Schistosoma mansoni infection as a predictor of severe anaemia in schoolchildren in eastern Sudan

Schistosoma haematobium DNA and eggs in urine of patients from Sohag, Egypt

Background

Diagnosis of schistosomiasis depends mainly on stool or urine microscopy for Schistosoma egg detection as well as immunoassays. The low sensitivity of these conventional tests makes molecular detection the diagnostic method of choice. The study aimed to detect the molecular prevalence of urine schistosomiasis and evaluate microscopic examination vs. PCR technique for detection of Schistosoma haematobium (S. haematobium) in urine of patients with suggestive symptoms or previous history of urine schistosomiasis coming from endemic regions.

Results

This cross-sectional study was performed on eighty patients attending the urology clinic of Sohag University Teaching Hospital from August 2016 to July 2018. Socio-demographic data and clinical data were collected. Urine samples from all study individuals were collected and examined microscopically for S. haematobium eggs as well as detection of S. haematobium DNA of using PCR assay. Microscopic examination and PCR were positive among (68.8%) and (87.5%) of cases, respectively. There was 60% agreement between microscopy and molecular assay. Microscopy was a good test to rule in cases of urine schistosomiasis, with 100% specificity and 100% PPV, but was of limited sensitivity (NPV = 40%) and missed 12.5% of positive cases. Among studied patient variables, only hematuria showed association with urine schistosomiasis with statistical significance.

Conclusion

Urine schistosomiasis was highly prevalent in studied population. Considering the high sensitivity and specificity of PCR, it should be implemented as the test of choice, especially in chronic urinary schistosomiasis with low infection setting. In our study population, patients presenting hematuria were likely to have S. haematobium.

Severe childhood anemia and emergency blood transfusion in Gadarif Hospital, eastern Sudan

BACKGROUND

Anemia is a major cause of global morbidity and mortality, particularly among children. Management of anemia depends on causes and severity of anemia. However blood transfusion is a lifesaving intervention in severe and life-threatening anemia. There are no published data on blood transfusion for anemia in Sudan.

METHODS

A descriptive study was conducted in Gadarif Hospital in eastern Sudan during 1 August, 2017 to 31 March, 2018. Consecutive children who presented at the emergency room with an indication for blood transfusion were enrolled in the study. A detailed history was gathered from all patients. Physical examinations, including vital signs, were performed. The World Health Organization guidelines for blood transfusion were followed.

RESULTS

During the study period, a total of 1800 children were admitted to the emergency pediatric ward in Gadarif Hospital and were assessed for anemia, 513 (28.5%) were anemic and 141 (7.8%) had severe anemia. Three hundred anemic children received blood transfusion. The median (interquartile) of the age of the 300 children who received blood transfusion was 4.2 4.2(2.0-9.0) years. A total of 148 (49.3%) of the children were boys and 151 (50.3%) were younger than 5 years. The diagnoses associated with the order for blood transfusion were sickle cell disease (129, 43.0%), active bleeding (58, 19.3%), malaria (50, 16.7%), visceral leishmaniasis (25, 8.3%), severe acute malnutrition (16, 5.30%), snake bite (11, 3.7%), sepsis (5, 1.7%), and others. Two hundred eighty-five (95.0%) children improved, nine children were discharged against medical advice, and six (2.0%) children died.

CONCLUSION

There is a high burden of anemia in eastern Sudan. Sickle cell disease, malaria, and visceral leishmaniasis are the main causes of anemia in this region. Further research on blood transfusion is needed.

