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Donnelly O, Mesquita S, Archer J, Ali SM, Bartonicek Z, Lugli EB, Webster BL. Refining the Schistosoma haematobium recombinase polymerase amplification (Sh-RPA) assay: moving towards point-of-care use in endemic settings. Parasit Vectors 2024; 17:321. [PMID: 39068490 PMCID: PMC11283713 DOI: 10.1186/s13071-024-06380-9] [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: 04/25/2024] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Urogenital schistosomiasis is caused by the parasitic trematode Schistosoma haematobium. Sensitive and specific point-of-care diagnostics are needed for elimination of this disease. Recombinase polymerase amplification (RPA) assays meet these criteria, and an assay to diagnose S. haematobium has been developed (Sh-RPA). However, false-positive results can occur, and optimisation of reaction conditions to mitigate these is needed. Ease of use and compatibility of DNA extraction methods must also be considered. METHODS Using synthetic DNA, S. haematobium genomic DNA (gDNA), and urine samples from clinical cases, Sh-RPA reactions incorporating different betaine concentrations (0 M, 1 M, 2.5 M, 12.5 M) and the sample-to-water ratios were tested to determine effects on assay specificity and sensitivity. In addition, five commercial DNA extraction kits suitable for use in resource-limited settings were used to obtain gDNA from single S. haematobium eggs and evaluated in terms of DNA quality, quantity, and compatibility with the Sh-RPA assay. All samples were also evaluated by quantitative polymerase chain reaction (qPCR) to confirm DNA acquisition. RESULTS The analytical sensitivity of the Sh-RPA with all betaine concentrations was ≥ 10 copies of the synthetic Dra1 standard and 0.1 pg of S. haematobium gDNA. The addition of betaine improved Sh-RPA assay specificity in all reaction conditions, and the addition of 2.5 M of betaine together with the maximal possible sample volume of 12.7 µl proved to be the optimum reaction conditions. DNA was successfully isolated from a single S. haematobium egg using all five commercial DNA extraction kits, but the Sh-RPA performance of these kits varied, with one proving to be incompatible with RPA reactions. CONCLUSIONS The addition of 2.5 M of betaine to Sh-RPA reactions improved reaction specificity whilst having no detrimental effect on sensitivity. This increases the robustness of the assay, advancing the feasibility of using the Sh-RPA assay in resource-limited settings. The testing of commercial extraction kits proved that crude, rapid, and simple methods are sufficient for obtaining DNA from single S. haematobium eggs, and that these extracts can be used with Sh-RPA in most cases. However, the observed incompatibility of specific kits with Sh-RPA highlights the need for each stage of a molecular diagnostic platform to be robustly tested prior to implementation.
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Affiliation(s)
- Owain Donnelly
- Wolfson Wellcome Biomedical Laboratories, Department of Science, Natural History Museum, Cromwell Road, London, SW7 5BD, UK
- Malaria Biochemistry Laboratory, The Francis Crick Institute, 1 Midland Road, London, NW1 1AT, UK
| | - Silvia Mesquita
- Wolfson Wellcome Biomedical Laboratories, Department of Science, Natural History Museum, Cromwell Road, London, SW7 5BD, UK
- René Rachou Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - John Archer
- Wolfson Wellcome Biomedical Laboratories, Department of Science, Natural History Museum, Cromwell Road, London, SW7 5BD, UK
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Said M Ali
- Public Health Laboratory-Ivo de Carneri, P.O. Box 122, Chake-Chake, Pemba, United Republic of Tanzania
| | - Zikmund Bartonicek
- Wolfson Wellcome Biomedical Laboratories, Department of Science, Natural History Museum, Cromwell Road, London, SW7 5BD, UK
- Department of Genetics, Evolution and Environment, University College London, London, UK
| | - Elena B Lugli
- Wolfson Wellcome Biomedical Laboratories, Department of Science, Natural History Museum, Cromwell Road, London, SW7 5BD, UK
| | - Bonnie L Webster
- Wolfson Wellcome Biomedical Laboratories, Department of Science, Natural History Museum, Cromwell Road, London, SW7 5BD, UK.
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Lamberti O, Kayuni S, Kumwenda D, Ngwira B, Singh V, Moktali V, Dhanani N, Wessels E, Van Lieshout L, Fleming FM, Mzilahowa T, Bustinduy AL. Female genital schistosomiasis burden and risk factors in two endemic areas in Malawi nested in the Morbidity Operational Research for Bilharziasis Implementation Decisions (MORBID) cross-sectional study. PLoS Negl Trop Dis 2024; 18:e0012102. [PMID: 38718065 PMCID: PMC11104661 DOI: 10.1371/journal.pntd.0012102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/20/2024] [Accepted: 03/25/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Female genital schistosomiasis (FGS), caused by the parasite Schistosoma haematobium (Sh), is prevalent in Sub-Saharan Africa. FGS is associated with sexual dysfunction and reproductive morbidity, and increased prevalence of HIV and cervical precancerous lesions. Lack of approved guidelines for FGS screening and diagnosis hinder accurate disease burden estimation. This study evaluated FGS burden in two Sh-endemic areas in Southern Malawi by visual and molecular diagnostic methods. METHODOLOGY/PRINCIPAL FINDINGS Women aged 15-65, sexually active, not menstruating, or pregnant, were enrolled from the MORBID study. A midwife completed a questionnaire, obtained cervicovaginal swab and lavage, and assessed FGS-associated genital lesions using hand-held colposcopy. 'Visual-FGS' was defined as specific genital lesions. 'Molecular-FGS' was defined as Sh DNA detected by real-time PCR from swabs. Microscopy detected urinary Sh egg-patent infection. In total, 950 women completed the questionnaire (median age 27, [IQR] 20-38). Visual-and molecular-FGS prevalence were 26·9% (260/967) and 8·2% (78/942), respectively. 6·5% of women with available genital and urinary samples (38/584) had egg-patent Sh infection. There was a positive significant association between molecular- and visual-FGS (AOR = 2·9, 95%CI 1·7-5·0). 'Molecular-FGS' was associated with egg-patent Sh infection (AOR = 7·5, 95% CI 3·27-17·2). Some villages had high 'molecular-FGS' prevalence, despite <10% prevalence of urinary Sh among school-age children. CONCLUSIONS/SIGNIFICANCE Southern Malawi carries an under-recognized FGS burden. FGS was detectable in villages not eligible for schistosomiasis control strategies, potentially leaving girls and women untreated under current WHO guidelines. Validated field-deployable methods could be considered for new control strategies.
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Affiliation(s)
- Olimpia Lamberti
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sekeleghe Kayuni
- Centre for Health, Agriculture and Development Research and Consulting (CHAD), Blantyre, Malawi
- MASM Medi Clinics Limited, Medical Aid Society of Malawi (MASM), Lilongwe, Malawi
- Malawi Liverpool Wellcome Programme (MLW), Kamuzu University of Health Sciences (KUHeS), Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Dingase Kumwenda
- Centre for Health, Agriculture and Development Research and Consulting (CHAD), Blantyre, Malawi
| | - Bagrey Ngwira
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Els Wessels
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisette Van Lieshout
- Department of Medical Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Themba Mzilahowa
- Centre for Health, Agriculture and Development Research and Consulting (CHAD), Blantyre, Malawi
| | - Amaya L. Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Lamberti O, Bozzani F, Kiyoshi K, Bustinduy AL. Time to bring female genital schistosomiasis out of neglect. Br Med Bull 2024; 149:45-59. [PMID: 38220571 PMCID: PMC10938538 DOI: 10.1093/bmb/ldad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/08/2023] [Accepted: 12/09/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Female genital schistosomiasis (FGS) is a chronic gynaecological disease affecting girls and women in sub-Saharan Africa (SSA), caused by the parasite Schistosoma (S.) haematobium. FGS is associated with sexual dysfunction, reproductive tract morbidity and increased prevalence of HIV and cervical precancer lesions. SOURCE OF DATA Key peer-reviewed published literature. AREAS OF AGREEMENT FGS screening and diagnosis require costly equipment and specialized training, seldom available in resource-limited settings. FGS surveillance is not included in wider schistosomiasis control strategies. The interplay of FGS with other SRH infections is not fully understood. Integration of FGS within sexual and reproductive health (SRH) control programmes needs to be explored. AREAS OF CONTROVERSY There are no standardized methods for individual or population-based FGS screening and diagnosis, hindering accurate disease burden estimates and targeted resource allocation. Treatment recommendations rely on public health guidelines, without rigorous clinical evidence on efficacy. GROWING POINTS Integrating FGS screening with SRH programmes offers an opportunity to reach at-risk women with limited access to healthcare services. Home-based self-sampling coupled with handheld colposcopes operated by primary healthcare workers show promise for FGS diagnosis and surveillance at scale. AREAS TIMELY FOR DEVELOPING RESEARCH There is growing interest in decentralizing strategies for FGS screening and diagnosis. The accurate predictions on the 'cost-effectiveness' of these approaches will determine their affordability and feasibility within the overburdened health systems in SSA. Clinical trials are needed to optimize FGS treatment. Longitudinal studies can expand on the epidemiological knowledge on co-morbidities and integration within other SRH interventions.
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Affiliation(s)
- Olimpia Lamberti
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Fiammetta Bozzani
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Kita Kiyoshi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Shukla JD, Kleppa E, Holmen S, Ndhlovu PD, Mtshali A, Sebitloane M, Vennervald BJ, Gundersen SG, Taylor M, Kjetland EF. The Association Between Female Genital Schistosomiasis and Other Infections of the Lower Genital Tract in Adolescent Girls and Young Women: A Cross-Sectional Study in South Africa. J Low Genit Tract Dis 2023; 27:291-296. [PMID: 37379442 PMCID: PMC10309100 DOI: 10.1097/lgt.0000000000000756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
OBJECTIVES/PURPOSES OF THE STUDY This study aimed to explore the relationship between female genital schistosomiasis (FGS), sexually transmitted infections, bacterial vaginosis, and yeast among young women living in Schistosoma haematobium-endemic areas. METHODS In a cross-sectional study of young women, sexually active, aged 16 to 22 years in rural KwaZulu-Natal, South Africa, in 32 randomly selected rural schools in schistosomiasis-endemic areas, the authors performed gynecological and laboratory investigations, diagnosed FGS and other infections, and did face-to-face interviews. RESULTS Female genital schistosomiasis was the second most prevalent current genital infection (23%), significantly more common in those who had urinary schistosomiasis (35%), compared with those without (19%, p < .001). In the FGS-positive group, 35% had human papillomavirus compared with 24% in the FGS-negative group (p = .010). In the FGS-positive group, 37% were seropositive for herpes simplex virus infection, compared with 30% in the FGS-negative group (p = .079). There were significantly fewer chlamydia infections among women with FGS (20%, p = .018) compared with those who did not have FGS (28%). CONCLUSIONS Female genital schistosomiasis was the second most common genital infection after herpes simplex virus. Human papillomavirus infection was significantly associated with FGS, but Chlamydia was negatively associated with FGS. Women with FGS may have had more frequent contact with the health system for genital discharge. The results show the importance of the inclusion of FGS in the national management protocols for genital infections in areas endemic for S. haematobium and highlight a more comprehensive approach to diagnosis and genital disease management.
