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Helling-Giese G, Demarta-Gatsi C, Richter J. Female genital schistosomiasis (FGS) in returned travellers - A review of reported cases. Eur J Obstet Gynecol Reprod Biol 2024; 303:28-34. [PMID: 39396434 DOI: 10.1016/j.ejogrb.2024.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 09/20/2024] [Accepted: 09/30/2024] [Indexed: 10/15/2024]
Abstract
INTRODUCTION Female genital schistosomiasis (FGS) is the manifestation of schistosomiasis in the lower and the upper reproductive organs. In endemic areas FGS is frequent with a tremendous impact on reproductive health. Anecdotal observations indicate that FGS also occurs in travellers who became infected when exposing themselves in natural water bodies in endemic areas. The objective of this study is to summarize existing knowledge on FGS in travellers with a focus on FGS-associated morbidity, diagnosis, and treatment. MATERIAL AND METHODS The PubMed database was searched for reports on FGS in travellers from 1980 to 2023. Case reports of FGS in travellers were identified and reviewed. RESULTS Thirty-eight case reports were identified. The most common manifestation of FGS were lesions at the vulva (n = 16), the cervix (n = 11), the ovaries and Fallopian tubes (n = 6), the vagina (n = 3) and the endometrium (n = 2). With a few exceptions the diagnosis was spurious. 15 patients with vulval schistosomiasis were treated with the anti-helminthic drug praziquantel (i.e. 40 mg/kg) in 1-3 doses. In all but one patient the lesions disappeared three to six months after treatment. CONCLUSIONS This study shows that FGS in travellers exhibits the same disease manifestations as in FGS patients living in endemic areas. However, correct diagnosis was established after months to years delaying treatment and cure. This precludes the inclusion of FGS in diagnostic guidelines for female travellers returning from endemic areas for schistosomiasis.
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Affiliation(s)
| | - Claudia Demarta-Gatsi
- Global Health R&D of the Healthcare Business of Merck KGaA, Darmstadt, Germany, Ares Trading S.A. (an affiliate of Merck KGaA, Darmstadt, Germany), Eysins, Switzerland.
| | - Joachim Richter
- Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Germany.
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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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Makaula P, Sadalaki JR, Muula AS, Kayuni S, Jemu S, Bloch P. Schistosomiasis in Malawi: a systematic review. Parasit Vectors 2014; 7:570. [PMID: 25490938 PMCID: PMC4288699 DOI: 10.1186/s13071-014-0570-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 11/25/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Schistosomiasis remains an important public health problem that undermines social and economic development in tropical regions of the world, mainly Sub-Saharan Africa. We are not aware of any systematic review of the literature of the epidemiology and transmission of schistosomiasis in Malawi since 1985. Therefore, we reviewed the current state of knowledge of schistosomiasis epidemiology and transmission in this country and identified knowledge gaps and relevant areas for future research and research governance. METHODS We conducted computer-aided literature searches of Medline, SCOPUS and Google Scholar using the keywords: "schistosomiasis", "Bilharzia", "Bulinus" and "Biomphalaria" in combination with "Malawi". These searches were supplemented by iterative reviews of reference lists for relevant publications in peer reviewed international scientific journals or other media. The recovered documents were reviewed for their year of publication, location of field or laboratory work, authorship characteristics, ethics review, funding sources as well as their findings regarding parasite and intermediate host species, environmental aspects, geographical distribution, seasonality of transmission, and infection prevalence and intensities. REVIEW A total of 89 documents satisfied the inclusion criteria and were reviewed. Of these, 76 were published in international scientific journals, 68 were peer reviewed and 54 were original research studies. Most of the documents addressed urinary schistosomiasis and about two thirds of them dealt with the definitive host. Few documents addressed the parasites and the intermediate hosts. While urinary schistosomiasis occurs in most parts of Malawi, intestinal schistosomiasis mainly occurs in the central and southern highlands, Likoma Island and Lower Shire. Studies in selected communities estimated prevalence rates of up to 94.9% for Schistosoma haematobium and up to 67.0% for Schistosoma mansoni with considerable geographical variation. The main intermediate host species are Bulinus globosus and Bulinus nyassanus for urinary schistosomiasis and Biomphalaria pfeifferi for intestinal schistosomiasis. Seasonality of transmission tends to vary according to geographical, environmental, biological and behavioural factors. CONCLUSION Transmission of schistosomiasis in Malawi appears to be highly focal, with considerable variation in space and time. Many locations have not been covered by epidemiological investigations and, thus, information on the transmission of schistosomiasis in Malawi remains fragmented. Functional infection risk assessment systems based on systematic investigations and surveillance are required for developing informed prevention and control strategies.
