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Ndubani R, Lamberti O, Kildemoes A, Hoekstra P, Fitzpatrick J, Kelly H, Vwalika B, Randrianasolo B, Sturt A, Kayuni S, Choko A, Kasese N, Kjetland E, Nemungadi T, Mocumbi S, Samson A, Ntapara E, Thomson A, Danstan E, Chikwari CD, Martin K, Rabiu I, Terkie G, Chaima D, Kasoka M, Joeker K, Arenholt LTS, Leutscher P, Stothard R, Rabozakandria O, Gouvras A, Munthali T, Hameja G, Kanfwa P, Hikabasa H, Ayles H, Shanaube K, Bustinduy AL. The first BILGENSA Research Network workshop in Zambia: identifying research priorities, challenges and needs in genital bilharzia in Southern Africa. Wellcome Open Res 2024; 9:360. [PMID: 39170763 PMCID: PMC11336559 DOI: 10.12688/wellcomeopenres.22429.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 08/23/2024] Open
Abstract
Female genital schistosomiasis (FGS) and male genital schistosomiasis (MGS) are gender-specific manifestations of urogenital schistosomiasis. Morbidity is a consequence of prolonged inflammation in the human genital tract caused by the entrapped eggs of the waterborne parasite, Schistosoma (S.) haematobium. Both diseases affect the sexual and reproductive health (SRH) of millions of people globally, especially in sub-Sahara Africa (SSA). Awareness and knowledge of these diseases is largely absent among affected communities and healthcare workers in endemic countries. Accurate burden of FGS and MGS disease estimates, single and combined, are absent, mostly due to the absence of standardized methods for individual or population-based screening and diagnosis. In addition, there are disparities in country-specific FGS and MGS knowledge, research and implementation approaches, and diagnosis and treatment. There are currently no WHO guidelines to inform practice. The BILGENSA (Genital Bilharzia in Southern Africa) Research Network aimed to create a collaborative multidisciplinary network to advance clinical research of FGS and MGS across Southern African endemic countries. The workshop was held in Lusaka, Zambia over two days in November 2022. Over 150 researchers and stakeholders from different schistosomiasis endemic settings attended. Attendees identified challenges and research priorities around FGS and MGS from their respective countries. Key research themes identified across settings included: 1) To increase the knowledge about the local burden of FGS and MGS; 2) To raise awareness among local communities and healthcare workers; 3) To develop effective and scalable guidelines for disease diagnosis and management; 4) To understand the effect of treatment interventions on disease progression, and 5) To integrate FGS and MGS within other existing sexual and reproductive health (SRH) services. In its first meeting, the BILGENSA Network set forth a common research agenda across S. haematobium endemic countries for the control of FGS and MGS.
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Affiliation(s)
| | - Olimpia Lamberti
- Department of Clinical Research, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Anna Kildemoes
- Section for Parasitology and Aquatic Pathobiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pytsje Hoekstra
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Helen Kelly
- Department of Clinical Research, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Bellington Vwalika
- Department of gynaecology, University of Zambia, Lusaka, Lusaka Province, Zambia
| | | | - Amy Sturt
- Infectious Diseases Section, Veterans Affairs Healthcare System, Palo Alto, USA
- 8. Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Seke Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Augustine Choko
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Eyrun Kjetland
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences,, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Department of Infectious Diseases, Norwegian Centre for Imported and Tropical Diseases, Oslo, Norway
| | - Takalani Nemungadi
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences,, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Sibone Mocumbi
- Manhiça Health Research Centre (CISM), Maputo Central Hospital, Maputo, Mozambique
| | - Anna Samson
- Department of Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Elizabeth Ntapara
- Mbeya Medical Research Centre (MMRC), National Institute of Medical Research, Mwanza, Tanzania
| | - Anifrid Thomson
- Mbeya Medical Research Centre (MMRC), National Institute of Medical Research, Mwanza, Tanzania
| | - Elizabeth Danstan
- Biomedical Research and Training Institute, Harare, Harare Province, Zimbabwe
| | - Chido Dziya Chikwari
- Biomedical Research and Training Institute, Harare, Harare Province, Zimbabwe
- The Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe
| | - Kevin Martin
- Department of Clinical Research, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
- Biomedical Research and Training Institute, Harare, Harare Province, Zimbabwe
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Ibrahim Rabiu
- Department of Community Medicine, Gombe State University, Gombe, Gombe, Nigeria
| | - Gifty Terkie
- Department of Community Medicine, Gombe State University, Gombe, Gombe, Nigeria
| | - David Chaima
- Department of Pathology, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Manuel Kasoka
- Department of gynaecology, University of Zambia, Lusaka, Lusaka Province, Zambia
| | - Karoline Joeker
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Louise Thomsen Schmidt Arenholt
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
- Department of Obstetrics and Gynecology, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Peter Leutscher
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Obstetrics and Gynecology, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Russel Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | - Tendai Munthali
- School of Public Health, University of Zambia, Lusaka, Lusaka Province, Zambia
- Department of Public Health, Ministry of Health, Lusaka, Zambia
| | - Grace Hameja
- Department of Neglected Tropical Diseases, Ministry of Health, Lusaka, Zambia
| | - Paul Kanfwa
- Department of gynaecology, University of Zambia, Lusaka, Lusaka Province, Zambia
| | - Halwindi Hikabasa
- School of Public Health, University of Zambia, Lusaka, Lusaka Province, Zambia
| | - Helen Ayles
- Zambart School of Medicine, Lusaka, Zambia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | | | - Amaya L. Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
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Nemungadi TG, Kleppa E, Galappaththi-Arachchige HN, Pillay P, Gundersen SG, Vennervald BJ, Ndhlovu PD, Taylor M, Naidoo S, Kjetland EF. Predictors for participation in mass-treatment and female genital schistosomiasis re-investigation, and the effect of praziquantel treatment in South African adolescents. PLoS Negl Trop Dis 2024; 18:e0011798. [PMID: 38536861 PMCID: PMC11020363 DOI: 10.1371/journal.pntd.0011798] [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: 11/15/2023] [Revised: 04/16/2024] [Accepted: 03/12/2024] [Indexed: 04/18/2024] Open
Abstract
OBJECTIVE Female Genital Schistosomiasis (FGS) causes intravaginal lesions and symptoms that could be mistaken for sexually transmitted diseases or cancer. In adults, FGS lesions [grainy sandy patches (GSP), homogenous yellow patches (HYP), abnormal blood vessels and rubbery papules] are refractory to treatment. The effect of treatment has never been explored in young women; it is unclear if gynaecological investigation will be possible in this young age group (16-23 years). We explored the predictors for accepting anti-schistosomal treatment and/or gynaecological reinvestigation in young women, and the effects of anti-schistosomal mass-treatment (praziquantel) on the clinical manifestations of FGS at an adolescent age. METHOD The study was conducted between 2011 and 2013 in randomly selected, rural, high schools in Ilembe, uThungulu and Ugu Districts, KwaZulu-Natal Province, East Coast of South Africa. At baseline, gynaecological investigations were conducted in female learners in grades 8 to 12, aged 16-23 years (n = 2293). Mass-treatment was offered in the low-transmission season between May and August (a few in September, n = 48), in accordance with WHO recommendations. Reinvestigation was offered after a median of 9 months (range 5-14 months). Univariate, multivariable and logistic regression analysis were used to measure the association between variables. RESULTS Prevalence: Of the 2293 learners who came for baseline gynaecological investigations, 1045 (46%) had FGS lesions and/or schistosomiasis, 209/1045 (20%) had GSP; 208/1045 (20%) HYP; 772/1045 (74%) had abnormal blood vessels; and 404/1045 (39%) were urine positive. Overall participation rate for mass treatment and gynaecological investigation: Only 26% (587/2293) learners participated in the mass treatment and 17% (401/2293) participated in the follow up gynaecological reinvestigations. Loss to follow-up among those with FGS: More than 70% of learners with FGS lesions at baseline were lost to follow-up for gynaecological investigations: 156/209 (75%) GSP; 154/208 (74%) HYP; 539/722 (75%) abnormal blood vessels; 238/404 (59%) urine positive. The grade 12 pupil had left school and did not participate in the reinvestigations (n = 375; 16%). Follow-up findings: Amongst those with lesions who came for both treatment and reinvestigation, 12/19 still had GSP, 8/28 had HYP, and 54/90 had abnormal blood vessels. Only 3/55 remained positive for S. haematobium ova. Factors influencing treatment and follow-up gynaecological investigation: HIV, current water contact, water contact as a toddler and urinary schistosomiasis influenced participation in mass treatment. Grainy sandy patches, abnormal blood vessels, HYP, previous pregnancy, current water contact, water contact as a toddler and father present in the family were strongly associated with coming back for follow-up gynaecological investigation. Challenges in sample size for follow-up analysis of the effect of treatment: The low mass treatment uptake and loss to follow up among those who had baseline FGS reduced the chances of a larger sample size at follow up investigation. However, multivariable analysis showed that treatment had effect on the abnormal blood vessels (adjusted odds ratio = 2.1, 95% CI 1.1-3.9 and p = 0.018). CONCLUSION Compliance to treatment and gynaecological reinvestigation was very low. There is need to embark on large scale awareness and advocacy in schools and communities before implementing mass-treatment and investigation studies. Despite challenges in sample size and significant loss to follow-up, limiting the ability to fully understand the treatment's effect, multivariable analysis demonstrated a significant treatment effect on abnormal blood vessels.