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Affiliation(s)
- Jilna Dilip Shukla
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway
| | - Elisabeth Kleppa
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sigve Holmen
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Andile Mtshali
- Department of Infection Prevention and Control, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Motshedisi Sebitloane
- Discipline of Gynaecology, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Birgitte Jyding Vennervald
- Section for Parasitology and Aquatic Pathobiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Svein Gunnar Gundersen
- Department for Global Development and Planning, University of Agder, Kristiansand, Norway
| | - Myra Taylor
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Eyrun Floerecke Kjetland
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Global Health, Oslo University Hospital, Norway
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Cervical lesion proportion measure using a digital gridded imaging technique to assess cervical pathology in women with genital schistosomiasis. PLoS Negl Trop Dis 2022; 16:e0009995. [PMID: 35788749 PMCID: PMC9286223 DOI: 10.1371/journal.pntd.0009995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 07/15/2022] [Accepted: 05/19/2022] [Indexed: 11/26/2022] Open
Abstract
Female genital schistosomiasis (FGS) is characterized by a pattern of lesions which manifest at the cervix and the vagina, such as homogeneous and grainy sandy patches, rubbery papules in addition to neovascularization. A tool for quantification of the lesions is needed to improve FGS research and control programs. Hitherto, no tools are available to quantify clinical pathology at the cervix in a standardized and reproducible manner. This study aimed to develop and validate a cervical lesion proportion (CLP) measure for quantification of cervical pathology in FGS. A digital imaging technique was applied in which a grid containing 424 identical squares was positioned on high resolution digital images from the cervix of 70 women with FGS. CLP was measured for each image by observers counting the total number of squares containing at least one type of FGS associated lesion. For assessment of inter- and intra-observer reliability, three different observers measured CLP independently. In addition, a rubbery papule count (RPC) was determined in a similar manner. The intraclass correlation coefficient was 0.94 (excellent) for the CLP inter-rater reliability and 0.90 (good) for intra-rater reliability and the coefficients for the RPC were 0.88 and 0.80 (good), respectively. The CLP facilitated a reliable and reproducible quantification of FGS associated lesions of the cervix. In the future, grading of cervical pathology by CLP may provide insight into the natural course of schistosome egg-induced pathology of the cervix and may have a role in assessing praziquantel treatment efficacy against FGS. Trial Registration: ClinicalTrials.gov, trial number NCT04115072; trial URL https://clinicaltrials.gov/ct2/show/NCT04115072?term=Female+genital+schistosomiasis+AND+Madagascar&draw=2&rank=1. Female genital schistosomiasis (FGS) is characterized by development of egg-induced chronic inflammatory lesions of the cervix and the vagina. FGS causes various symptoms such vaginal discharge, genital itch, pelvic pain and post-coital bleeding, and the disease is further associated with reproductive complications such as ectopic pregnancy and infertility. Moreover, FGS is today hypothesized as a risk factor for transmission of HIV in Sub-Saharan Africa. General prevention directed against Schistosoma infection and use of praziquantel as anthelmintic drug therapy are cornerstones in the FGS control strategy. The aim of the study was to test inter- and intra-rater reliability using a cervical lesion proportion (CLP) measure in a series of digital images from women living in a Schistosoma haematobium hyperendemic area in Madagascar”. In that overall context, we have developed a digital image-based tool for quantitative assessment of FGS associated cervical lesions, which enables evaluation of treatment outcome at individual as well as community level with particular focus on resolution of cervical pathology, but also on risk of recurrence. The tool will also provide new information in understanding the natural history of FGS including development of clinical pathology.
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Bustinduy AL, Randriansolo B, Sturt AS, Kayuni SA, Leustcher PDC, Webster BL, Van Lieshout L, Stothard JR, Feldmeier H, Gyapong M. An update on female and male genital schistosomiasis and a call to integrate efforts to escalate diagnosis, treatment and awareness in endemic and non-endemic settings: The time is now. ADVANCES IN PARASITOLOGY 2022; 115:1-44. [PMID: 35249661 DOI: 10.1016/bs.apar.2021.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The last decades have brought important insight and updates in the diagnosis, management and immunopathology of female genital schistosomiasis (FGS) and male genital schistosomiasis (MGS). Despite sharing a common parasitic aetiological agent, FGS and MGS have typically been studied separately. Infection with Schistosoma haematobium manifests with gender-specific clinical manifestations and consequences of infection, albeit having a similar pathogenesis within the human genital tract. Schistosoma haematobium is a known urinary bladder carcinogen, but its potential causative role in other types of neoplasia, such as cervical cancer, is not fully understood. Furthermore, the impact of praziquantel treatment on clinical outcomes remains largely underexplored, as is the interplay of FGS/MGS with relevant reproductive tract infections such as HIV and Human Papillomavirus. In non-endemic settings, travel and immigrant health clinics need better guidance to correctly identify and treat FGS and MGS. Our review outlines the latest advances and remaining knowledge gaps in FGS and MGS research. We aim to pave a way forward to formulate more effective control measures and discuss elimination targets. With a growing community awareness in health practitioners, scientists and epidemiologists, alongside the sufferers from these diseases, we aspire to witness a new generation of young women and men free from the downstream disabling manifestations of disease.
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Affiliation(s)
- Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | | | - Amy S Sturt
- Section of Infectious Diseases, Veterans Affairs Palo Alto Health Care System, Palo Alto, United States
| | - Seke A Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; MASM Medi Clinics Limited, Blantyre, Malawi
| | - Peter D C Leustcher
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Lisette Van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Hermann Feldmeier
- Charité University Medicine Berlin, Institute of Microbiology, Infectious Diseases and Immunology, Berlin, Germany
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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Archer J, Patwary FK, Sturt AS, Webb EL, Phiri CR, Mweene T, Hayes RJ, Ayles H, Brienen EAT, van Lieshout L, Webster BL, Bustinduy AL. Validation of the isothermal Schistosoma haematobium Recombinase Polymerase Amplification (RPA) assay, coupled with simplified sample preparation, for diagnosing female genital schistosomiasis using cervicovaginal lavage and vaginal self-swab samples. PLoS Negl Trop Dis 2022; 16:e0010276. [PMID: 35286336 PMCID: PMC8947142 DOI: 10.1371/journal.pntd.0010276] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 03/24/2022] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Female genital schistosomiasis (FGS) is a neglected and disabling gynecological disease that can result from infection with the parasitic trematode Schistosoma haematobium. Accurate diagnosis of FGS is crucial for effective case management, surveillance and control. However, current methods for diagnosis and morbidity assessment can be inaccessible to those at need, labour intensive, costly and unreliable. Molecular techniques such as PCR can be used to reliably diagnose FGS via the detection of Schistosoma DNA using cervicovaginal lavage (CVL) samples as well as lesser-invasive vaginal self-swab (VSS) and cervical self-swab samples. PCR is, however, currently unsuited for use in most endemic settings. As such, in this study, we assessed the use of a rapid and portable S. haematobium recombinase polymerase amplification (Sh-RPA) isothermal molecular diagnostic assay, coupled with simplified sample preparation methodologies, to detect S. haematobium DNA using CVL and VSS samples provided by patients in Zambia. METHODOLOGY/PRINCIPAL FINDINGS VSS and CVL samples were screened for FGS using a previously developed Sh-RPA assay. DNA was isolated from VSS and CVL samples using the QIAamp Mini kit (n = 603 and 527, respectively). DNA was also isolated from CVL samples using two rapid and portable DNA extraction methods: 1) the SpeedXtract Nucleic Acid Kit (n = 223) and 2) the Extracta DNA Tissue Prep Kit (n = 136). Diagnostic performance of the Sh-RPA using VSS DNA extacts (QIAamp Mini kit) as well as CVL DNA extracts (QIAamp Mini kit, SpeedXtract Nucleic Acid Kit and Extracta DNA Tissue Prep Kit) was then compared to a real-time PCR reference test. Results suggest that optimal performance may be achieved when the Sh-RPA is used with PuVSS samples (sensitivity 93.3%; specificity 96.6%), however no comparisons between different DNA extraction methods using VSS samples could be carried out within this study. When using CVL samples, sensitivity of the Sh-RPA ranged between 71.4 and 85.7 across all three DNA extraction methods when compared to real-time PCR using CVL samples prepared using the QIAamp Mini kit. Interestingly, of these three DNA extraction methods, the rapid and portable SpeedXtract method had the greatest sensitivity and specificity (85.7% and 98.1%, respectively). Specificity of the Sh-RPA was >91% across all comparisons. CONCLUSIONS/SIGNIFICANCE These results supplement previous findings, highlighting that the use of genital self-swab sampling for diagnosing FGS should be explored further whilst also demonstrating that rapid and portable DNA isolation methods can be used to detect S. haematobium DNA within clinical samples using RPA. Although further development and assessment is needed, it was concluded that the Sh-RPA, coupled with simplified sample preparation, shows excellent promise as a rapid and sensitive diagnostic tool capable of diagnosing FGS at the point-of-care in resource-poor schistosomiasis-endemic settings.
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Affiliation(s)
- John Archer
- Wolfson Wellcome Biomedical Laboratories, Department of Zoology, Natural History Museum, Cromwell Road, London, United Kingdom
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
| | - Farhan K. Patwary
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
| | - Amy S. Sturt
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
| | - Emily L. Webb
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
| | | | - Tobias Mweene
- School of Medicine, University of Zambia, Zambart, Lusaka, Zambia
| | - Richard J. Hayes
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
| | - Helen Ayles
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
- School of Medicine, University of Zambia, Zambart, Lusaka, Zambia
| | - Eric A. T. Brienen
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Bonnie L. Webster
- Wolfson Wellcome Biomedical Laboratories, Department of Zoology, Natural History Museum, Cromwell Road, London, United Kingdom
| | - Amaya L. Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
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Jacobson J, Pantelias A, Williamson M, Kjetland EF, Krentel A, Gyapong M, Mbabazi PS, Djirmay AG. Addressing a silent and neglected scourge in sexual and reproductive health in Sub-Saharan Africa by development of training competencies to improve prevention, diagnosis, and treatment of female genital schistosomiasis (FGS) for health workers. Reprod Health 2022; 19:20. [PMID: 35073965 PMCID: PMC8785555 DOI: 10.1186/s12978-021-01252-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/27/2021] [Indexed: 11/14/2022] Open
Abstract
Background Schistosomiasis is an acute and chronic disease caused by parasitic worms, that can take two main forms: intestinal or urogenital. If left untreated, the urogenital form can lead to female genital schistosomiasis (FGS) in women and girls; frequently resulting in severe reproductive health complications which are often misdiagnosed as sexually-transmitted infections (STIs) or can be confused with cervical cancer. Despite its impact on women’s reproductive health, FGS is typically overlooked in medical training and remains poorly recognized with low awareness both in affected communities and in health professionals. FGS has been described as the one of the most neglected sexual and reproductive health issues in sub-Saharan Africa (Swai in BMC Infect Dis 6:134, 2006; Kukula in PLoS Negl Trop Dis 13:e0007207; Joint United Nations Programme on HIV/AIDS (UNAIDS) 2019). Increased knowledge and awareness of FGS is required to end this neglect, improve women’s reproductive health, and decrease the burden of this preventable and treatable neglected tropical disease.
Methods We conducted interactive virtual workshops, in collaboration with the World Health Organization (WHO), engaging 64 participants with medical and public health backgrounds from around the world to establish standardized skills (or competencies) for prevention, diagnosis, and treatment of FGS at all levels of the health system. The competencies were drafted in small groups, peer-reviewed, and finalized by participants. Results This participatory process led to identification of 27 skills needed for FGS prevention, diagnosis, and management for two categories of health workers; those working in a clinical setting, and those working in a community setting. Among them, ten relate to the diagnosis of FGS including three that involve a pelvic exam and seven that do not. Six constitute the appropriate behaviors required to treat FGS in a clinical setting. Eleven address the community setting, with six relating to the identification of women at risk and five relating to prevention. Conclusion Defining the skills necessary for FGS management is a critical step to prepare for proper diagnosis and treatment of women and girls in sub-Saharan Africa by trained health professionals. The suggested competencies can now serve as the foundation to create educative tools and curricula to better train health care workers on the prevention, diagnosis, and management of FGS. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01252-2. Schistosomiasis belongs to the group of neglected tropical diseases (NTDs) found in tropical and subtropical countries, disproportionately affecting poor populations with limited access to safe water and adequate sanitation. Female genital schistosomiasis (FGS) is a chronic disease caused by parasitic worms, schistososomes, transmitted by contact with infested fresh water. When left untreated, FGS can lead to severe reproductive health complications, such as sub-or infertility and ectopic pregnancy. FGS is a leading neglected issue in sexual and reproductive health in sub-Saharan Africa; however, health professionals are not familiar with it, leading to misdiagnosis and improper treatment. A critical challenge in addressing the burden of FGS is the knowledge gap about the disease in communities and health professionals in endemic areas and the world at large. As part of an FGS Accelerated Scale Together (FAST) package, and in an attempt to address the knowledge gap in health professionals, we organized an interactive workshop bringing together a group of 64 participants working in sexual and reproductive health generally, and/or FGS specifically. Together, we developed a comprehensive set of required skills for health workers training on FGS. The workshop participants drafted 27 skills (or competencies) to diagnose, treat, and prevent FGS. Establishing what health workers must know is a crucial first step towards the integration of FGS into women’s health care. The competencies are now available and can be used as a framework in the development of training for health professionals, opening the doors to better reproductive health for women.