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Affiliation(s)
- Peter Makaula
- Research for Health Environment and Development, P.O. Box 345, Mangochi, Malawi.
| | - John R Sadalaki
- School of Public Health and Family Medicine, Department of Public Health, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi.
| | - Adamson S Muula
- School of Public Health and Family Medicine, Department of Public Health, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi.
| | - Sekeleghe Kayuni
- Medical Aid Society of Malawi (MASM) Medi Clinics, P.O. Box 1254, Blantyre, Malawi.
| | - Samuel Jemu
- Ministry of Health, P.O. Box 30377, Capital City, Lilongwe 3, Malawi.
| | - Paul Bloch
- Steno Health Promotion Center, Steno Diabetes Center, Niels Steensens Vej 8, DK-2820, Gentofte, Denmark.
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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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Genital schistosomiasis as a cause of female sterility and acute abdomen. Fertil Steril 2010; 93:2075.e7-9. [PMID: 20138271 DOI: 10.1016/j.fertnstert.2009.05.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 05/19/2009] [Accepted: 05/19/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To report the case of a Nigerian patient who suffered from sterility and underwent abdominal laparotomy to remove an adnexal tumor. Histologic analysis revealed Schistosoma haematobium ova. DESIGN Case report. SETTING Multidisciplinary group practice and teaching hospital. PATIENTS One patient who underwent an abdominal laparotomy to remove an adnexal tumor. INTERVENTION(S) In vitro fertilization and adnexal tumor resection via laparotomy. MAIN OUTCOME MEASURE(S) Treatment of the adnexal tumor affecting the reproductive health. RESULT(S) Histologic analysis performed on the tissue removed at surgery revealed fibrous patches around aggregates of calcified Schistosoma haematobium eggs in the fallopian tube wall. CONCLUSION(S) Schistosomiasis needs to be considered as a differential diagnosis of female infertility and sterility.
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Tang LJ, De Seta F, Odreman F, Venge P, Piva C, Guaschino S, Garcia RC. Proteomic Analysis of Human Cervical-Vaginal Fluids. J Proteome Res 2007; 6:2874-83. [PMID: 17539673 DOI: 10.1021/pr0700899] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The pathophysiology of vaginal conditions is still ill-defined at a molecular level. Because the proteome of the human cervical-vaginal fluid (CVF) has not been reported to date, we undertook the identification of proteins present in the cell-free fraction of these fluids. Proteins were separated bidimensionally (2-D) by isoelectrofocusing (pH 3-11) followed by SDS-polyacrylamide electrophoresis. The proteins of 147 spots were identified by matrix-assisted laser desorption/ ionization-time-of-flight-mass spectrometry (MALDI-TOF/TOF). This approach was supplemented by immunoassays for markers of neutrophils (myeloperoxidase, MPO; neutrophil gelatinase-associated lipocalin, NGAL/HNL) and eosinophils (eosinophil cationic protein: ECP) and by immunoblotting (lactoferrin, calgranulins A and B and annexins A1 and A3. Nearly half of the proteins (69/147) and protein fragments detected were found to be plasma components, on the basis of which the human CVF can be broadly considered a plasma transudate. Although the pattern of protein spots was very similar for all fluids analyzed, a relative overabundance of major plasma proteins such as albumin, transferrin, immunoglobulins, apolipoproteins, alpha-1-acid glycoprotein 1, and calgranulins was associated with the presence of a high number of polymorphonuclear leukocytes in the lavages from which those cell-free fluids had been obtained. Instead, fluids from women experiencing vulvovaginal candidiasis did not show differences in the protein maps compared with asymptomatic individuals. Neutrophil and eosinophil granule secretion proteins were also detected in variable amounts in the lavage fluids by both immunoassay and immunoblotting, indicating polymorphonuclear cell activation.
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Affiliation(s)
- Li-Jun Tang
- Leukocyte Biology and Proteomics Groups, International Centre for Genetic Engineering and Biotechnology, Area Science Park, Padriciano 99, 34012 Trieste, Italy
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7
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Kameh D, Smith A, Brock MS, Ndubisi B, Masood S. Female Genital Schistosomiasis: Case Report and Review of the Literature. South Med J 2004; 97:525-7. [PMID: 15180032 DOI: 10.1097/00007611-200405000-00022] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 37-year-old woman, originally from South Africa, presented for a gynecologic examination. Speculum examination revealed a friable cervical lesion. Both the cervical smear and biopsy contained intact, viable schistosome eggs consistent with those of Schistosoma haematobium. Appropriate treatment was initiated promptly, avoiding significant morbidity. The diagnosis of female genital schistosomiasis must be considered when the patient has a history of travel to or residence in endemic areas.
