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Rodríguez-Molino P, González Martínez S, Bustamante Amador J, Mellado-Sola I, Montes Martín L, Falces-Romero I, García López-Hortelano M, Hurtado-Gallego J, Mellado MJ, Grasa C, Sainz T. Schistosomiasis in migrant children and adolescents in a paediatric tropical referral unit in Spain: diagnosis and long-term management challenges. Eur J Pediatr 2024:10.1007/s00431-024-05623-2. [PMID: 39143347 DOI: 10.1007/s00431-024-05623-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/28/2024] [Accepted: 05/19/2024] [Indexed: 08/16/2024]
Abstract
Globalisation and population movement have led to an increasing number of migrant children residing in areas non-endemic for schistosomiasis. However, diagnosing and managing schistosomiasis in children remain controversial. This study aims to investigate the prevalence of schistosomiasis in migrant children and to describe the diagnostic approach and management strategies, including long-term follow-up, to explore the potential role of serological tests in evaluating treatment response. We conducted a retrospective descriptive study spanning from January 2014-July 2021 at a referral unit for Paediatric Tropical Diseases in Madrid (Spain). The study included patients under 18 years diagnosed with schistosomiasis. Of 679 children screened for schistosomiasis, 73 (10.8%) tested positive. The median age was 16.3 years [IQR 9-17.6], 74% male. The majority originated from Sub-Saharan Africa (47%) and Asia (47%). Only 40% presented with symptoms, with gastrointestinal (18%) and cutaneous (17%) manifestations being the most common. Eosinophilia was observed in 43% (median [IQR]: 1103/mm3 [671-1536]), and ova were visualised in the urine of 2/50 (4.0%). Praziquantel treatment was administered to 92%, and 5 patients required retreatment. Follow-up data were available for 58 (80%) over a median period of 9 months [IQR 6-19.8], revealing a progressive decline in eosinophil count, IgE titres, and ELISA optical density. Conclusion: In this series, the prevalence of schistosomiasis among migrant children was significant (10%), highlighting the importance of including serological tests in migrant health screening. The disease is largely asymptomatic, eosinophilia is often absent, and visualisation of ova in urine is exceedingly rare. Eosinophil count, IgE titres, and ELISA optical density could prove valuable as an initial approach for monitoring inflammation during follow-up assessments. What is Known: • The burden of disease related to schistosomiasis is significant, particulary in children, and it is advisable to screen this vulnerable population. What is New: • Eosinophilia may not be present in parasitic infections, so serological tests are crucial for screening migrant children. • Serological monitoring facilitates long-term management of migrant children with schistosomiasis.
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Affiliation(s)
- Paula Rodríguez-Molino
- General Paediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain
- Autonomous University of Madrid (UAM), Madrid, Spain
- Centro de Investigacion en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | | | - Jorge Bustamante Amador
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain
- Hospital Paediatrics Department, Childhood Infections, El Escorial Hospital, Madrid, Spain
- Health Centre Guzmán el Bueno, SERMAS, Madrid, Spain
| | - Isabel Mellado-Sola
- General Paediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain
- Autonomous University of Madrid (UAM), Madrid, Spain
| | | | - Iker Falces-Romero
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain
- Centro de Investigacion en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Department of Microbiology and Parasitology, La Paz University Hospital, Madrid, Spain
| | - Milagros García López-Hortelano
- General Paediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain
- Centro de Investigacion en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Translational Research Network in Paediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Jara Hurtado-Gallego
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain
- Centro de Investigacion en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - María José Mellado
- General Paediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain
- Autonomous University of Madrid (UAM), Madrid, Spain
- Centro de Investigacion en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Translational Research Network in Paediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Carlos Grasa
- General Paediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain
- Autonomous University of Madrid (UAM), Madrid, Spain
- Centro de Investigacion en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Talía Sainz
- General Paediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain.
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain.
- Autonomous University of Madrid (UAM), Madrid, Spain.
- Centro de Investigacion en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.
- Translational Research Network in Paediatric Infectious Diseases (RITIP), Madrid, Spain.