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Affiliation(s)
| | | | - Megan Williamson
- Bridges to Development, Washington, USA.,University of Geneva, Geneva, Switzerland
| | - Eyrun Floerecke Kjetland
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, 4041, South Africa.,Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, 0450, Oslo, Norway
| | - Alison Krentel
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa and Bruyère Research Institute, Ottawa, Canada
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Pamela Sabina Mbabazi
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Amadou Garba Djirmay
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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9
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Orish VN, Morhe EKS, Azanu W, Alhassan RK, Gyapong M. The parasitology of female genital schistosomiasis. CURRENT RESEARCH IN PARASITOLOGY & VECTOR-BORNE DISEASES 2022; 2:100093. [PMID: 35719849 PMCID: PMC9198370 DOI: 10.1016/j.crpvbd.2022.100093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/14/2022] [Accepted: 05/19/2022] [Indexed: 11/17/2022]
Abstract
Female genital schistosomiasis (FGS) is the gynaecological presentation of Schistosoma haematobium infection, resulting from egg deposition in the female genital tract. Despite the fact that this condition has been reported in the early days of the discovery of S. haematobium in Egypt, its existence has been grossly neglected, causing many women in schistosomiasis-endemic areas to go through a preventable, debilitating, and stigmatizing presentation of FGS. To prevent this, increasing awareness of FGS is necessary for all, especially healthcare providers, to improve the diagnosis, management, and treatment. As proposed by the FAST package project, several healthcare professionals with different specializations are expected to be involved in the management of FGS. It is therefore important that basic updated knowledge on the parasitology of the disease be acquired by healthcare professionals. This review provides basic information necessary to improve the knowledge of FGS among healthcare professionals in areas endemic to schistosomiasis. Armed with these basic details, healthcare professionals can improve their confidence in the management and treatment of FGS, contributing significantly to the control and prevention of FGS in endemic areas. A review of female genital schistosomiasis. Data on the life-cycle of Schistosoma haematobium, and pathogenesis and clinical features of female genital schistosomiasis. Summary of diagnostic methods and treatment, control and prevention of female genital schistosomiasis. Increasing awareness among healthcare workers is key to the management, control, and prevention of the disease.
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Affiliation(s)
- Verner N. Orish
- Department of Microbiology and Immunology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
- Corresponding author.
| | - Emmanuel Komla Senanu Morhe
- Department of Obstetrics and Gynecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Wisdom Azanu
- Department of Obstetrics and Gynecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Robert K. Alhassan
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
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10
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Sturt AS, Webb EL, Himschoot L, Phiri CR, Mapani J, Mudenda M, Kjetland EF, Mweene T, Levecke B, van Dam GJ, Corstjens PLAM, Ayles H, Hayes RJ, van Lieshout L, Hansingo I, Francis SC, Cools P, Bustinduy AL. Association of Female Genital Schistosomiasis With the Cervicovaginal Microbiota and Sexually Transmitted Infections in Zambian Women. Open Forum Infect Dis 2021; 8:ofab438. [PMID: 34557562 PMCID: PMC8454507 DOI: 10.1093/ofid/ofab438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/20/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The cervicovaginal microbiota, including sexually transmitted infections (STIs), have not been well described in female genital schistosomiasis (FGS). METHODS Women (aged 18-31, sexually active, nonpregnant) were invited to participate at the final follow-up of the HPTN 071 (PopART) Population Cohort in January-August 2018. We measured key species of the cervicovaginal microbiota (Lactobacillus crispatus, L. iners, Gardnerella vaginalis, Atopobium vaginae, and Candida) and STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium) using quantitative PCR (qPCR). We evaluated associations of the microbiota and STI presence and concentration with FGS (qPCR-detected Schistosoma DNA in any of 3 genital specimens). RESULTS The presence and concentration of key cervicovaginal species did not differ between participants with (n = 30) or without FGS (n = 158). A higher proportion of participants with FGS had T. vaginalis compared with FGS-negative women (P = .08), with further analysis showing that T. vaginalis was more prevalent among women with ≥2 Schistosoma qPCR-positive genital specimens (50.0%, 8/16) than among FGS-negative women (21.5%, 34/158; P = .01). CONCLUSIONS We found weak evidence of an association between the presence of T. vaginalis and FGS, with a stronger association in women with a higher-burden FGS infection. Additional research is needed on potential between-parasite interactions, especially regarding HIV-1 vulnerability.
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Affiliation(s)
- Amy S Sturt
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily L Webb
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Lisa Himschoot
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Joyce Mapani
- Department of Obstetrics and Gynecology, Livingstone Central Hospital, Livingstone, Zambia
| | - Maina Mudenda
- Department of Obstetrics and Gynecology, Livingstone Central Hospital, Livingstone, Zambia
| | - Eyrun F Kjetland
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
- University of KwaZulu-Natal, Durban, South Africa
| | | | - Bruno Levecke
- Department of Virology, Parasitology, and Immunology, Ghent University, Merelbeke, Belgium
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Helen Ayles
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Zambart, Lusaka, Zambia
| | - Richard J Hayes
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Isaiah Hansingo
- Department of Obstetrics and Gynecology, Livingstone Central Hospital, Livingstone, Zambia
| | - Suzanna C Francis
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Piet Cools
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Virology, Parasitology, and Immunology, Ghent University, Merelbeke, Belgium
| | - Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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11
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Aula OP, McManus DP, Jones MK, Gordon CA. Schistosomiasis with a Focus on Africa. Trop Med Infect Dis 2021; 6:109. [PMID: 34206495 PMCID: PMC8293433 DOI: 10.3390/tropicalmed6030109] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 12/19/2022] Open
Abstract
Schistosomiasis is a common neglected tropical disease of impoverished people and livestock in many developing countries in tropical Africa, the Middle East, Asia, and Latin America. Substantial progress has been made in controlling schistosomiasis in some African countries, but the disease still prevails in most parts of sub-Saharan Africa with an estimated 800 million people at risk of infection. Current control strategies rely primarily on treatment with praziquantel, as no vaccine is available; however, treatment alone does not prevent reinfection. There has been emphasis on the use of integrated approaches in the control and elimination of the disease in recent years with the development of health infrastructure and health education. However, there is a need to evaluate the present status of African schistosomiasis, primarily caused by Schistosoma mansoni and S. haematobium, and the factors affecting the disease as the basis for developing more effective control and elimination strategies in the future. This review provides an historical perspective of schistosomiasis in Africa and discusses the current status of control efforts in those countries where the disease is endemic.
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Affiliation(s)
- Oyime Poise Aula
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane 4006, Australia;
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
| | - Donald P. McManus
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane 4006, Australia;
| | - Malcolm K. Jones
- School of Veterinary Sciences, University of Queensland, Gatton 4343, Australia;
| | - Catherine A. Gordon
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane 4006, Australia;
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12
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Rite EE, Kapalata SN, Munisi DZ. Prevalence, Intensity, and Factors Associated with Urogenital Schistosomiasis among Women of Reproductive Age in Mbogwe District Council, Geita Region, Tanzania. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5923025. [PMID: 33178830 PMCID: PMC7609139 DOI: 10.1155/2020/5923025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/02/2020] [Accepted: 08/24/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Urogenital schistosomiasis remains a public health problem in Tanzania. Control programs mostly target school-going children ignoring other vulnerable groups like women of child bearing age. Previous evidence has shown that women of reproductive age suffer greatest morbidities in endemic areas. This study sought to determine the prevalence, intensity, and factors associated with urogenital schistosomiasis among women of reproductive age in the Mbogwe District. METHODS A population-based analytical cross-section study was conducted in the Mbogwe District. A semistructured questionnaire was administered. Urine samples of 20-30 mils collected between 10.00 am to 02.00 pm and examined for Schistosoma eggs and infection intensity microscopically. Data analysis was done using SPSS version 20. RESULTS A total of 426 women of reproductive age, with median age of 26, and interquartile range of 11years were recruited and assessed. The prevalence of urogenital schistosomiasis was 4.5% and mean egg intensity of 19.5eggs/10mil of urine. After adjusting for confounders, lower level of education was associated with an increased risk of urogenital schistosomiasis infections (AOR 8.355, 95% CI 3.055-23.001). CONCLUSION Urogenital schistosomiasis among women of reproductive age in the Mbogwe District is a problem. Education is the factor associated with the disease; the neglected tropical disease control program should develop strategies that should include provision of health education and should involve women of reproductive age as they act as infection reservoir. More studies are recommended to explore the possibility of reproductive complications among infected women in endemic areas.
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Affiliation(s)
- Erasto Eleck Rite
- Department of Public Health, College of Health Sciences, University of Dodoma, P.O. Box 259, Dodoma, Tanzania
| | - Secilia Ng'weshemi Kapalata
- Department of Public Health, College of Health Sciences, University of Dodoma, P.O. Box 259, Dodoma, Tanzania
| | - David Zadock Munisi
- Department of Biomedical Sciences, College of Health Sciences, University of Dodoma, P.O. Box 259, Dodoma, Tanzania
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13
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Analytical and Clinical Assessment of a Portable, Isothermal Recombinase Polymerase Amplification (RPA) Assay for the Molecular Diagnosis of Urogenital Schistosomiasis. Molecules 2020; 25:molecules25184175. [PMID: 32933094 PMCID: PMC7570534 DOI: 10.3390/molecules25184175] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 12/21/2022] Open
Abstract
Accurate diagnosis of urogenital schistosomiasis is crucial for disease surveillance and control. Routine diagnostic methods, however, lack sensitivity when assessing patients with low levels of infection still able to maintain pathogen transmission. Therefore, there is a need for highly sensitive diagnostic tools that can be used at the point-of-care in endemic areas. Recombinase polymerase amplification (RPA) is a rapid and sensitive diagnostic tool that has been used to diagnose several pathogens at the point-of-care. Here, the analytical performance of a previously developed RPA assay (RT-ShDra1-RPA) targeting the Schistosoma haematobium Dra1 genomic region was assessed using commercially synthesised S. haematobium Dra1 copies and laboratory-prepared samples spiked with S. haematobium eggs. Clinical performance was also assessed by comparing diagnostic outcomes with that of a reference diagnostic standard, urine-egg microscopy. The RT-ShDra1-RPA was able to detect 1 × 101 copies of commercially synthesised Dra1 DNA as well as one S. haematobium egg within laboratory-spiked ddH2O samples. When compared with urine-egg microscopy, the overall sensitivity and specificity of the RT-ShDra1-RPA assay was 93.7% (±88.7–96.9) and 100% (±69.1–100), respectively. Positive and negative predictive values were 100% (±97.5–100) and 50% (±27.2–72.8), respectively. The RT-ShDra1-RPA therefore shows promise as a rapid and highly sensitive diagnostic tool able to diagnose urogenital schistosomiasis at the point-of-care.
