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Rodríguez-Molino P, González Martínez S, Bustamante Amador J, Mellado-Sola I, Montes Martín L, Falces-Romero I, García López-Hortelano M, Hurtado-Gallego J, Mellado MJ, Grasa C, Sainz T. Schistosomiasis in migrant children and adolescents in a paediatric tropical referral unit in Spain: diagnosis and long-term management challenges. Eur J Pediatr 2024:10.1007/s00431-024-05623-2. [PMID: 39143347 DOI: 10.1007/s00431-024-05623-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/28/2024] [Accepted: 05/19/2024] [Indexed: 08/16/2024]
Abstract
Globalisation and population movement have led to an increasing number of migrant children residing in areas non-endemic for schistosomiasis. However, diagnosing and managing schistosomiasis in children remain controversial. This study aims to investigate the prevalence of schistosomiasis in migrant children and to describe the diagnostic approach and management strategies, including long-term follow-up, to explore the potential role of serological tests in evaluating treatment response. We conducted a retrospective descriptive study spanning from January 2014-July 2021 at a referral unit for Paediatric Tropical Diseases in Madrid (Spain). The study included patients under 18 years diagnosed with schistosomiasis. Of 679 children screened for schistosomiasis, 73 (10.8%) tested positive. The median age was 16.3 years [IQR 9-17.6], 74% male. The majority originated from Sub-Saharan Africa (47%) and Asia (47%). Only 40% presented with symptoms, with gastrointestinal (18%) and cutaneous (17%) manifestations being the most common. Eosinophilia was observed in 43% (median [IQR]: 1103/mm3 [671-1536]), and ova were visualised in the urine of 2/50 (4.0%). Praziquantel treatment was administered to 92%, and 5 patients required retreatment. Follow-up data were available for 58 (80%) over a median period of 9 months [IQR 6-19.8], revealing a progressive decline in eosinophil count, IgE titres, and ELISA optical density. Conclusion: In this series, the prevalence of schistosomiasis among migrant children was significant (10%), highlighting the importance of including serological tests in migrant health screening. The disease is largely asymptomatic, eosinophilia is often absent, and visualisation of ova in urine is exceedingly rare. Eosinophil count, IgE titres, and ELISA optical density could prove valuable as an initial approach for monitoring inflammation during follow-up assessments. What is Known: • The burden of disease related to schistosomiasis is significant, particulary in children, and it is advisable to screen this vulnerable population. What is New: • Eosinophilia may not be present in parasitic infections, so serological tests are crucial for screening migrant children. • Serological monitoring facilitates long-term management of migrant children with schistosomiasis.
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Affiliation(s)
- Paula Rodríguez-Molino
- General Paediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain
- Autonomous University of Madrid (UAM), Madrid, Spain
- Centro de Investigacion en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | | | - Jorge Bustamante Amador
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain
- Hospital Paediatrics Department, Childhood Infections, El Escorial Hospital, Madrid, Spain
- Health Centre Guzmán el Bueno, SERMAS, Madrid, Spain
| | - Isabel Mellado-Sola
- General Paediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain
- Autonomous University of Madrid (UAM), Madrid, Spain
| | | | - Iker Falces-Romero
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain
- Centro de Investigacion en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Department of Microbiology and Parasitology, La Paz University Hospital, Madrid, Spain
| | - Milagros García López-Hortelano
- General Paediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain
- Centro de Investigacion en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Translational Research Network in Paediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Jara Hurtado-Gallego
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain
- Centro de Investigacion en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - María José Mellado
- General Paediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain
- Autonomous University of Madrid (UAM), Madrid, Spain
- Centro de Investigacion en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Translational Research Network in Paediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Carlos Grasa
- General Paediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain
- Autonomous University of Madrid (UAM), Madrid, Spain
- Centro de Investigacion en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Talía Sainz
- General Paediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain.
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain.
- Autonomous University of Madrid (UAM), Madrid, Spain.
- Centro de Investigacion en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.
- Translational Research Network in Paediatric Infectious Diseases (RITIP), Madrid, Spain.
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Dos Santos M, de Faria MT, da Silva JO, Gandra IB, Ribeiro AJ, Silva KA, Nogueira LM, Machado JM, da Silveira Mariano RM, Gonçalves AAM, Ludolf F, Candia-Puma MA, Chávez-Fumagalli MA, Campos-da-Paz M, Giunchetti RC, Galdino AS. A Mini-Review on Elisa-Based Diagnosis of Schistosomiasis. Curr Mol Med 2024; 24:585-598. [PMID: 37143281 DOI: 10.2174/1566524023666230504140828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Schistosomiasis is a neglected tropical parasitic disease caused by trematode worms of the genus schistosoma, which affects approximately 240 million people worldwide. the diagnosis of the disease can be performed by parasitological, molecular, and/or immunological methods, however, the development of new diagnostic methods still essential to guide policy decisions, monitor disease trends and assess the effectiveness of interventions. OBJECTIVE in this sense, the current work summarizes the findings of a systematic review regarding antigens applied in the enzyme-linked immunosorbent assay test, which were patented and published over the last ten years. METHODS the literature search strategy used medical subject heading (mesh) terms to define as descriptors. "schistosoma mansoni" was used in arrangement with the descriptors "immunoassay", "enzyme-linked immunosorbent assay", "elisa", and "antigens", using the "and" connector. the patent search was done using keywords, including diagnosis and schistosoma or schistosomiasis or schistosome. several databases were employed for the patent search, such as intellectual property national institute; european patent office; the united states patent and trademark office; patent scope, and google patents. RESULTS forty-one articles were retrieved, of which only five met the eligibility criteria. seventeen patents were taken from the databases, and a brief description of the most relevant inventions is given here. CONCLUSION schistosomiasis is considered the most important helminthic disease in worldwide. therefore, it is important to of searching for and develops diagnostic methods based on serology to reduce morbidity and mortality caused by the disease.
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Affiliation(s)
- Michelli Dos Santos
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São Joao Del-Rei, Sebastião Gonçalves Coelho, Divinópolis, 400, 35501-296, MG, Brazil
| | - Mariana Teixeira de Faria
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São Joao Del-Rei, Sebastião Gonçalves Coelho, Divinópolis, 400, 35501-296, MG, Brazil
| | - Jonatas Oliveira da Silva
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São Joao Del-Rei, Sebastião Gonçalves Coelho, Divinópolis, 400, 35501-296, MG, Brazil
| | - Isadora Braga Gandra
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São Joao Del-Rei, Sebastião Gonçalves Coelho, Divinópolis, 400, 35501-296, MG, Brazil
| | - Anna Julia Ribeiro
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São Joao Del-Rei, Sebastião Gonçalves Coelho, Divinópolis, 400, 35501-296, MG, Brazil
| | - Kamila Alves Silva
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São Joao Del-Rei, Sebastião Gonçalves Coelho, Divinópolis, 400, 35501-296, MG, Brazil
| | - Lais Moreira Nogueira
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São Joao Del-Rei, Sebastião Gonçalves Coelho, Divinópolis, 400, 35501-296, MG, Brazil
| | - Juliana Martins Machado
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São Joao Del-Rei, Sebastião Gonçalves Coelho, Divinópolis, 400, 35501-296, MG, Brazil
| | - Reysla Maria da Silveira Mariano
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, 31270-901, MG, Brazil
| | - Ana Alice Maia Gonçalves
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, 31270-901, MG, Brazil
| | - Fernanda Ludolf
- Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Mayron Antonio Candia-Puma
- Computational Biology and Chemistry Research Group, Vicerrectorado de Investigación, Universidad Católica de Santa María, Urb. San José S/N, Umacollo, Arequipa, 04000, Peru
| | - Miguel Angel Chávez-Fumagalli
- Computational Biology and Chemistry Research Group, Vicerrectorado de Investigación, Universidad Católica de Santa María, Urb. San José S/N, Umacollo, Arequipa, 04000, Peru
| | - Mariana Campos-da-Paz
- Laboratório de Bioativos & NanoBiotecnologia, Universidade Federal de São João Del-Rei, Sebastião Gonçalves Coelho, Divinópolis, 400, 35501-296, MG, Brazil
| | - Rodolfo Cordeiro Giunchetti
- Laboratório de Biologia das Interações Celulares, Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, 31270-901, MG, Brazil
| | - Alexsandro Sobreira Galdino
- Laboratório de Biotecnologia de Microrganismos, Universidade Federal de São Joao Del-Rei, Sebastião Gonçalves Coelho, Divinópolis, 400, 35501-296, MG, Brazil
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Expression of CD117 (c-Kit) on Circulating B Cells in Pediatric Schistosomiasis. Infect Immun 2022; 90:e0016022. [PMID: 35862720 PMCID: PMC9387214 DOI: 10.1128/iai.00160-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Few B cells express CD27, the primary marker for memory B cells, in pediatric schistosomiasis, suggesting B cell malfunction. This study further demonstrates unexpected high expression of CD117 on circulating B cells in children highly exposed to Schistosoma mansoni infectious larvae. CD117 is expressed by immature or lymphoma B cells, but not by mature, circulating cells. We therefore sought to define the significance of CD117 on blood B cells. We found that CD117-positive (CD117+) B cells increased with the intensity of schistosome infection. In addition, CD117 expression was reduced on CD23+ B cells previously shown to correlate with resistance to infection. Stimulation with a panel of cytokines demonstrated that CD117 levels were upregulated in response to a combination of interleukin 4 (IL-4) and stem cell factor (SCF), the ligand for CD117, whereas IL-2 led to a reduction. In addition, stimulation with SCF generally reduced B cell activation levels. Upon further investigation, it was established that multiple circulating cells expressed increased levels of CD117, including monocytes, neutrophils, and eosinophils, and expression levels correlated with that of B cells. Finally, we identified a population of large circulating cells with features of reticulocytes. Overall, our results suggest that hyperexposure to intravascular parasitic worms elicits immature cells from the bone marrow. Levels of SCF were shown to reduce as children began to transition through puberty. The study results pose an explanation for the inability of children to develop significant immunity to infection until after puberty.