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Manca F, Ciminata G, Grieve E, Reboud J, Cooper J, McIntosh E. Cost-effectiveness of sentinel screening of endemic diseases alongside malaria diagnosis: A case study in schistosomiasis. PLoS Negl Trop Dis 2024; 18:e0012339. [PMID: 39074148 PMCID: PMC11309411 DOI: 10.1371/journal.pntd.0012339] [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: 04/19/2023] [Revised: 08/08/2024] [Accepted: 07/05/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND In countries where malaria is endemic, the use of rapid diagnostic tests(RDTs) has become routine, especially in rural settings. Such regions are characterised by often having other co-endemic infectious diseases, at high levels of prevalence. AIM To illustrate the potential added-value of "sentinel" screening for patients presenting for a routine diagnostic test for malaria, at healthcare facilities in Uganda. METHODS We developed an economic model by combining two decision trees, one for malaria and a second for the co-endemic disease schistosomiasis. The integrated model was designed to inform policy strategies for the co-endemic disease in addition to malaria (i.e., whether to test opportunistically for schistosomiasis or use mass drug administration(MDA) as per usual practice).We performed the analysis on three comparators varying testing accuracy and costs. RESULTS Sentinel screening can provide added value to the testing of patients compared with the status quo: when schistosomiasis prevalence is high then MDA is preferential; if low prevalence, treating no one is preferred. If the disease has average levels of prevalence, then a strategy involving testing is preferred. Prevalence thresholds driving the dominant strategy are dependent upon the model parameters, which are highly context specific. At average levels of prevalence for schistosomiasis and malaria for Uganda, adding a sentinel screening was cost-effective when the accuracy of test was higher than current diagnostics and when economies of scope were generated(Expected value clinical Information = 0.65$ per DALY averted, 137.91$ per correct diagnoses).Protocols using diagnostics with current accuracy levels were preferred only for levels of MDA coverage below 75%. CONCLUSION The importance of the epidemiological setting is crucial in determining the best cost-effective strategy for detecting endemic disease. Economies of scope can make sentinel screenings cost-effective strategies in specific contexts. Blanket thresholds recommended for MDA may not always be the preferred option for endemic diseases.
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Affiliation(s)
- Francesco Manca
- School of health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Giorgio Ciminata
- School of health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Eleanor Grieve
- School of health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Julien Reboud
- James Watt School of Engineering, University of Glasgow, Glasgow, United Kingdom
| | - Jonathan Cooper
- James Watt School of Engineering, University of Glasgow, Glasgow, United Kingdom
| | - Emma McIntosh
- School of health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Ally O, Kanoi BN, Ochola L, Nyanjom SG, Shiluli C, Misinzo G, Gitaka J. Schistosomiasis diagnosis: Challenges and opportunities for elimination. PLoS Negl Trop Dis 2024; 18:e0012282. [PMID: 38990839 PMCID: PMC11239039 DOI: 10.1371/journal.pntd.0012282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
OVERVIEW The roadmap adopted by the World Health Organization (WHO) for eliminating neglected tropical diseases aims to eliminate schistosomiasis, as a public health concern, by 2030. While progress has been made towards reducing schistosomiasis morbidity control in several sub-Saharan African countries, there is still more that needs to be done. Proper surveillance using accurate diagnostics with acceptable sensitivity and specificity is essential for evaluating the success of all efforts against schistosomiasis. Microscopy, despite its low sensitivity, remains the gold standard approach for diagnosing the disease. Although many efforts have been made to develop new diagnostics based on circulating parasite proteins, genetic markers, schistosome egg morphology, and their paramagnetic properties, none has been robust enough to replace microscopy. This review highlights common diagnostic approaches for detecting schistosomiasis in field and clinical settings, major challenges, and provides new and novel opportunities and diagnosis pathways that will be critical in supporting elimination of schistosomiasis. METHODS We searched for relevant and reliable published literature from PubMed, Scopus, google scholar, and Web of science. The search strategies were primarily determined by subtopic, and hence the following words were used (schistosom*, diagnosis, Kato-Katz, antibody test, circulating antigen, POC-CCA, UCP-LF-CAA, molecular diagnostics, nucleic acid amplification test, microfluidics, lab-on a disk, lab-on chip, recombinase polymerase amplification (RPA), LAMP, portable sequencer, nanobody test, identical multi-repeat sequences, diagnostic TPPs, REASSURED, extraction free), and Boolean operators AND and/OR were used to refine the searching capacity. Due to the global public health nature of schistosomiasis, we also searched for reliable documents, reports, and research papers published by international health organizations, World Health Organization (WHO), and Center for Disease control and Elimination.
