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Cnops L, Huyse T, Maniewski U, Soentjens P, Bottieau E, Van Esbroeck M, Clerinx J. Acute Schistosomiasis With a Schistosoma mattheei × Schistosoma haematobium Hybrid Species in a Cluster of 34 Travelers Infected in South Africa. Clin Infect Dis 2020; 72:1693-1698. [DOI: 10.1093/cid/ciaa312] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 03/25/2020] [Indexed: 12/19/2022] Open
Abstract
Abstract
Background
Diagnosis of schistosomiasis remains elusive soon after infection. We evaluated several diagnostic methods in a cluster of travelers with simultaneous freshwater exposure in South Africa.
Methods
Eosinophil count, schistosome antibody tests, stool and urine microscopy, and serum Dra1 PCR assays were performed at weeks 4–5 (early symptomatic phase), 7–8 (praziquantel treatment), and 13–14 (after treatment). Sequencing was done on serum samples from 3 patients to identify the species.
Results
Of the 34 travelers (16 adults and 18 children), 32 developed symptoms 2–6 weeks after exposure. A raised eosinophil count (>750/µL) was seen in 12 of 33 at weeks 4–5, and in 22 of 34 at weeks 7–8. Schistosoma antibodies were detected in 3 of 33 at weeks 4–5 and in 12 of 34 at weeks 7–8 and weeks 13–14. The Dra1 PCR result was positive in 24 of 33 travelers at weeks 4–5, in 31 of 34 at weeks 7–8, in 25 of 34 at weeks 13–14, and at least once in all. Ova were absent in all urine and stool samples obtained. Sequencing identified Schistosoma mattheei nuclear and Schistosoma haematobium mitochondrial DNA, indicative of a hybrid species.
Conclusions
The Dra1 PCR confirmed the diagnosis in all exposed travelers at a much earlier stage than conventional tests. The causative species is probably an S. mattheei × S. haematobium hybrid.
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Affiliation(s)
- Lieselotte Cnops
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Tine Huyse
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Department of Biology, Royal Museum for Central Africa, Tervuren, Belgium
| | - Ula Maniewski
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Patrick Soentjens
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Joannes Clerinx
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
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Tumwebaze I, Clewing C, Dusabe MC, Tumusiime J, Kagoro-Rugunda G, Hammoud C, Albrecht C. Molecular identification of Bulinus spp. intermediate host snails of Schistosoma spp. in crater lakes of western Uganda with implications for the transmission of the Schistosoma haematobium group parasites. Parasit Vectors 2019; 12:565. [PMID: 31775865 PMCID: PMC6882369 DOI: 10.1186/s13071-019-3811-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 11/15/2019] [Indexed: 12/05/2022] Open
Abstract
Background Human schistosomiasis is the second most important tropical disease and occurs in two forms in Africa (intestinal and urogenital) caused by the digenetic trematodes Schistosoma mansoni and Schistosoma haematobium, respectively. A proposed recent shift of schistosomiasis above a previously established altitudinal threshold of 1400 m above sea level in western Ugandan crater lakes has triggered more research interest there. Methods Based on extensive field sampling in western Uganda and beyond and employing an approach using sequences of the mitochondrial barcoding gene cytochrome c oxidase subunit 1 (cox1) this study aims were: (i) identification and establishment of the phylogenetic affinities of Bulinus species as potential hosts for Schistosoma spp.; (ii) determining diversity, frequency and distribution patterns of Bulinus spp.; and (iii) establishing genetic variability and phylogeographical patterns using Bayesian inference and parsimony network analyses. Results Out of the 58 crater lakes surveyed, three species of Bulinus snails were found in 34 crater lakes. Bulinus tropicus was dominating, Bulinus forskalii was found in two lakes and Bulinus truncatus in one. The latter two species are unconfirmed potential hosts for S. haematobium in this region. However, Bulinus tropicus is an important species for schistosomiasis transmission in ruminants. Bulinus tropicus comprised 31 haplotypes while both B. forskalii and B. truncatus exhibited only a single haplotype in the crater lakes. All species clustered with most of the haplotypes from surrounding lake systems forming source regions for the colonization of the crater lakes. Conclusions This first detailed malacological study of the crater lakes systems in western Uganda revealed presence of Bulinus species that are either not known or not regionally known to be hosts for S. haematobium, the causing agent of human urogenital schistosomiasis. Though this disease risk is almost negligible, the observed dominance of B. tropicus in the crater lakes shows that there is a likelihood of a high risk of infections with Schistosoma bovis. Thus, extra attention should be accorded to safeguard wild and domestic ruminants in this region as the population benefits from these animals.
