical disease which may affect any part of the genital tract in women. Female genital schistosomiasis (FGS) may cause abnormal vaginal discharge, contact bleeding, genital tumours, ectopic pregnancies and increased susceptibility to HIV. Symptoms may mimic those typical of sexually transmitted infections (STIs) and women with genital schistosomiasis may be incorrectly diagnosed. An expert consensus meeting suggested that the following findings by visual inspection should serve as proxy indicators for the diagnosis of schistosomiasis of the lower genital tract in women from S. haematobium endemic areas: sandy patches appearing as (1) single or clustered grains or (2) sandy patches appearing as homogenous, yellow areas, or (3) rubbery papules. In this atlas we aim to provide an overview of the genital mucosal manifestations of schistosomiasis in women. METHODOLOGY/PRINCIPAL FINDINGS Photocolposcopic images were captured from women, between 1994 and 2012 in four different study sites endemic for S. haematobium in Malawi, Zimbabwe, South Africa and Madagascar. Images and specimens were sampled from sexually active women between 15 and 49 years of age. Colposcopic images of other diseases are included for differential diagnostic purposes. SIGNIFICANCE This is the first atlas to present the clinical manifestations of schistosomiasis in the lower female genital tract. It will be freely available for online use, downloadable as a presentation and for print. It could be used for training purposes, further research, and in clinical practice.
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Affiliation(s)
- Hanne M. Norseth
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway
- University of Oslo, Oslo, Norway
| | | | - Elisabeth Kleppa
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway
- University of Oslo, Oslo, Norway
| | | | - Peter M. Jourdan
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Borghild Roald
- Center for Paediatric and Pregnancy Related Pathology, Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Sigve D. Holmen
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Svein G. Gundersen
- Research Department, Sorlandet Hospital HF, Kristiansand, Norway
- Department for Global Development and Planning, Institute for Development Studies, University of Agder, Kristiansand, Norway
| | - Jayanthilall Bagratee
- Discipline of Obstetrics and Gynaecology, School of Clinical Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Mathias Onsrud
- Department of Gynaecology, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Eyrun F. Kjetland
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway
- Discipline of Public Health Medicine, Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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138
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Colley DG, Secor WE. Immunology of human schistosomiasis. Parasite Immunol 2014; 36:347-57. [PMID: 25142505 PMCID: PMC4278558 DOI: 10.1111/pim.12087] [Citation(s) in RCA: 163] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 10/30/2013] [Indexed: 12/25/2022]
Abstract
There is a wealth of immunologic studies that have been carried out in experimental and human schistosomiasis that can be classified into three main areas: immunopathogenesis, resistance to reinfection and diagnostics. It is clear that the bulk of, if not all, morbidity due to human schistosomiasis results from immune-response-based inflammation against eggs lodged in the body, either as regulated chronic inflammation or resulting in fibrotic lesions. However, the exact nature of these responses, the antigens to which they are mounted and the mechanisms of the critical regulatory responses are still being sorted out. It is also becoming apparent that protective immunity against schistosomula as they develop into adult worms develops slowly and is hastened by the dying of adult worms, either naturally or when they are killed by praziquantel. However, as with anti-egg responses, the responsible immune mechanisms and inducing antigens are not clearly established, nor are any potential regulatory responses known. Finally, a wide variety of immune markers, both cellular and humoral, can be used to demonstrate exposure to schistosomes, and immunologic measurement of schistosome antigens can be used to detect, and thus diagnose, active infections. All three areas contribute to the public health response to human schistosome infections.