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14
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King CH, Binder S, Shen Y, Whalen CC, Campbell CH, Wiegand RE, Olsen A, Secor WE, Montgomery SP, Musuva R, Mwinzi PNM, Magnussen P, Kinung’hi S, Andrade GN, Ezeamama AE, Colley DG. SCORE Studies on the Impact of Drug Treatment on Morbidity due to Schistosoma mansoni and Schistosoma haematobium Infection. Am J Trop Med Hyg 2020; 103:30-35. [PMID: 32400348 PMCID: PMC7351303 DOI: 10.4269/ajtmh.19-0830] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/26/2020] [Indexed: 01/14/2023] Open
Abstract
The Schistosomiasis Consortium for Operational Research (SCORE) was funded in 2008 to improve the evidence base for control and elimination of schistosomiasis-better understanding of the systemic morbidities experienced by children in schistosomiasis-endemic areas and the response of these morbidities to treatment, being essential for updating WHO guidelines for mass drug administration (MDA) in endemic areas. This article summarizes the SCORE studies that aimed to gauge the impact of MDA-based treatment on schistosomiasis-related morbidities. Morbidity cohort studies were embedded in the SCORE's larger field studies of gaining control of schistosomiasis in Kenya and Tanzania. Following MDA, cohort children had less undernutrition, less portal vein dilation, and increased quality of life in Year 5 compared with baseline. We also conducted a pilot study of the Behavioral Assessment System for Children (BASC-2) in conjunction with the Kenya gaining control study, which demonstrated beneficial effects of treatment on classroom behavior. In addition, the SCORE's Rapid Answers Project performed systematic reviews of previously available data, providing two meta-analyses related to morbidity. The first documented children's infection-related deficits in school attendance and achievement and in formal tests of learning and memory. The second showed that greater reductions in egg output following drug treatment correlates significantly with reduced odds of most morbidities. Overall, these SCORE morbidity studies provided convincing evidence to support the use of MDA to improve the health of school-aged children in endemic areas. However, study findings also support the need to use enhanced metrics to fully assess and better control schistosomiasis-associated morbidity.
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Affiliation(s)
- Charles H. King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Sue Binder
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Ye Shen
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia
| | - Christopher C. Whalen
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia
| | - Carl H. Campbell
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Ryan E. Wiegand
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Annette Olsen
- Section for Parasitology and Aquatic Pathobiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - William Evan Secor
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P. Montgomery
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rosemary Musuva
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Pauline N. M. Mwinzi
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Pascal Magnussen
- Centre for Medical Parasitology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Safari Kinung’hi
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Gisele N. Andrade
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Amara E. Ezeamama
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Daniel G. Colley
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
- Department of Microbiology, University of Georgia, Athens, Georgia
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15
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Cunningham LJ, Campbell SJ, Armoo S, Koukounari A, Watson V, Selormey P, Stothard JR, Idun B, Asiedu M, Ashong Y, Adams ER, Osei-Atweneboana MY. Assessing expanded community wide treatment for schistosomiasis: Baseline infection status and self-reported risk factors in three communities from the Greater Accra region, Ghana. PLoS Negl Trop Dis 2020; 14:e0007973. [PMID: 32339185 PMCID: PMC7205311 DOI: 10.1371/journal.pntd.0007973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 05/07/2020] [Accepted: 12/05/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This paper reports on the baseline prevalence and associated risk factor findings of a pilot, longitudinal study exploring community-wide treatment of schistosomiasis and soil-transmitted helminthiasis, using albendazole plus praziquantel in the Greater Accra region of Ghana. METHOD From three communities, at least, 658 individuals were enrolled into the study via random household selection. Prevalence and intensity of schistosomiasis and STH infection were determined from stool and urine samples with a questionnaire being administered in order to explore other morbidities and risk factors. Factor analysis of household demographic variables was undertaken to generate a socioeconomic score; this was then further categorised into tertiles. Proportional-odds cumulative logit generalised estimating equation (GEE) models were used to investigate categorical ordinal intensity of infection associations with morbidity. Separately, logistic GEE models were used to investigate risk factor associations with infection prevalence. RESULTS Both Schistosoma haematobium and S. mansoni were prevalent in the three communities, with the prevalence of S. haematobium ranging from 3.3% (24/679; 95% CI = 1.9-4.7) to 19% (114/632; 95% CI = 15.8-22.2) and S. mansoni ranging from 30% (202/679; 95% CI = 26.5-33.5) to 78.3% (409/536; 95% CI = 74.7-81.9). The total prevalence of STH across all three sites was negligible at 1.3% (24/1847; 95% CI = 0.8-1.9) comprising mainly hookworm (10/1847). Multivariable statistical models indicated males to be 2.3 (95% CI = 1.7-3.3) times more likely to have a high intensity S. mansoni infection and 1.5 (95% CI = 1.1-2) times more likely to have a high intensity of S. haematobium infection compared to females. There was no significant difference in the likelihood of infection with S. mansoni between adults and school age children (SAC), however S. haematobium infections were found to be 2.5 (95% CI = 1.8-3.5) times more likely to occur in school age children than in adults. Multivariable statistical models (adjusted for age and sex) indicated an association between schistosomiasis and a number of self-reported morbidity indicators (notably diarrhoea and blood in stool and urine). Low socio-economic status was also associated with SCH infection (OR: 2; 95% CI = 1.3-3.2). CONCLUSION The communities targeted by this study showed a range of Schistosoma prevalence's of infection, from hypo-endemic through to meso-endemic and hyper-endemic. The prevalence of SCH across the different age groups in the study locations highlights the large number of individuals currently being left out of the standard morbidity control method of annual treatment of the SAC.
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Affiliation(s)
- Lucas J. Cunningham
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Samuel Armoo
- Department of Biomedical and Public Health Research, Council for Scientific and Industrial Research—Water Research Institute, Council Close, Accra, Ghana
| | - Artemis Koukounari
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
| | - Victoria Watson
- Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | - Pamela Selormey
- Department of Biomedical and Public Health Research, Council for Scientific and Industrial Research—Water Research Institute, Council Close, Accra, Ghana
| | - J. Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Bright Idun
- Department of Biomedical and Public Health Research, Council for Scientific and Industrial Research—Water Research Institute, Council Close, Accra, Ghana
| | - Manfred Asiedu
- Department of Biomedical and Public Health Research, Council for Scientific and Industrial Research—Water Research Institute, Council Close, Accra, Ghana
| | - Yvonne Ashong
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Emily R. Adams
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mike Yaw Osei-Atweneboana
- Department of Biomedical and Public Health Research, Council for Scientific and Industrial Research—Water Research Institute, Council Close, Accra, Ghana
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16
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Kayuni SA, LaCourse EJ, Makaula P, Lampiao F, Juziwelo L, Fawcett J, Shaw A, Alharbi MH, Verweij JJ, Stothard JR. Case Report: Highlighting Male Genital Schistosomiasis (MGS) in Fishermen from the Southwestern Shoreline of Lake Malawi, Mangochi District. Am J Trop Med Hyg 2020; 101:1331-1335. [PMID: 31701858 DOI: 10.4269/ajtmh.19-0562] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Urogenital schistosomiasis causes morbidity within the genitalia but is underreported and infrequently examined in men. To draw attention to male genital schistosomiasis (MGS), a longitudinal cohort study was conducted among fishermen along the southwestern shoreline of Lake Malawi. A case series of five participants is presented inclusive of questionnaire interviews, parasitological examinations, ultrasonography, and provision of a standard dose (40 mg/kg) of praziquantel (PZQ) treatment at baseline, 1-, 3-, 6-, and 12-month follow-up time points. Eggs of Schistosoma haematobium were observed in urine or semen across all time points; parasitological diagnostics were bolstered by real-time PCR for Schistosoma DNA in semen and by portable ultrasonography to document putative MGS-associated morbidity. We highlight the importance of developing standard diagnostic tests for MGS and increasing the accessibility of PZQ treatment to men, especially those in at-risk endemic areas.
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Affiliation(s)
- Sekeleghe A Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,MASM Medi Clinics Limited, Medical Society of Malawi (MASM), Blantyre, Malawi
| | - E James LaCourse
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Peter Makaula
- Research for Health Environment and Development (RHED), Mangochi, Malawi
| | - Fanuel Lampiao
- Physiology Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Lazarus Juziwelo
- National Schistosomiasis and STH Control Program, Community Health Sciences Unit (CHSU), Ministry of Health, Lilongwe, Malawi
| | - Joanna Fawcett
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Alexandra Shaw
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mohammad H Alharbi
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jaco J Verweij
- Elisabeth-TweeSteden Hospital Tilburg, Laboratory for Medical Microbiology and Immunology, Tilburg, The Netherlands
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Gadoth A, Mvumbi G, Hoff NA, Musene K, Mukadi P, Ashbaugh HR, Doshi RH, Javanbakht M, Gorbach P, Okitolonda-Wemakoy E, Klausner JD, Rimoin AW. Urogenital Schistosomiasis and Sexually Transmitted Coinfections among Pregnant Women in a Schistosome-Endemic Region of the Democratic Republic of Congo. Am J Trop Med Hyg 2020; 101:828-836. [PMID: 31392943 DOI: 10.4269/ajtmh.19-0024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Schistosomiasis afflicts an estimated 10 million pregnant women in Africa annually. With mounting evidence of adverse impacts to reproductive health resulting from urogenital schistosomiasis, including increased transmission of HIV, further research on prenatal disease epidemiology is warranted, with implications for maternal and fetal health. Between October 2016 and March 2017, we conducted a cross-sectional study examining the prevalence of urogenital schistosomiasis and its association with sexually transmitted infections (STIs) other than HIV among pregnant women visiting antenatal clinics in Kisantu health zone, Democratic Republic of Congo. An extensive sociodemographic and clinical survey was administered to consenting participants, with urine samples and vaginal swabs collected to deduce active schistosomiasis and STIs, respectively. In total, 17.4% of expectant mothers were infected with Schistosoma haematobium, 3.1% with Chlamydia trachomatis (CT), 1.4% with Neisseria gonorrhoeae (NG), and 14.6% with Trichomonas vaginalis (TV). Women infected with urogenital schistosomiasis were at significantly increased odds of harboring a CT, NG, or TV infection (adjusted odds ratio = 3.0, 95% CI: 1.5, 6.0), but reports of clinical symptoms were low, ranging from 17.2% of schistosomiasis to 30.8% of TV cases. Laboratory confirmation of schistosomiasis and STIs provided objective evidence of disease in a cohort with low symptomology where syndromic management may not suffice. Shedding light on local risk factors and associated coinfections of urogenital schistosomiasis can identify unique intervention opportunities for prenatal care in trematode-endemic regions and aid in reducing adverse pregnancy outcomes.
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Affiliation(s)
- Adva Gadoth
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Gisèle Mvumbi
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Nicole A Hoff
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Kamy Musene
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Patrick Mukadi
- National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Hayley R Ashbaugh
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Reena H Doshi
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Marjan Javanbakht
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Pamina Gorbach
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | | | - Jeffrey D Klausner
- Department of Medicine, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California.,Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Anne W Rimoin
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
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18
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How can schistosome circulating antigen assays be best applied for diagnosing male genital schistosomiasis (MGS): an appraisal using exemplar MGS cases from a longitudinal cohort study among fishermen on the south shoreline of Lake Malawi. Parasitology 2019; 146:1785-1795. [PMID: 31452477 PMCID: PMC6939168 DOI: 10.1017/s0031182019000969] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We provide an update on diagnostic methods for the detection of urogenital schistosomiasis (UGS) in men and highlight that satisfactory urine-antigen diagnostics for UGS lag much behind that for intestinal schistosomiasis, where application of a urine-based point-of-care strip assay, the circulating cathodic antigen (CCA) test, is now advocated. Making specific reference to male genital schistosomiasis (MGS), we place greater emphasis on parasitological detection methods and clinical assessment of internal genitalia with ultrasonography. Unlike the advances made in defining a clinical standard protocol for female genital schistosomiasis, MGS remains inadequately defined. Whilst urine filtration with microscopic examination for ova of Schistosoma haematobium is a convenient but error-prone proxy of MGS, we describe a novel low-cost sampling and direct visualization method for the enumeration of ova in semen. Using exemplar clinical cases of MGS from our longitudinal cohort study among fishermen along the shoreline of Lake Malawi, the portfolio of diagnostic needs is appraised including: the use of symptomatology questionnaires, urine analysis (egg count and CCA measurement), semen analysis (egg count, circulating anodic antigen measurement and real-time polymerase chain reaction analysis) alongside clinical assessment with portable ultrasonography.