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Ondigo BN, Hamilton RE, Magomere EO, Onkanga IO, Mwinzi PN, Odiere MR, Ganley-Leal L. Potential Utility of Systemic Plasma Biomarkers for Evaluation of Pediatric Schistosomiasis in Western Kenya. Front Immunol 2022; 13:887213. [PMID: 35603171 PMCID: PMC9121796 DOI: 10.3389/fimmu.2022.887213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/08/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Current diagnostic tools for schistosomiasis are limited, and new tests are necessary to enhance disease diagnosis and surveillance. Identification of novel disease-specific biomarkers may facilitate the development of such tests. We evaluated a panel of biomarkers used in sepsis and parasitic diseases for their potential suitability in the diagnosis of schistosomiasis. Objective The study evaluated the levels of systemic plasma biomarkers in relation to Schistosoma mansoni infection and parasite burden. Methods Six biomarkers were measured in the plasma of children from schistosomiasis-endemic regions using ELISA. The concentration of soluble CD23 (sCD23) and lipopolysaccharide (LPS) was tested in 199 and 124 plasma samples, respectively, while interleukin-6 (IL-6), soluble triggering receptor expressed on myeloid (sTREM) cells, eotaxin-1, and fatty acid-binding protein (FABP) concentrations were tested in 30 plasma samples. Results The concentration of IL-6, eotaxin-1, FABP, and LPS was similar between schistosome-infected and uninfected children. The schistosome-infected children had higher median levels of sTREM and sCD23 as compared to uninfected children, 119.0 (29.9-208.9) versus 10.7 (0.0-73.4) (p = 0.046) and 2,549.0 (1,899.0-3,356.0) vs. 2,035.0 (1,448.0-2,939.0) (p = 0.05), respectively. In addition, sTREM was positively correlated with egg density (p = 0.017). Conclusion Our data show that active schistosomiasis per se is associated with elevated levels of sTREM and sCD23. sTREM has potential diagnostic and prognostic values. However, these biomarkers did not distinguish between children with low egg burden and uninfected children.
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Affiliation(s)
- Bartholomew N. Ondigo
- Department of Biochemistry and Molecular Biology, Faculty of Science, Egerton University, Egerton, Kenya,*Correspondence: Bartholomew N. Ondigo,
| | - Rachael E. Hamilton
- School of Public Health, Boston University, Boston, MA, United States,Global Development, Elegance Biotechnologies, Wayne, PA, United States
| | - Edwin O. Magomere
- Department of Biochemistry and Molecular Biology, Faculty of Science, Egerton University, Egerton, Kenya
| | - Isaac O. Onkanga
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Pauline N. Mwinzi
- Regional Office for Africa, World Health Organization, Brazzaville, Democratic Republic of Congo
| | - Maurice R. Odiere
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Lisa Ganley-Leal
- Global Development, Elegance Biotechnologies, Wayne, PA, United States
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Mduluza-Jokonya TL, Vengesai A, Midzi H, Kasambala M, Jokonya L, Naicker T, Mduluza T. Algorithm for diagnosis of early Schistosoma haematobium using prodromal signs and symptoms in pre-school age children in an endemic district in Zimbabwe. PLoS Negl Trop Dis 2021; 15:e0009599. [PMID: 34339415 PMCID: PMC8360514 DOI: 10.1371/journal.pntd.0009599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 08/12/2021] [Accepted: 06/27/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction Prompt diagnosis of acute schistosomiasis benefits the individual and provides opportunities for early public health intervention. In endemic areas schistosomiasis is usually contracted during the first 5 years of life, thus it is critical to look at how the infection manifests in this age group. The aim of this study was to describe the prodromal signs and symptoms of early schistosomiasis infection, correlate these with early disease progression and risk score to develop an easy to use clinical algorithm to identify early Schistosoma haematobium infection cases in resource limited settings. Methodology Two hundred and four, preschool age children who were lifelong residence of a schistosomiasis endemic district and at high risk of acquiring schistosomiasis were followed up from July 2019 to December 2019, during high transmission season. The children received interval and standard full clinical evaluations and laboratory investigations for schistosomiasis by clinicians blinded from their schistosomiasis infection status. Diagnosis of S. haematobium was by urine filtration collected over three consecutive days. Signs and symptoms of schistosomiasis at first examination visit were compared to follow-up visits. Signs and symptoms common on the last schistosomiasis negative visit (before a subsequent positive) were assigned as early schistosomiasis infection (ESI), after possible alternative causes were ruled out. Logistic regression identified clinical predictors. A model based score was assigned to each predictor to create a risk for every child. An algorithm was created based on the predictor risk scores and validated on a separate cohort of 537 preschool age children. Results Twenty-one percent (42) of the participants were negative for S. haematobium infection at baseline but turned positive at follow-up. The ESI participants at the preceding S. haematobium negative visit had the following prodromal signs and symptoms in comparison to non-ESI participants; pruritic rash adjusted odds ratio (AOR) = 21.52 (95% CI 6.38–72.66), fever AOR = 82 (95% CI 10.98–612), abdominal pain AOR = 2.6 (95% CI 1.25–5.43), pallor AOR = 4 (95% CI 1.44–11.12) and a history of facial/body swelling within the previous month AOR = 7.31 (95% CI 3.49–15.33). Furthermore 16% of the ESI group had mild normocytic anaemia, whilst 2% had moderate normocytic anaemia. A risk score model was created using a rounded integer from the relative risks ratios. The diagnostic algorithm created had a sensitivity of 81% and a specificity of 96.9%, Positive predictive value = 87.2% and NPV was 95.2%. The area under the curve for the algorithm was 0.93 (0.90–0.97) in comparison with the urine dipstick AUC = 0.58 (0.48–0.69). There was a similar appearance in the validation cohort as in the derivative cohort. Conclusion This study demonstrates for the first time prodromal signs and symptoms associated with early S. haematobium infection in pre-school age children. These prodromal signs and symptoms pave way for early intervention and management, thus decreasing the harm of late diagnosis. Our algorithm has the potential to assist in risk-stratifying pre-school age children for early S. haematobium infection. Independent validation of the algorithm on another cohort is needed to assess the utility further. Schistosoma haematobium causes urogenital infection and in endemic areas schistosomiasis is usually contracted during the first 5 years of life, thus it is critical to look at how the infection manifests in this age group. Prompt diagnosis of acute schistosomiasis is required to benefit the individuals and provide opportunities for early treatment and public health intervention. The study examined symptoms that correlated with early disease progression and risk scored to develop an easy to use clinical algorithm to identify early S. haematobium infection cases. The children received standard full clinical evaluations by clinicians who were blinded from schistosomiasis diagnosis by parasitological examination. An algorithm was created based on the predictor risk scores and participants had the following prodromal signs and symptoms; pruritic rash, abdominal pain, pallor, abdominal pain, inguinal lymphadenopathy and a history of facial/body swelling within the previous month. A risk score model, diagnostic algorithm, was created that compared to urine dipstick and parasitology. This study demonstrates the clinical signs and symptoms associated with early S. haematobium infection in pre-school age children. These prodromal signs and symptoms pave way for early intervention and management, thus decreasing the harm of late diagnosis common in populations from endemic areas.