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Affiliation(s)
- Darian Kameh
- Department of Pathology, University of Florida Health Science Center at Jacksonville, Jacksonville, FL 32209, USA
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8
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Abstract
Genital symptoms in tropical countries and among returned travellers can arise from a variety of bacterial, protozoal, and helminthic infections which are not usually sexually transmitted. The symptoms may mimic classic sexually transmitted infections (STIs) by producing ulceration (for example, amoebiasis, leishmaniasis), wart-like lesions (schistosomiasis), or lesions of the upper genital tract (epididymo-orchitis caused by tuberculosis, leprosy, and brucellosis; salpingitis as a result of tuberculosis, amoebiasis, and schistosomiasis). A variety of other genital symptoms less suggestive of STI are also seen in tropical countries. These include hydrocele (seen with filariasis), which can be no less stigmatising than STI, haemospermia (seen with schistosomiasis), and hypogonadism (which may occur in lepromatous leprosy). This article deals in turn with genital manifestations of filariasis, schistosomiasis, amoebiasis, leishmaniasis, tuberculosis and leprosy and gives clinical presentation, diagnosis, and treatment.
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MESH Headings
- Amebiasis/diagnosis
- Diagnosis, Differential
- Female
- Filariasis/diagnosis
- Genital Diseases, Female/diagnosis
- Genital Diseases, Female/microbiology
- Genital Diseases, Female/parasitology
- Genital Diseases, Male/diagnosis
- Genital Diseases, Male/microbiology
- Genital Diseases, Male/parasitology
- Humans
- Leishmaniasis, Cutaneous/diagnosis
- Leprosy/diagnosis
- Male
- Schistosomiasis/diagnosis
- Sexually Transmitted Diseases/diagnosis
- Tuberculosis, Female Genital/diagnosis
- Tuberculosis, Male Genital/diagnosis
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Affiliation(s)
- J Richens
- University College London, London, UK.
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9
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Midzi N, Ndhlovu PD, Nyanga L, Kjetland EF, Reimert CM, Vennervald BJ, Gomo E, Mudenge G, Friis H, Gundersen SG, Mduluza T. Assessment of eosinophil cationic protein as a possible diagnostic marker for female genital schistosomiasis in women living in a Schistosoma haematobium endemic area. Parasite Immunol 2003; 25:581-8. [PMID: 15053779 DOI: 10.1111/j.0141-9838.2004.00670.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Eosinophil cationic protein (ECP) levels were measured in vaginal lavage extracts from 518 Zimbabwean reproductive women, age range 15-49 years, to assess the potential use of ECP as a diagnostic marker for female genital schistosomiasis (FGS). One hundred and fifty women had confirmed FGS status. These included 77 (cases) women who had ova in genital tissue and 73 (controls) women who had no ova in genital tissue. Participants were examined at baseline, 3 and 15 months post-treatment with praziquantel. ECP levels were determined using the enzyme linked immunosorbent assay (ECP-ELISA). ECP levels from 18 Norwegian women were used to calculate the diagnostic values of the test. FGS was diagnosed from the study population using genital biopsy and smears. Women were also diagnosed for urinary schistosomiasis using the urine filtration technique. The prevalence of urinary schistosomiasis was 39 % at baseline and this declined to 8% and 6% at 3 and 15 month post-treatment surveys, respectively. There was a higher mean ECP level in women with FGS, 889.3 ng/mL (95% CI: 457.0-1327.5) compared to the endemic control group, 359.1 ng/mL (95%, CI: 227.3-490.9), P = 0.027. Mean ECP levels declined at 3 months following treatment of infected individuals. There was no correlation between ECP levels and tissue ova density, and urine egg intensity. The sensitivity, specificity, positive and negative predictive values for the ECP-ELISA test were 35%, 80%, 65% and 53%, respectively. Our results indicate that FGS causes an inflammatory immune response that increases ECP levels in genital fluid. Treatment of schistosomiasis results in a regression of pathology and a decline in ECP levels. However, other factors such as allergy and microbial infection could also be responsible for increased ECP levels in genital mucosa. These conditions will affect the validity of the test in diagnosis of FGS.