Supplementation with micronutrients and schistosomiasis: systematic review and meta-analysis

Schistosomiasis is a parasitic disease caused by helminths of the genus Schistosoma with two presentations; one intestinal and another urinary; which depend on the specie of Schistosoma. One of the species that can produce intestinal schistosomiasis is Schistosoma mansoni, and the specie that produces urinary schistosomiasis is Schistosoma haematobium. Infection can be aggravated by a deficient nutritional status, which negatively impacts the immune system and increases susceptibility to infection. The main objective of this meta-analysis is to determine if a relationship exists between multimicronutrient supplementation and the reduction of infestation with Schistosoma mansoni and Schistosoma haematobium in children and adolescents. A search was conducted through a scientific literature database, and articles that complied with the pre-established requirements were retrieved. The Review Manager (Rev Man) 5.3 computer program was used for data processing and analysis was carried out with the objective of testing whether the addition of micronutrient supplementation to treatment with broad-spectrum antiparasitic anthelmintic medication has an impact on schistosomiasis infection. Of the 257 initial articles retrieved, eight were included both quantitatively and qualitatively in the meta-analysis. Supplementation reduces infestation with Schistosoma spp 1.33 times more than placebo. In individuals infested with Schistosoma, mansoni supplementation is 1.30 times more effective than placebo and for individuals infested with Schistosoma haematobium, supplementation is 1.62 times more effective than the placebo. The results show a clear relationship between supplementation and reduction of infestation. The supplementation with micronutrients decreases the presence of Schistosoma spp in children and adolescents.

Schistosomiasis in School Age Children in Sierra Leone After 6 Years of Mass Drug Administration With Praziquantel

Historic data and baseline surveys showed schistosomiasis as highly/moderately endemic in 7 of 14 districts in Sierra Leone, justifying annual/biennial mass drug administration (MDA) with praziquantel. MDA commenced in 2009 and reported treatment coverage had been above the World Health Organization recommended 75% of target population. Assessment in 2012 showed significant reduction in infection. In 2016, another national school-based survey was conducted to evaluate the progress. Two schools from each category (high, moderate or low) of endemic communities in each MDA district and five schools in non-MDA districts were selected. Fifty children (25 boys and 25 girls) aged 9-14 years were randomly selected per school. Parasitological examination of 1,980 stool and 1,382 urine samples were conducted. Overall Schistosoma mansoni prevalence in the seven MDA districts decreased to 20.4% (95% CI: 18.7-22.3%) in 2016 from 42.2% (95% CI: 39.8-44.5%) at baseline (p < 0.0001). Mean overall S. mansoni intensity of infection reduced to 52.8 epg (95% CI: 43.2-62.4 epg) in 2016 from 100.5 epg (95% CI: 88.7-112.3 epg) at baseline (p < 0.001). The prevalence of Schistosoma haematobium in the five MDA districts that had baseline prevalence data decreased to 2.2% (95% CI: 1.5-3.1%) in 2016 from 18.3% (95% CI: 16.3-20.5%) at baseline (p < 0.0001). Mean overall intensity of infection increased to 1.12 e/10 ml (95% CI: 0.55-0.1.70 e/10 ml) in 2016 compared to 0.47 e/10 ml (95% CI: 0.16-0.78 e/10 ml) in 2012 (p < 0.05) (no baseline data). No district was highly endemic in 2016 compared to three at baseline and there was no significant difference in prevalence or intensity of infection by sex for both species. This survey illustrated the significant progress made in controlling schistosomiasis in Sierra Leone. The fact that prevalence and intensity of infection showed an increase from the 2010 level suggested a detrimental effect of missing MDA due to the Ebola toward schistosomiasis control. The national program needs to continue the treatment and adopt a comprehensive approach including water, hygiene, and sanitation measures to achieve control and elimination of schistosomiasis.

Integrated delivery of school health interventions through the school platform: Investing for the future