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Affiliation(s)
- Ombeni Ally
- Department of Molecular Biology and Biotechnology, Pan African University Institute for Basic Sciences, Technology and Innovation (PAUSTI), Nairobi, Kenya
- Department of Biology, College of Natural and Mathematical Sciences, University of Dodoma, Dodoma, Tanzania
| | - Bernard N Kanoi
- Centre for Research in Infectious Diseases, College of Graduate Studies and Research, Mount Kenya University, General Kago Rd, Thika, Kenya
| | - Lucy Ochola
- Department of Tropical and Infectious Diseases, Institute of Primate Research, Nairobi, Kenya
| | - Steven Ger Nyanjom
- Department of Biochemistry, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Clement Shiluli
- Centre for Research in Infectious Diseases, College of Graduate Studies and Research, Mount Kenya University, General Kago Rd, Thika, Kenya
| | - Gerald Misinzo
- SACIDS Africa Center of Excellence for Infectious Diseases, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Jesse Gitaka
- Centre for Research in Infectious Diseases, College of Graduate Studies and Research, Mount Kenya University, General Kago Rd, Thika, Kenya
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Lamberti O, Kayuni S, Kumwenda D, Ngwira B, Singh V, Moktali V, Dhanani N, Wessels E, Van Lieshout L, Fleming FM, Mzilahowa T, Bustinduy AL. Female genital schistosomiasis burden and risk factors in two endemic areas in Malawi nested in the Morbidity Operational Research for Bilharziasis Implementation Decisions (MORBID) cross-sectional study. PLoS Negl Trop Dis 2024; 18:e0012102. [PMID: 38718065 PMCID: PMC11104661 DOI: 10.1371/journal.pntd.0012102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/20/2024] [Accepted: 03/25/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Female genital schistosomiasis (FGS), caused by the parasite Schistosoma haematobium (Sh), is prevalent in Sub-Saharan Africa. FGS is associated with sexual dysfunction and reproductive morbidity, and increased prevalence of HIV and cervical precancerous lesions. Lack of approved guidelines for FGS screening and diagnosis hinder accurate disease burden estimation. This study evaluated FGS burden in two Sh-endemic areas in Southern Malawi by visual and molecular diagnostic methods. METHODOLOGY/PRINCIPAL FINDINGS Women aged 15-65, sexually active, not menstruating, or pregnant, were enrolled from the MORBID study. A midwife completed a questionnaire, obtained cervicovaginal swab and lavage, and assessed FGS-associated genital lesions using hand-held colposcopy. 'Visual-FGS' was defined as specific genital lesions. 'Molecular-FGS' was defined as Sh DNA detected by real-time PCR from swabs. Microscopy detected urinary Sh egg-patent infection. In total, 950 women completed the questionnaire (median age 27, [IQR] 20-38). Visual-and molecular-FGS prevalence were 26·9% (260/967) and 8·2% (78/942), respectively. 6·5% of women with available genital and urinary samples (38/584) had egg-patent Sh infection. There was a positive significant association between molecular- and visual-FGS (AOR = 2·9, 95%CI 1·7-5·0). 'Molecular-FGS' was associated with egg-patent Sh infection (AOR = 7·5, 95% CI 3·27-17·2). Some villages had high 'molecular-FGS' prevalence, despite <10% prevalence of urinary Sh among school-age children. CONCLUSIONS/SIGNIFICANCE Southern Malawi carries an under-recognized FGS burden. FGS was detectable in villages not eligible for schistosomiasis control strategies, potentially leaving girls and women untreated under current WHO guidelines. Validated field-deployable methods could be considered for new control strategies.