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Affiliation(s)
- Takalani Girly Nemungadi
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Elisabeth Kleppa
- Norwegian Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway
| | | | - Pavitra Pillay
- Department of Biomedical and Clinical Technology, Durban University of Technology, KwaZulu-Natal, Durban, South Africa
| | - Svein Gunnar Gundersen
- Institute for Global Development and Planning, University of Agder, Kristiansand, Norway
| | - Birgitte Jyding Vennervald
- Section for Parasitology and Aquatic Pathobiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Myra Taylor
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Saloshni Naidoo
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Eyrun Floerecke Kjetland
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Norwegian Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway
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Kaizilege GK, Ndaboine E, Chuma C, Mujuni F, Kiritta R, Matovelo D, Ottoman O, Elias E, Masalu N, Kidenya BR, Mazigo HD. Unraveling cervical cancer screening dilemmas: histopathological insights from VIA and LEEP at bugando medical centre, Mwanza. BMC Cancer 2024; 24:66. [PMID: 38216912 PMCID: PMC10785426 DOI: 10.1186/s12885-023-11779-1] [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] [Received: 08/03/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND The single-visit strategy, also known as the "screen-and-treat" approach, is widely used to screen for cervical cancer in low- and middle-income countries. The screen-and-treat approach leads to unnecessary or inadequate treatment. Thus, a study was conducted to determine the histopathological patterns of aceto-white lesions on visual inspection with acetic acid (VIA) in patients who underwent a Loop Electrosurgical Excision Procedure (LEEP) at Bugando Medical Centre between January 2016 and December 2020. METHOD A 5-year retrospective cross-sectional case record review was conducted on 329 women who had LEEP at Bugando Medical Centre following a positive VIA cervical screening test. A standard data abstraction form was used to collect patient information. Missing client information records and LEEP without histopathological results were exclusion criteria. For statistical analysis, STATA version 15 was used; in descriptive statistics, frequency, mean, and standard deviation were used. The Chi2 and Fisher's exact tests were used to investigate the relationship between patient characteristics and histopathological patterns, and a P-value of 0.05 was considered statistically significant in multinomial models. RESULTS This study looked at 329 patients who had LEEP following a VIA positive but were not eligible for cryotherapy. Our study participants had a mean age of 40 ± 8.2 SD. There were 203 (61.7%) patients with benign lesions, including 4 with schistosomiasis and 2 with cervical tuberculosis. The precancerous lesions were discovered in 100 cases (30.4%), and 26 (7.9%) already had invasive cervical cancer. Out of 100 patients with precancerous lesions, 58 (17.6%) and 42 (12.8%) have high- and low-grade squamous intraepithelial (HSIL and LSIL) lesions, respectively. The presence of a precancerous lesion was found to be associated with age 31-40 years (P-value 0.042) and HIV positivity (P-value 0.004). CONCLUSION Most patients in this study had benign cervical lesions, which do not require LEEP treatment. Nonetheless, a considerable percentage of invasive cervical malignancies and rare benign diseases such as schistosomiasis and cervical tuberculosis were identified. A screen-and-treat approach within well-equipped tertiary hospitals like Bugando Medical Centre should explore alternative options instead of relying solely on straight LEEP.
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Affiliation(s)
- Godfrey K Kaizilege
- Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania
| | - Edgar Ndaboine
- Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania.
| | - Clotilda Chuma
- Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania
| | - Fridolin Mujuni
- Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania
| | - Richard Kiritta
- Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania
| | - Dismas Matovelo
- Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania
| | - Oscar Ottoman
- Department of Pathology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania
| | - Edrick Elias
- Department of Pathology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania
| | - Nestory Masalu
- Department of Oncology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania
| | - Benson R Kidenya
- Department of Biochemistry and Molecular Biology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania
| | - Humphrey D Mazigo
- Department of Parasitology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania
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Kingery JR, Chalem A, Mukerebe C, Shigella PS, Miyaye D, Magawa RG, Ward M, Kalluvya SE, McCormick J, Maganga JK, Colombe S, Aristide C, Corstjens PLAM, Lee MH, Changalucha JM, Downs JA. Schistosoma mansoni Infection Is Associated With Increased Monocytes and Fewer Natural Killer T Cells in the Female Genital Tract. Open Forum Infect Dis 2022; 9:ofac657. [PMID: 36601557 PMCID: PMC9801228 DOI: 10.1093/ofid/ofac657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Schistosoma mansoni infection may impair genital mucosal antiviral immunity, but immune cell populations have not been well characterized. We characterized mononuclear cells from cervical brushings of women with and without S mansoni infection. We observed lower frequencies of natural killer T cells and higher frequencies of CD14+ monocytes in infected women.