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Affiliation(s)
- Immaculate Tumwebaze
- Department of Animal Ecology and Systematics, Justus Liebig University Giessen, Giessen, Germany.
| | - Catharina Clewing
- Department of Animal Ecology and Systematics, Justus Liebig University Giessen, Giessen, Germany
| | | | - Julius Tumusiime
- Department of Biology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Grace Kagoro-Rugunda
- Department of Biology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Cyril Hammoud
- Department of Biology, Royal Museum for Central Africa, Leuvensesteenweg 13, 3080, Tervuren, Belgium.,Limnology Research Unit, Ghent University, K. L. Ledeganckstraat 35, 9000, Ghent, Belgium
| | - Christian Albrecht
- Department of Animal Ecology and Systematics, Justus Liebig University Giessen, Giessen, Germany.,Department of Biology, Mbarara University of Science and Technology, Mbarara, Uganda
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Alexander CL, Cottom L, Smith K, Perrow K, Coyne M, Jones BL. Schistosomiasis in Scottish travellers: public health importance of laboratory testing and the need for enhanced surveillance. J Public Health (Oxf) 2019; 40:138-145. [PMID: 28335010 DOI: 10.1093/pubmed/fdx024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Indexed: 11/13/2022] Open
Abstract
Background Imported schistosomiasis is of significant public health importance and is likely to be underestimated since infection is often asymptomatic. We describe data from travellers residing in Scotland which includes a subset of group travellers from one of the largest Health Boards in Scotland. Methods Clotted bloods were obtained during the period 2001-15 from a total of 8163 Scottish travellers. This included seven groups comprising of 182 travellers. Sera were examined for the presence of Schistosome species antibody at the Scottish Parasite Diagnostic and Reference Laboratory (SPDRL). Results Of all, 25% (n = 1623) tested positive with 40% (n = 651) of those patients aged between 20 and 24 years. Although 62% (n = 1006) of those who tested positive reported travel to Africa, important information on the specific region visited was lacking in almost one-third of samples received. Overall, 62 (34%) of group travellers tested positive and 95% (n = 59) reporting travel to Africa. Conclusions Globalization, affordable air travel and improved awareness, are likely to contribute towards the increasing number of imported schistosomiasis cases. Therefore, enhanced surveillance capturing detailed travel history and fresh water exposures will improve risk stratification, pre-travel advice and optimize testing and treatment regimes for this increasingly important parasitic disease.
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Affiliation(s)
- Claire L Alexander
- Scottish Parasite Diagnostic and Reference Laboratory (SPDRL), Glasgow, UK
| | - Laura Cottom
- Department of Medical Microbiology, Glasgow Royal Infirmary, Glasgow, UK
| | - Kitty Smith
- Travel Medicine Team, Health Protection Scotland, Glasgow, UK
| | - Kali Perrow
- Travel Medicine Team, Health Protection Scotland, Glasgow, UK
| | - Michael Coyne
- Scottish Parasite Diagnostic and Reference Laboratory (SPDRL), Glasgow, UK
| | - Brian L Jones
- Scottish Parasite Diagnostic and Reference Laboratory (SPDRL), Glasgow, UK
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Narváez A, Arhda N, Pais M, Puello S, Abuward I, Fidalgo M, Romaniouk I, Díaz Rodríguez C. Esquistosomiasis genitourinaria como causa de macrohematuria persistente en paciente de 20 años natural de Madagascar, asociado a parasitosis intestinal por Trichuris trichuria y Necator americanus. Nefrologia 2019; 39:559-560. [DOI: 10.1016/j.nefro.2019.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/25/2019] [Indexed: 10/26/2022] Open
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Abstract
PURPOSE OF REVIEW International travel, adventure travel, and eco-tourism are increasing over the past few decades. This review aims to summarize the spectrum of infections associated with recreational freshwater activities and international travel. RECENT FINDINGS Recreational water activities can be associated with a wide range of infections. Acute febrile illnesses due to leptospirosis and schistosomiasis are not uncommon in travelers following extensive freshwater exposure. Aeromonas and other water-associated pathogens are important to consider in a traveler presenting with a skin and soft tissue infection. Recreational water activities are often associated with diarrheal illnesses, especially in children, and the range of enteric pathogens includes bacterial pathogens such as Escherichia coli O157:H7 and Shigella species and the protozoan parasites Cryptosporidium and Giardia duodenalis. Infections due to free-living amebas though rare can lead to fulminant central nervous system infections. A diverse range of infections may be associated with freshwater exposure, and it is important that these entities are considered in a returning traveler presenting with an acute illness.