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Affiliation(s)
- Olimpia Lamberti
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sekeleghe Kayuni
- Centre for Health, Agriculture and Development Research and Consulting (CHAD), Blantyre, Malawi
- MASM Medi Clinics Limited, Medical Aid Society of Malawi (MASM), Lilongwe, Malawi
- Malawi Liverpool Wellcome Programme (MLW), Kamuzu University of Health Sciences (KUHeS), Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Dingase Kumwenda
- Centre for Health, Agriculture and Development Research and Consulting (CHAD), Blantyre, Malawi
| | - Bagrey Ngwira
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Els Wessels
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisette Van Lieshout
- Department of Medical Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Themba Mzilahowa
- Centre for Health, Agriculture and Development Research and Consulting (CHAD), Blantyre, Malawi
| | - Amaya L. Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Rakotozandrindrainy R, Rakotoarivelo RA, Kislaya I, Marchese V, Rasamoelina T, Solonirina J, Ratiaharison EF, Razafindrakoto R, Razafindralava NM, Rakotozandrindrainy N, Radomanana M, Andrianarivelo MR, Klein P, Lorenz E, Jaeger A, Hoekstra PT, Corstjens PLAM, Schwarz NG, van Dam GJ, May J, Fusco D. Schistosome infection among pregnant women in the rural highlands of Madagascar: A cross-sectional study calling for public health interventions in vulnerable populations. PLoS Negl Trop Dis 2024; 18:e0011766. [PMID: 38626192 PMCID: PMC11051649 DOI: 10.1371/journal.pntd.0011766] [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: 11/03/2023] [Revised: 04/26/2024] [Accepted: 03/26/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Schistosomiasis is a parasitic infection highly prevalent in sub-Saharan Africa (SSA) with Madagascar being among the countries with highest burden of the disease worldwide. Despite WHO recommendations, suggesting treatment of pregnant women after the first trimester, this group is still excluded from Mass Drug Administration programs. Our study, had the objective to measure the prevalence of schistosome infection among pregnant women in Madagascar in order to inform public health policies for treatment in this vulnerable population. METHODS Women were recruited for this cross-sectional study between April 2019 and February 2020 when attending Antenatal Care Services (ANCs) at one of 42 included Primary Health Care Centers. The urine-based upconverting reporter particle, lateral flow (UCP-LF) test detecting circulating anodic antigen was used for the detection of schistosome infections. To identify factors associated with the prevalence of schistosome infection crude and adjusted prevalence ratios and 95% CIs were estimated using mixed-effect Poisson regression. RESULTS Among 4,448 participating women aged between 16 and 47 years, the majority (70.4%, 38 n = 3,133) resided in rural settings. Overall, the prevalence of schistosome infection was 55.9% (n = 2486, CI 95%: 53.3-58.5). A statistically significant association was found with age group (increased prevalence in 31-47 years old, compared to 16-20 years old (aPR = 1.15, CI 95%: 1.02-1.29) and with uptake of antimalaria preventive treatment (decreased prevalence, aPR = 0.85, CI 95%: 0.77-0.95). No other associations of any personal characteristics or contextual factors with schistosome infection were found in our multivariate regression analysis. DISCUSSION AND CONCLUSION The high prevalence of schistosome infection in pregnant women supports the consideration of preventive schistosomiasis treatment in ANCs of the Malagasy highlands. We strongly advocate for adapting schistosomiasis programs in highly endemic contexts. This, would contribute to both the WHO and SDGs agendas overall to improving the well-being of women and consequently breaking the vicious cycle of poverty perpetuated by schistosomiasis.