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Affiliation(s)
| | | | | | | | - Donald Miyaye
- National Institute for Medical Research, Mwanza, Tanzania
| | - Ruth G Magawa
- National Institute for Medical Research, Mwanza, Tanzania
| | - Maureen Ward
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Samuel E Kalluvya
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Jason McCormick
- Flow Cytometry Core Laboratory, Weill Cornell Medicine, New York, New York, USA
| | - Jane K Maganga
- National Institute for Medical Research, Mwanza, Tanzania,Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Soledad Colombe
- Outbreak Research Team, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Christine Aristide
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, TheNetherlands
| | - Myung Hee Lee
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | | | - Jennifer A Downs
- Correspondence: Jennifer A. Downs, MD, MSc, PhD, Center for Global Health, Weill Cornell Medicine, 402 E 67th St, Second Floor, New York, NY, 10065, USA ()
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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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Sturt AS, Webb EL, Phiri CR, Mudenda M, Mapani J, Kosloff B, Cheeba M, Shanaube K, Bwalya J, Kjetland EF, Francis SC, Corstjens PLAM, van Dam GJ, van Lieshout L, Hansingo I, Ayles H, Hayes RJ, Bustinduy AL. Female Genital Schistosomiasis and HIV-1 Incidence in Zambian Women: A Retrospective Cohort Study. Open Forum Infect Dis 2021; 8:ofab349. [PMID: 34337098 PMCID: PMC8320261 DOI: 10.1093/ofid/ofab349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/29/2021] [Indexed: 12/19/2022] Open
Abstract
Background Female genital schistosomiasis (FGS) has been associated with prevalent HIV-1. We estimated the incidence of HIV-1 infection in Zambian women with and without FGS. Methods Women (aged 18–31, nonpregnant, sexually active) were invited to participate in this study in January–August 2018 at the final follow-up of the HPTN 071 (PopART) Population Cohort. HIV-1-negative participants at enrollment (n = 492) were included in this analysis, with testing to confirm incident HIV-1 performed in HPTN 071 (PopART). The association of incident HIV-1 infection with FGS (Schistosoma DNA detected by polymerase chain reaction [PCR] in any genital specimen) was assessed with exact Poisson regression. Results Incident HIV-1 infections were observed in 4.1% (20/492) of participants. Women with FGS were twice as likely to seroconvert as women without FGS but with no statistical evidence for a difference (adjusted rate ratio, 2.16; 95% CI, 0.21–12.30; P = .33). Exploratory analysis suggested an association with HIV-1 acquisition among women with ≥2 positive genital PCR specimens (rate ratio, 6.02; 95% CI, 0.58–34.96; P = .13). Conclusions Despite higher HIV seroconversion rates in women with FGS, there was no statistical evidence of association, possibly due to low power. Further longitudinal studies should investigate this association in a setting with higher schistosomiasis endemicity.
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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
| | | | - Maina Mudenda
- Department of Obstetrics and Gynaecology, Livingstone Central Hospital, Livingstone, Zambia
| | - Joyce Mapani
- Department of Obstetrics and Gynaecology, Livingstone Central Hospital, Livingstone, Zambia
| | - Barry Kosloff
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.,Zambart, Lusaka, Zambia
| | | | | | | | - Eyrun F Kjetland
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.,Discipline of Public Health, University of KwaZulu-Natal, Discipline of Public Health, Durban, South Africa
| | - Suzanna C Francis
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Isaiah Hansingo
- Department of Obstetrics and Gynaecology, Livingstone Central Hospital, Livingstone, Zambia
| | - 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
| | - Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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8
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Sturt AS, Webb EL, Francis SC, Hayes RJ, Bustinduy AL. Beyond the barrier: Female Genital Schistosomiasis as a potential risk factor for HIV-1 acquisition. Acta Trop 2020; 209:105524. [PMID: 32416076 PMCID: PMC7429987 DOI: 10.1016/j.actatropica.2020.105524] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 12/16/2022]
Abstract
Female genital schistosomiasis (FGS) results from egg-deposition in the female reproductive tract primarily by the waterborne parasite Schistosoma (S.) haematobium, and less commonly by Schistosoma (S.) mansoni. FGS affects an estimated 20-56 million women worldwide, mostly in sub-Saharan Africa. There is cross-sectional evidence of increased HIV-1 prevalence in schistosomiasis-infected women, but a causal relationship between FGS and either HIV-1 acquisition or transmission has not been fully established. Beyond the pathognomonic breach in the cervicovaginal barrier caused by FGS, this narrative review explores potential mechanisms for a synergistic relationship between S. haematobium infection, FGS, and HIV-1 acquisition through vaginal inflammation and target cell recruitment.
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Affiliation(s)
- A S Sturt
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom.
| | - E L Webb
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - S C Francis
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - R J Hayes
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - A L Bustinduy
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
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9
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Sturt AS, Webb EL, Phiri CR, Mweene T, Chola N, van Dam GJ, Corstjens PLAM, Wessels E, Stothard JR, Hayes R, Ayles H, Hansingo I, van Lieshout L, Bustinduy AL. Genital self-sampling compared with cervicovaginal lavage for the diagnosis of female genital schistosomiasis in Zambian women: The BILHIV study. PLoS Negl Trop Dis 2020; 14:e0008337. [PMID: 32663222 PMCID: PMC7360036 DOI: 10.1371/journal.pntd.0008337] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/29/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Given the potentially causal association of female genital schistosomiasis (FGS) with HIV-1 infection, improved diagnostics are urgently needed to scale-up FGS surveillance. The BILHIV (bilharzia and HIV) study assessed the performance of home-based self-collection methods (cervical and vaginal swabs) compared to cervicovaginal lavage (CVL) for the detection of Schistosoma DNA by real-time polymerase chain reaction (PCR). METHODS Between January and August 2018, a consecutive series of female participants from the Population-Cohort of the previous HIV prevention trial HPTN 071 (PopART), resident in Livingstone, Zambia were invited to take part in BILHIV if they were 18-31 years old, non-pregnant and sexually active. Genital self-collected swabs and a urine specimen were obtained and a questionnaire completed at home visits. CVL was obtained at clinic follow-up. RESULTS 603 women self-collected genital swabs. Of these, 527 women had CVL performed by a mid-wife during clinic follow-up. Schistosoma DNA was more frequently detected in genital self-collected specimens (24/603, 4.0%) compared to CVL (14/527, 2.7%). Overall, 5.0% (30/603) women had female genital schistosomiasis, defined as a positive PCR by any genital sampling method (cervical swab PCR, vaginal swab PCR, or CVL PCR) and 95% (573/603) did not have a positive genital PCR. The sensitivity of any positive genital self-collected swab against CVL was 57.1% (95% CI 28.9-82.3%), specificity 97.3% (95.5-98.5%). In a subset of participants with active schistosome infection, determined by detectable urine Circulating Anodic Antigen (CAA) (15.1%, 91/601), positive PCR (4.3%, 26/601), or positive microscopy (5.5%, 33/603), the sensitivity of any positive self-collected specimen against CVL was 88.9% (51.8-99.7%). CONCLUSIONS Genital self-sampling increased the overall number of PCR-based FGS diagnoses in a field setting, compared with CVL. Home-based sampling may represent a scalable alternative method for FGS community-based diagnosis in endemic resource limited settings.