School health and nutrition (SHN) programmes are recognized as a significant contributor to both health and education sector goals. The school system offers an ideal platform from which to deliver basic health interventions that target the most common health conditions affecting school-age children (SAC) in low-income countries, leading to improved participation and learning outcomes. However, governments require evidence to cost, design, and implement these programmes. In Ethiopia, prevalent health conditions affecting SAC's education participation and learning outcomes include infection with soil-transmitted helminths (STHs), hunger, and malnutrition. In recognition of the multiple issues affecting the health and education of SAC, the government has taken a proactive approach, coordinating an integrated SHN programme designed to be implemented in partnership and monitored and financed through a single, integrated mechanism. The programme, known as the Enhanced School Health Initiative (ESHI), integrates three complimentary health interventions: deworming; school feeding; and provision of a water, sanitation, and hygiene (WASH) package in schools, which in delivery aim to maximize the benefits of each of the individual components. Operational research surrounding the ESHI programme includes both qualitative and quantitative analyses. Here, we present an overview of the ESHI programme and its genesis. We also introduce three additional supporting papers that provide in-depth analyses of key findings, including the baseline situational analysis, the costs, and community perceptions of the programme. The findings from ESHI provide initial evidence to develop an understanding of the related costs and synergies of integrating multiple health interventions onto a single platform. The work has translated into strengthened institutional capacity and improved cross-sectoral coordination. The government is now committed to supporting 25 million school children in Ethiopia through SHN. The ESHI model serves as a reference point for other countries looking to scale up targeted SHN interventions.

High Efficacy of Praziquantel in Schistosoma haematobium-Infected Children in Taraba State, Northeast Nigeria: A follow-up study

Objectives

This study aimed to assess the efficacy of praziquantel in reducing urinary schistosomiasis prevalence, parasite burden and morbidity rates among a previously reported sample of Schistosoma haematobium-infected children. In addition, predisposing factors for reinfection one year post-treatment were also determined.

Methods

This prospective follow-up study was conducted between March 2014 and February 2015 among 675 previously reported children with urinary schistosomiasis in the Murbai and Surbai communities of Ardo Kola, Taraba State, Nigeria. A single dose of 40 mg/kg of praziquantel was administered to each infected child, with a second dose administered one month later if necessary. The number of S. haematobium eggs in urine samples was calculated at baseline and post-treatment.

Results

At four weeks post-treatment, the overall cure rate was 98.1%. Among children with low and heavy parasite burdens at baseline, egg reduction rates (ERRs) were 100% and 96.5%, respectively. The vast majority of children with microhaematuria (98.7%) and proteinuria (98.6%) at baseline were cured at follow-up. Following a second dose, the ERR, overall and morbidity cure rates increased to 100%. At one year post-treatment, 272 infected children (40.3%) were re-assessed; of these, 51 children (18.8%) were reinfected. Close proximity to bodies of water (odds ratio [OR] = 1.23, 95% confidence interval [CI]: 0.998-1.530; P = 0.05) and fishing (OR = 2.23, 95% CI: 0.828-6.040; P = 0.01) were significant factors that predisposed children to reinfection.

Conclusion

A moderate rate of reinfection was noted. Governmental and nongovernmental organisations in Nigeria should collaborate on mass treatment and health education campaigns to reduce the incidence of urinary schistosomiasis reinfections.

Types of trematodes infecting freshwater snails found in irrigation canals in the East Nile locality, Khartoum, Sudan

Background

The planorbid freshwater snails of the two genera, Biomphalaria and Bulinus -have been vigorously studied due to the role they play as intermediate hosts of schistosomiasis. In Sudan specifically, most studies have focused on the chemical and ecological control of the two genera, but few studies have looked at their biological control. This study explored the coexistence of other species of freshwater snails and the two genera along with their trematode infections in relation to a number of environmental factors in the East Nile locality, Khartoum state, Sudan.

Methods

Freshwater snails from irrigation canals (abueshreens) were sampled monthly from January 2004 to December 2005. The snails were examined for trematode infections by cercarial emergence immediately after collection and then weekly for an additional four weeks to allow for the maturation of prepatent infections. Vegetation cover in the study sites as well as the physicochemical characteristics of the water, including temperature, were also recorded.

Results

A total of 10,493 snails, representing seven species, were collected. The most abundant species was Biomphalaria pfeifferi, representing 48.6 % of the sample. Overall, 14.1 % of the snails were found to be shedding some type of cercariae. Five species were found to have infections; among these the Bulinus truncatus species was found to be the most heavily infected, with an overall prevalence of 46.2 %. Double infections were recorded in only two B. truncatus snails and one Cleopatra bulimoides snail. Twenty different morphotypes of cercariae were recorded, seven of which appeared not to conform to previously described cercariae from Africa. Xiphidiocercariae type 1 was the most common type of cercariae recovered, accounting for 44.3 % of all infections. The density of snails tended to be lower during the summer months than the winter months, except for M. tuberculata snails, which were not affected by seasonal changes.