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Affiliation(s)
| | | | - Irina Kislaya
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Valentina Marchese
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | | | | | | | | | | | | | - Mickael Radomanana
- Infectious diseases service, University Hospital Tambohobe, Fianarantsoa, Madagascar
| | | | - Philipp Klein
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Eva Lorenz
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Anna Jaeger
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | | | | | - Norbert Georg Schwarz
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
| | | | - Jürgen May
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Daniela Fusco
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
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Zacharia A, Kinabo C, Makene T, Omary H, Ogweno G, Lyamuya F, Ngasala B. Accuracy and precision of dried urine spot method for the detection of Schistosoma mansoni circulating cathodic antigens in resource-limited settings. Infect Dis Poverty 2024; 13:15. [PMID: 38369522 PMCID: PMC10874577 DOI: 10.1186/s40249-024-01183-7] [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: 11/13/2023] [Accepted: 01/31/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND The World Health Organization recommends the use of Schisto point-of-care circulating cathodic antigens (Schisto POC-CCA) for screening of Schistosoma mansoni as it offers better sensitivity than microscopy. However, there are limitation facing the use of this method including timely availability of the test cassettes. The aim of this study was to determine the reliability of dried urine spot (DUS) method for collection of urine and detection of S. mansoni using Schisto POC-CCA cassettes in a resource-limited settings. METHODS A cross-sectional study was conducted between October and November 2022 among 250 primary school children in Sengerema District, northwestern Tanzania. S. mansoni CCA was detected in filter paper-based DUS, liquid urine using DUS Schisto POC-CCA (index), and direct urine Schisto POC-CCA (comparator) methods respectively. S. mansoni eggs in stool were detected using duplicate Kato-Katz (KK) method. The measures of accuracy were computed and compared between the index and comparator methods. The strength of agreement between inter-raters precisions was tested using Cohen's kappa (k). RESULTS This study revealed S. mansoni prevalence rates of 28.8%, 54.0% and 50.8% by duplicate KK, direct urine Schisto POC-CCA and DUS Schisto POC-CCA methods respectively. The mean intensity of infection among infected participants was 86.3 eggs per gram of stool (EPG) ranging from 12.0 EPG to 824.0 EPG. The sensitivity of DUS Schisto POC-CCA and direct urine Schisto POC-CCA was 94.44% (95% CI: 89.15-99.74%) and 97.22% (95% CI: 93.43-100.00%) respectively. The DUS Schisto POC-CCA method had slightly higher specificity (66.85%) than direct urine Schisto POC-CCA method (63.48%). The accuracy of the DUS Schisto POC-CCA was found to be slightly high (74.80%, 95% CI: 68.94-79.06%) compared to that of direct urine Schisto POC-CCA (73.20%, 95% CI: 67.25-78.59%). There was good agreement between two laboratory technologists who performed the DUS Schisto POC-CCA method on similar samples (k = 0.80, 95% CI: 0.59-0.95). CONCLUSIONS The DUS Schisto POC-CCA method had comparable S. mansoni detection accuracy to direct urine Schisto POC-CCA. This suggests that the method could be a potential alternative to direct urine Schisto POC-CCA for screening S. mansoni in resource-limited situations.
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Affiliation(s)
- Abdallah Zacharia
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Clemence Kinabo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Twilumba Makene
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Huda Omary
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - George Ogweno
- National Institute for Medical Research, Mwanza, Tanzania
| | - Faraja Lyamuya
- Neglected Tropical Diseases Control Program, Ministry of Health, Dodoma, Tanzania
| | - Billy Ngasala