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Affiliation(s)
- D G Colley
- Department of Microbiology, Center for Tropical and Emerging Global Disease, The University of Georgia, Athens, GA, USA
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139
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Mahmoudi LB, Platt JL, Graham JP. The integration of water, sanitation and hygiene services into the US President's Emergency Plan for AIDS Relief: A qualitative study. Glob Public Health 2014; 10:1-14. [DOI: 10.1080/17441692.2014.966736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Lyana B. Mahmoudi
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | | | - Jay P. Graham
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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140
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Ndeffo Mbah ML, Skrip L, Greenhalgh S, Hotez P, Galvani AP. Impact of Schistosoma mansoni on malaria transmission in Sub-Saharan Africa. PLoS Negl Trop Dis 2014; 8:e3234. [PMID: 25329403 PMCID: PMC4199517 DOI: 10.1371/journal.pntd.0003234] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 09/02/2014] [Indexed: 01/22/2023] Open
Abstract
Background Sub-Saharan Africa harbors the majority of the global burden of malaria and schistosomiasis infections. The co-endemicity of these two tropical diseases has prompted investigation into the mechanisms of coinfection, particularly the competing immunological responses associated with each disease. Epidemiological studies have shown that infection with Schistosoma mansoni is associated with a greater malaria incidence among school-age children. Methodology We developed a co-epidemic model of malaria and S. mansoni transmission dynamics which takes into account key epidemiological interaction between the two diseases in terms of elevated malaria incidence among individuals with S. mansoni high egg output. The model was parameterized for S. mansoni high-risk endemic communities, using epidemiological and clinical data of the interaction between S. mansoni and malaria among children in sub-Saharan Africa. We evaluated the potential impact of the S. mansoni–malaria interaction and mass treatment of schistosomiasis on malaria prevalence in co-endemic communities. Principal Findings Our results suggest that in the absence of mass drug administration of praziquantel, the interaction between S. mansoni and malaria may reduce the effectiveness of malaria treatment for curtailing malaria transmission, in S. mansoni high-risk endemic communities. However, when malaria treatment is used in combination with praziquantel, mass praziquantel administration may increase the effectiveness of malaria control intervention strategy for reducing malaria prevalence in malaria- S. mansoni co-endemic communities. Conclusions/Significance Schistosomiasis treatment and control programmes in regions where S. mansoni and malaria are highly prevalent may have indirect benefits on reducing malaria transmission as a result of disease interactions. In particular, mass praziquantel administration may not only have the direct benefit of reducing schistosomiasis infection, it may also reduce malaria transmission and disease burden. Malaria and Schistosoma mansoni are co-endemic in many regions of sub-Saharan Africa. Evidence from clinical and epidemiological studies support the hypothesis that concurrent infection with S. mansoni is associated with greater malaria incidence among school-age children. We use mathematical modeling to evaluate the epidemiological impact of S. mansoni infection on malaria transmission in sub-Saharan Africa. Using epidemiological data on the increased risk of malaria incidence in S. mansoni endemic communities from Senegal, we developed a co-epidemic model of malaria and S. mansoni transmission dynamics to address key epidemiological interactions between the two diseases. Parameterizing our model for S. mansoni high-risk endemic communities, we show that the interaction between S. mansoni and malaria may reduce the effectiveness of malaria treatment for curtailing malaria transmission. Moreover, we show that in addition to reducing schistosomiasis health burden, mass praziquantel administration will generate indirect benefit in terms of reducing malaria transmission and disease burden in S. mansoni–malaria co-endemic communities. Our findings indicate the possible benefit of scaling up schistosomiasis control efforts in sub-Saharan Africa, and especially in areas were S. mansoni and malaria are highly prevalent.
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Affiliation(s)
- Martial L. Ndeffo Mbah
- School of Public Health, Yale University, New Haven, Connecticut, United States of America
- * E-mail:
| | - Laura Skrip
- School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Scott Greenhalgh
- School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Peter Hotez
- National School of Tropical Medicine, and Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, Texas, United States of America
| | - Alison P. Galvani
- School of Public Health, Yale University, New Haven, Connecticut, United States of America
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Ramamoorthi R, Graef KM, Dent J. WIPO Re:Search: Accelerating anthelmintic development through cross-sector partnerships. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2014; 4:220-5. [PMID: 25516832 PMCID: PMC4266808 DOI: 10.1016/j.ijpddr.2014.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
WIPO Re:Search leverages pharmaceutical assets to advance anthelmintic research. BIO Ventures for Global Health (BVGH) facilitates collaborations and capacity building. Novartis scientists trained a Cameroonian researcher on advanced biochemistry skills. Researchers from Canada and Cameroon partnered to discover onchocerciasis drugs. Natural products were screened against schistosomes and soil-transmitted helminths.