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Affiliation(s)
- Amy S. Sturt
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Emily L. Webb
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - 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
| | - Els Wessels
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J. Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Richard Hayes
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen Ayles
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Zambart, Lusaka, Zambia
| | - Isaiah Hansingo
- Department of Obstetrics and Gynaecology, Livingstone Central Hospital, Livingstone, Zambia
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Amaya L. Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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10
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Bochner AF, Baeten JM, Secor WE, van Dam GJ, Szpiro AA, Njenga SM, Corstjens PLAM, Newsam A, Mugo NR, Celum C, Mujugira A, McClelland RS, Barnabas RV. Associations between schistosomiasis and HIV-1 acquisition risk in four prospective cohorts: a nested case-control analysis. J Int AIDS Soc 2020; 23:e25534. [PMID: 32585078 PMCID: PMC7316390 DOI: 10.1002/jia2.25534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/08/2020] [Accepted: 05/04/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Globally, schistosomes infect approximately 200 million people, with 90% of infections in sub-Saharan Africa. Schistosomiasis is hypothesized to increase HIV-1 acquisition risk, and multiple cross-sectional studies reported strong associations. We evaluated this hypothesis within four large prospective cohorts. METHODS We conducted nested case-control analyses within three longitudinal cohorts of heterosexual HIV-1 serodiscordant couples and one female sex worker (FSW) cohort from Kenya and Uganda. The serodiscordant couples studies were conducted between 2004 and 2012 while the FSW cohort analysis included participant follow-up from 1993 to 2014. Cases HIV-1 seroconverted during prospective follow-up; three controls were selected per case. The presence of circulating anodic antigen in archived serum, collected prior to HIV-1 seroconversion, identified participants with active schistosomiasis; immunoblots determined the schistosome species. Data from serodiscordant couples cohorts were pooled, while the FSW cohort was analysed separately to permit appropriate confounder adjustment. RESULTS We included 245 HIV-1 seroconverters and 713 controls from the serodiscordant couples cohorts and 330 HIV-1 seroconverters and 962 controls from the FSW cohort. The prevalence of active schistosomiasis was 20% among serodiscordant couples and 22% among FSWs. We found no association between schistosomiasis and HIV-1 acquisition risk among males (adjusted odds ratio (aOR) = 0.99, 95% CI 0.59 to 1.67) or females (aOR = 1.21, 95% CI 0.64 to 2.30) in serodiscordant couples. Similarly, in the FSW cohort we detected no association (adjusted incidence rate ratio (aIRR) = 1.11, 95% CI 0.83 to 1.50). Exploring schistosome species-specific effects, there was no statistically significant association between HIV-1 acquisition risk and Schistosoma mansoni (serodiscordant couples: aOR = 0.90, 95% CI 0.56 to 1.44; FSW: aIRR = 0.83, 95% CI 0.53 to 1.20) or Schistosoma haematobium (serodiscordant couples: aOR = 1.06, 95% CI 0.46 to 2.40; FSW: aIRR = 1.64, 95% CI 0.93 to 2.87) infection. CONCLUSIONS Schistosomiasis was not a strong risk factor for HIV-1 acquisition in these four prospective studies. S. mansoni was responsible for the majority of schistosomiasis in these cohorts, and our results do not support the hypothesis that S. mansoni infection is associated with increased HIV-1 acquisition risk. S. haematobium infection was associated with a point estimate of elevated HIV-1 risk in the FSW cohort that was not statistically significant, and there was no trend towards a positive association in the serodiscordant couples cohorts.
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Affiliation(s)
- Aaron F Bochner
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Jared M Baeten
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- School of MedicineUniversity of WashingtonSeattleWAUSA
| | - W Evan Secor
- Division of Parasitic Diseases and MalariaCenter for Global HealthCenters for Disease Control and PreventionAtlantaGAUSA
| | - Govert J van Dam
- Department of ParasitologyLeiden University Medical CenterLeidenthe Netherlands
| | - Adam A Szpiro
- Department of BiostatisticsUniversity of WashingtonSeattleWAUSA
| | | | - Paul L A M Corstjens
- Department of Cell and Chemical BiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Austin Newsam
- Division of Parasitic Diseases and MalariaCenter for Global HealthCenters for Disease Control and PreventionAtlantaGAUSA
| | - Nelly R Mugo
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Kenya Medical Research InstituteNairobiKenya
| | - Connie Celum
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- School of MedicineUniversity of WashingtonSeattleWAUSA
| | - Andrew Mujugira
- Infectious Diseases InstituteCollege of Health SciencesMakerere UniversityKampalaUganda
| | - R Scott McClelland
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- School of MedicineUniversity of WashingtonSeattleWAUSA
| | - Ruanne V Barnabas
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- School of MedicineUniversity of WashingtonSeattleWAUSA
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11
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Pillay P, Downs JA, Changalucha JM, Brienen EAT, Ramarokoto CE, Leutscher PDC, Vennervald BJ, Taylor M, Kjetland EF, Van Lieshout L. Detection of Schistosoma DNA in genital specimens and urine: A comparison between five female African study populations originating from S. haematobium and/or S. mansoni endemic areas. Acta Trop 2020; 204:105363. [PMID: 32035055 DOI: 10.1016/j.actatropica.2020.105363] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 01/16/2023]
Abstract
Female Genital Schistosomiasis (FGS) is a neglected disease affecting millions, however challenging to diagnose. This explorative descriptive study compares Schistosoma real-time PCR analysis of cervico-vaginal lavages (CVL) with corresponding urine and stool samples of 933 women from five different previously described study populations. Sampling included 310 women from an S. mansoni endemic region in Mwanza, Tanzania and 112 women from a nearby S. haematobium endemic region. Findings were compared with samples collected from S. haematobium endemic regions in South Africa from 394 women and from 117 women from Madagascar of which 79 were urine pre-selected microscopy positive cases from highly-endemic communities and 38 were urine microscopy negatives from a low-endemic community. As anticipated, urine and stool microscopy and gynecological investigations varied substantially between study populations; however, the same Schistosoma real-time PCR was performed in one reference laboratory. Schistosoma DNA was detected in 13% (120/933) of the CVL, ranging from 3% in the S. mansoni Tanzanian endemic region to 61% in the pre-selected Malagasy urine microscopy positive cases. Detectable Schistosoma DNA in CVL was associated with Schistosoma DNA in urine but not with microscopic detection of eggs in urine or by cytological examination. This study confirmed real-time PCR for the detection of Schistosoma DNA in gynecological samples to be a valuable diagnostic tool to study the distribution of FGS within schistosomiasis endemic areas.
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Affiliation(s)
- P Pillay
- Department of Biomedical and Clinical Technology, Durban University of Technology, South Africa; Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - J A Downs
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, USA
| | - J M Changalucha
- Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - E A T Brienen
- Department of Parasitology, Leiden University Medical Center, The Netherlands
| | - C E Ramarokoto
- Department of Epidemiology, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - P D C Leutscher
- Centre for Clinical Research, North Denmark Regional Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark
| | - B J Vennervald
- Section for Parasitology and Aquatic Pathobiology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - M Taylor
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - E F Kjetland
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo Norway
| | - L Van Lieshout
- Department of Parasitology, Leiden University Medical Center, The Netherlands
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12
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Dupnik KM, Lee MH, Mishra P, Reust MJ, Colombe S, Haider SR, Yao B, Vick K, Zhang T, Xiang J, Miyaye D, Magawa R, Lyimo E, Mukerebe C, Mngara J, Kalluvya SE, de Dood CJ, van Dam GJ, Corstjens PLAM, Downs JA. Altered Cervical Mucosal Gene Expression and Lower Interleukin 15 Levels in Women With Schistosoma haematobium Infection but Not in Women With Schistosoma mansoni Infection. J Infect Dis 2020; 219:1777-1785. [PMID: 30590736 DOI: 10.1093/infdis/jiy742] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 12/21/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Schistosomiasis increases the risk of human immunodeficiency virus (HIV) acquisition in women by mechanisms that are incompletely defined. Our objective was to determine how the cervical environment is impacted by Schistosoma haematobium or Schistosoma mansoni infection by quantifying gene expression in the cervical mucosa and cytokine levels in cervicovaginal lavage fluid. METHODS We recruited women with and those without S. haematobium infection and women with and those without S. mansoni infection from separate villages in rural Tanzania with high prevalences of S. haematobium and S. mansoni, respectively. Infection status was determined by urine and stool microscopy and testing for serum circulating anodic antigen. RNA was extracted from cervical cytobrush samples for transcriptome analysis. Cytokine levels were measured by magnetic bead immunoassay. RESULTS In the village where S. haematobium was prevalent, 110 genes were differentially expressed in the cervical mucosa of 18 women with versus 39 without S. haematobium infection. Among the 27 cytokines analyzed in cervicovaginal lavage fluid from women in this village, the level of interleukin 15 was lower in the S. haematobium-infected group (62.8 vs 102.9 pg/mL; adjusted P = .0013). Differences were not observed in the S. mansoni-prevalent villages between 11 women with and 29 without S. mansoni infection. CONCLUSIONS We demonstrate altered cervical mucosal gene expression and lower interleukin 15 levels in women with S. haematobium infection as compared to those with S. mansoni infection, which may influence HIV acquisition and cancer risks. Studies to determine the effects of antischistosome treatment on these mucosal alterations are needed.