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Affiliation(s)
- Tariro L. Mduluza-Jokonya
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal; KwaZulu-Natal, Durban, South Africa
- * E-mail:
| | - Arthur Vengesai
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal; KwaZulu-Natal, Durban, South Africa
| | - Herald Midzi
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal; KwaZulu-Natal, Durban, South Africa
- Department of Biochemistry, University of Zimbabwe, Harare, Zimbabwe
| | - Maritha Kasambala
- Department of Biochemistry, University of Zimbabwe, Harare, Zimbabwe
| | - Luxwell Jokonya
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal; KwaZulu-Natal, Durban, South Africa
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Thajasvarie Naicker
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal; KwaZulu-Natal, Durban, South Africa
| | - Takafira Mduluza
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal; KwaZulu-Natal, Durban, South Africa
- Department of Biochemistry, University of Zimbabwe, Harare, Zimbabwe
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Osakunor DNM, Mduluza T, Osei-Hyiaman D, Burgess K, Woolhouse MEJ, Mutapi F. Schistosoma haematobium infection is associated with alterations in energy and purine-related metabolism in preschool-aged children. PLoS Negl Trop Dis 2020; 14:e0008866. [PMID: 33315875 PMCID: PMC7735607 DOI: 10.1371/journal.pntd.0008866] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/08/2020] [Indexed: 12/17/2022] Open
Abstract
Helminths are parasitic worms that infect over a billion people worldwide. The pathological consequences from infection are due in part, to parasite-induced changes in host metabolic pathways. Here, we analyse the changes in host metabolic profiles, in response to the first Schistosoma haematobium infection and treatment in Zimbabwean children. A cohort of 83 schistosome-negative children (2-5 years old) as determined by parasitological examination, guardian interviews and examination of medical records, was recruited at baseline. Children were followed up after three months for parasitological diagnosis of their first S. haematobium infection, by detection of parasite eggs excreted in urine. Children positive for infection were treated with the antihelminthic drug praziquantel, and treatment efficacy checked three months after treatment. Blood samples were taken at each time point, and capillary electrophoresis mass spectrometry in conjunction with multivariate analysis were used to compare the change in serum metabolite profiles in schistosome-infected versus uninfected children. Following baseline at the three-month follow up, 11 children had become infected with S. haematobium (incidence = 13.3%). Our results showed that infection with S. haematobium was associated with significant increases (>2-fold) in discriminatory metabolites, linked primarily with energy (G6P, 3-PG, AMP, ADP) and purine (AMP, ADP) metabolism. These observed changes were commensurate with schistosome infection intensity, and levels of the affected metabolites were reduced following treatment, albeit not significantly. This study demonstrates that early infection with S. haematobium is associated with alterations in host energy and purine metabolism. Taken together, these changes are consistent with parasite-related clinical manifestations of malnutrition, poor growth and poor physical and cognitive performance observed in schistosome-infected children.
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Affiliation(s)
- Derick N. M. Osakunor
- Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, King’s Buildings, Edinburgh, United Kingdom
- * E-mail:
| | - Takafira Mduluza
- Biochemistry Department, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe
| | - Douglas Osei-Hyiaman
- Laboratory of Physiologic Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, United States of America
- Metabolomics Research Division, Human Metabolome Technologies Inc., Tsuruoka, Yamagata, Japan
- Department of Systems Neurophysiology, Graduate School of Medical & Dental Science, Tokyo Medical and Dental University, Bunkyo City, Tokyo, Japan
| | - Karl Burgess
- Centre for Synthetic and Systems Biology, University of Edinburgh, CH Waddington Building, King’s Buildings, Edinburgh, United Kingdom
| | - Mark E. J. Woolhouse
- Usher Institute, University of Edinburgh, Ashworth Laboratories, King’s Buildings, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, King’s Buildings, Edinburgh, United Kingdom
| | - Francisca Mutapi
- Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, King’s Buildings, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, King’s Buildings, Edinburgh, United Kingdom
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Mduluza-Jokonya TL, Naicker T, Jokonya L, Midzi H, Vengesai A, Kasambala M, Choto E, Rusakaniko S, Sibanda E, Mutapi F, Mduluza T. Association of Schistosoma haematobium infection morbidity and severity on co-infections in pre-school age children living in a rural endemic area in Zimbabwe. BMC Public Health 2020; 20:1570. [PMID: 33076903 PMCID: PMC7574170 DOI: 10.1186/s12889-020-09634-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/29/2020] [Indexed: 12/18/2022] Open
Abstract
Background Individuals living in Schistosoma haematobium endemic areas are often at risk of having other communicable diseases simultaneously. This usually creates diagnostic difficulties leading to misdiagnosis and overlooking of schistosomiasis infection. In this study we investigated the prevalence and severity of coinfections in pre-school age children and further investigated associations between S. haematobium prevalence and under 5 mortality. Methods A community based cross-sectional survey was conducted in Shamva District, Zimbabwe. Using random selection, 465 preschool age children (1–5 years of age) were enrolled through clinical examination by two independent clinicians for the following top morbidity causing conditions: respiratory tract infections, dermatophytosis, malaria and fever of unknown origin. The conditions and their severe sequels were diagnosed as per approved WHO standards. S. haematobium infection was diagnosed by urine filtration and the children were screened for conditions common in the study area which included HIV, tuberculosis, malnutrition and typhoid. Data was analysed using univariate and multinomial regression analysis and relative risk (RR) calculated. Results Prevalence of S. haematobium was 35% (145). The clinical conditions assessed had the following prevalence in the study population: upper respiratory tract infection 40% (229), fever of unknown origin 45% (189), dermatophytosis 18% and malaria 18% (75). The odds of co-infections observed with S. haematobium infection were: upper respiratory tract infection aOR = 1.22 (95% CI 0.80 to 1.87), dermatophytosis aOR = 4.79 (95% CI 2.78 to 8.25), fever of unknown origin aOR = 10.63 (95% CI 6.48–17.45) and malaria aOR = 0.91 (95% CI 0.51 to1.58). Effect of schistosomiasis coinfection on disease progression based on the odds of the diseases progressing to severe sequalae were: Severe pneumonia aOR = 8.41 (95% CI 3.09–22.93), p < 0.0001, complicated malaria aOR = 7.09 (95% CI 1.51–33.39), p = 0.02, severe dermatophytosis aOR = 20.3 (95% CI 4.78–83.20):p = 0.03, and fever of unknown origin aOR = 1.62 (95%CI 1.56–4.73), p = 0.02. Conclusion This study revealed an association between schistosomiasis and the comorbidity conditions of URTI, dermatophytosis, malaria and FUO in PSAC living in a schistosomiasis endemic area. A possible detrimental effect where coinfection led to severe sequels of the comorbidity conditions was demonstrated. Appropriate clinical diagnostic methods are required to identify associated infectious diseases and initiate early treatment of schistosomiasis and co-infections in PSAC.