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Meulah B, Oyibo P, Hoekstra PT, Moure PAN, Maloum MN, Laclong-Lontchi RA, Honkpehedji YJ, Bengtson M, Hokke C, Corstjens PLAM, Agbana T, Diehl JC, Adegnika AA, van Lieshout L. Validation of artificial intelligence-based digital microscopy for automated detection of Schistosoma haematobium eggs in urine in Gabon. PLoS Negl Trop Dis 2024; 18:e0011967. [PMID: 38394298 PMCID: PMC10917302 DOI: 10.1371/journal.pntd.0011967] [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: 10/24/2023] [Revised: 03/06/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Schistosomiasis is a significant public health concern, especially in Sub-Saharan Africa. Conventional microscopy is the standard diagnostic method in resource-limited settings, but with limitations, such as the need for expert microscopists. An automated digital microscope with artificial intelligence (Schistoscope), offers a potential solution. This field study aimed to validate the diagnostic performance of the Schistoscope for detecting and quantifying Schistosoma haematobium eggs in urine compared to conventional microscopy and to a composite reference standard (CRS) consisting of real-time PCR and the up-converting particle (UCP) lateral flow (LF) test for the detection of schistosome circulating anodic antigen (CAA). METHODS Based on a non-inferiority concept, the Schistoscope was evaluated in two parts: study A, consisting of 339 freshly collected urine samples and study B, consisting of 798 fresh urine samples that were also banked as slides for analysis with the Schistoscope. In both studies, the Schistoscope, conventional microscopy, real-time PCR and UCP-LF CAA were performed and samples with all the diagnostic test results were included in the analysis. All diagnostic procedures were performed in a laboratory located in a rural area of Gabon, endemic for S. haematobium. RESULTS In study A and B, the Schistoscope demonstrated a sensitivity of 83.1% and 96.3% compared to conventional microscopy, and 62.9% and 78.0% compared to the CRS. The sensitivity of conventional microscopy in study A and B compared to the CRS was 61.9% and 75.2%, respectively, comparable to the Schistoscope. The specificity of the Schistoscope in study A (78.8%) was significantly lower than that of conventional microscopy (96.4%) based on the CRS but comparable in study B (90.9% and 98.0%, respectively). CONCLUSION Overall, the performance of the Schistoscope was non-inferior to conventional microscopy with a comparable sensitivity, although the specificity varied. The Schistoscope shows promising diagnostic accuracy, particularly for samples with moderate to higher infection intensities as well as for banked sample slides, highlighting the potential for retrospective analysis in resource-limited settings. TRIAL REGISTRATION NCT04505046 ClinicalTrials.gov.
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Affiliation(s)
- Brice Meulah
- Leiden University Center for Infectious Diseases (LUCID), Leiden University Medical Center, Leiden, The Netherlands
- Centre de Recherches Médicales des Lambaréné, CERMEL, Lambaréné, Gabon
| | - Prosper Oyibo
- Mechanical, Maritime and Material Engineering, Delft University of Technology, Delft, The Netherlands
| | - Pytsje T. Hoekstra
- Leiden University Center for Infectious Diseases (LUCID), Leiden University Medical Center, Leiden, The Netherlands
| | - Paul Alvyn Nguema Moure
- Centre de Recherches Médicales des Lambaréné, CERMEL, Lambaréné, Gabon
- Ecole doctorale régionale d’Afrique centrale en infectiologie tropicale de Franceville, Gabon
| | | | | | - Yabo Josiane Honkpehedji
- Leiden University Center for Infectious Diseases (LUCID), Leiden University Medical Center, Leiden, The Netherlands
- Centre de Recherches Médicales des Lambaréné, CERMEL, Lambaréné, Gabon
- Fondation pour la Recherche Scientifique, Cotonou, Benin
| | - Michel Bengtson
- Leiden University Center for Infectious Diseases (LUCID), Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelis Hokke
- Leiden University Center for Infectious Diseases (LUCID), 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
| | - Temitope Agbana
- Mechanical, Maritime and Material Engineering, Delft University of Technology, Delft, The Netherlands
| | - Jan Carel Diehl
- Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Ayola Akim Adegnika
- Leiden University Center for Infectious Diseases (LUCID), Leiden University Medical Center, Leiden, The Netherlands
- Centre de Recherches Médicales des Lambaréné, CERMEL, Lambaréné, Gabon
- Ecole doctorale régionale d’Afrique centrale en infectiologie tropicale de Franceville, Gabon
- Fondation pour la Recherche Scientifique, Cotonou, Benin
- Institut fur Tropenmedizin, Universitat Tubingen, Tubingen, Germany
| | - Lisette van Lieshout
- Leiden University Center for Infectious Diseases (LUCID), Leiden University Medical Center, Leiden, The Netherlands
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8
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Zacharia A, Makene T, Kinabo C, Ogweno G, Lyamuya F, Ngasala B. Dried urine spot method for detection of Schistosoma mansoni circulating cathodic antigen in resource-limited settings: a proof of concept study. Front Immunol 2023; 14:1216710. [PMID: 37753086 PMCID: PMC10518387 DOI: 10.3389/fimmu.2023.1216710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/28/2023] [Indexed: 09/28/2023] Open
Abstract