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19
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von Braun A, Trawinski H, Wendt S, Lübbert C. Schistosoma and Other Relevant Helminth Infections in HIV-Positive Individuals-an Overview. Trop Med Infect Dis 2019; 4:tropicalmed4020065. [PMID: 31013827 PMCID: PMC6631468 DOI: 10.3390/tropicalmed4020065] [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: 03/05/2019] [Revised: 04/03/2019] [Accepted: 04/10/2019] [Indexed: 11/16/2022] Open
Abstract
For many years, researchers have postulated that helminthic infections may increase susceptibility to HIV, and that immune activation may have contributed to the extensive spread of HIV in sub-Saharan Africa. In the meantime, immunological studies have provided some evidence in support of this hypothesis, while cross-sectional clinical studies were able to further support the assumed association between HIV infection and selected helminthic co-infections. However, as many of the helminthic infections relevant to HIV-infected patients belong to the group of “neglected tropical diseases”, as defined by the World Health Organization, a certain lack of attention has inhibited progress in fully scaling up treatment and prevention efforts. In addition, despite the fact that the challenges of co-infections have preoccupied clinicians for over two decades, relevant research questions remain unanswered. The following review aims to provide a concise overview of associations between HIV and selected helminthic co-infections concerning aspects of HIV acquisition and transmission, clinical and immunological findings in co-infected individuals, as well as treatment and prevention efforts.
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Affiliation(s)
- Amrei von Braun
- Division of Infectious Diseases and Tropical Medicine, Leipzig University Hospital, University of Leipzig, 04103 Leipzig, Germany.
- Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, 04103 Leipzig, Germany.
| | - Henning Trawinski
- Division of Infectious Diseases and Tropical Medicine, Leipzig University Hospital, University of Leipzig, 04103 Leipzig, Germany.
- Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, 04103 Leipzig, Germany.
| | - Sebastian Wendt
- Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, 04103 Leipzig, Germany.
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, 04103 Leipzig, Germany.
| | - Christoph Lübbert
- Division of Infectious Diseases and Tropical Medicine, Leipzig University Hospital, University of Leipzig, 04103 Leipzig, Germany.
- Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, 04103 Leipzig, Germany.
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20
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Maju M, Sharma A, Beeram A, Ostrach B. A colonial legacy of HIV/AIDS, NTD, and STI super-syndemics: Eugenicist foreign aid and intertwined health burdens in Nigeria. Glob Public Health 2019; 14:1221-1240. [PMID: 30829113 DOI: 10.1080/17441692.2019.1582683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Syndemics theory has been applied to the structurally shaped, biologically facilitated co-occurrence of HIV/AIDS with Neglected Tropical Diseases (NTDs) and with sexually transmitted infections (STIs). The biological and social pathways of interaction between all three ailments have not yet been analysed together. The effects of these diseases are often exacerbated by structural factors including access to care and socioeconomic status. We explore the interrelated biological pathways and structural factors that have further heightened the risk for HIV/AIDS, NTDs, and STIs. Furthermore, we argue women in rural areas are at an increased risk for all three diseases due to biological and social factors including increased distance to quality care and lower reproductive autonomy. This paper integrates the established syndemics of HIV/NTDs and HIV/STIs within the historical and modern contexts of colonisation and neo-colonisation in Nigeria. We explore the effects of colonisation on women's health by evaluating the influence of foreign aid policies, structural programmes, and shifting gender norms. Applying a syndemic approach, juxtaposed by historical contextualisation, offers important implications for the prevention and treatment of HIV/AIDS, STIs, and NTDs. Our analysis suggests a perspective through which to view health of regions with a history of colonisation.
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Affiliation(s)
- Mehar Maju
- a Department of Community Health Sciences, UCLA Fielding School of Public Health , Los Angeles, CA , USA.,b Department of Anthropology , Boston University , Boston, MA , USA
| | - Andria Sharma
- c Department of Biology , Boston University , Boston, MA , USA.,d Rutgers New Jersey Medical School, School of Medicine, Newark , New Jersey , USA
| | - Archana Beeram
- c Department of Biology , Boston University , Boston, MA , USA.,e Imperial College London, School of Public Health , London , UK
| | - Bayla Ostrach
- f Family Medicine, and Affiliated Faculty, Medical Anthropology , Boston University School of Medicine , Boston, MA.,g Sociology and Anthropology , University of North Carolina Asheville , NC , USA
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21
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Loc L, Mbanefo EC, Khludenev G, Lamanna O, Banskota N, Hsieh MH. Schistosoma haematobium cercarial infection alters subsequent systemic immune responses to eggs but has minimal impact on immune responses to egg injection of the bladder. Parasite Immunol 2018; 41:e12602. [PMID: 30417508 DOI: 10.1111/pim.12602] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 10/27/2018] [Accepted: 11/06/2018] [Indexed: 11/29/2022]
Abstract
AIMS Mouse bladder wall injection with Schistosoma haematobium eggs has been used to overcome limitations in animal models of urogenital schistosomiasis. However, the effect of the absence of cercarial infection on immune responses to eggs in this model is unknown. We hypothesized that cercarial infection would alter local bladder and systemic immune responses to eggs in this model. METHODS AND RESULTS Mice were infected or not infected with S haematobium cercariae, and then, their bladder walls injected with S haematobium eggs or vehicle 5 weeks following cercarial infection. Three weeks later, mice were bled, sacrificed, perfused and their bladders harvested. Parasitological parameters and gross bladder pathology were not changed in egg-injected bladders by cercarial exposure. Figure S1 shows no changes in either granulomas or fibrosis. The only bladder cytokine upregulated in egg-injected bladders by cercarial exposure (vs no exposure) was leptin. Cercarial exposure, compared to no exposure, resulted in increased serum, IL-1α, IL-13 and TGF-β in bladder egg-injected mice. CONCLUSION Cercarial exposure altered systemic responses of several cytokines in bladder egg-injected mice, but surprisingly, only modified leptin expression in bladder tissue. This suggests that depending on the specific application, cercarial exposure may not be strictly necessary to model local immune responses in the bladder wall egg injection mouse model of urogenital schistosomiasis.
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Affiliation(s)
- Le Loc
- Biomedical Research Institute, Rockville, Maryland
| | | | | | | | | | - Michael H Hsieh
- Biomedical Research Institute, Rockville, Maryland.,Division of Urology, Children's National Health System, Washington, District of Columbia.,The George Washington University, Washington, District of Columbia
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22
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A systematic review with epidemiological update of male genital schistosomiasis (MGS): A call for integrated case management across the health system in sub-Saharan Africa. Parasite Epidemiol Control 2018; 4:e00077. [PMID: 30662962 PMCID: PMC6324017 DOI: 10.1016/j.parepi.2018.e00077] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 10/16/2018] [Accepted: 10/16/2018] [Indexed: 02/03/2023] Open
Abstract
Male genital schistosomiasis (MGS) is a gender specific manifestation of urogenital schistosomiasis (UGS) first described in 1911 by Madden in Egypt. Today, while affecting millions of men and boys worldwide, MGS receives insufficient attention, especially in sub-Saharan Africa (SSA). To provide a systematic review with an epidemiological update of MGS, we inspected both online and hardcopy resources in our appraisal. A total of 147 articles were eventually identified, only 31 articles were exclusively focused on MGS with original or targeted research. From these, we discuss pertinent clinico-pathological features of MGS, highlight the possible connection and interplay with HIV, and assess current diagnostic techniques alongside consideration of their use and application in SSA. To appreciate the burden of MGS more fully, especially in endemic areas, there is a clear need for better surveillance and longitudinal population research to investigate the best point-of-care (POC) diagnostic and its performance through time. Furthermore, to optimise individual case management, exploration of alternative praziquantel dosing regimens is needed for MGS in men with or without HIV co-infection.
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23
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Abdel-Naser MB, Altenburg A, Zouboulis CC, Wollina U. Schistosomiasis (bilharziasis) and male infertility. Andrologia 2018; 51:e13165. [DOI: 10.1111/and.13165] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/13/2018] [Accepted: 08/29/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Andreas Altenburg
- Departments of Dermatology, Venereology, Allergology and Immunology; Dessau Medical Center; Brandenburg Medical School Theodor Fontane; Dessau Germany
| | - Christos C. Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology; Dessau Medical Center; Brandenburg Medical School Theodor Fontane; Dessau Germany
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum; Academic Teaching Hospital of the Technical University of Dresden; Dresden Germany
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24
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Lothe A, Zulu N, Øyhus AO, Kjetland EF, Taylor M. Treating schistosomiasis among South African high school pupils in an endemic area, a qualitative study. BMC Infect Dis 2018; 18:239. [PMID: 29801483 PMCID: PMC5970489 DOI: 10.1186/s12879-018-3102-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 04/17/2018] [Indexed: 12/02/2022] Open
Abstract
Background Schistosomiasis, a neglected tropical disease caused by parasites that infest open water sources such as rivers and dams may increase susceptibility to HIV. Mass-treatment with praziquantel tablets, recommended by the World Health Organization reduces the prevalence of schistosomiasis. The goal in endemic areas is 75% treatment participation in every treatment round (e.g. yearly). However, in rural Ugu district, KwaZulu-Natal, South-Africa there was low participation among pupils in a Department of Health Mass-Treatment Campaign for schistosomiasis. Methods Nested in a large study on schistosomiasis the study was conducted in 2012 over 4 months using qualitative methods with the Health Belief Model as the conceptual framework. Purposive sampling was done. Focus Group Discussions were undertaken at six schools in grades 10–12. Individual in-depth interviews were held with one teacher and two pupils at each school. In addition three traditional healers and a community health worker were interviewed. Results The severity of schistosomiasis was not recognised and neither was the pupils’ susceptibility. Barriers to treatment included confusing S, haematobium symptoms with sexually transmitted infections, teasing and stigma. Conclusions Increased knowledge, health literacy for treatment, and correct understanding about the severity of schistosomiasis may provide cues to action. The study indicates that comprehensive information may increase pupil participation in mass-treatment and decrease schistosomiasis prevalence. Trial registration This study was registered with clinicaltrials.gov registry database and the registration number is NCT01154907 30 June 2011.
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Affiliation(s)
- Andrea Lothe
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, 0424, Oslo, Norway.,Institute for Global Development and Planning, University of Agder, 4630, Kristiansand, Norway
| | - Nqobile Zulu
- Centre for Communication, Media and Society, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Arne Olav Øyhus
- Institute for Global Development and Planning, University of Agder, 4630, Kristiansand, Norway
| | - Eyrun Floerecke Kjetland
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, 0424, Oslo, Norway.,Discipline of Public Health Medicine, Howard College Campus, University of KwaZulu-Natal, Room 219, George Campbell Building, Science Drive, Durban, 4001, South Africa
| | - Myra Taylor
- Discipline of Public Health Medicine, Howard College Campus, University of KwaZulu-Natal, Room 219, George Campbell Building, Science Drive, Durban, 4001, South Africa.
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25
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King CH. Mapping Out the under-Recognized Burden of Human Infertility Linked to Schistosoma haematobium Infection. Am J Trop Med Hyg 2018; 98:937-938. [PMID: 29405110 PMCID: PMC5928843 DOI: 10.4269/ajtmh.17-1016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Charles H King
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio
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26
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Downs JA, de Dood CJ, Dee HE, McGeehan M, Khan H, Marenga A, Adel PE, Faustine E, Issarow B, Kisanga EF, Kisigo GA, Ngahyolerwa S, Zahoro F, Miyaye D, Magawa RG, Mngara J, Lee MH, Corstjens PLAM, van Dam GJ, Fitzgerald DW. Schistosomiasis and Human Immunodeficiency Virus in Men in Tanzania. Am J Trop Med Hyg 2017; 96:856-862. [PMID: 28167600 DOI: 10.4269/ajtmh.16-0897] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
AbstractSchistosomiasis is a parasitic worm infection that affects over 260 million individuals worldwide. Women with schistosome infections have been demonstrated to have a 4-fold increase in the odds of human immunodeficiency virus (HIV) infection compared with women without schistosome infections. A relationship between schistosome and HIV infections has not been clearly defined in men. Among 674 men aged 18-50 years living in rural Tanzania, we identified 429 (63.6%) who had a schistosome infection as defined by serum positivity for schistosome circulating anodic antigen, visualization of parasite eggs in urine or stool, or both. HIV infection was identified in 38 (5.6%). The odds of HIV infection was 1.3 [95% confidence interval = 0.6-2.5] (P = 0.53) among men with any schistosome infection (Schistosoma haematobium or Schistosoma mansoni), and it was 1.4 [0.6-3.3] (P = 0.43) among men with S. haematobium infection. Men with S. haematobium infection were significantly more likely to report the symptom of hemospermia than men without S. haematobium infection. We conclude that schistosome infections appear to have little to no association with HIV infection in men.