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Affiliation(s)
- Tariro L Mduluza-Jokonya
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa. .,Department of Biochemistry, University of Zimbabwe, P.O. Box MP 167, Mt Pleasant, Harare, Zimbabwe.
| | - Thajasvarie Naicker
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Luxwell Jokonya
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.,Department of Surgery, College of Health Sciences, University of Zimbabwe, P.O. Box MP 167, Mt Pleasant, Harare, Zimbabwe
| | - Herald Midzi
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Arthur Vengesai
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Maritha Kasambala
- Department of Biochemistry, University of Zimbabwe, P.O. Box MP 167, Mt Pleasant, Harare, Zimbabwe
| | - Emilia Choto
- Department of Biochemistry, University of Zimbabwe, P.O. Box MP 167, Mt Pleasant, Harare, Zimbabwe
| | - Simbarashe Rusakaniko
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, P.O. Box MP 167, Mt Pleasant, Harare, Zimbabwe
| | - Elopy Sibanda
- Twin Palms Medical Centre, 113 Kwame Nkrumah Avenue, Harare, Zimbabwe
| | - Francisca Mutapi
- Institute for Immunology and Infection Research and Centre for Immunity, Infection and Evolution, School of Biological Sciences, University of Edinburgh, Ashworth Laboratories, King's Buildings, Charlotte Auerbach Rd., Edinburgh, EH9 3JT, UK
| | - Takafira Mduluza
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.,Department of Biochemistry, University of Zimbabwe, P.O. Box MP 167, Mt Pleasant, Harare, Zimbabwe
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8
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Volkman T, Clifford V, Paxton GA. Schistosoma serology after praziquantel treatment of Schistosoma infection in refugee children resettled in Australia: A retrospective analysis. Travel Med Infect Dis 2020; 37:101680. [DOI: 10.1016/j.tmaid.2020.101680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/12/2020] [Accepted: 04/15/2020] [Indexed: 11/30/2022]
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9
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Mduluza-Jokonya TL, Naicker T, Kasambala M, Jokonya L, Vengesai A, Midzi H, Choto E, Musonza K, Rusankaniko S, Sibanda E, Mutapi F, Mduluza T. Clinical morbidity associated with Schistosoma haematobium infection in pre-school age children from an endemic district in Zimbabwe. Trop Med Int Health 2020; 25:1110-1121. [PMID: 32502300 DOI: 10.1111/tmi.13451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate Schistosoma haematobium morbidity in infected pre-school age children and establish their disease burden. METHODOLOGY Pre-school age children (1-5 years) who were lifelong residents of the study area and had no other infections were included in the study. Participants underwent a physical examination with clinicians blinded to their infection status. Diagnosis of S. haematobium was by urine filtration. RESULTS The prevalence of S. haematobium was 35.1% (146/416). The clinical features observed in patients with Schistosoma haematobium were as follows: wheezes (morbidity attributable factor (AF = 93.9%), haematuria (AF = 92.6%), ascites (AF = 91.5%), atopy (AF = 76.9%), inguinal lymphadenopathy (AF = 68.4%), stunting (AF = 38.2), malnutrition (MUAC)(AF = 20%) and weight for height scales (AF = 5%). Schistosoma. haematobium infected children were at greater odds ratio of presenting with inguinal lymphadenopathy (AOR)=99.2(95% CI 24.2 to 854.5), wheezes in the chest (AOR = 35.4 95% CI 15.3 to 94.2), Distended abdomen with ascites (AOR = 23.9 95% CI 11.4 to 54), haematuria (AOR = 12.6 95% CI 11.6 to 14.1), atopy history (AOR = 5.6 95% CI 1.85 to 20.2), malnutrition (AOR = 2.3 95% CI 1.4 to 3.2) and stunting (AOR = 1.9 95% CI 1.1 to2.7). CONCLUSION The study is novel as it demonstrates for the first time clinical morbidity markers associated with S. haematobium infection in pre-school age children. Furthermore the study adds scientific evidence to the call for inclusion of pre-school age children in schistosomiasis control programmes. These morbidity markers highlight the need for early diagnosis and screening for S. haematobium in pre-school age children.
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Affiliation(s)
- Tariro L Mduluza-Jokonya
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Department of Biochemistry, University of Zimbabwe, Harare, Zimbabwe
| | - Thajasvarie Naicker
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Maritha Kasambala
- Department of Biochemistry, University of Zimbabwe, Harare, Zimbabwe
| | - Luxwell Jokonya
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Department of Surgery, University of Zimbabwe, Harare, Zimbabwe
| | - Arthur Vengesai
- Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Department of Surgery, University of Zimbabwe, Harare, Zimbabwe
| | - Herald Midzi
- Department of Biochemistry, University of Zimbabwe, Harare, Zimbabwe
| | - Emilia Choto
- Department of Biochemistry, University of Zimbabwe, Harare, Zimbabwe
| | - Kimpton Musonza
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | | | | | - Francisca Mutapi
- Institute for Immunology and Infection Research and Centre for Immunity, Infection and Evolution, School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | - Takafira Mduluza
- Department of Biochemistry, University of Zimbabwe, Harare, Zimbabwe
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10
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Olliaro PL, Coulibaly JT, Garba A, Halleux C, Keiser J, King CH, Mutapi F, N’Goran EK, Raso G, Scherrer AU, Sousa-Figueiredo JC, Stete K, Utzinger J, Vaillant MT. Efficacy and safety of single-dose 40 mg/kg oral praziquantel in the treatment of schistosomiasis in preschool-age versus school-age children: An individual participant data meta-analysis. PLoS Negl Trop Dis 2020; 14:e0008277. [PMID: 32569275 PMCID: PMC7360067 DOI: 10.1371/journal.pntd.0008277] [Citation(s) in RCA: 8] [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: 12/27/2019] [Revised: 07/14/2020] [Accepted: 04/08/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Better knowledge of the efficacy and safety of single-dose 40 mg/kg oral praziquantel in preschool-age children is required, should preventive chemotherapy programs for schistosomiasis be expanded to include this age group. METHODOLOGY We analyzed individual participant-level data from 16 studies (13 single-arm or cohort studies and three randomized trials), amounting to 683 preschool-age children (aged <6 years) and 2,010 school-age children (aged 6-14 years). Children had a documented Schistosoma mansoni or S. haematobium infection, were treated with single 40 mg/kg oral praziquantel, and assessed between 21 and 60 days post-treatment. Efficacy was expressed as arithmetic mean and individual egg reduction rate (ERR) and meta-analyzed using general linear models and mixed models. Safety was summarized using reported adverse events (AEs). PRINCIPAL FINDINGS Preschool-age children had significantly lower baseline Schistosoma egg counts and more losses to follow-up compared to school-age children. No difference in efficacy was found between preschool- and school-age children using a general linear model of individual-participant ERR with baseline log-transformed egg count as covariate and study, age, and sex as fixed variables, and a mixed model with a random effect on the study. Safety was reported in only four studies (n = 1,128 individuals); few AEs were reported in preschool-age children 4 and 24 hours post-treatment as well as at follow-up. Three severe but not serious AEs were recorded in school-age children during follow-up. CONCLUSIONS/SIGNIFICANCE There is no indication that single-dose 40 mg/kg oral praziquantel would be less efficacious and less safe in preschool-age children compared to school-age children, with the caveat that only few randomized comparisons exist between the two age groups. Preventive chemotherapy might therefore be extended to preschool-age children, with proper monitoring of its efficacy and safety.
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Affiliation(s)
- Piero L. Olliaro
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jean T. Coulibaly
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | - Amadou Garba
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Christine Halleux
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Charles H. King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, United States of America
- Schistosomiasis Consortium for Operational Research and Evaluation, University of Georgia, Athens, Georgia, United States of America
| | - Francisca Mutapi
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), Ashworth Laboratories, University of Edinburgh, Edinburgh, United Kingdom
- Institute of Immunology and Infection Research, Centre for Immunity, Infection and Evolution, School of Biological Sciences, Ashworth Laboratories, University of Edinburgh, Edinburgh, United Kingdom
| | - Eliézer K. N’Goran
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | - Giovanna Raso
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Alexandra U. Scherrer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - José Carlos Sousa-Figueiredo
- Department of Life Sciences, Natural History Museum, Wolfson Wellcome Biomedical Laboratories, London, United Kingdom
- Centro de Investigação em Saúde de Angola, Hospital Provincial, Bengo, Angola
| | - Katarina Stete
- Division of Infectious Diseases, Department of Medicine II, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Michel T. Vaillant
- Centre of Competences for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
- * E-mail:
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11
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Mangano VD, Bianchi C, Ouedraogo M, Kabore Y, Corran P, Silva N, Sirima SB, Nebie I, Bruschi F, Modiano D. Antibody response to Schistosoma haematobium and other helminth species in malaria-exposed populations from Burkina Faso. Acta Trop 2020; 205:105381. [PMID: 32007449 DOI: 10.1016/j.actatropica.2020.105381] [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: 03/25/2019] [Revised: 01/25/2020] [Accepted: 01/29/2020] [Indexed: 10/25/2022]
Abstract
Infection with helminths in sub-Saharan Africa could modulate the immune response towards Plasmodium falciparum as well as susceptibility to malaria infection and disease. The aim of this study is to assess the antibody responses to helminths species in malaria-exposed populations from Burkina Faso. Plasma samples were collected in rural villages inhabited by Fulani, Mossi and Rimaibe communities, and IgG against parasitic helminths were measured by ELISA. The prevalence of IgG against antigens of Strongyloides stercoralis, Wuchereria bancrofti and Schistosoma haematobium (Soluble Egg Antigen, SEA) was 5%, 16% and 63% respectively, in line with estimates of infection prevalence in the region for the three parasites. Anti-SEA IgG prevalence was highest at 10-20 years of age, higher in males than females, and did not show differences between ethnic groups. However, the Fulani showed lower levels of anti-SEA IgG suggesting that lighter S. haematobium infections may occur in the ethnic group known for a marked lower susceptibility to P. falciparum. The present data support the use of serological methods for integrated surveillance of neglected tropical diseases such as soil-transmitted helminths, lymphatic filariasis and bilharzia. Furthermore, as helminth infections might promote downregulation of immune responses against intracellular pathogens, the observation of lower anti-SEA IgG levels in the malaria resistant Fulani population warrants further investigation into the immunological cross-talk between S. haematobium and P. falciparum in this geographical region.