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Stanton MC, Adriko M, Arinaitwe M, Howell A, Davies J, Allison G, LaCourse EJ, Muheki E, Kabatereine NB, Stothard JR. Intestinal schistosomiasis in Uganda at high altitude (>1400 m): malacological and epidemiological surveys on Mount Elgon and in Fort Portal crater lakes reveal extra preventive chemotherapy needs. Infect Dis Poverty 2017; 6:34. [PMID: 28162096 PMCID: PMC5292801 DOI: 10.1186/s40249-017-0248-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/19/2017] [Indexed: 01/24/2023] Open
Abstract
Background Intestinal schistosomiasis is of public health importance in Uganda but communities living above 1400 m are not targeted for control as natural transmission is thought unlikely. To assess altitudinal boundaries and at-risk populations, conjoint malacological and epidemiological surveys were undertaken on Mount Elgon (1139 m–3937 m), in Fort Portal crater lakes and in the Rwenzori Mountains (1123 m–4050 m). Methods Seventy freshwater habitats [Mount Elgon (37), Fort Portal crater lakes (23), Rwenzori Mountains (8) and Lake Albert (2)] were inspected for Biomphalaria species. Water temperature, pH and conductivity were recorded. A parasitological examination of 756 schoolchildren [Mount Elgon (300), Fort Portal crater lakes (456)] by faecal microscopy of duplicate Kato-Katz smears from two consecutive stool samples was bolstered by antigen (urine-CCA dipstick) and antibody (SEA-ELISA) diagnostic assays. Results Biomphalaria spp. was found up to 1951 m on Mount Elgon and 1567 m in the Fort Portal crater lakes. Although no snail from Mount Elgon shed cercariae, molecular analysis judged 7.1% of snails sampled at altitudes above 1400 m as having DNA of Schistosoma mansoni; in Fort Portal crater lakes three snails shed schistosome cercariae. Prevalence of intestinal schistosomiasis as measured in schoolchildren by Kato-Katz (Mount Elgon = 5.3% v. Fort Portal crater lakes = 10.7%), CCA urine-dipsticks (18.3% v. 34.4%) and SEA-ELISA (42.3% v. 63.7%) showed negative associations with increasing altitude with some evidence of infection up to 2000 m. Conclusions Contrary to expectations, these surveys clearly show that natural transmission of intestinal schistosomiasis occurs above 1400 m, possibly extending up to 2000 m. Using spatial epidemiological predictions, this now places some extra six million people at-risk, denoting an expansion of preventive chemotherapy needs in Uganda. Electronic supplementary material The online version of this article (doi:10.1186/s40249-017-0248-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michelle C Stanton
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Moses Adriko
- Vector Control Division, Ministry of Health, Kampala, P.O. Box 1661, Uganda
| | - Moses Arinaitwe
- Vector Control Division, Ministry of Health, Kampala, P.O. Box 1661, Uganda
| | - Alison Howell
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Juliet Davies
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Gillian Allison
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - E James LaCourse
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Edridah Muheki
- Vector Control Division, Ministry of Health, Kampala, P.O. Box 1661, Uganda
| | - Narcis B Kabatereine
- Vector Control Division, Ministry of Health, Kampala, P.O. Box 1661, Uganda.,Schistosomiasis Control Initiative, Imperial College London, London, W2 1PG, UK
| | - J Russell Stothard
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
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Rochat L, Bizzini A, Senn N, Bochud PY, Genton B, de Vallière S. Acute schistosomiasis: a risk underestimated by travelers and a diagnosis frequently missed by general practitioners-a cluster analysis of 42 travelers. J Travel Med 2015; 22:168-73. [PMID: 25604932 DOI: 10.1111/jtm.12187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/11/2014] [Accepted: 10/17/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND In 2011, a patient was admitted to our hospital with acute schistosomiasis after having returned from Madagascar and having bathed at the Lily waterfalls. On the basis of this patient's indication, infection was suspected in 41 other subjects. This study investigated (1) the knowledge of the travelers about the risks of schistosomiasis and their related behavior to evaluate the appropriateness of prevention messages and (2) the diagnostic workup of symptomatic travelers by general practitioners