Conclusion

The findings of this study indicate that besides schistosomes, other larval trematodes are found, and some use the same intermediate hosts as the schistosomes. Further studies should be conducted to determine whether some of these trematodes could be manipulated for the biological control of schistosomiasis.

Electronic supplementary material

The online version of this article (doi:10.1186/s40249-016-0108-y) contains supplementary material, which is available to authorized users.

Efficacy and safety of arachidonic acid for treatment of Schistosoma mansoni-infected children in Menoufiya, Egypt

Arachidonic acid (ARA), an omega-6 fatty acid, kills juvenile and adult schistosomes in vitro and displays highly significant and safe therapeutic effects in mice and hamsters infected with Schistosoma mansoni or S. haematobium. This study aims to examine the efficacy and safety of ARA in treatment of school-age children infected with S. mansoni. In total, 66 S. mansoni-infected schoolchildren (20-23 children/study arm) received a single dose of 40 mg/kg praziquantel (PZQ), ARA (10 mg/kg per day for 15 days), or PZQ combined with ARA. The children were examined before and after treatment for worm egg counts in stool and blood biochemical and immunological parameters. ARA proved to be as efficacious as PZQ in treatment of schoolchildren with low infection intensity (78% and 85% cure rates, respectively). For moderate-intensity infection, the ARA and PZQ combination led to 100% cure rate. Biochemical, hematological, and immunological parameters were either unchanged or ameliorated after ARA therapy.

Association of eumycetoma and schistosomiasis

Eumycetoma is a morbid chronic granulomatous subcutaneous fungal disease. Despite high environmental exposure to this fungus in certain regions of the world, only few develop eumycetoma for yet unknown reasons. Animal studies suggest that co-infections skewing the immune system to a Th2-type response enhance eumycetoma susceptibility. Since chronic schistosomiasis results in a strong Th2-type response and since endemic areas for eumycetoma and schistosomiasis do regionally overlap, we performed a serological case-control study to identify an association between eumycetoma and schistosomiasis. Compared to endemic controls, eumycetoma patients were significantly more often sero-positive for schistosomiasis (p = 0.03; odds ratio 3.2, 95% CI 1.18-8.46), but not for toxoplasmosis, an infection inducing a Th1-type response (p = 0.6; odds ratio 1.5, 95% CI 0.58-3.83). Here, we show that schistosomiasis is correlated to susceptibility for a fungal disease for the first time.

Situation analysis of schistosomiasis and soil-transmitted helminthes in River Nile State, Sudan

BACKGROUND

Infection with schistosomiasis and soil-transmitted helminthes (SSTH) constitutes a major health problem worldwide, yet the burden of disease is in the tropical countries. The disease is endemic in River Nile State, Sudan but the exact prevalence rate is unknown.

METHODS

A survey of 2490 pupils in 103 basic schools in River Nile State, Sudan was conducted to determine the prevalence and distribution of SSTH infections. Stool and urine samples were collected and examined for ova of Schistosoma haematobium, S. mansoni and intestinal worms.Questionnaires were used to obtain demographic data, to quantify exposure to surface waters and to assess the perception of pupils and stakeholders about risk behviours and control strategies.

RESULTS AND CONCLUSION

The prevalence of S. haematobium in the River Nile State was 1.7% with variation between localities (range= 0.58-3.5%). No S. mansoni infection was detected and the prevalence rate for intestinal helminthes was 0.1%.

Schistosoma haematobium infections among schoolchildren in central Sudan one year after treatment with praziquantel

Background

Chemotherapy with praziquantel (PZQ) is the mainstay of schistosomiasis control. However, there are recent concerns about tolerance or resistance to PZQ, so that monitoring its efficacy in different settings is required.