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12
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Mogeni P, Vandormael A, Cuadros D, Appleton C, Tanser F. Impact of community piped water coverage on re-infection with urogenital schistosomiasis in rural South Africa. eLife 2020; 9:54012. [PMID: 32178761 PMCID: PMC7108860 DOI: 10.7554/elife.54012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/10/2020] [Indexed: 12/15/2022] Open
Abstract
Previously, we demonstrated that coverage of piped water in the seven years preceding a parasitological survey was strongly predictive of Schistosomiasis haematobium infection in a nested cohort of 1976 primary school children (Tanser, 2018). Here, we report on the prospective follow up of infected members of this nested cohort (N = 333) for two successive rounds following treatment. Using a negative binomial regression fitted to egg count data, we found that every percentage point increase in piped water coverage was associated with 4.4% decline in intensity of re-infection (incidence rate ratio = 0.96, 95% CI: 0.93–0.98, p=0.004) among the treated children. We therefore provide further compelling evidence in support of the scaleup of piped water as an effective control strategy against Schistosoma haematobium transmission.
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Affiliation(s)
- Polycarp Mogeni
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.,KwaZulu-Natal Innovation and Sequencing Platform (KRISP), University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Alain Vandormael
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.,KwaZulu-Natal Innovation and Sequencing Platform (KRISP), University of KwaZulu-Natal, KwaZulu-Natal, South Africa.,Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Diego Cuadros
- Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, United States.,Health Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, United States
| | - Christopher Appleton
- School of Life Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Frank Tanser
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.,Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, United Kingdom
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13
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Mutsaka-Makuvaza MJ, Matsena-Zingoni Z, Tshuma C, Katsidzira A, Webster B, Zhou XN, Midzi N. Knowledge, perceptions and practices regarding schistosomiasis among women living in a highly endemic rural district in Zimbabwe: implications on infections among preschool-aged children. Parasit Vectors 2019; 12:458. [PMID: 31547850 PMCID: PMC6757404 DOI: 10.1186/s13071-019-3668-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 08/13/2019] [Indexed: 11/13/2022] Open
Abstract
Background Schistosomiasis primarily affects poor and neglected communities due to their lack of safe water and sanitation facilities. In an effort to improve intervention strategies, the present study investigated the association of socio-demographic characteristics of women with their existing knowledge, perceptions and practices (KPP) in five urogenital schistosomiasis endemic rural communities in Zimbabwe. Methods In February 2016, a cross sectional study was conducted in which 426 women in rural Madziwa area, Shamva District were interviewed using a pretested structured questionnaire seeking their KPP and socio-demographic characteristics. Logistic regression analysis was performed to identify socio-demographic factors associated with the KPP variables. Results Among the 426 participants, 93.7% knew about schistosomiasis, while 97.7 and 87.5% understood the disease transmission and methods for prevention, respectively. A significantly higher percentage of women aged ≥ 30 years compared to those < 30 years indicated that infertility is a complication of untreated chronic schistosomiasis (OR: 1.7, 95% CI: 0.9–3.0). Compared to women who had no history of infection, those who had been infected before were more likely to think that they were currently infected (OR: 3.7, 95% CI: 2.4–6.0). Bathing in unsafe water sources was more common in non-apostolic compared to apostolic followers (OR: 2.1, 95% CI: 1.2–3.7). Sole use of unsafe water for domestic purposes was significantly higher in uneducated women compared to the educated (OR: 1.8, 95% CI: 1.0–3.1). Compared to women of the Chakondora community, those in Chihuri, Nduna and Kaziro were more likely to know that dysuria is a symptom of schistosomiasis while those in Chihuri were also likely to allow young children to perform water contact activities (OR: 2.9, 95% CI: 1.5–5.5). Conclusions Despite the high level of schistosomiasis awareness, some women had inadequate knowledge about the mode of transmission and preventive measures for schistosomiasis. Socio-demographic characteristics were associated with the KPP of women. Thus, disease control efforts should consider socio-demographic factors, which may influence the knowledge, perceptions and practices of occupants in a given setting.
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Affiliation(s)
- Masceline Jenipher Mutsaka-Makuvaza
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, P. O. Box A178, Avondale, Harare, Zimbabwe.,National Institute of Health Research, Ministry of Health and Child Care, P.O. Box CY573, Causeway, Harare, Zimbabwe
| | - Zvifadzo Matsena-Zingoni
- National Institute of Health Research, Ministry of Health and Child Care, P.O. Box CY573, Causeway, Harare, Zimbabwe.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, 27 St Andrews' Road, Parktown, Johannesburg, 2193, South Africa
| | - Cremance Tshuma
- Mashonaland Central Provincial Health Office, Ministry of Health and Child Care, Bindura, Mashonaland Central, Zimbabwe
| | - Agnes Katsidzira
- Harare Central Hospital, P.O Box ST 14, Southerton, Harare, Zimbabwe
| | - Bonnie Webster
- Department of Life Sciences, Natural History Museum, 14 Cromwell Road, London, SW7 5BD, UK
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Centre for Disease Control and Prevention, Shanghai, 200025, China
| | - Nicholas Midzi
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, P. O. Box A178, Avondale, Harare, Zimbabwe.
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14
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Mutsaka-Makuvaza MJ, Matsena-Zingoni Z, Katsidzira A, Tshuma C, Chin'ombe N, Zhou XN, Webster B, Midzi N. Urogenital schistosomiasis and risk factors of infection in mothers and preschool children in an endemic district in Zimbabwe. Parasit Vectors 2019; 12:427. [PMID: 31477172 PMCID: PMC6721289 DOI: 10.1186/s13071-019-3667-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 08/13/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND To design appropriate schistosomiasis control programmes that include women and preschool-aged children (PSAC) it is essential to assess their disease profile and the risk factors predisposing them to infection. This study aimed to determine the prevalence of urogenital schistosomiasis and the risk factors of infection among PSAC and their caregivers in an endemic area of Zimbabwe. METHODS A cross-sectional study involving screening for urogenital schistosomiasis infections and treatment of 860 participants [535 children aged ≤ 5 years and 325 caregivers (≥ 15 years)] was carried out in five communities, namely Chihuri, Mupfure, Chakondora, Nduna and Kaziro, in February 2016. Haematuria was recorded for each participant and urine filtration was performed to determine the presence and infection intensity of Schistosoma haematobium. A pre-tested questionnaire was administered to the caregivers seeking knowledge, practices and perceptions regarding schistosomiasis. Data analysis was performed using descriptive statistics and logistic regression. RESULTS Overall 132 (15.4%) of the 860 participants had S. haematobium infections. Among these, 61 (18.7%) of the 325 caregivers and 71 (13.3%) of the 535 children were infected. The infection prevalence was significantly different between caregivers and PSAC (χ2 = 4.7040, df = 1, P = 0.030). Children whose caregivers used river water for bathing were more likely to be infected compared to children whose caregivers used protected well water (OR: 2.2, 95% CI: 1.3-3.7). The risks of being infected with schistosomiasis were higher in children whose caregivers were infected compared to children whose caregivers had no infection (AOR: 3.9, 95% CI: 1.7-8.6). In caregivers, those who bathed in river water were at higher risk of schistosomiasis infection compared to those who used water from a protected well (AOR: 3.0, 95% CI: 1.4-6.4). CONCLUSIONS According to the World Health Organization guidelines, the observed overall prevalence of urogenital schistosomiasis qualifies this area as a moderate risk area requiring mass chemotherapy once every two years. Water contact practices of caregivers, and their perceptions and knowledge regarding schistosomiasis are risk factors for infection in both themselves and PSAC. Thus, disease control efforts targeting caregivers or PSAC should include health education and provision of alternative clean and safe water sources.