Neglected tropical diseases (NTDs), malaria, and tuberculosis have a devastating effect on an estimated 1.6 billion people worldwide. The World Intellectual Property Organization (WIPO) Re:Search consortium accelerates the development of new drugs, vaccines, and diagnostics for these diseases by connecting the assets and resources of pharmaceutical companies, such as compound libraries and expertise, to academic or nonprofit researchers with novel product discovery or development ideas. As the WIPO Re:Search Partnership Hub Administrator, BIO Ventures for Global Health (BVGH) fields requests from researchers, identifies Member organizations able to fulfill these requests, and helps forge mutually beneficial collaborations. Since its inception in October 2011, WIPO Re:Search membership has expanded to more than 90 institutions, including leading pharmaceutical companies, universities, nonprofit research institutions, and product development partnerships from around the world. To date, WIPO Re:Search has facilitated over 70 research agreements between Consortium Members, including 11 collaborations focused on anthelmintic drug discovery.
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Affiliation(s)
- Roopa Ramamoorthi
- BIO Ventures for Global Health, 401 Terry Avenue North, Seattle, WA 98109, United States
| | - Katy M Graef
- BIO Ventures for Global Health, 401 Terry Avenue North, Seattle, WA 98109, United States
| | - Jennifer Dent
- BIO Ventures for Global Health, 401 Terry Avenue North, Seattle, WA 98109, United States
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142
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Chimberengwa PT, Masuka N, Gombe NT, Bangure D, Tshimanga M, Takundwa L. Schistosomiasis outbreak investigation, Empandeni Ward, Mangwe District, Matabeleland South Province, June 2012; a case control study. BMC Res Notes 2014; 7:623. [PMID: 25204324 PMCID: PMC4167133 DOI: 10.1186/1756-0500-7-623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND On 20th of June 2012, 31 pupils from Kwite primary school reported to the local clinic complaining of passing bloody urine. A study was conducted to identify factors, the etiology and risks of contracting the disease. METHODS An unmatched 1:2 case control study was conducted at Kwite primary school. A case was defined as any child aged between seven to fifteen years, resident in Empandeni Ward for not less than two months, who had passed bloody urine with or without dysuria, fever, fatigue or lower abdominal pains from the 01/06/12 to 07/07/12. A control was a classmate of a case, staying in the same ward, who had not passed bloody urine. Controls were chosen by lottery method. A pretested questionnaire was administered to pupils and their caregivers. Environmental assessment was conducted; line lists, case notes, and district outbreak preparedness and response were reviewed using standard checklists. RESULTS All the 42 cases, and 84 controls were enrolled into the study. The median age for cases and controls was 10 years (Q1 = 9, Q3 = 12) and 10 years (Q1 = 8, Q3 = 11), respectively. Swimming in Kwite dam [AOR = 9.02, 95% CI (2.29-35.53)] and bathing in the dam [AOR = 3.22, 95% CI (1.10-9.41)] were independent factors associated with contracting schistosomiasis. Schistosoma hematobium was isolated in 31 out of 100 urine specimens examined. Bulinus globosus snails were identified at Kwite dam. CONCLUSION The outbreak was driven by human contact with S. hematobium infested Kwite dam water, while poor knowledge on prevention of schistosomiasis by the Kwite community was evident. As a result of this study, health education to pupils and the community, mass drug administration on school pupils and mollusciding at the dam were done. The provincial health team adopted as on-going activities, the inclusion of schistosomiasis prevention and control in malaria pre-elimination activities.
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Affiliation(s)
| | | | | | - Donewell Bangure
- Department of Community Medicine, University of Zimbabwe, P,O, Box A178, Avondale, Harare, Zimbabwe.