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Affiliation(s)
- Kathryn M Dupnik
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Myung Hee Lee
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Pallavi Mishra
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Mary Juliet Reust
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Soledad Colombe
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Syeda Razia Haider
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Benjamin Yao
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Kaitlin Vick
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Tuo Zhang
- Genomics Resources Core Facility, Weill Cornell Medicine, New York, New York
| | - Jenny Xiang
- Genomics Resources Core Facility, Weill Cornell Medicine, New York, New York
| | - Donald Miyaye
- National Institute for Medical Research, Bugando Medical Centre, Mwanza, Tanzania
| | - Ruth Magawa
- National Institute for Medical Research, Bugando Medical Centre, Mwanza, Tanzania
| | - Eric Lyimo
- National Institute for Medical Research, Bugando Medical Centre, Mwanza, Tanzania
| | - Crispin Mukerebe
- National Institute for Medical Research, Bugando Medical Centre, Mwanza, Tanzania
| | - Julius Mngara
- National Institute for Medical Research, Bugando Medical Centre, Mwanza, Tanzania
| | | | | | - Govert J van Dam
- Department of Parasitology, Leiden University, Leiden, the Netherlands
| | | | - Jennifer A Downs
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York.,Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania
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13
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Lee Y, Song HB, Jung BK, Choe G, Choi MH. Case Report of Urinary Schistosomiasis in a Returned Traveler in Korea. THE KOREAN JOURNAL OF PARASITOLOGY 2020; 58:51-55. [PMID: 32145727 PMCID: PMC7066443 DOI: 10.3347/kjp.2020.58.1.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/04/2019] [Indexed: 12/12/2022]
Abstract
A 23-year-old Korean woman with a residence history in Kenya and Malawi for about 2 years presented with gross hematuria for 1 month. Blood tests were within normal range except eosinophilia. Asymmetrically diffuse wall thickening and calcification were observed at the urinary bladder on CT. Multiple erythematous nodular lesions were observed in the cystoscopy and transurethral resection was done. Numerous eggs of Schistosoma haematobium with granulomatous inflammation were observed in the submucosal layer of the bladder. The patient was diagnosed with schistosomiasis-related cystitis and treated with praziquantel (40 mg/kg/day) twice before and after transurethral resection. This case suggests that S. haematobium infection should be considered as a cause of hematuria in Korea when the patient had a history of traveling endemic areas of schistosomiasis.
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Affiliation(s)
- Yangkyu Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea
| | - Hyun Beom Song
- Department of Tropical Medicine and Parasitology and Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Bong-Kwang Jung
- Department of Tropical Medicine and Parasitology and Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea
| | - Gheeyoung Choe
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea
| | - Min-Ho Choi
- Department of Tropical Medicine and Parasitology and Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul 03080, Korea
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14
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Yegorov S, Joag V, Galiwango RM, Good SV, Okech B, Kaul R. Impact of Endemic Infections on HIV Susceptibility in Sub-Saharan Africa. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2019; 5:22. [PMID: 31798936 PMCID: PMC6884859 DOI: 10.1186/s40794-019-0097-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/07/2019] [Indexed: 02/08/2023]
Abstract
Human immunodeficiency virus (HIV) remains a leading cause of global morbidity with the highest burden in Sub-Saharan Africa (SSA). For reasons that are incompletely understood, the likelihood of HIV transmission is several fold higher in SSA than in higher income countries, and most of these infections are acquired by young women. Residents of SSA are also exposed to a variety of endemic infections, such as malaria and various helminthiases that could influence mucosal and systemic immunology. Since these immune parameters are important determinants of HIV acquisition and progression, this review explores the possible effects of endemic infections on HIV susceptibility and summarizes current knowledge of the epidemiology and underlying immunological mechanisms by which endemic infections could impact HIV acquisition. A better understanding of the interaction between endemic infections and HIV may enhance HIV prevention programs in SSA.
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Affiliation(s)
- Sergey Yegorov
- 1Departments of Immunology and Medicine, University of Toronto, Toronto, Canada.,2Department of Pedagogical Mathematics and Natural Science, Faculty of Education and Humanities, Suleyman Demirel University, Almaty, Kazakhstan
| | - Vineet Joag
- 3Department of Microbiology and Immunology, University of Minnesota, Minneapolis, MN USA
| | - Ronald M Galiwango
- 1Departments of Immunology and Medicine, University of Toronto, Toronto, Canada
| | - Sara V Good
- 4Genetics & Genome Biology, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON Canada.,5Community Health Sciences, University of Manitoba, Winnipeg, MB Canada
| | | | - Rupert Kaul
- 1Departments of Immunology and Medicine, University of Toronto, Toronto, Canada.,7Department of Medicine, University Health Network, Toronto, Canada
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15
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Yegorov S, Joag V, Galiwango RM, Good SV, Mpendo J, Tannich E, Boggild AK, Kiwanuka N, Bagaya BS, Kaul R. Schistosoma mansoni treatment reduces HIV entry into cervical CD4+ T cells and induces IFN-I pathways. Nat Commun 2019; 10:2296. [PMID: 31127086 PMCID: PMC6534541 DOI: 10.1038/s41467-019-09900-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 04/02/2019] [Indexed: 01/21/2023] Open
Abstract
Schistosoma mansoni (Sm) infection has been linked with an increased risk of HIV acquisition in women. Therefore, defining the mechanism(s) by which Sm alters HIV susceptibility might lead to new HIV prevention strategies. Here, we analyze the impact of standard Sm therapy in HIV-uninfected Sm+ Ugandan adult women on genital HIV susceptibility and mucosal and systemic immunology. Schistosomiasis treatment induces a profound reduction of HIV entry into cervical and blood CD4+ T cells that is sustained for up to two months, despite transient systemic and mucosal immune activation and elevated genital IL-1α levels. Genital IFN-α2a levels are also elevated post-treatment, and IFN-α2a blocks HIV entry into primary CD4+ T cells ex vivo. Transcriptomic analysis of blood mononuclear cells post-Sm treatment shows IFN-I pathway up-regulation and partial reversal of Sm-dysregulated interferon signaling. These findings indicate that Sm therapy may reduce HIV susceptibility for women with Sm infection, potentially through de-repression of IFN-I pathways.