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Affiliation(s)
- Masceline Jenipher Mutsaka-Makuvaza
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, P. O. Box A178, Avondale, Harare, Zimbabwe.,National Institute of Health Research, Ministry of Health and Child Care, P.O. Box CY573, Causeway, Harare, Zimbabwe
| | - Zvifadzo Matsena-Zingoni
- National Institute of Health Research, Ministry of Health and Child Care, P.O. Box CY573, Causeway, Harare, Zimbabwe.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, 27 St Andrews' Road, Parktown, Johannesburg, 2193, South Africa
| | - Agnes Katsidzira
- Harare Central Hospital, P.O Box ST 14, Southerton, Harare, Zimbabwe
| | - Cremance Tshuma
- Mashonaland Central Provincial Health Office, Ministry of Health and Child Care, Bindura, Mashonaland Central, Zimbabwe
| | - Nyasha Chin'ombe
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, P. O. Box A178, Avondale, Harare, Zimbabwe
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Centre for Disease Control and Prevention, Shanghai, 200025, China
| | - Bonnie Webster
- Department of Life Sciences, Natural History Museum, 14 Cromwell Road, London, SW7 5BD, UK
| | - Nicholas Midzi
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, P. O. Box A178, Avondale, Harare, Zimbabwe.
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15
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Mutsaka-Makuvaza MJ, Matsena-Zingoni Z, Tshuma C, Ray S, Zhou XN, Webster B, Midzi N. Reinfection of urogenital schistosomiasis in pre-school children in a highly endemic district in Northern Zimbabwe: a 12 months compliance study. Infect Dis Poverty 2018; 7:102. [PMID: 30268157 PMCID: PMC6162945 DOI: 10.1186/s40249-018-0483-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/04/2018] [Indexed: 12/19/2022] Open
Abstract
Background In light of the shift to aiming for schistosomiasis elimination, the following are needed: data on reinfection patterns, participation, and sample submission adherence of all high-risk age groups to intervention strategies. This study was conducted to assess prevalence, reinfections along with consecutive participation, sample submission adherence, and effect of treatment on schistosomiasis prevalence in children aged five years and below in an endemic district in Zimbabwe, over one year. Methods The study was conducted from February 2016–February 2017 in Madziwa area, Shamva district. Following community mobilisation, mothers brought their children aged 5 years and below for recruitment at baseline and also urine sample collection at baseline, 3, 6, 9 and 12 months follow up surveys. At each time point, urine was tested for urogenital schistosomiasis by urine filtration and children found positive received treatment. Schistosoma haematobium prevalence, reinfections as well as children participation, and urine sample submission at each visit were assessed at each time point for one year. Results Of the 535 children recruited from the five communities, 169 (31.6%) participated consecutively at all survey points. The highest mean number of samples submitted was 2.9 among communities and survey points. S. haematobium prevalence significantly reduced from 13.3% at baseline to 2.8% at 12 months for all participants and from 24.9% at baseline to 1.8% at 12 months (P < 0.001) for participants coming at all- time points. Among the communities, the highest baseline prevalence was found in Chihuri for both the participants coming consecutively (38.5%, 10/26) and all participants (20.4%, 21/103). Reinfections were significantly high at 9 months follow up survey (P = 0.021) and in Mupfure (P = 0.003). New infections significantly decreased over time (P < 0.001). Logistic regression analysis showed that the risk of acquiring schistosomiasis was high in some communities (P < 0.05). Conclusions S. haematobium infections and reinfections are seasonal and depend on micro-geographical settings. The risk of being infected with schistosomes in pre-school aged children increases with increasing age. Sustained treatment of infected individuals in a community reduces prevalence overtime. Participation compliance at consecutive visits and sample submission adherence are important for effective operational control interventions. Electronic supplementary material The online version of this article (10.1186/s40249-018-0483-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Masceline Jenipher Mutsaka-Makuvaza
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, P. O. Box A178, Avondale, Harare, Zimbabwe.,National Institute of Health Research, Ministry of Health and Child Care, P.O. Box CY573, Causeway, Harare, Zimbabwe
| | - Zvifadzo Matsena-Zingoni
- National Institute of Health Research, Ministry of Health and Child Care, P.O. Box CY573, Causeway, Harare, Zimbabwe.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, 27 St Andrews' Road, Parktown, Johannesburg, 2193, South Africa
| | - Cremance Tshuma
- Mashonaland Central Provincial Health Office, Ministry of health and Child Care, Bindura, Zimbabwe
| | - Sunanda Ray
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, P. O. Box A178, Avondale, Harare, Zimbabwe
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Centre for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Bonnie Webster
- Parasites and Vectors Division, National History Museum, London, UK
| | - Nicholas Midzi
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, P. O. Box A178, Avondale, Harare, Zimbabwe.
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Song HB, Kim J, Jin Y, Lee JS, Jeoung HG, Lee YH, Saeed AAW, Hong ST. Comparison of ELISA and Urine Microscopy for Diagnosis of Schistosoma haematobium Infection. J Korean Med Sci 2018; 33:e238. [PMID: 30093850 PMCID: PMC6082808 DOI: 10.3346/jkms.2018.33.e238] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/28/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Schistosoma haematobium which causes urogenital schistosomiasis (UGS) is highly prevalent in African countries. Urine microscopy (UM) is the first-line diagnostic method of UGS. Enzyme-linked immunosorbent assay (ELISA) is a common method for screening many parasite infections primarily or alternatively. The present study established an in-house diagnostic system by ELISA and evaluated its diagnostic efficacy in comparison with UM for screening UGS in White Nile State, Republic of Sudan, 2011-2013. METHODS A total of 490 participants were screened by UM or ELISA, and 149 by both. The in-house ELISA system was established employing soluble egg antigen of S. haematobium and the cut-off absorbance was set at 0.270. RESULTS Of the 149 subjects, 58 participants (38.9%) were positive by UM, 119 (79.9%) were positive by ELISA and 82 (55.0%) showed consistently positive or negative results by both methods. The diagnostic sensitivity of ELISA was 94.8% and specificity was 29.7% based on UM results. The ELISA positive serum samples also cross-reacted with egg antigens of Schistosoma mansoni and Schistosoma japonicum. CONCLUSION We have established in-house ELISA for screening serum immunoglobulin (Ig) G antibodies by employing soluble egg antigen of S. haematobium for diagnosis of UGS with 94.8% sensitivity and 29.7% specificity. The ELISA system can supplement the conventional diagnosis by UM.
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Affiliation(s)
- Hyun Beom Song
- Department of Parasitology and Tropical Medicine, Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Korea
| | - Jiyoung Kim
- Department of Parasitology and Tropical Medicine, Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Korea
| | - Yan Jin
- Department of Microbiology, Dongguk University College of Medicine, Gyeongju, Korea
| | - Jin Soo Lee
- Korea Association of Health Promotion, Seoul, Korea
| | | | - Young Ha Lee
- Department of Infection Biology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Abd Al Wahab Saeed
- Center for Neglected Tropical Diseases Control, White Nile State, Republic of Sudan
| | - Sung-Tae Hong
- Department of Parasitology and Tropical Medicine, Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Korea
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Universal Health Coverage in Africa: Coinfections and Comorbidities. Trends Parasitol 2018; 34:813-817. [PMID: 30057348 DOI: 10.1016/j.pt.2018.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/06/2018] [Accepted: 07/09/2018] [Indexed: 11/23/2022]
Abstract
At the 67th session of the World Health Organization (WHO) Regional Committee meeting in August 2017, African health ministers adopted a range of transformational actions intended to strengthen health systems in countries, leading to Universal Health Coverage (UHC). A critical challenge for UHC is the existence of coinfections and noncommunicable diseases (NCDs), characterised by comorbidities.