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143
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Midzi N, Mduluza T, Chimbari MJ, Tshuma C, Charimari L, Mhlanga G, Manangazira P, Munyati SM, Phiri I, Mutambu SL, Midzi SS, Ncube A, Muranzi LP, Rusakaniko S, Mutapi F. Distribution of schistosomiasis and soil transmitted helminthiasis in Zimbabwe: towards a national plan of action for control and elimination. PLoS Negl Trop Dis 2014; 8:e3014. [PMID: 25121489 PMCID: PMC4133179 DOI: 10.1371/journal.pntd.0003014] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 05/21/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Schistosomiasis and STH are among the list of neglected tropical diseases considered for control by the WHO. Although both diseases are endemic in Zimbabwe, no nationwide control interventions have been implemented. For this reason in 2009 the Zimbabwe Ministry of Health and Child Care included the two diseases in the 2009-2013 National Health Strategy highlighting the importance of understanding the distribution and burden of the diseases as a prerequisite for elimination interventions. It is against this background that a national survey was conducted. METHODOLOGY A countrywide cross-sectional survey was carried out in 280 primary schools in 68 districts between September 2010 and August 2011. Schistosoma haematobium was diagnosed using the urine filtration technique. Schistosoma mansoni and STH (hookworms, Trichuris trichiura, Ascaris lumbricoides) were diagnosed using both the Kato Katz and formol ether concentration techniques. MAIN FINDINGS Schistosomiasis was more prevalent country-wide (22.7%) than STH (5.5%). The prevalence of S. haematobium was 18.0% while that of S. mansoni was 7.2%. Hookworms were the most common STH with a prevalence of 3.2% followed by A. lumbricoides and T. trichiura with prevalence of 2.5% and 0.1%, respectively. The prevalence of heavy infection intensity as defined by WHO for any schistosome species was 5.8% (range 0%-18.3% in districts). Only light to moderate infection intensities were observed for STH species. The distribution of schistosomiasis and STH varied significantly between provinces, districts and schools (p<0.001). Overall, the prevalence of co-infection with schistosomiasis and STH was 1.5%. The actual co-endemicity of schistosomiasis and STH was observed in 43 (63.2%) of the 68 districts screened. CONCLUSION AND RECOMMENDATIONS This study provided comprehensive baseline data on the distribution of schistosomiasis and STH that formed the basis for initiating a national control and elimination programme for these two neglected tropical diseases in Zimbabwe.
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Affiliation(s)
- Nicholas Midzi
- Department of Medical Microbiology, University of Zimbabwe, Harare, Zimbabwe
| | - Takafira Mduluza
- Department of Biochemistry, University of Zimbabwe, Harare, Zimbabwe
- College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
- * E-mail:
| | - Moses J. Chimbari
- College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Clement Tshuma
- Epidemiology & Disease Control, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Lincoln Charimari
- Afro-Regional Zimbabwe Offices, World Health Organization, Harare, Zimbabwe
| | - Gibson Mhlanga
- Epidemiology & Disease Control, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Portia Manangazira
- Epidemiology & Disease Control, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Isaac Phiri
- Epidemiology & Disease Control, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Stanley S. Midzi
- Afro-Regional Zimbabwe Offices, World Health Organization, Harare, Zimbabwe
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Kjetland EF, Norseth HM, Taylor M, Lillebø K, Kleppa E, Holmen SD, Andebirhan A, Yohannes TH, Gundersen SG, Vennervald BJ, Bagratee J, Onsrud M, Leutscher PDC. Classification of the lesions observed in female genital schistosomiasis. Int J Gynaecol Obstet 2014; 127:227-8. [PMID: 25179171 DOI: 10.1016/j.ijgo.2014.07.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 06/29/2014] [Accepted: 08/06/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Eyrun F Kjetland
- Department of Infectious Diseases, Norwegian Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway; Discipline of Public Health Medicine, Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Hanne M Norseth
- Department of Infectious Diseases, Norwegian Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Myra Taylor
- Discipline of Public Health Medicine, Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Kristine Lillebø
- Department of Infectious Diseases, Norwegian Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Elisabeth Kleppa
- Department of Infectious Diseases, Norwegian Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sigve D Holmen
- Department of Infectious Diseases, Norwegian Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Asmeret Andebirhan
- Ayder Referral Hospital, College of Health Sciences, Mekelle University, Ethiopia
| | | | - Svein G Gundersen