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Affiliation(s)
- N Midzi
- Blair Research Institute, Harare, Zimbabwe
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10
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Abstract
In this paper we summarise the parasitological, clinical and epidemiological characteristics of female genital schistosomiasis (FGS), a frequent manifestation of the infection with Schistosoma haematobium. Means to diagnose and treat lesions in the lower and upper genital tract are discussed. Based on clinical findings and available pathophysiological as well as immunological data it is conceivable that FGS of the cervix and vagina not only facilitates the infection with agents of sexually transmitted diseases, but presumably also alters the natural history of such infections. Two infectious agents are of particular concern: the Human Immunodeficiency Virus and the oncogenic Human Papilloma Viruses. Possible interactions and their consequences are discussed and research areas which should be addressed are outlined.
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Affiliation(s)
- G Poggensee
- Institute of Tropical Medicine and Medical Faculty Charité, Humboldt-University, Berlin, Germany.
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11
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Feldmeier H, Helling-Giese G, Poggensee G. Unreliability of PAP smears to diagnose female genital schistosomiasis. Trop Med Int Health 2001; 6:31-3. [PMID: 11263462 DOI: 10.1046/j.1365-3156.2001.00647.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- H Feldmeier
- Epidemiology Working Group, Faculty of Medicine, Freie Universität Berlin, Germany.
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12
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Tischendorf FW, Brattig NW, Lintzel M, Büttner DW, Burchard GD, Bork K, Müller M. Eosinophil granule proteins in serum and urine of patients with helminth infections and atopic dermatitis. Trop Med Int Health 2000; 5:898-905. [PMID: 11169280 DOI: 10.1046/j.1365-3156.2000.00649.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Eosinophil cationic protein (ECP) and eosinophil-derived neurotoxin (EPX) are cytotoxic molecules involved in helminth infections and allergic reactions. Hitherto most clinical chemical studies have been concerned with the analysis of serum ECP in allergic diseases. The aim of this study was to examine whether serum as well as urine levels of these proteins are useful clinical chemical parameters in helminthiases and allergic diseases such as atopic dermatitis. Comparing these diseases under the same methodological conditions, levels of ECP and EPX were generally higher in helminthiases than in atopic dermatitis and non-helminth, non-allergic diseases. The highest levels of both proteins occurred in tropical worm diseases, in particular hookworm disease and onchocerciasis. When comparing helminthiases with allergic disorder, only hookworm disease (ECP and EPX) and onchocerciasis (EPX) exhibited significantly higher eosinophil cationic protein serum levels than atopic dermatitis. In patients with schistosomiasis mansoni and egg loads of > 1000-10 000 eggs/g stool (epg) EPX serum levels were significantly higher than in patients exhibiting loads < 1000 epg. Urinary analyses revealed only EPX to be present in measurable amounts. Levels of this protein were much higher in urine of patients with hookworm disease and onchocerciasis than in those with atopic dermatitis and in healthy controls. The results suggest that besides serum EPX, urinary EPX may be a useful clinical chemical parameter in eosinophilia of helminth and allergic aetiology.
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Affiliation(s)
- F W Tischendorf
- Department of Clinical Chemistry, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany.
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Jyding Vennervald B, Kahama AI, Reimert CM. Assessment of morbidity in Schistosoma haematobium infection: current methods and future tools. Acta Trop 2000; 77:81-9. [PMID: 10996123 DOI: 10.1016/s0001-706x(00)00116-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Recently, new potential tools for assessment of Schistosoma haematobium related morbidity have emerged. The tools are based on detection of S. haematobium egg antigens in urine or detection of eosinophil cationic protein (ECP) in urine, which may reflect the inflammatory response in the urinary tract. So far two markers have been assessed in long-term post treatment follow-up studies, allowing for an evaluation both before treatment and during regression and reappearance of infection and urinary tract morbidity. The results from these studies and the usefulness of the markers as morbidity assessment tools are discussed.
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Affiliation(s)
- B Jyding Vennervald
- Danish Bilharziasis Laboratory, Jaegersborg Allé 1D, 2920, Charlottenlund, Denmark.
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14
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Abstract
Schistosoma haemtobium infection in travelers from endemic areas is usually asymptomatic, or presents with hematuria. Uncommon manifestations include neurological syndromes, genital dysaesthesias and watery or blood stained semen. This organism also causes disease within all structures of the female genital tract because of communications between pelvic venous complexes, and can occur long after return home. Schistosomiasis may not be suspected, resulting in delays in diagnosis and treatment. We present two cases which illustrate the diverse nature of this condition.