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Affiliation(s)
- Jennifer A Downs
- Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania.,Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York
| | - Claudia J de Dood
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hannah E Dee
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York
| | - Megan McGeehan
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York
| | | | | | - Patrick E Adel
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Edward Faustine
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Benson Issarow
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | | | | | - Frank Zahoro
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Donald Miyaye
- National Institute for Medical Research-Mwanza Research Centre, Mwanza, Tanzania
| | - Ruth Gideon Magawa
- National Institute for Medical Research-Mwanza Research Centre, Mwanza, Tanzania
| | - Julius Mngara
- National Institute for Medical Research-Mwanza Research Centre, Mwanza, Tanzania
| | - Myung Hee Lee
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York
| | - Paul L A M Corstjens
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Daniel W Fitzgerald
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York
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27
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Galappaththi-Arachchige HN, Amlie Hegertun IE, Holmen S, Qvigstad E, Kleppa E, Sebitloane M, Ndhlovu PD, Vennervald BJ, Gundersen SG, Taylor M, Kjetland EF. Association of Urogenital Symptoms with History of Water Contact in Young Women in Areas Endemic for S. haematobium. A Cross-Sectional Study in Rural South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13111135. [PMID: 27854250 PMCID: PMC5129345 DOI: 10.3390/ijerph13111135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 10/24/2016] [Accepted: 11/07/2016] [Indexed: 11/25/2022]
Abstract
Female genital schistosomiasis is a neglected tropical disease caused by Schistosoma haematobium. Infected females may suffer from symptoms mimicking sexually transmitted infections. We explored if self-reported history of unsafe water contact could be used as a simple predictor of genital schistosomiasis. In a cross-sectional study in rural South Africa, 883 sexually active women aged 16–22 years were included. Questions were asked about urogenital symptoms and water contact history. Urine samples were tested for S. haematobium ova. A score based on self-reported water contact was calculated and the association with symptoms was explored while adjusting for other genital infections using multivariable logistic regression analyses. S. haematobium ova were detected in the urine of 30.5% of subjects. Having ova in the urine was associated with the water contact score (p < 0.001). Symptoms that were associated with water contact included burning sensation in the genitals (p = 0.005), spot bleeding (p = 0.012), abnormal discharge smell (p = 0.018), bloody discharge (p = 0.020), genital ulcer (p = 0.038), red urine (p < 0.001), stress incontinence (p = 0.001) and lower abdominal pain (p = 0.028). In S. haematobium endemic areas, self-reported water contact was strongly associated with urogenital symptoms. In low-resource settings, a simple history including risk of water contact behaviour can serve as an indicator of urogenital schistosomiasis.
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Affiliation(s)
- Hashini Nilushika Galappaththi-Arachchige
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Postboks 4956 Nydalen, Oslo 0450, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo 0312, Norway.
| | - Ingrid Elise Amlie Hegertun
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Postboks 4956 Nydalen, Oslo 0450, Norway.
| | - Sigve Holmen
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Postboks 4956 Nydalen, Oslo 0450, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo 0312, Norway.
| | - Erik Qvigstad
- Institute of Clinical Medicine, University of Oslo, Oslo 0312, Norway.
- Department of Gynaecology, Women and Children's Division, Ullevaal University Hospital, Oslo 0450, Norway.
| | - Elisabeth Kleppa
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Postboks 4956 Nydalen, Oslo 0450, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo 0312, Norway.
| | - Motshedisi Sebitloane
- Discipline of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban 4001, South Africa.
| | | | - Birgitte Jyding Vennervald
- Section for Parasitology and Aquatic Diseases, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark.
| | - Svein Gunnar Gundersen
- Research Unit, Sorlandet Hospital, Kristiansand 4615, Norway.
- Department of Global Development and Planning, University of Agder, Kristiansand 4630, Norway.
| | - Myra Taylor
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa.
| | - Eyrun Floerecke Kjetland
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Postboks 4956 Nydalen, Oslo 0450, Norway.
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa.
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28
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Yirenya-Tawiah DR, Ackumey MM, Bosompem KM. Knowledge and awareness of genital involvement and reproductive health consequences of urogenital schistosomiasis in endemic communities in Ghana: a cross-sectional study. Reprod Health 2016; 13:117. [PMID: 27655032 PMCID: PMC5031356 DOI: 10.1186/s12978-016-0238-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 09/14/2016] [Indexed: 11/21/2022] Open
Abstract
Background The World Health Organization, in the year 2009, renamed Schistosomiasis haematobium disease, urinary schistosomiasis, as urogenital schistosomiasis. This study, sought to determine whether urogenital schistosomiasis endemic community members were aware of the broadened scope of the disease and associated certain reproductive health related signs and symptoms to S. haematobium infection. Method This is a cross-sectional study in which 2,585 respondents aged 15–49 years from 30 riparian communities along the lower arm of the Volta lake were interviewed using a structured questionnaire; 24 focus group discussions were also conducted. Descriptive statistics were used to determine the frequency of responses for each question posed and Chi squared tests used to determine the associations between demographic variables and variables of interest. Binary logistic regression was used to predict the probability of a reported symptom as an indicator of urogenital schistosomiasis. Thematic analysis was used to examine narratives. Result Ninety four percent of male respondents and 88.7 % of female respondents acknowledged schistosomiasis as a water-borne disease. Only 207 out of 1,096 subjects (18.9 %) responding to questionnaire agreed to the knowledge that urogenital schistosomiasis can have reproductive health implications. A significant difference in variation in this knowledge was found between males (14.5 %) and females (7.2 %) (p = 0.001). The study also found that, although knowledge on HIV was high, only 12.3 % of respondents knew that urogenital schistosomiasis could facilitate the acquisition of HIV. Women who reported to have ever suffered schistosomiasis were 1.3 and 1.5 times more likely to report vaginal discharge and vaginal itch. Sexual dysfunction (11.1 %) and urethral discharge (10.6 %) were the most frequently reported symptoms among males. Conclusion The study finds very limited knowledge on the reproductive health consequences of the disease among endemic communities. It is recommended that health education on urogenital schistosomiasis should also include issues on symptoms of the disease, reproductive health consequences and HIV transmission.
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Affiliation(s)
- Dzidzo R Yirenya-Tawiah
- Institute of Environment and Sanitation Studies, University of Ghana, P.O Box 209, Legon, Accra, Ghana.
| | - Mercy M Ackumey
- School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Kwabena M Bosompem
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
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Sah VK, Wang L, Min X, Rizal R, Feng Z, Ke Z, Deng M, Li L, Li H. Human schistosomiasis: A diagnostic imaging focused review of a neglected disease. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jrid.2015.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Santos J, Fernandes E, Ferreira JA, Lima L, Tavares A, Peixoto A, Parreira B, Correia da Costa JM, Brindley PJ, Lopes C, Santos LL. P53 and cancer-associated sialylated glycans are surrogate markers of cancerization of the bladder associated with Schistosoma haematobium infection. PLoS Negl Trop Dis 2014; 8:e3329. [PMID: 25502795 PMCID: PMC4263606 DOI: 10.1371/journal.pntd.0003329] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 10/08/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Bladder cancer is a significant health problem in rural areas of Africa and the Middle East where Schistosoma haematobium is prevalent, supporting an association between malignant transformation and infection by this blood fluke. Nevertheless, the molecular mechanisms linking these events are poorly understood. Bladder cancers in infected populations are generally diagnosed at a late stage since there is a lack of non-invasive diagnostic tools, hence enforcing the need for early carcinogenesis markers. METHODOLOGY/PRINCIPAL FINDINGS Forty-three formalin-fixed paraffin-embedded bladder biopsies of S. haematobium-infected patients, consisting of bladder tumours, tumour adjacent mucosa and pre-malignant/malignant urothelial lesions, were screened for bladder cancer biomarkers. These included the oncoprotein p53, the tumour proliferation rate (Ki-67>17%), cell-surface cancer-associated glycan sialyl-Tn (sTn) and sialyl-Lewisa/x (sLea/sLex), involved in immune escape and metastasis. Bladder tumours of non-S. haematobium etiology and normal urothelium were used as controls. S. haematobium-associated benign/pre-malignant lesions present alterations in p53 and sLex that were also found in bladder tumors. Similar results were observed in non-S. haematobium associated tumours, irrespectively of their histological nature, denoting some common molecular pathways. In addition, most benign/pre-malignant lesions also expressed sLea. However, proliferative phenotypes were more prevalent in lesions adjacent to bladder tumors while sLea was characteristic of sole benign/pre-malignant lesions, suggesting it may be a biomarker of early carcionogenesis associated with the parasite. A correlation was observed between the frequency of the biomarkers in the tumor and adjacent mucosa, with the exception of Ki-67. Most S. haematobium eggs embedded in the urothelium were also positive for sLea and sLex. Reinforcing the pathologic nature of the studied biomarkers, none was observed in the healthy urothelium. CONCLUSION/SIGNIFICANCE This preliminary study suggests that p53 and sialylated glycans are surrogate biomarkers of bladder cancerization associated with S. haematobium, highlighting a missing link between infection and cancer development. Eggs of S. haematobium express sLea and sLex antigens in mimicry of human leukocytes glycosylation, which may play a role in the colonization and disease dissemination. These observations may help the early identification of infected patients at a higher risk of developing bladder cancer and guide the future development of non-invasive diagnostic tests.
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Affiliation(s)
- Júlio Santos
- Experimental Pathology and Therapeutics group, Portuguese Institute for Oncology of Porto, Porto, Portugal
- Clínica Sagrada Esperança, Luanda, Angola
| | - Elisabete Fernandes
- Experimental Pathology and Therapeutics group, Portuguese Institute for Oncology of Porto, Porto, Portugal
- Grupo de Investigação em Cancro Digestivo (GICD), Porto, Portugal
| | - José Alexandre Ferreira
- Experimental Pathology and Therapeutics group, Portuguese Institute for Oncology of Porto, Porto, Portugal
- Department of Chemistry of the University of Aveiro, Aveiro, Portugal
| | - Luís Lima
- Experimental Pathology and Therapeutics group, Portuguese Institute for Oncology of Porto, Porto, Portugal
- Research Department, LPCC-Portuguese League Against Cancer (NRNorte), Porto, Portugal
- Núcleo de Investigação em Farmácia – Centro de Investigação em Saúde e Ambiente (CISA), School of Allied Health Sciences – Polytechnic Institute of Porto, Porto, Portugal
| | - Ana Tavares
- Experimental Pathology and Therapeutics group, Portuguese Institute for Oncology of Porto, Porto, Portugal
- Department of Pathology, Portuguese Institute for Oncology of Porto, Porto, Portugal
| | - Andreia Peixoto
- Experimental Pathology and Therapeutics group, Portuguese Institute for Oncology of Porto, Porto, Portugal
| | - Beatriz Parreira
- Experimental Pathology and Therapeutics group, Portuguese Institute for Oncology of Porto, Porto, Portugal
| | - José Manuel Correia da Costa
- Center for the Study of Animal Science (ICETA), University of Porto, Porto, Portugal
- INSA, National Institute of Health, Porto, Portugal
| | - Paul J. Brindley
- Research Center for Neglected Diseases of Poverty- Department of Microbiology, Immunology & Tropical Medicine, School of Medicine & Health Sciences, George Washington University, Washington, D.C., United States of America
| | - Carlos Lopes
- Experimental Pathology and Therapeutics group, Portuguese Institute for Oncology of Porto, Porto, Portugal
- Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto, Porto, Portugal
| | - Lúcio L. Santos
- Experimental Pathology and Therapeutics group, Portuguese Institute for Oncology of Porto, Porto, Portugal
- Health School of University of Fernando Pessoa, Porto, Portugal
- Department of Surgical Oncology, Portuguese Institute for Oncology, Porto, Portugal
- National Cancer Center, Luanda, Angol
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Norseth HM, Ndhlovu PD, Kleppa E, Randrianasolo BS, Jourdan PM, Roald B, Holmen SD, Gundersen SG, Bagratee J, Onsrud M, Kjetland EF. The colposcopic atlas of schistosomiasis in the lower female genital tract based on studies in Malawi, Zimbabwe, Madagascar and South Africa. PLoS Negl Trop Dis 2014; 8:e3229. [PMID: 25412334 PMCID: PMC4238986 DOI: 10.1371/journal.pntd.0003229] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 08/29/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Schistosoma (S.) haematobium is a neglected tropical disease which may affect any part of the genital tract in women. Female genital schistosomiasis (FGS) may cause abnormal vaginal discharge, contact bleeding, genital tumours, ectopic pregnancies and increased susceptibility to HIV. Symptoms may mimic those typical of sexually transmitted infections (STIs) and women with genital schistosomiasis may be incorrectly diagnosed. An expert consensus meeting suggested that the following findings by visual inspection should serve as proxy indicators for the diagnosis of schistosomiasis of the lower genital tract in women from S. haematobium endemic areas: sandy patches appearing as (1) single or clustered grains or (2) sandy patches appearing as homogenous, yellow areas, or (3) rubbery papules. In this atlas we aim to provide an overview of the genital mucosal manifestations of schistosomiasis in women. METHODOLOGY/PRINCIPAL FINDINGS Photocolposcopic images were captured from women, between 1994 and 2012 in four different study sites endemic for S. haematobium in Malawi, Zimbabwe, South Africa and Madagascar. Images and specimens were sampled from sexually active women between 15 and 49 years of age. Colposcopic images of other diseases are included for differential diagnostic purposes. SIGNIFICANCE This is the first atlas to present the clinical manifestations of schistosomiasis in the lower female genital tract. It will be freely available for online use, downloadable as a presentation and for print. It could be used for training purposes, further research, and in clinical practice.