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Affiliation(s)
- Sergey Yegorov
- Departments of Immunology and Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada. .,Department of Science Education, Faculty of Education and Humanities, Suleyman Demirel University, 1/1 Abylai Khan Street, Kaskelen, Almaty, 040900, Kazakhstan.
| | - Vineet Joag
- Departments of Immunology and Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Department of Microbiology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Ronald M Galiwango
- Departments of Immunology and Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Sara V Good
- Genetics & Genome Biology, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay St., Toronto, ON, M5G 0A4, Canada.,Community Health Sciences, University of Manitoba, 750 Bannatyne Ave, Winnipeg, MB, R3E 0W2, Canada
| | - Juliet Mpendo
- Uganda Virus Research Institute -International AIDS Vaccine Initiative HIV Vaccine Program, 51/59 Nakiwogo Rd, P.O.Box 49, Entebbe, Uganda
| | - Egbert Tannich
- Bernhard Nocht Institute for Tropical Medicine, National Reference Centre for Tropical Pathogens, Bernhard-Nocht-Str. 74, 20359, Hamburg, Germany
| | - Andrea K Boggild
- Department of Medicine, University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Public Health Ontario Laboratories, 661 University Ave, Toronto, ON, M5G 1M1, Canada
| | - Noah Kiwanuka
- Uganda Virus Research Institute -International AIDS Vaccine Initiative HIV Vaccine Program, 51/59 Nakiwogo Rd, P.O.Box 49, Entebbe, Uganda.,Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Bernard S Bagaya
- Uganda Virus Research Institute -International AIDS Vaccine Initiative HIV Vaccine Program, 51/59 Nakiwogo Rd, P.O.Box 49, Entebbe, Uganda.,Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Rupert Kaul
- Departments of Immunology and Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Department of Medicine, University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
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Galappaththi-Arachchige HN, Holmen S, Koukounari A, Kleppa E, Pillay P, Sebitloane M, Ndhlovu P, van Lieshout L, Vennervald BJ, Gundersen SG, Taylor M, Kjetland EF. Evaluating diagnostic indicators of urogenital Schistosoma haematobium infection in young women: A cross sectional study in rural South Africa. PLoS One 2018; 13:e0191459. [PMID: 29451887 PMCID: PMC5815575 DOI: 10.1371/journal.pone.0191459] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 12/07/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Urine microscopy is the standard diagnostic method for urogenital S. haematobium infection. However, this may lead to under-diagnosis of urogenital schistosomiasis, as the disease may present itself with genital symptoms in the absence of ova in the urine. Currently there is no single reliable and affordable diagnostic method to diagnose the full spectrum of urogenital S. haematobium infection. In this study we explore the classic indicators in the diagnosis of urogenital S. haematobium infection, with focus on young women. METHODS In a cross-sectional study of 1237 sexually active young women in rural South Africa, we assessed four diagnostic indicators of urogenital S. haematobium infection: microscopy of urine, polymerase chain reaction (PCR) of cervicovaginal lavage (CVL), urogenital symptoms, and sandy patches detected clinically in combination with computerised image analysis of photocolposcopic images. We estimated the accuracy of these diagnostic indicators through the following analyses: 1) cross tabulation (assumed empirical gold standard) of the tests against the combined findings of sandy patches and/or computerized image analysis and 2) a latent class model of the four indicators without assuming any gold standard. RESULTS The empirical approach showed that urine microscopy had a sensitivity of 34.7% and specificity of 75.2% while the latent class analysis approach (LCA) suggested a sensitivity of 81.0% and specificity of 85.6%. The empirical approach and LCA showed that Schistosoma PCR in CVL had low sensitivity (14.1% and 52.4%, respectively) and high specificity (93.0% and 98.0, respectively). Using LCA, the presence of sandy patches showed a sensitivity of 81.6 and specificity of 42.4%. The empirical approach and LCA showed that urogenital symptoms had a high sensitivity (89.4% and 100.0%, respectively), whereas specificity was low (10.6% and 12.3%, respectively). CONCLUSION All the diagnostic indicators used in the study had limited accuracy. Using urine microscopy or Schistosoma PCR in CVL would only confirm a fraction of the sandy patches found by colposcopic examination.
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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, Oslo Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- * E-mail:
| | - Sigve Holmen
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo Norway
| | - Artemis Koukounari
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elisabeth Kleppa
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo Norway
| | - Pavitra Pillay
- Department of Biomedical and Clinical Technology, Durban University of Technology, KwaZulu- Natal, South Africa
| | - Motshedisi Sebitloane
- Discipline of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Patricia Ndhlovu
- Imperial College London, Claybrook Centre, London, United Kingdom
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Centre, Leiden, Netherlands
| | - Birgitte Jyding Vennervald
- Section for Parasitology and Aquatic Diseases, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Svein Gunnar Gundersen
- Research Unit, Sorlandet Hospital, Kristiansand, Norway
- Department of 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
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17
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Miller-Fellows SC, Howard L, Kramer R, Hildebrand V, Furin J, Mutuku FM, Mukoko D, Ivy JA, King CH. Cross-sectional interview study of fertility, pregnancy, and urogenital schistosomiasis in coastal Kenya: Documented treatment in childhood is associated with reduced odds of subfertility among adult women. PLoS Negl Trop Dis 2017; 11:e0006101. [PMID: 29176778 PMCID: PMC5720807 DOI: 10.1371/journal.pntd.0006101] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 12/07/2017] [Accepted: 11/07/2017] [Indexed: 11/19/2022] Open
Abstract
Background Previous research has documented an increased risk of subfertility in areas of sub-Saharan Africa, as well as an ecological association between urogenital schistosomiasis prevalence and decreased fertility. This pilot project examined reproductive patterns and the potential effects of childhood urogenital Schistosoma haematobium infection and individual treatment experience on adult subfertility among women who were long-term residents in an S. haematobium-endemic region of coastal Kenya. Methodology/Principal findings We analyzed findings from 162 in-depth interviews with women of childbearing age in a rural, coastal community, linking them, if possible, to their individual treatment records from previous multi-year longitudinal studies of parasitic infections. Reproductive histories indicated a much local higher local rate of subfertility (44%) than worldwide averages (8–12%). Although, due to the very high regional prevalence of schistosomiasis, a clear relationship could not be demonstrated between a history of S. haematobium infection and adult subfertility, among a convenience sub-sample of 61 women who had received documented treatment during previous interventional trials, a significant association was found between age at first anti-schistosomal treatment and later fertility in adulthood, with those women treated before age 21 significantly less likely to have subfertility (P = 0.001). Conclusions/Significance The high subfertility rate documented in this pilot study suggests the importance of programs to prevent and treat pelvic infections in their early stages to preclude reproductive tract damage. The available documented treatment data also suggest that early anti-schistosomal treatment may prevent the fertility-damaging effects of urogenital schistosomiasis, and lend support for programs that provide universal treatment of children in S. haematobium-endemic regions. Infertility is an unwelcome complication of many infectious diseases. In sub-Saharan Africa, where women experience the highest rates of subfertility in the world, the helminthic parasite Schistosoma haematobium, is also highly prevalent. Chronic and repeated infections with S. haematobium cause inflammation of the pelvic organs and kidneys, a condition known as urogenital schistosomiasis. Past studies have statistically linked past and present S. haematobium infection to the risk of infection-associated female genital lesions and with risk for subfertility in adulthood. The present study used in-depth interviews to document reproductive health histories of 162 women, aged 15 to 62, residing in an S. haematobium-endemic area of coastal Kenya, in order to examine the association of their earlier anti-schistosomal treatment with their fertility patterns. A self-reported history of past treatment was not associated with lower odds of infertility. However, among 61 with verified treatments given during previous local campaigns, it was found that women who were treated before age 21 experienced significantly fewer period of subfertility during their adult life. The findings suggest that anti-schistosomal treatment during childhood may prevent the fertility-damaging effects of urogenital schistosomiasis. They also lend support for programs that provide universal treatment of children in S. haematobium-endemic regions.