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Affiliation(s)
- J A Crump
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand
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15
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Poggensee G, Feldmeier H, Krantz I. Schistosomiasis of the female genital tract: public health aspects. PARASITOLOGY TODAY (PERSONAL ED.) 1999; 15:378-81. [PMID: 10461167 DOI: 10.1016/s0169-4758(99)01497-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this paper Gabriele Poggensee, Hermann Feldmeier and Ingela Krantz discuss the public health relevance of female genital schistosomiasis (FGS). Some of the stated hypotheses are supported only by clinical observations and/or circumstantial evidence as valid epidemiological and immunological data of this disease entity are still very scanty. Morbidity caused by the presence of schistosome eggs in the lower and upper genital tract have been almost completely neglected during the past two decades. This has been acknowledged by the WHO and, in 1997, the Gender Task Force of the WHO's Tropical Disease Research Programme (TDR) included FGS in a list of scientific areas that deserve high research priority.
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Affiliation(s)
- G Poggensee
- Institut für Tropenmedizin, Spandauer Damm 130, 14050 Berlin, Germany.
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16
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Richter J, Poggensee G, Kjetland EF, Helling-Giese G, Chitsulo L, Kumwenda N, Gundersen SG, Deelder AM, Reimert CM, Haas H, Krantz I, Feldmeier H. Reversibility of lower reproductive tract abnormalities in women with Schistosoma haematobium infection after treatment with praziquantel--an interim report. Acta Trop 1996; 62:289-301. [PMID: 9028413 DOI: 10.1016/s0001-706x(96)00030-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Little is known whether and to what extent antiparasitic treatment cures female genital schistosomiasis (FGS). Using a standard protocol, of twenty-one women with FGS nine were re-examined at two to nine weeks after they had been treated with praziquantel at a single dose of 40 mg/kg. Symptoms related to pathology of the urinary tract and to a lesser extent of genital pathology subsided in most patients. Schistosoma haematobium ova were no longer detectable in urine of any of the patients post-treatment. Efficiency of chemotherapy against adult worms was confirmed by the disappearance of circulating anodic antigen (CAA) in serum. Sandy patches showed resolution in two of four cases after chemotherapy. Papillomata due to schistosomiasis alone improved, but persisted in mixed infection with human papilloma virus (HPV) or when HPV was the only underlying cause. In one patient ulcera could not be related with certainty to schistosomiasis at admission, but resolved after treatment with parziquantel. Leukoplakia (two cases) was not influenced by chemotherapy, or even increased during follow-up, regardless of whether ova had been detected or not. Although the follow-up period was rather short, time intervals were not standardized, and a relatively small number of patients was investigated, it could be shown that genital pathology due to sequestered S. haematobium ova is, at least partially, reversible already two to nine weeks after killing the adult worms by praziquantel. This is paralleled by a normalization of inflammatory immune responses detectable in histological sections and vaginal lavage.
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Affiliation(s)
- J Richter
- Institute of Tropical Medicine, Berlin, Germany
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17
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Helling-Giese G, Sjaastad A, Poggensee G, Kjetland EF, Richter J, Chitsulo L, Kumwenda N, Racz P, Roald B, Gundersen SG, Krantz I, Feldmeier H. Female genital schistosomiasis (FGS): relationship between gynecological and histopathological findings. Acta Trop 1996; 62:257-67. [PMID: 9028410 DOI: 10.1016/s0001-706x(96)00027-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Schistosomiasis of the lower female reproductive tract manifests itself in a broad spectrum of clinical features. However, clinical and histopathological findings have never been studied in a synoptic manner. Based on the assumption that any type of pathology present in the female reproductive tract is the expression of a complex pathophysiological reaction towards eggs sequestered in the genital tissues, we decided to analyze colposcopic and histopathological findings in a comprehensive manner. Thirty-three women in Malawi with urinary and genital schistosomiasis were examined parasitologically and gynecologically. A thorough colposcopic examination with photodocumentation was performed and biopsies were taken from the cervix, the vagina and/or the vulva for histological sectioning and immunohistochemistry. The predominant colposcopic findings were sandy patches on the cervical surface similar to those seen in the bladder and polypous/papillomatous tumors with irregular surface on the vaginal wall and in the vulvar area. The histopathological sections of sandy-patch-like lesions demonstrated only a small cellular reaction around S. haematobium eggs in various stages of disintegration. In contrast, in the case of polyps the histology revealed a more pronounced immunological reaction characterized by a heavy cellular infiltrate. One case of invasive squamous cell carcinoma of the cervix was diagnosed. We conclude that colposcopy is a useful tool in the detection of FGS related pathology in the lower female reproductive tract and that the synoptic assessment of surface and of corresponding histological sections helped to understand the pathophysiology of S. haematobium associated disease in genital tissue.
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Affiliation(s)
- G Helling-Giese
- Department of Gynecology and Obstetrics, Frauenklinik Finkenau, Hamburg, Germany
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