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Affiliation(s)
- Hanne M. Norseth
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway
- University of Oslo, Oslo, Norway
| | | | - Elisabeth Kleppa
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway
- University of Oslo, Oslo, Norway
| | | | - Peter M. Jourdan
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Borghild Roald
- Center for Paediatric and Pregnancy Related Pathology, Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Sigve D. Holmen
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Svein G. Gundersen
- Research Department, Sorlandet Hospital HF, Kristiansand, Norway
- Department for Global Development and Planning, Institute for Development Studies, University of Agder, Kristiansand, Norway
| | - Jayanthilall Bagratee
- Discipline of Obstetrics and Gynaecology, School of Clinical Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Mathias Onsrud
- Department of Gynaecology, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Eyrun F. Kjetland
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway
- Discipline of Public Health Medicine, Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Abstract
Schistosomiasis remains one of the most important tropical parasitic infections threatening millions of lives in endemic areas. Cases of infections due to Schistosoma spp, the diecious digenetic trematodes have been on the increase over the last decades. While considerable efforts have been made to reduce infections and morbidities in most endemic areas, these efforts seem to be tailored only towards a specific group (school-based resources). This bias towards school children in epidemiological studies has also been observed in various research efforts in sub-Saharan Africa, thus making it difficult to produce a reliable estimate of the extent of infection in other strata of the population at risk. In recent times, attention has been drawn to Schistosoma spp infections in infants and preschool children, while studies on epidemiology of maternal schistosomiasis still suffer neglect. Considering the potential morbidity of Schistosoma infections on the mothers, fetuses, and neonates, as evidenced in some animal models and human case studies, more attention is solicited in all areas of observational studies and clinical trials, for maternal schistosomiasis with the aim of providing relevant data and information for effective management of the disease during pregnancy.
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Yirenya-Tawiah D, Annang TN, Apea-Kubi KA, Lomo G, Mensah D, Akyeh L, Bosompem KM. Chlamydia Trachomatis and Neisseria Gonorrhoeae prevalence among women of reproductive age living in urogenital schistosomiasis endemic area in Ghana. BMC Res Notes 2014; 7:349. [PMID: 24917067 PMCID: PMC4060753 DOI: 10.1186/1756-0500-7-349] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 06/02/2014] [Indexed: 11/13/2022] Open
Abstract
Background Many studies have shown an overlap in the epidemiology of sexually transmitted infections (STIs) and urogenital schistosomiasis among young women living in schistosomiasis endemic areas. Yet we found no study assessing the prevalence of STI infections in urogenital schistosomiasis endemic areas in Ghana. As part of an epidemiological study on urogenital schistosomiasis and HIV, we sought to assess the prevalence of both Chlamydia trachomatis (CT) and Neisseria gonorhoeae (NG) infections among women living in schistosomiasis endemic communities and explore the relationship between the sexually transmitted infections (STIs) and demographic characteristics, sexual behaviour and self-reported symptoms. Methods This was a cross-sectional study in which endocervical samples were collected from 191 women aged 15–49 years from October 2005 to March 2006. Samples were examined for CT and NG using Polymerase Chain Reaction (PCR). A structured questionnaire was also used to elicit information on study participant’s gynaecological and obstetric history and symptoms for genital infection. Chi-square test and binary logistic regression were used to assess association between CT and NG and other variables such as age, sexual behaviour and self-reported symptoms. Results The overall prevalence of CT and NG were 6.3% and 2.6% respectively.The highest prevalence rates of CT were in the 15 to 19 year group while only individuals between 15 and 39 years were positive for NG. There was no association between CT and age, contraceptive use and the other variables assessed. NG on the other hand was found to be associated with age, number of births and number of sexual partners only by chi-square test. Conclusions Our research revealed higher prevalence of CT and NG infections when compared to previous studies conducted among higher risk groups in non-urogenital schistosomiasis areas in Ghana. We therefore recommend further studies of these STIs in urogenital schistosomiasis endemic areas in the country.
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Affiliation(s)
- Dzidzo Yirenya-Tawiah
- Institute for Environment and Sanitation Studies, University of Ghana, Legon, Ghana.
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Sang HC, Muchiri G, Ombok M, Odiere MR, Mwinzi PNM. Schistosoma haematobium hotspots in south Nyanza, western Kenya: prevalence, distribution and co-endemicity with Schistosoma mansoni and soil-transmitted helminths. Parasit Vectors 2014; 7:125. [PMID: 24667030 PMCID: PMC3994281 DOI: 10.1186/1756-3305-7-125] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 03/09/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Schistosomiasis studies in western Kenya have mainly focused on the intestinal form, with evidence of urinary schistosomiasis remaining anecdotal. Detailed disease mapping has been carried out predominantly along the shores of Lake Victoria, but there is a paucity of information on intestinal and urinary schistosomiasis in inland sites. METHODS This cross-sectional survey of 3,487 children aged 7-18 years from 95 schools in south Nyanza, western Kenya determined the prevalence, infection intensity, and geographical distribution of Schistosoma haematobium, evaluating its co-endemicity with Schistosoma mansoni and soil-transmitted helminths (STHs). Helminth eggs were analyzed from single urine (for S. haematobium) and stool (for S. mansoni and STHs) samples by centrifugation and Kato-Katz, respectively. Hematuria was used as a proxy indicator for S. haematobium. Schools and water bodies (ponds, water-points, streams, dams and rivers) were mapped using Geographical Information System and prevalence maps obtained using ArcView GIS Software. RESULTS S. haematobium infections with an overall prevalence of 9.3% (95% CI = 8.4-10.2%) were mostly prevalent in Rachuonyo, 22.4% (95% CI = 19.2-25.9% and 19.7 eggs/10 ml) and Migori, 10.7% (95% CI = 9.2-12.3% and 29.5 eggs/10 ml) districts, particularly around Kayuka pond and Ongoche river respectively. Overall infections correlated with hematuria (r = 0.9, P < 0.0001) and were more likely in boys (P < 0.0001, OR = 0.624). S. mansoni infections with an overall prevalence of 13% (95% CI =11.9-14.1%) were majorly confined along the shores of Lake Victoria. STH infections were homogenously distributed with A. lumbricoides occurring in 5.4% (95% CI = 4.7-6.3%) and T. trichiura in 2.8% (95% CI = 2.3-3.4%) of the children. Although S. mansoni infections were more co-endemic with S. haematobium, only A. lumbricoides infections were positively associated with S. haematobium (P = 0.0295, OR = 0.4585). Overall prevalence of S. haematobium monoinfection was 7.2% (95% CI = 6.4-8%), S. mansoni monoinfection was 12.3% (95% CI = 10.4-12.5%), and S. haematobium-S. mansoni coinfection was 1.2% (95% CI = 0.9-1.6%). There was no significant difference in infection intensity between mono and coinfections. CONCLUSION Prevalence distribution maps obtained are important for planning and implementing disease control programs in these areas.
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Affiliation(s)
- Huldah C Sang
- Center for Global Health Research, Kenya Medical Research Institute, P.O. Box 1578-40100, Kisumu, Kenya
| | - Geoffrey Muchiri
- Center for Global Health Research, Kenya Medical Research Institute, P.O. Box 1578-40100, Kisumu, Kenya
| | - Maurice Ombok
- Center for Global Health Research, Kenya Medical Research Institute, P.O. Box 1578-40100, Kisumu, Kenya
| | - Maurice R Odiere
- Center for Global Health Research, Kenya Medical Research Institute, P.O. Box 1578-40100, Kisumu, Kenya
| | - Pauline NM Mwinzi
- Center for Global Health Research, Kenya Medical Research Institute, P.O. Box 1578-40100, Kisumu, Kenya
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Kjetland EF, Hegertun IEA, Baay MFD, Onsrud M, Ndhlovu PD, Taylor M. Genital schistosomiasis and its unacknowledged role on HIV transmission in the STD intervention studies. Int J STD AIDS 2014; 25:705-15. [DOI: 10.1177/0956462414523743] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Treatment of sexually transmitted infections (STIs) has been hypothesised to decrease HIV transmission. Although observational studies show an association between STIs and HIV, only one prospective randomised controlled trial (RCT) has confirmed this. Female genital schistosomiasis can cause genital lesions, accompanied by bloody discharge, ulcers or malodorous discharge. Genital schistosomiasis is common, starts before puberty and symptoms can be mistaken for STIs. Three observational studies have found an association between schistosomiasis and HIV. Genital lesions that develop in childhood are chronic. This paper sought to explore the possible effects of schistosomiasis on the RCTs of STI treatment for HIV prevention. In the study sites, schistosomiasis was a likely cause of genital lesions. The studies recruited women that may have had genital schistosomal lesions established in childhood. Schistosomiasis endemic areas with different prevalence levels may have influenced HIV incidence in intervention and control sites differently, and some control group interventions may have influenced the impact of schistosomiasis on the study results. Schistosomiasis is a neglected cause of genital tract disease. It may have been an independent cause of HIV incidence in the RCTs of STI treatment for HIV prevention and may have obscured the findings of these trials.
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Affiliation(s)
- Eyrun F Kjetland
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, School of Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Ingrid EA Hegertun
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway
| | - Marc FD Baay
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway
- Laboratory of Cancer Research and Clinical Oncology, University of Antwerp, Wilrijk, Belgium
| | - Mathias Onsrud
- Department of Gynaecology and Obstetrics, Oslo University Hospital, Oslo, Norway
| | | | - Myra Taylor
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, School of Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Urogenital schistosomiasis in women of reproductive age and pregnant mothers in Kwale County, Kenya. J Helminthol 2013; 89:105-11. [PMID: 24103656 DOI: 10.1017/s0022149x13000643] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Generally, women residing in areas endemic for urinary schistosomiasis may suffer from female genital schistosomiasis which is acquired during childhood. The objective of this cross-sectional study was to estimate the prevalence and intensity of infection of Schistosoma haematobium in women of reproductive age (16-45 years) and to investigate whether S. haematobium had any effect on kidney function. A total of 394 women of known pregnancy status (158 pregnant and 236 non-pregnant) were recruited from five villages (known for their high prevalence of infection of S. haematobium) in Kwale County. Serum samples were analysed to determine levels of urea and creatinine as proxy indicators of kidney function. Data revealed that pregnant women did not, on average, have a higher prevalence or intensity of infection of urinary schistosomiasis than non-pregnant women. During pregnancy, the level of prevalence and intensity of infection of S. haematobium was highest in the first trimester (0-13 weeks), dropped in the second trimester (14-26 weeks) and rose again in the third trimester (27-40 weeks). In addition, 24.8% of women were infected with hookworm, while none were diagnosed with malaria parasites. Of 250 samples analysed for serum urea and creatinine, none had significant levels of pathology, either in pregnant or non-pregnant women. Despite World Health Organization (WHO) recommendations that pregnant women should be treated with praziquantel after the first trimester, in practice this has not been the case in many countries, including Kenya. In view of this, healthcare providers should be informed to consider treatment of pregnant women infected with schistosomiasis during antenatal visits and whenever there is mass drug administration as recommended by the WHO.