to evaluate medical care of travelers with a history of freshwater exposure in tropical areas. METHODS A questionnaire was sent to the 42 travelers with potential exposure to schistosomiasis. It focused on pre-travel knowledge of the disease, bathing conditions, clinical presentation, first suspected diagnosis, and treatment. RESULTS Of the 42 questionnaires, 40 (95%) were returned, among which 37 travelers (92%) reported an exposure to freshwater, and 18 (45%) were aware of the risk of schistosomiasis. Among these latter subjects, 16 (89%) still reported an exposure to freshwater. Serology was positive in 28 (78%) of 36 exposed subjects at least 3 months after exposure. Of the 28 infected travelers, 23 (82%) exhibited symptoms and 16 (70%) consulted their general practitioner before the information about the outbreak had spread, but none of these patients had a serology for schistosomiasis done during the first consultation. CONCLUSIONS The usual prevention message of avoiding freshwater contact when traveling in tropical regions had no impact on the behavior of these travelers, who still went swimming at the Lily waterfalls. This prevention message should, therefore, be either modified or abandoned. The clinical presentation of acute schistosomiasis is often misleading. General practitioners should at least request an eosinophil count, when confronted with a returning traveler with fever. If eosinophilia is detected, it should prompt the search for a parasitic disease.
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Affiliation(s)
- Laurence Rochat
- Travel Clinic, Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland
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McCreesh N, Booth M. The effect of simulating different intermediate host snail species on the link between water temperature and schistosomiasis risk. PLoS One 2014; 9:e87892. [PMID: 24988377 PMCID: PMC4079337 DOI: 10.1371/journal.pone.0087892] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 01/03/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION A number of studies have attempted to predict the effects of climate change on schistosomiasis risk. The importance of considering different species of intermediate host snails separately has never previously been explored. METHODS An agent-based model of water temperature and Biomphalaria pfeifferi population dynamics and Schistosoma mansoni transmission was parameterised to two additional species of snail: B. glabrata and B. alexandrina. RESULTS Simulated B. alexandrina populations had lower minimum and maximum temperatures for survival than B. pfeifferi populations (12.5-29.5°C vs. 14.0-31.5°C). B. glabrata populations survived over a smaller range of temperatures than either B. pfeifferi or B. alexandrina (17.0°C-29.5°C). Infection risk peaked at 16.5°C, 25.0°C and 19.0°C respectively when B. pfeifferi, B. glabrata and B. alexandrina were simulated. For all species, infection risk increased sharply once a minimum temperature was reached. CONCLUSIONS The results from all three species suggest that infection risk may increase dramatically with small increases in temperature in areas at or near the currents limits of schistosome transmission. The effect of small increases in temperature in areas where schistosomiasis is currently found will depend both on current temperatures and on the species of snail acting as intermediate host(s) in the area. In most areas where B. pfeifferi is the host, infection risk is likely to decrease. In cooler areas where B. glabrata is the host, infection risk may increase slightly. In cooler areas where B. alexandrina is the host, infection risk may more than double with only 2°C increase in temperature. Our results show that it is crucial to consider the species of intermediate host when attempting to predict the effects of climate change on schistosomiasis.
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Affiliation(s)
- Nicky McCreesh
- School of Medicine, Pharmacy and Health, Durham University, Durham, United Kingdom
- * E-mail:
| | - Mark Booth
- School of Medicine, Pharmacy and Health, Durham University, Durham, United Kingdom
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Soentjens P, Clerinx J, Aerssens A, Cnops L, Van Esbroeck M, Bottieau E. Diagnosing Acute Schistosomiasis. Clin Infect Dis 2013; 58:304-5. [DOI: 10.1093/cid/cit683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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