Methods

A longitudinal study was conducted to evaluate the impact of PZQ for the treatment of Schistosoma haematobium infection among schoolchildren at Al Salamania, Central Sudan. Parasitological examinations for S. haematobium were performed in a cohort of schoolchildren (6–15 years of age) before and 1 year after treatment with a single dose of PZQ 40 mg/kg.

Results

Out of 562 (309 boys and 253 girls) schoolchildren recruited from three elementary schools, 420 completed one longitudinal dataset that comprised of data from two time points; baseline, and follow-up 1 year after treatment with a single dose of PZQ 40 mg/kg for S. haematobium infection. A single dose of PZQ significantly reduced the prevalence of S. haematobium infection by 83.3% (from 51.4% to 8.6%) and the geometric mean intensity of infection of positive individuals by 17.0% (from 87.7 to 72.8 eggs/10 ml of urine) 1 year after treatment. While there was no significant difference in the reduction of the prevalence of S. haematobium infection between the gender or age groups, there was a significantly higher reduction of intensity of S. haematobium infection among girls in comparison with boys.

Conclusion

There was a significant reduction of S. haematobium infection 1 year after PZQ treatment in this setting.

Schistosoma mansoni infection among prenatal attendees at a secondary-care hospital in central Sudan

OBJECTIVE

To investigate the epidemiology of Schistosoma mansoni infection among pregnant women in a secondary-care hospital in Geizera state, Sudan.

METHOD

Between August and September 2010, a cross-sectional study was conducted and questionnaires were administered to obtain basic sociodemographic and obstetric characteristics of pregnant women attending prenatal care at Araba Waeshreen Hospital. Stool samples were investigated for helminth infection via formol-ether concentration and Kato-Katz techniques.

RESULTS

Of 292 pregnant women, 38 (13.0%) had S. mansoni infections. Hymenolepis nana and hookworm infections were present in 5 (1.7%) and 1 (0.3%) women, respectively. The intensity of the S. mansoni infection was light, moderate, and high in 13 (34.2%), 21 (55.3%), and 4 (10.5%) women, respectively. In multivariate analyses, parity, gestational age, and occupation were not associated with S. mansoni infection, unlike maternal age less than 20 years (odds ratio [OR] 9.8; 95% confidence interval [CI], 1.5-16.3; P=0.01) and no education (OR 6.2; 95% CI, 2.8-12.9; P<0.001).

CONCLUSION

There was a high level of S. mansoni infection among pregnant women in the present setting, especially among younger women and those with no education. Control and preventive measures should be used in the area.

High levels of Schistosoma mansoni infections among schoolchildren in central Sudan one year after treatment with praziquantel

A longitudinal study was conducted to evaluate the impact of praziquantel (PZQ) for the treatment of Schistosoma mansoni infection among schoolchildren in Al Gunaid in Central Sudan. A cohort of schoolchildren (6-15 years of age) was investigated before and 1 year after treatment with a single dose of PZQ 40 mg/kg. Parasitological examinations for S. mansoni were performed before and after treatment, and prevalence and intensity of infection were analysed. Of 2741 schoolchildren recruited from six elementary schools at baseline, 2521 were successfully traced and re-examined at follow-up, with two complete sets of longitudinal parasitological data on S. mansoni. Boys showed significantly higher prevalence of S. mansoni infection than girls. A single dose of PZQ reduced the overall prevalence of S. mansoni infection by 36.7% (from 59.1 to 37.4%) and the intensity of infection by 41.1% (from 116.7 to 68.7 eggs per gram of stool) 1 year after treatment. The reduction in prevalence was significantly higher among the group of children with heavy infections (by 76.1%, from 6.7 to 1.6%) and among girls (by 54.1%, 42.3 to 19.4%) at 1 year after treatment. Thus, in spite of a significant reduction in the prevalence and intensity of S. mansoni infection 1 year after PZQ treatment, the prevalence of the disease was still high and further research is needed on this topic.