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Osakunor DNM, Mduluza T, Midzi N, Chase-Topping M, Mutsaka-Makuvaza MJ, Chimponda T, Eyoh E, Mduluza T, Pfavayi LT, Wami WM, Amanfo SA, Murray J, Tshuma C, Woolhouse MEJ, Mutapi F. Dynamics of paediatric urogenital schistosome infection, morbidity and treatment: a longitudinal study among preschool children in Zimbabwe. BMJ Glob Health 2018; 3:e000661. [PMID: 29616147 PMCID: PMC5875666 DOI: 10.1136/bmjgh-2017-000661] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/27/2018] [Accepted: 02/28/2018] [Indexed: 01/14/2023] Open
Abstract
Background Recent research has shown that in schistosome-endemic areas preschool-aged children (PSAC), that is, ≤5 years, are at risk of infection. However, there exists a knowledge gap on the dynamics of infection and morbidity in this age group. In this study, we determined the incidence and dynamics of the first urogenital schistosome infections, morbidity and treatment in PSAC. Methods Children (6 months to 5 years) were recruited and followed up for 12 months. Baseline demographics, anthropometric and parasitology data were collected from 1502 children. Urinary morbidity was assessed by haematuria and growth-related morbidity was assessed using standard WHO anthropometric indices. Children negative for Schistosoma haematobium infection were followed up quarterly to determine infection and morbidity incidence. Results At baseline, the prevalence of S haematobium infection and microhaematuria was 8.5% and 8.6%, respectively. Based on different anthropometric indices, 2.2%-8.2% of children were malnourished, 10.1% underweight and 18.0% stunted. The fraction of morbidity attributable to schistosome infection was 92% for microhaematuria, 38% for stunting and malnutrition at 9%-34%, depending on indices used. S haematobium-positive children were at greater odds of presenting with microhaematuria (adjusted OR (AOR)=25.6; 95% CI 14.5 to 45.1) and stunting (AOR=1.7; 95% CI 1.1 to 2.7). Annual incidence of S haematobium infection and microhaematuria was 17.4% and 20.4%, respectively. Microhaematuria occurred within 3 months of first infection and resolved in a significant number of children, 12 weeks post-praziquantel treatment, from 42.3% to 10.3%; P<0.001. Conclusion We demonstrated for the first time the incidence of schistosome infection in PSAC, along with microhaematuria, which appears within 3 months of first infection and resolves after praziquantel treatment. A proportion of stunting and malnutrition is attributable to S haematobium infection. The study adds scientific evidence to the calls for inclusion of PSAC in schistosome control programmes.
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Affiliation(s)
- Derick Nii Mensah Osakunor
- Centre for Infection, Immunity and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK
| | - Takafira Mduluza
- Department of Biochemistry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.,School of Laboratory Medicine and Medical Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Nicholas Midzi
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Margo Chase-Topping
- Centre for Immunity, Infection and Evolution, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Masceline Jenipher Mutsaka-Makuvaza
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.,National Institute of Health Research, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Theresa Chimponda
- Department of Biochemistry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Enwono Eyoh
- Centre for Infection, Immunity and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK
| | - Tariro Mduluza
- Department of Biochemistry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Lorraine Tsitsi Pfavayi
- Department of Biochemistry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Welcome Mkululi Wami
- Centre for Infection, Immunity and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK
| | - Seth Appiah Amanfo
- Centre for Immunity, Infection and Evolution, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Janice Murray
- Centre for Infection, Immunity and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK
| | - Clement Tshuma
- Epidemiology and Disease Control, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Mark Edward John Woolhouse
- Centre for Immunity, Infection and Evolution, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Edinburgh, UK
| | - Francisca Mutapi
- Centre for Infection, Immunity and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK.,NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Edinburgh, UK
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Abstract
Schistosomiasis affects over 200 million people worldwide, most of whom are children. Research and control strategies directed at preschool-aged children (PSAC), i.e., ≤5 years old, have lagged behind those in older children and adults. With the recent WHO revision of the schistosomiasis treatment guidelines to include PSAC, and the recognition of gaps in our current knowledge on the disease and its treatment in this age group, there is now a concerted effort to address these shortcomings. Global and national schistosome control strategies are yet to include PSAC in treatment schedules. Maximum impact of schistosome treatment programmes will be realised through effective treatment of PSAC. In this review, we (i) discuss the current knowledge on the dynamics and consequences of paediatric schistosomiasis and (ii) identify knowledge and policy gaps relevant to these areas and to the successful control of schistosome infection and disease in this age group. Herein, we highlight risk factors, immune mechanisms, pathology, and optimal timing for screening, diagnosis, and treatment of paediatric schistosomiasis. We also discuss the tools required for treating schistosomiasis in PSAC and strategies for accessing them for treatment.
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Affiliation(s)
- Derick N. M. Osakunor
- Centre for Immunity, Infection and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- * E-mail:
| | - Mark E. J. Woolhouse
- Centre for Immunity, Infection and Evolution, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
| | - Francisca Mutapi
- Centre for Immunity, Infection and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
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A preface on advances in diagnostics for infectious and parasitic diseases: detecting parasites of medical and veterinary importance. Parasitology 2017; 141:1781-8. [PMID: 25415359 DOI: 10.1017/s0031182014001309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
There are many reasons why detection of parasites of medical and veterinary importance is vital and where novel diagnostic and surveillance tools are required. From a medical perspective alone, these originate from a desire for better clinical management and rational use of medications. Diagnosis can be at the individual-level, at close to patient settings in testing a clinical suspicion or at the community-level, perhaps in front of a computer screen, in classification of endemic areas and devising appropriate control interventions. Thus diagnostics for parasitic diseases has a broad remit as parasites are not only tied with their definitive hosts but also in some cases with their vectors/intermediate hosts. Application of current diagnostic tools and decision algorithms in sustaining control programmes, or in elimination settings, can be problematic and even ill-fitting. For example in resource-limited settings, are current diagnostic tools sufficiently robust for operational use at scale or are they confounded by on-the-ground realities; are the diagnostic algorithms underlying public health interventions always understood and well-received within communities which are targeted for control? Within this Special Issue (SI) covering a variety of diseases and diagnostic settings some answers are forthcoming. An important theme, however, throughout the SI is to acknowledge that cross-talk and continuous feedback between development and application of diagnostic tests is crucial if they are to be used effectively and appropriately.
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Hinz R, Schwarz NG, Hahn A, Frickmann H. Serological approaches for the diagnosis of schistosomiasis - A review. Mol Cell Probes 2016; 31:2-21. [PMID: 27986555 DOI: 10.1016/j.mcp.2016.12.003] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 11/28/2016] [Accepted: 12/12/2016] [Indexed: 01/14/2023]
Abstract
Schistosomiasis is a common disease in endemic areas of Sub-Saharan Africa, South America and Asia. It is rare in Europe, mainly imported from endemic countries due to travelling or human migration. Available methods for the diagnosis of schistosomiasis comprise microscopic, molecular and serological approaches, with the latter detecting antigens or antibodies associated with Schistosoma spp. infection. The serological approach is a valuable screening tool in low-endemicity settings and for travel medicine, though the interpretation of any diagnostic results requires knowledge of test characteristics and a patient's history. Specific antibody detection by most currently used assays is only possible in a relatively late stage of infection and does not allow for the differentiation of acute from previous infections for therapeutic control or the discrimination between persisting infection and re-infection. Throughout the last decades, new target antigens have been identified, and assays with improved performance and suitability for use in the field have been developed. For numerous assays, large-scale studies are still required to reliably characterise assay characteristics alone and in association with other available methods for the diagnosis of schistosomiasis. Apart from S. mansoni, S. haematobium and S. japonicum, for which most available tests were developed, other species of Schistosoma that occur less frequently need to be taken into account. This narrative review describes and critically discusses the results of published studies on the evaluation of serological assays that detect antibodies against different Schistosoma species of humans. It provides insights into the diagnostic performance and an overview of available assays and their suitability for large-scale use or individual diagnosis, and thus sets the scene for serological diagnosis of schistosomiasis and the interpretation of results.