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Affiliation(s)
- Sarah C. Miller-Fellows
- Department of Anthropology, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Laura Howard
- Department of Anthropology, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Rebekah Kramer
- Department of Anthropology, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Vanessa Hildebrand
- Department of Anthropology, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Jennifer Furin
- Department of Anthropology, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Francis M. Mutuku
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Dunstan Mukoko
- Vector-borne Disease Unit, Ministry of Health, Nairobi, Kenya
| | - Julianne A. Ivy
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Charles H. King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, United States of America
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
- * E-mail:
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18
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Bustinduy AL, Stothard JR, Friedman JF. Paediatric and maternal schistosomiasis: shifting the paradigms. Br Med Bull 2017; 123:115-125. [PMID: 28910994 PMCID: PMC6279106 DOI: 10.1093/bmb/ldx028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 07/16/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND In endemic areas, schistosomiasis causes both overt and subclinical disease in young children and their mothers, as well as in returned travellers. SOURCES OF DATA Key recently published literature. AREAS OF AGREEMENT An action plan for paediatric schistosomiasis and female genital schistosomiasis (FGS) is needed with expanded access to praziquantel (PZQ) treatment required. AREAS OF CONTROVERSY Schistosomiasis-related morbidity is underappreciated. Present and future demand for PZQ treatment is bottlenecked, imbalanced and inequitable. Current dosing, treatment algorithms and access plans are suboptimal with treatment stalled during pregnancy. GROWING POINTS Raised dosing of PZQ (>40 mg/kg) is being explored in young children. Surveillance of female genital schistosomiasis FGS is increasing. Use of PZQ in pregnancy is safe and preventive chemotherapy guidelines are being revised in morbidity- and transmission-control settings. AREAS TIMELY FOR DEVELOPING RESEARCH Shifting focus of population-level control to individual-case management. Detection and prevention of FGS within general health services and integration of PZQ treatment for women and children in antenatal clinics. Feasibility studies assessing alternative and expanded access to PZQ treatment to at-risk children and mothers and pregnant women.
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Affiliation(s)
- Amaya L Bustinduy
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - J Russell Stothard
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Jennifer F Friedman
- Center for International Health Research, Rhode Island Hospital, 55 Claverick Street, Suite 101, Providence, RI 02903, USA
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19
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Molecular testing for clinical diagnosis and epidemiological investigations of intestinal parasitic infections. Clin Microbiol Rev 2016; 27:371-418. [PMID: 24696439 DOI: 10.1128/cmr.00122-13] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Over the past few decades, nucleic acid-based methods have been developed for the diagnosis of intestinal parasitic infections. Advantages of nucleic acid-based methods are numerous; typically, these include increased sensitivity and specificity and simpler standardization of diagnostic procedures. DNA samples can also be stored and used for genetic characterization and molecular typing, providing a valuable tool for surveys and surveillance studies. A variety of technologies have been applied, and some specific and general pitfalls and limitations have been identified. This review provides an overview of the multitude of methods that have been reported for the detection of intestinal parasites and offers some guidance in applying these methods in the clinical laboratory and in epidemiological studies.
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20
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Christinet V, Lazdins-Helds JK, Stothard JR, Reinhard-Rupp J. Female genital schistosomiasis (FGS): from case reports to a call for concerted action against this neglected gynaecological disease. Int J Parasitol 2016; 46:395-404. [PMID: 27063073 DOI: 10.1016/j.ijpara.2016.02.006] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 02/06/2023]
Abstract
In recent years, control of neglected tropical diseases has been increasingly gaining momentum and interventions against schistosomiasis are being progressively scaled-up through expansion of donated praziquantel and preventive chemotherapy campaigns. However, the public health importance of female genital schistosomiasis is not fully recognised nor its control is adequately addressed. Taking a clinical and anatomopathological perspective, we evaluated the available literature to highlight the importance of female genital schistosomiasis and its connections with two sexually transmitted infections of global importance, Human Immunodeficiency Virus (HIV) and Human Papilloma Virus. Outside the long list of clinical descriptive reports beginning in 1899, there is presently a shocking gap in epidemiological assessment and a significant underestimation of the burden of FGS remains. The scarcity of integrated approaches to address female genital schistosomiasis calls for more concerted action in its detection, treatment and prevention alongside other concomitant women's health issues, otherwise female genital schistosomiasis will remain a neglected gynaecological disease.
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Affiliation(s)
- Vanessa Christinet
- Centre International de Recherches, d'Enseignements et de Soins en Milieu Tropical (CIRES), Akonolinga, Cameroon
| | | | - J Russell Stothard
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
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21
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He P, Song LG, Xie H, Liang JY, Yuan DY, Wu ZD, Lv ZY. Nucleic acid detection in the diagnosis and prevention of schistosomiasis. Infect Dis Poverty 2016; 5:25. [PMID: 27025210 PMCID: PMC4812660 DOI: 10.1186/s40249-016-0116-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 03/14/2016] [Indexed: 11/25/2022] Open
Abstract
Schistosomiasis is an important zoonotic parasitic disease that causes serious harms to humans and animals. Surveillance and diagnosis play key roles in schistosomiasis control, however, current techniques for surveillance and diagnosis of the disease have limitations. As genome data for parasites are increasing, novel techniques for detection incorporating nucleotide sequences are receiving widespread attention. These sensitive, specific, and rapid detection methods are particularly important in the diagnosis of low-grade and early infections, and may prove to have clinical significance. This paper reviews the progress of nucleic acid detection in the diagnosis and prevention of schistosomiasis, including such aspects as the selection of target genes, and development and application of nucleic acid detection methods.
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Affiliation(s)
- Ping He
- Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China.,Key Laboratory of Tropical Disease Control, Ministry of Education, Guangzhou, 510080, China.,Department of Pathogenic Biology, Medical School, Xizang Minzu University, Xianyang, 712082, China
| | - Lan-Gui Song
- Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China.,Key Laboratory of Tropical Disease Control, Ministry of Education, Guangzhou, 510080, China
| | - Hui Xie
- Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China.,Key Laboratory of Tropical Disease Control, Ministry of Education, Guangzhou, 510080, China
| | - Jin-Yi Liang
- Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China.,Key Laboratory of Tropical Disease Control, Ministry of Education, Guangzhou, 510080, China
| | - Dong-Ya Yuan
- Department of Pathogenic Biology, Medical School, Xizang Minzu University, Xianyang, 712082, China
| | - Zhong-Dao Wu
- Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China. .,Key Laboratory of Tropical Disease Control, Ministry of Education, Guangzhou, 510080, China.
| | - Zhi-Yue Lv
- Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China. .,Key Laboratory of Tropical Disease Control, Ministry of Education, Guangzhou, 510080, China.