- Research Department, Sorlandet Hospital HF, Kristiansand, Norway; Institute for Development Studies, University of Agder, Kristiansand, Norway
| | - Birgitte J Vennervald
- Section for Parasitology and Aquatic Diseases, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Jayanthilall Bagratee
- Discipline of Obstetrics and Gynecology, Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Mathias Onsrud
- Department of Gynecology, Oslo University Hospital, Oslo, Norway
| | - Peter D C Leutscher
- Department of Infectious Diseases, Aarhus University Hospital/Skejby, Aarhus, Denmark
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145
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Wilson S, Jones FM, van Dam GJ, Corstjens PLAM, Riveau G, Fitzsimmons CM, Sacko M, Vennervald BJ, Dunne DW. Human Schistosoma haematobium antifecundity immunity is dependent on transmission intensity and associated with immunoglobulin G1 to worm-derived antigens. J Infect Dis 2014; 210:2009-16. [PMID: 25001462 PMCID: PMC4241947 DOI: 10.1093/infdis/jiu374] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Immunity that reduces worm fecundity and, in turn, reduces morbidity is proposed for Schistosoma haematobium, a parasite of major public health importance. Mathematical models of epidemiological trends suggest that antifecundity immunity is dependent on antibody responses to adult-worm-derived antigen. Methods For a Malian cohort (age, 5–29 years) residing in high-transmission fishing villages or a moderate-transmission village, worm fecundity was assessed using the ratio of urinary egg excretion to levels of circulating anodic antigen, a Schistosoma-specific antigen that is steadily secreted by adult worms. Fecundity was modeled against host age, infection transmission intensity, and antibody responses specific to soluble worm antigen (SWA), tegument allergen-like 1, and 28-kDa glutathione-S-transferase. Results Worm fecundity declined steadily until a host age of 11 years. Among children, host age and transmission were negatively associated with worm fecundity. A significant interaction term between host age and transmission indicates that antifecundity immunity develops earlier in high-transmission areas. SWA immunoglobulin G1 (IgG1) levels explained the effect of transmission on antifecundity immunity. Conclusion Antifecundity immunity, which is likely to be protective against severe morbidity, develops rapidly during childhood. Antifecundity immunity is associated with SWA-IgG1, with higher infection transmission increasing this response at an earlier age, leading to earlier development of antifecundity immunity.
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Affiliation(s)
- Shona Wilson
- Department of Pathology, University of Cambridge, United Kingdom
| | - Frances M Jones
- Department of Pathology, University of Cambridge, United Kingdom
| | | | - Paul L A M Corstjens
- Department of Molecular Cell Biology, Leiden University Medical Center, The Netherlands
| | - Gilles Riveau
- CIIL, Inserm U1019, Pasteur Institute, Lille, France
| | | | - Moussa Sacko
- Institut National de Recherche en Santé Publique, Bamako, Mali
| | - Birgitte J Vennervald
- Centre for Health Research and Development, Faculty of Life Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - David W Dunne
- Department of Pathology, University of Cambridge, United Kingdom
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Ramarokoto CE, Kildemoes AO, Randrianasolo BS, Ravoniarimbinina P, Ravaoalimalala VE, Leutscher P, Kjetland EF, Vennervald BJ. Eosinophil granule proteins ECP and EPX as markers for a potential early-stage inflammatory lesion in female genital schistosomiasis (FGS). PLoS Negl Trop Dis 2014; 8:e2974. [PMID: 25033206 PMCID: PMC4102437 DOI: 10.1371/journal.pntd.0002974] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 05/09/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Genital granulomas induced by Schistosoma haematobium eggs can manifest as different lesion types visible by colposcopy; rubbery papules (RP), homogenous sandy patches (HSP) and grainy sandy patches (GSP). Pronounced tissue eosinophilia is a candidate marker for active S. haematobium pathology, as viable schistosome egg granulomas often are eosinophil rich. Here it was investigated whether eosinophil granule proteins ECP (eosinophil cationic protein) and EPX (eosinophil protein-X) in urine and genital lavage can be used as markers for active FGS lesions. METHODS Uro-genital samples from 118 Malagasy women were analysed for ECP and EPX by standard sandwich avidin/biotin amplified ELISA. PRINCIPAL FINDINGS The women with RP lesions had significantly higher levels of ECP and EPX in both lavage and urine. Furthermore, women with RP lesions were significantly younger than those with GSP. This could indicate that RP lesions might be more recently established and thus represent an earlier inflammatory lesion stage. CONCLUSION ECP in genital lavage might be a future tool aiding the identification of FGS pathology at a stage where reversibility remains a possibility following praziquantel treatment.