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Seyam R. A systematic review of the correlates and management of nonpremature ejaculatory dysfunction in heterosexual men. Ther Adv Urol 2013; 5:254-97. [PMID: 24082920 DOI: 10.1177/1756287213497231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION A better understanding of ejaculatory disorders has led to an increasing interest in nonpremature ejaculatory dysfunction (non-PE EjD). Current reviews on the subject use a symptom-based classification to describe ejaculatory dysfunction even when it is a single case report. While these reviews provide important information on the disorder, a clearer picture of the prevalence of non-PE EjD in relation to the community and various pathophysiologic states is needed. OBJECTIVES The objective of this study was to provide a systematic review of studies of non-PE EjD excluding single case reports. METHODS A systematic review of Medline for terms including ejaculation, orgasm or hematospermia. Association with terms delay, pain or headache was made. The search was restricted to male gender and articles written in English. Abstracts were reviewed and those mainly concerned with premature ejaculation were excluded. RESULTS A total of 333 articles on non-PE EjD were identified. The condition was reported in community-based studies. In certain patient populations, non-PE EjD was commonly reported in association with antidepressant and antipsychotic treatments, in patients with chronic prostatitis/chronic pelvic pain syndrome, patients with lower urinary tract symptoms particularly in association with medical or surgical treatment, patients with retroperitoneal surgery and in patients with neurological diseases. Few articles were concerned with treatment options. CONCLUSION There is a significant prevalence of non-PE EjD in the community and in association with particular disease states or as a side effect of medical or surgical interventions. There is a need to direct efforts to prevent and treat these conditions.
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Affiliation(s)
- Raouf Seyam
- King Faisal Specialist Hospital and Research Center, PO Box 3354, MBC 83, Riyadh 11211, Saudi Arabia
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Barsoum RS, Esmat G, El-Baz T. Human schistosomiasis: clinical perspective: review. J Adv Res 2013; 4:433-44. [PMID: 25685450 PMCID: PMC4293888 DOI: 10.1016/j.jare.2013.01.005] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 01/21/2013] [Accepted: 01/24/2013] [Indexed: 02/03/2023] Open
Abstract
The clinical manifestations of schistosomiasis pass by acute, sub acute and chronic stages that mirror the immune response to infection. The later includes in succession innate, TH1 and TH2 adaptive stages, with an ultimate establishment of concomitant immunity. Some patients may also develop late complications, or suffer the sequelae of co-infection with other parasites, bacteria or viruses. Acute manifestations are species-independent; occur during the early stages of invasion and migration, where infection-naivety and the host's racial and genetic setting play a major role. Sub acute manifestations occur after maturity of the parasite and settlement in target organs. They are related to the formation of granulomata around eggs or dead worms, primarily in the lower urinary tract with Schistosoma haematobium, and the colon and rectum with Schistosoma mansoni, Schistosoma japonicum, Schistosoma intercalatum and Schistosoma mekongi infection. Secondary manifestations during this stage may occur in the kidneys, liver, lungs or other ectopic sites. Chronic morbidity is attributed to the healing of granulomata by fibrosis and calcification at the sites of oval entrapment, deposition of schistosomal antigen-antibody complexes in the renal glomeruli or the development of secondary amyloidosis. Malignancy may complicate the chronic lesions in the urinary bladder or colon. Co-infection with salmonella or hepatitis viruses B or C may confound the clinical picture of schistosomiasis, while the latter may have a negative impact on the course of other co-infections as malaria, leishmaniasis and HIV. Prevention of schistosomiasis is basically geared around education and periodic mass treatment, an effective vaccine being still experimental. Praziquantel is the drug of choice in the treatment of active infection by any species, with a cure rate of 80%. Other antischistosomal drugs include metrifonate for S. haematobium, oxamniquine for S. mansoni and Artemether and, possibly, Mirazid for both. Surgical treatment may be needed for fibrotic lesions.
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Affiliation(s)
| | - Gamal Esmat
- Department of Tropical Medicine, Cairo University, Egypt
| | - Tamer El-Baz
- Department of Tropical Medicine, Cairo University, Egypt
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Kjetland EF, Leutscher PD, Ndhlovu PD. A review of female genital schistosomiasis. Trends Parasitol 2012; 28:58-65. [DOI: 10.1016/j.pt.2011.10.008] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 10/23/2011] [Accepted: 10/24/2011] [Indexed: 12/21/2022]
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Examining the relationship between urogenital schistosomiasis and HIV infection. PLoS Negl Trop Dis 2011; 5:e1396. [PMID: 22163056 PMCID: PMC3232194 DOI: 10.1371/journal.pntd.0001396] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 09/23/2011] [Indexed: 11/29/2022] Open
Abstract
Background Urogenital schistosomiasis, caused by infection with Schistosoma haematobium, is widespread and causes substantial morbidity on the African continent. The infection has been suggested as an unrecognized risk factor for incident HIV infection. Current guidelines recommend preventive chemotherapy, using praziquantel as a public health tool, to avert morbidity due to schistosomiasis. In individuals of reproductive age, urogenital schistosomiasis remains highly prevalent and, likely, underdiagnosed. This comprehensive literature review was undertaken to examine the evidence for a cause-effect relationship between urogenital schistosomiasis and HIV/AIDS. The review aims to support discussions of urogenital schistosomiasis as a neglected yet urgent public health challenge. Methodology/Principal Findings We conducted a systematic search of the literature including online databases, clinical guidelines, and current medical textbooks. We describe plausible local and systemic mechanisms by which Schistosoma haematobium infection could increase the risk of HIV acquisition in both women and men. We also detail the effects of S. haematobium infection on the progression and transmissibility of HIV in co-infected individuals. We briefly summarize available evidence on the immunomodulatory effects of chronic schistosomiasis and the implications this might have for populations at high risk of both schistosomiasis and HIV. Conclusions/Significance Studies support the hypothesis that urogenital schistosomiasis in women and men constitutes a significant risk factor for HIV acquisition due both to local genital tract and global immunological effects. In those who become HIV-infected, schistosomal co-infection may accelerate HIV disease progression and facilitate viral transmission to sexual partners. Establishing effective prevention strategies using praziquantel, including better definition of treatment age, duration, and frequency of treatment for urogenital schistosomiasis, is an important public health priority. Our findings call attention to this pressing yet neglected public health issue and the potential added benefit of scaling up coverage of schistosomal treatment for populations in whom HIV infection is prevalent. Urogenital schistosomiasis is a parasitic infection caused by a worm, Schistosoma haematobium, which lives in the bloodstream of infected individuals. It affects at least 112 million people, mostly in sub-Saharan Africa, and has been suggested to be a risk factor for becoming infected with HIV. We reviewed publications in order to examine whether it seems likely that this parasitic infection could be a risk factor for HIV. Evidence from many types of studies supports the hypothesis that urogenital schistosomiasis does increase a person's risk of becoming infected with HIV. Studies also suggest that individuals who have both urogenital schistosomiasis and HIV have a more aggressive HIV infection and can more easily transmit HIV to their sexual partners. Praziquantel is an oral, nontoxic, inexpensive medication that is safe in pregnancy and is recommended for treatment of schistosomiasis. In areas where both infections co-exist, regular administration of praziquantel both to young girls and to sexually-active women may be an important approach to reducing HIV transmission. Our findings support the importance of making praziquantel more available to people who live in areas of the world where both urogenital schistosomiasis and HIV infection are widespread.
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Downs JA, Mguta C, Kaatano GM, Mitchell KB, Bang H, Simplice H, Kalluvya SE, Changalucha JM, Johnson WD, Fitzgerald DW. Urogenital schistosomiasis in women of reproductive age in Tanzania's Lake Victoria region. Am J Trop Med Hyg 2011; 84:364-9. [PMID: 21363971 DOI: 10.4269/ajtmh.2011.10-0585] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We conducted a community-based study of 457 women aged 18-50 years living in eight rural villages in northwest Tanzania. The prevalence of female urogenital schistosomiasis (FUS) was 5% overall but ranged from 0% to 11%. FUS was associated with human immunodeficiency virus (HIV) infection (odds ratio [OR] = 4.0, 95% confidence interval [CI] = 1.2-13.5) and younger age (OR = 5.5 and 95% CI = 1.2-26.3 for ages < 25 years and OR = 8.2 and 95% CI = 1.7-38.4 for ages 25-29 years compared with age > 35 years). Overall HIV prevalence was 5.9% but was 17% among women with FUS. We observed significant geographical clustering of schistosomiasis: northern villages near Lake Victoria had more Schistosoma mansoni infections (P < 0.0001), and southern villages farther from the lake had more S. haematobium (P = 0.002). Our data support the postulate that FUS may be a risk factor for HIV infection and may contribute to the extremely high rates of HIV among young women in sub-Saharan Africa.
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Affiliation(s)
- Jennifer A Downs
- Center for Global Health, Weill-Cornell Medical College, 440 East 69th Street, New York, NY 10065, USA.
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Dupinay T, Restorp K, Leutscher P, Rousset D, Chemin I, Migliani R, Magnius L, Norder H. High prevalence of hepatitis B virus genotype E in Northern Madagascar indicates a West-African lineage. J Med Virol 2010; 82:1515-26. [PMID: 20648605 DOI: 10.1002/jmv.21865] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The prevalence of hepatitis B virus (HBV) markers was investigated in 563 inhabitants aged 15-55 years from a sugar cane region, Sirama, and from a village, Mataipako, in Northern Madagascar. Serological markers of past or present infection were significantly higher in Sirama, 74% versus 45%. There was no difference in the prevalence of chronic HBsAg carriers, 8.7% versus 8.5% between the two regions. Sequencing the S gene in 45 strains revealed a predominance of genotype E, in 53%, followed by subgenotype A1 in 22%, and genotype D in 18%. Phylogenetic analyses of the genotype E strains showed homology with West African strains. All A1 isolates were similar to Malawi strains. Most genotype D strains were subgenotype D7 and related to strains from Somalia and Tunisia. One genotype D strain formed a branch between Pacific D4 and African D7 strains at neighbor-joining analysis. The pre-core stop mutant was found in 33% of the genotype D strains, 17% of E but not in any A1 strain. The high prevalence and low variability of genotype E strains in only two villages, indicates a rather recent introduction of this genotype into Madagascar from West Africa, possibly through migration or slave trade. The wider spread and genetic relationship of genotype D with East African and Austronesian strains indicate an earlier introduction of this genotype. Molecular epidemiology of HBV may thus be used to complement linguistic and genetic studies on past human migrations in Africa.
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A wake up call for urinary schistosomiasis: reconciling research effort with public health importance. Parasitology 2009; 136:1593-610. [PMID: 19627633 DOI: 10.1017/s0031182009990552] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This review considers the current status of urinary schistosomiasis, caused by infection with Schistosoma haematobium, and argues that greater research effort and focus are needed to improve understanding of this neglected tropical disease (NTD). The inappropriateness of relying solely on data concerning the much more extensively studied intestinal form of schistosomiasis caused by S. mansoni is highlighted. The current lack of genome and transcriptome information for S. haematobium is directly hindering further targeted research and must be quickly rectified. Recent molecular phylogenies caution the expectation of similarities between schistosome species and highlight the close relationships of species within the S. haematobium group. Treatment, current and prospective drugs and vaccines, together with diagnosis are considered, highlighting the differences associated with urinary schistosomiasis. This infection has a significant and specific impact on the urino-genital system and has a strong association with bladder cancer, leading to severe and chronic morbidity. There is a clear need for new clinical initiatives in this area to better quantify the disease burden. Furthermore, emerging associations with HIV and other pathogens need to be closely monitored. Research is urgently needed to improve current knowledge in order to develop the next generation of control tools.
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