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Affiliation(s)
- Rebecca Hinz
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Germany; Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital Hamburg, Germany.
| | | | - Andreas Hahn
- Takeda Pharma Vertrieb GmbH & Co. KG, Berlin, Germany
| | - Hagen Frickmann
- Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital Hamburg, Germany; Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Germany
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Comparative Assessment of Health Benefits of Praziquantel Treatment of Urogenital Schistosomiasis in Preschool and Primary School-Aged Children. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9162631. [PMID: 27631011 PMCID: PMC5007301 DOI: 10.1155/2016/9162631] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/21/2016] [Accepted: 07/05/2016] [Indexed: 12/15/2022]
Abstract
Schistosomiasis is a major public health problem in Africa. However, it is only recently that its burden has become recognised as a significant component impacting on the health and development of preschool-aged children. A longitudinal study was conducted in Zimbabwean children to determine the effect of single praziquantel treatment on Schistosoma haematobium-related morbidity markers: microhaematuria, proteinuria, and albuminuria. Changes in these indicators were compared in 1-5 years versus 6-10 years age groups to determine if treatment outcomes differed by age. Praziquantel was efficacious at reducing infection 12 weeks after treatment: cure rate = 94.6% (95% CI: 87.9-97.7%). Infection rates remained lower at 12 months after treatment compared to baseline in both age groups. Among treated children, the odds of morbidity at 12 weeks were significantly lower compared to baseline for proteinuria: odds ratio (OR) = 0.54 (95% CI: 0.31-0.95) and albuminuria: OR = 0.05 (95% CI: 0.02-0.14). Microhaematuria significantly reduced 12 months after treatment, and the effect of treatment did not differ by age group: OR = 0.97 (95% CI: 0.50-1.87). In conclusion, praziquantel treatment has health benefits in preschool-aged children exposed to S. haematobium and its efficacy on infection and morbidity is not age-dependent.
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Kay GL, Millard A, Sergeant MJ, Midzi N, Gwisai R, Mduluza T, Ivens A, Nausch N, Mutapi F, Pallen M. Differences in the Faecal Microbiome in Schistosoma haematobium Infected Children vs. Uninfected Children. PLoS Negl Trop Dis 2015; 9:e0003861. [PMID: 26114287 PMCID: PMC4482744 DOI: 10.1371/journal.pntd.0003861] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 05/31/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Several infectious diseases and therapeutic interventions cause gut microbe dysbiosis and associated pathology. We characterised the gut microbiome of children exposed to the helminth Schistosoma haematobium pre- and post-treatment with the drug praziquantel (PZQ), with the aim to compare the gut microbiome structure (abundance and diversity) in schistosome infected vs. uninfected children. METHODS Stool DNA from 139 children aged six months to 13 years old; with S. haematobium infection prevalence of 27.34% was extracted at baseline. 12 weeks following antihelminthic treatment with praziqunatel, stool DNA was collected from 62 of the 139 children. The 16S rRNA genes were sequenced from the baseline and post-treatment samples and the sequence data, clustered into operational taxonomic units (OTUs). The OTU data were analysed using multivariate analyses and paired T-test. RESULTS Pre-treatment, the most abundant phyla were Bacteroidetes, followed by Firmicutes and Proteobacteria respectively. The relative abundance of taxa among bacterial classes showed limited variation by age group or sex and the bacterial communities had similar overall compositions. Although there were no overall differences in the microbiome structure across the whole age range, the abundance of 21 OTUs varied significantly with age (FDR<0.05). Some OTUs including Veillonella, Streptococcus, Bacteroides and Helicobacter were more abundant in children ≤ 1 year old compared to older children. Furthermore, the gut microbiome differed in schistosome infected vs. uninfected children with 27 OTU occurring in infected but not uninfected children, for 5 of these all Prevotella, the difference was statistically significant (p <0.05) with FDR <0.05. PZQ treatment did not alter the microbiome structure in infected or uninfected children from that observed at baseline. CONCLUSIONS There are significant differences in the gut microbiome structure of infected vs. uninfected children and the differences were refractory to PZQ treatment.
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Affiliation(s)
- Gemma Louise Kay
- Microbiology and Infection Unit, Division of Translational and Systems Medicine, Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry, West Midlands, United Kingdom
| | - Andrew Millard
- Microbiology and Infection Unit, Division of Translational and Systems Medicine, Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry, West Midlands, United Kingdom
| | - Martin J. Sergeant
- Microbiology and Infection Unit, Division of Translational and Systems Medicine, Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry, West Midlands, United Kingdom
| | - Nicholas Midzi
- National Institute of Health Research, Causeway, Harare, Zimbabwe
| | | | - Takafira Mduluza
- Department of Biochemistry, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe
| | - Alasdair Ivens
- Insitute of Immunology and Infection Research, Centre for Immunology, Infection and Evolution, School of Biological Sciences, University of Edinburgh, Ashworth Laboratories, King’s Buildings, Edinburgh, United Kingdom
| | - Norman Nausch
- Insitute of Immunology and Infection Research, Centre for Immunology, Infection and Evolution, School of Biological Sciences, University of Edinburgh, Ashworth Laboratories, King’s Buildings, Edinburgh, United Kingdom
| | - Francisca Mutapi
- Insitute of Immunology and Infection Research, Centre for Immunology, Infection and Evolution, School of Biological Sciences, University of Edinburgh, Ashworth Laboratories, King’s Buildings, Edinburgh, United Kingdom
| | - Mark Pallen
- Microbiology and Infection Unit, Division of Translational and Systems Medicine, Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry, West Midlands, United Kingdom
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Identifying and evaluating field indicators of urogenital schistosomiasis-related morbidity in preschool-aged children. PLoS Negl Trop Dis 2015; 9:e0003649. [PMID: 25793584 PMCID: PMC4368198 DOI: 10.1371/journal.pntd.0003649] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 02/26/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several studies have been conducted quantifying the impact of schistosome infections on health and development in school-aged children. In contrast, relatively little is known about morbidity levels in preschool-aged children (≤ 5 years) who have been neglected in terms of schistosome research and control. The aim of this study was to compare the utility of available point-of-care (POC) morbidity diagnostic tools in preschool versus primary school-aged children (6-10 years) and determine markers which can be used in the field to identify and quantify Schistosoma haematobium-related morbidity. METHODS/PRINCIPAL FINDINGS A comparative cross-sectional study was conducted to evaluate the performance of currently available POC morbidity diagnostic tools on Zimbabwean children aged 1-5 years (n=104) and 6-10 years (n=194). Morbidity was determined using the POC diagnostics questionnaire-based reporting of haematuria and dysuria, clinical examination, urinalysis by dipsticks, and urine albumin-to-creatinine ratio (UACR). Attributable fractions were used to quantify the proportion of morbidity attributable to S. haematobium infection. Based on results of attributable fractions, UACR was identified as the most reliable tool for detecting schistosome-related morbidity, followed by dipsticks, visual urine inspection, questionnaires, and lastly clinical examination. The results of urine dipstick attributes showed that proteinuria and microhaematuria accounted for most differences between schistosome egg-positive and negative children (T=-50.1; p<0.001). These observations were consistent in preschool vs. primary school-aged children. CONCLUSIONS/SIGNIFICANCE Preschool-aged children in endemic areas can be effectively screened for schistosome-related morbidity using the same currently available diagnostic tools applicable to older children. UACR for detecting albuminuria is recommended as the best choice for rapid assessment of morbidity attributed to S. haematobium infection in children in the field. The use of dipstick microhaematuria and proteinuria as additional indicators of schistosome-related morbidity would improve the estimation of disease burden in young children.
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Abstract
Schistosomiasis is a chronic disease that affects ∼200 million people. The extended health impact of the disease has been estimated to exceed that of malaria or tuberculosis and to be nearer to that of HIV/AIDS. Within endemic areas, children carry the heaviest burden of infection. Infection/disease is controlled by the treatment of infected subjects with the anthelminthic drug praziquantel. Global initiatives from Partners of Parasite Control, including the World Health Organization (WHO), advocate regular school-based deworming strategies to reduce the development of severe morbidity, promote school-child health and development, and improve the cognitive potential of children. Until recently, preschool-aged children were excluded from schistosome treatment, creating a health inequity in affected populations. In 2010, the WHO updated their recommendations for the treatment of schistosomiasis in preschool-aged children (ie, children aged ≤5 years). This change was the culmination of several decades of research on schistosome epidemiology, immunology, and pathology in this age group. The recent development of a pediatric formulation of praziquantel (soon to enter clinical trials) should advance control efforts in preschool-aged children, with the goal of including these children in preventative chemotherapy (as currently occurs for soil-transmitted helminths). This review discusses the research work supporting the WHO revision of recommendations for treating preschool-aged children, as well as current barriers and knowledge gaps in pediatric schistosomiasis control.
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Affiliation(s)
- Francisca Mutapi
- Institute of Immunology and Infection Research, Centre for Immunity, Infection and Evolution, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
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