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23
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Guimarães Cavalcanti M, Marcello de Araujo‐Neto J, Mauro Peralta J. Schistosomiasis: Clinical management of liver disease. Clin Liver Dis (Hoboken) 2015; 6:59-62. [PMID: 31040989 PMCID: PMC6490649 DOI: 10.1002/cld.495] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Marta Guimarães Cavalcanti
- Infectious and Parasitic Diseases ServiceHospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de JaneiroRio de JaneiroBrazil,Department of ImmunologyInstituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de JaneiroRio de JaneiroBrazil
| | - João Marcello de Araujo‐Neto
- Department of Clinical Medicine, Faculdade de MedicinaUniversidade Federal do Rio de JaneiroRio de JaneiroBrazil
| | - José Mauro Peralta
- Department of ImmunologyInstituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de JaneiroRio de JaneiroBrazil
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Knight M, Arican-Goktas HD, Ittiprasert W, Odoemelam EC, Miller AN, Bridger JM. Schistosomes and snails: a molecular encounter. Front Genet 2014; 5:230. [PMID: 25101114 PMCID: PMC4104801 DOI: 10.3389/fgene.2014.00230] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/30/2014] [Indexed: 11/13/2022] Open
Abstract
Biomphalaria glabrata snails play an integral role in the transmission of Schistosoma mansoni, the causative agent for human schistosomiasis in the Western hemisphere. For the past two decades, tremendous advances have been made in research aimed at elucidating the molecular basis of the snail/parasite interaction. The growing concern that there is no vaccine to prevent schistosomiasis and only one effective drug in existence provides the impetus to develop new control strategies based on eliminating schistosomes at the snail-stage of the life cycle. To elucidate why a given snail is not always compatible to each and every schistosome it encounters, B. glabrata that are either resistant or susceptible to a given strain of S. mansoni have been employed to track molecular mechanisms governing the snail/schistosome relationship. With such snails, genetic markers for resistance and susceptibility were identified. Additionally, differential gene expression studies have led to the identification of genes that underlie these phenotypes. Lately, the role of schistosomes in mediating non-random relocation of gene loci has been identified for the first time, making B. glabrata a model organism where chromatin regulation by changes in nuclear architecture, known as spatial epigenetics, orchestrated by a major human parasite can now be investigated. This review will highlight the progress that has been made in using molecular approaches to describe snail/schistosome compatibility issues. Uncovering the signaling networks triggered by schistosomes that provide the impulse to turn genes on and off in the snail host, thereby controlling the outcome of infection, could also yield new insights into anti-parasite mechanism(s) that operate in the human host as well.
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Affiliation(s)
- Matty Knight
- Department of Microbiology, Immunology and Tropical Medicine, The George Washington University Washington, DC, USA
| | | | | | - Edwin C Odoemelam
- Biosciences, Health Sciences and Social Care, Brunel University London London, UK
| | - André N Miller
- Schistosomiasis, Biomedical Research Institute Rockville, MD, USA
| | - Joanna M Bridger
- Biosciences, Health Sciences and Social Care, Brunel University London London, UK
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25
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Application of PCR-based methods for diagnosis of intestinal parasitic infections in the clinical laboratory. Parasitology 2014; 141:1863-72. [DOI: 10.1017/s0031182014000419] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
SUMMARYFor many years PCR- and other DNA-based methods of pathogen detection have been available in most clinical microbiology laboratories; however, until recently these tools were not routinely exploited for the diagnosis of parasitic infections. Laboratories were initially reluctant to implement PCR as incorporation of such assays within the algorithm of tools available for the most accurate diagnosis of a large variety of parasites was unclear. With regard to diagnosis of intestinal parasitic infections, the diversity of parasites that one can expect in most settings is far less than the parasitological textbooks would have you believe, hence developing a simplified diagnostic triage is feasible. Therefore the classical algorithm based on population, patient groups, use of immuno-suppressive drugs, travel history etc. is also applicable to decide when to perform and which additional techniques are to be used, if a multiplex PCR panel is used as a first-line screening diagnostic.
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Vinkeles Melchers NVS, van Dam GJ, Shaproski D, Kahama AI, Brienen EAT, Vennervald BJ, van Lieshout L. Diagnostic performance of Schistosoma real-time PCR in urine samples from Kenyan children infected with Schistosoma haematobium: day-to-day variation and follow-up after praziquantel treatment. PLoS Negl Trop Dis 2014; 8:e2807. [PMID: 24743389 PMCID: PMC3990496 DOI: 10.1371/journal.pntd.0002807] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 03/08/2014] [Indexed: 01/01/2023] Open
Abstract
Background In an effort to enhance accuracy of diagnosis of Schistosoma haematobium, this study explores day-to-day variability and diagnostic performance of real-time PCR for detection and quantification of Schistosoma DNA compared to other diagnostic tools in an endemic area before and after treatment. Methodology Previously collected urine samples (N = 390) from 114 preselected proven parasitological and/or clinical S. haematobium positive Kenyan schoolchildren were analyzed by a Schistosoma internal transcribed spacer-based real-time PCR after 14 years of storage. Pre-treatment day-to-day fluctuations of PCR and microscopy over three consecutive days were measured for 24 children using intra-class correlation coefficient. A combined ‘gold standard’ (PCR and/or microscopy positive) was used to measure sensitivity and negative predictive value (NPV) of several diagnostic tools at baseline, two and 18 months post-treatment with praziquantel. Principal Findings All 24 repeatedly tested children were PCR-positive over three days with little daily variation in median Ct-values, while 83.3% were found to be egg-positive for S. haematobium at day 1 and 75.0% at day 2 and 3 pre-treatment, signifying daily fluctuations in microscopy diagnosis. Of all 114 preselected schoolchildren, repeated microscopic measurements were required to detect 96.5% versus 100% of positive pre-treatment cases by single PCR. At two months post-treatment, microscopy and PCR detected 22.8% versus 69.3% positive children, respectively. Based on the ‘gold standard’, PCR showed high sensitivity (>92%) as compared to >31% sensitivity for microscopy, both pre- and post-treatment. Conclusions/Significance Detection and quantification of Schistosoma DNA in urine by real-time PCR was shown to be a powerful and specific diagnostic tool for detection of S. haematobium infections, with less day-to-day variation and higher sensitivity compared to microscopy. The superior performance of PCR before, and two and 18 months post-treatment provides a compelling argument for PCR as an accurate and reproducible tool for monitoring treatment efficacy. Schistosoma haematobium is a blood fluke that causes severe urogenital pathology and affects millions of people, mainly in sub-Sahara Africa. Current diagnosis is based on microscopic examination of urine samples, but this method is not only observer dependent, but also known for its low sensitivity and high day-to-day variability. Accurate diagnosis is important to assess community levels of infections for consideration of deworming campaigns, and to monitor treatment efficacy. We evaluated a real-time polymerase chain reaction (PCR) assay for specific detection and quantification of Schistosoma DNA in urine samples from 114 preselected S. haematobium infected schoolchildren of endemic coastal Kenya and compared the outcome to several other diagnostic methods. Three urine samples collected over three subsequent days from 24 participants were used for Analyzing day-to-day fluctuations in egg counts and Schistosoma DNA levels. Urine was also tested two and 18 months after praziquantel treatment. Compared to microscopy, we observed less day-to-day fluctuations and higher sensitivity with real-time PCR, in particular when tested two months after therapy. Real-time PCR is therefore useful for more accurate identification of S. haematobium, especially in monitoring control interventions.
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Affiliation(s)
| | - Govert J. van Dam
- Leiden University Medical Centre, Department of Parasitology, Centre of Infectious Diseases, Leiden, The Netherlands
| | - David Shaproski
- Leiden University Medical Centre, Department of Parasitology, Centre of Infectious Diseases, Leiden, The Netherlands
| | - Anthony I. Kahama
- Division of Vector Borne Diseases, Ministry of Health, Nairobi, Kenya
| | - Eric A. T. Brienen
- Leiden University Medical Centre, Department of Parasitology, Centre of Infectious Diseases, Leiden, The Netherlands
| | - Birgitte J. Vennervald
- Section for Parasitology and Aquatic Diseases, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lisette van Lieshout
- Leiden University Medical Centre, Department of Parasitology, Centre of Infectious Diseases, Leiden, The Netherlands
- * E-mail:
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