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Affiliation(s)
| | - Anna Overgaard Kildemoes
- Section for Parasitology and Aquatic Diseases, Faculty for Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Pascaline Ravoniarimbinina
- Helminthiasis Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Ministry of Public Health, Madagascar, Antananarivo, Madagascar
| | | | - Peter Leutscher
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Eyrun Floerecke Kjetland
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ulleval, Oslo, Norway
- School of Public Health Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Birgitte Jyding Vennervald
- Section for Parasitology and Aquatic Diseases, Faculty for Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Bustinduy A, King C, Scott J, Appleton S, Sousa-Figueiredo JC, Betson M, Stothard JR. HIV and schistosomiasis co-infection in African children. THE LANCET. INFECTIOUS DISEASES 2014; 14:640-9. [DOI: 10.1016/s1473-3099(14)70001-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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148
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Abstract
Human schistosomiasis--or bilharzia--is a parasitic disease caused by trematode flukes of the genus Schistosoma. By conservative estimates, at least 230 million people worldwide are infected with Schistosoma spp. Adult schistosome worms colonise human blood vessels for years, successfully evading the immune system while excreting hundreds to thousands of eggs daily, which must either leave the body in excreta or become trapped in nearby tissues. Trapped eggs induce a distinct immune-mediated granulomatous response that causes local and systemic pathological effects ranging from anaemia, growth stunting, impaired cognition, and decreased physical fitness, to organ-specific effects such as severe hepatosplenism, periportal fibrosis with portal hypertension, and urogenital inflammation and scarring. At present, preventive public health measures in endemic regions consist of treatment once every 1 or 2 years with the isoquinolinone drug, praziquantel, to suppress morbidity. In some locations, elimination of transmission is now the goal; however, more sensitive diagnostics are needed in both the field and clinics, and integrated environmental and health-care management will be needed to ensure elimination.
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Affiliation(s)
- Daniel G Colley
- Center for Tropical and Emerging Global Disease & Department of Microbiology, University of Georgia, Athens, GA, USA.
| | - Amaya L Bustinduy
- Liverpool School of Tropical Medicine, Department of Parasitology, Liverpool, UK
| | - W Evan Secor
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Charles H King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
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149
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Molyneux DH. Neglected tropical diseases: now more than just 'other diseases'--the post-2015 agenda. Int Health 2014; 6:172-80. [PMID: 24969646 DOI: 10.1093/inthealth/ihu037] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Neglected tropical diseases (NTDs) have become recognised as important health problems facing at least a billion people in the low-income countries and the poorest communities in middle-income countries. WHO plays a leading role in developing strategies to address these diseases, pharmaceutical companies provide drug donations to treat or control the NTDs and many partners from different constituencies have become increasingly committed to their control or elimination. This review looks to the post-2015 agenda and emphasises that despite the progress made over recent years, if the targets established are to be achieved, then not only will additional financial resources be required to up-scale treatments and increase access, but increased applied and operational research will be necessary to address problems and human capacity in NTD skills will need to be strengthened. Continuing advocacy for the relevance of control or elimination of NTDs must be placed in the context of universal health coverage and access to donated essential medicines for the poor as a right. The evidence that investment in NTD interventions are cost-effective and impact not only on health, but also to enhance socio-economic development, must be refined and promulgated. The global burden of disease attributable to NTDs requires reassessment to appropriately define the true burden, while the potential for unexpected events, political, climatic, environmental as well as biological, have the potential to reduce future progress towards the agreed post-2015 targets. NTD progress towards the WHO Roadmap targets and the fulfilment of the World Health Assembly Resolution 66.12 of 2013 demand continued commitment from all partner constituencies when challenges emerge.
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Affiliation(s)
- David H Molyneux
- Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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Kleppa E, Ramsuran V, Zulu S, Karlsen GH, Bere A, Passmore JAS, Ndhlovu P, Lillebø K, Holmen SD, Onsrud M, Gundersen SG, Taylor M, Kjetland EF, Ndung’u T. Effect of female genital schistosomiasis and anti-schistosomal treatment on monocytes, CD4+ T-cells and CCR5 expression in the female genital tract. PLoS One 2014; 9:e98593. [PMID: 24896815 PMCID: PMC4045760 DOI: 10.1371/journal.pone.0098593] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 05/06/2014] [Indexed: 11/19/2022] Open
Abstract
Background Schistosoma haematobium is a waterborne parasite that may cause female genital schistosomiasis (FGS), characterized by genital mucosal lesions. There is clinical and epidemiological evidence for a relationship between FGS and HIV. We investigated the impact of FGS on HIV target cell density and expression of the HIV co-receptor CCR5 in blood and cervical cytobrush samples. Furthermore we evaluated the effect of anti-schistosomal treatment on these cell populations. Design The study followed a case-control design with post treatment follow-up, nested in an on-going field study on FGS. Methods Blood and cervical cytobrush samples were collected from FGS negative and positive women for flow cytometry analyses. Urine samples were investigated for schistosome ova by microscopy and polymerase chain reaction (PCR). Results FGS was associated with a higher frequency of CD14+ cells (monocytes) in blood (11.5% in FGS+ vs. 2.2% in FGS-, p = 0.042). Frequencies of CD4+ cells expressing CCR5 were higher in blood samples from FGS+ than from FGS- women (4.7% vs. 1.5%, p = 0.018). The CD14+ cell population decreased significantly in both compartments after anti-schistosomal treatment (p = 0.043). Although the frequency of CD4+ cells did not change after treatment, frequencies of CCR5 expression by CD4+ cells decreased significantly in both compartments (from 3.4% to 0.5% in blood, p = 0.036; and from 42.4% to 5.6% in genital samples, p = 0.025). Conclusions The results support the hypothesis that FGS may increase the risk of HIV acquisition, not only through damage of the mucosal epithelial barrier, but also by affecting HIV target cell populations, and that anti-schistosomal treatment can modify this.
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Affiliation(s)
- Elisabeth Kleppa
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital (OUH), Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
- * E-mail:
| | - Veron Ramsuran
- HIV Pathogenesis Programme, Nelson R Mandela School of Medicine, University of KwaZulu-Natal (UKZN), Durban, South Africa
| | - Siphosenkosi Zulu
- School of Public Health Medicine, Nelson R Mandela School of Medicine, UKZN, Durban, South Africa
| | | | - Alfred Bere
- Emory Vaccine Center, Emory University, Atlanta, Georgia, United States of America
| | - Jo-Ann S. Passmore
- Division of Medical Virology, IDM, University of Cape Town, Cape Town, South Africa
| | | | - Kristine Lillebø
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital (OUH), Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sigve D. Holmen
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital (OUH), Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Svein Gunnar Gundersen
- Research Unit, Sorlandet Hospital, Kristiansand, Norway
- Centre for Development Studies, University of Agder, Kristiansand, Norway
| | - Myra Taylor
- School of Public Health Medicine, Nelson R Mandela School of Medicine, UKZN, Durban, South Africa
| | - Eyrun F. Kjetland
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital (OUH), Oslo, Norway
- School of Public Health Medicine, Nelson R Mandela School of Medicine, UKZN, Durban, South Africa
| | - Thumbi Ndung’u
- HIV Pathogenesis Programme, Nelson R Mandela School of Medicine, University of KwaZulu-Natal (UKZN), Durban, South Africa
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