Background Among the challenges in schistosomiasis surveillance and mapping surveys is the lack of a sensitive diagnostic method especially in low transmission setting. Currently, the WHO recommends the use point-of-care circulating cathodic antigen (Schisto POC-CCA) tests for surveillance and mapping of intestinal schistosomiasis. However, Schisto POC-CCA test has its drawbacks, one of which is the timely availability of test kits. One approach to overcoming this challenge is to develop a low-cost sampling method that allows for the collection and transport of urine specimens even in resource-limited settings. Objective To develop a simple and efficient method for the collection and detection of Schistosoma mansoni (S. mansoni) CCA using urine spotted onto filter paper. Methodology To develop a dried urine spot (DUS) method, various dried matrix extraction parameters were tested and optimized using predesigned steps. The parameters include the size of filter paper (determined by the number of punches), volume of solvents, and type of solvent. Moreover, we optimized the incubation conditions (time and temperature). Urine and stool specimens to conduct the experiments were collected from volunteer fishermen in Mwanza and this project staff. Data were entered into the Microsoft Excel spreadsheet and IBM Statistical Package for the Social Sciences, version 20 for analysis. Results The optimal results were obtained when the procedure was run under the following conditions: Five punches of filter paper containing DUS were dissolved in 150 µl of distilled water and incubated at room temperature for 24 hours in an Eppendorf tube. More than 93% of the assays performed under these conditions produced results that were either comparable to or significantly better than the standard method. Conclusion This study demonstrates the feasibility of collecting urine specimen (DUS) using filter paper and detecting Schistosoma CCA from DUS specimen using the Schisto POC-CCA cassette test.
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Affiliation(s)
- Abdallah Zacharia
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Twilumba Makene
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Clemence Kinabo
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - George Ogweno
- National Institute for Medical Research, Mwanza, Tanzania
| | - Faraja Lyamuya
- Neglected Tropical Diseases Control Program, Ministry of Health, Dodoma, Tanzania
| | - Billy Ngasala
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Makau-Barasa L, Assefa L, Aderogba M, Bell D, Solomon J, Urude RO, Nebe OJ, A-Enegela J, Damen JG, Popoola S, Diehl JC, Vdovine G, Agbana T. Performance evaluation of the AiDx multi-diagnostic automated microscope for the detection of schistosomiasis in Abuja, Nigeria. Sci Rep 2023; 13:14833. [PMID: 37684541 PMCID: PMC10491799 DOI: 10.1038/s41598-023-42049-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/05/2023] [Indexed: 09/10/2023] Open
Abstract
In this research, we report on the performance of automated optical digital detection and quantification of Schistosoma haematobium provided by AiDx NTDx multi-diagnostic Assist microscope. Our study was community-based, and a convenient sampling method was used in 17 communities in Abuja Nigeria, based on the disease prevalence information extracted from the baseline database on schistosomiasis, NTD Division, of the Federal Ministry of Health. At baseline, samples from 869 participants were evaluated of which 358 (34.1%) tested S. haematobium positive by the reference diagnostic standard. Registered images from the fully automated (autofocusing, scanning, image registration and processing, AI image analysis and automatic parasite count) AiDx assist microscope were analyzed. The Semi automated (autofocusing, scanning, image registration & processing and manual parasite count) and the fully automated AiDx Assist showed comparable sensitivities and specificities of [90.3%, 98%] and [89%, 99%] respectively. Overall, estimated egg counts of the semi-automated & fully automated AiDx Assist correlated significantly with the egg counts of conventional microscopy (r = 0.93, p ≤ 0.001 and r = 0.89, p ≤ 0.001 respectively). The AiDx Assist device performance is consistent with requirement of the World Health Organization diagnostic target product profile for monitoring, evaluation, and surveillance of Schistosomiasis elimination Programs.
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Affiliation(s)
| | - Liya Assefa
- The Ending Neglected Diseases (END) Fund, New York, USA
| | | | | | - Jacob Solomon
- NTD Division, Federal Ministry of Health, Abuja, Nigeria
| | | | | | | | - James G Damen
- Medical Lab Department, University of Jos, Jos, Nigeria
| | | | | | - Gleb Vdovine
- Delft University of Technology, Delft, The Netherlands
| | - Temitope Agbana
- AiDx Medical Bv, Pijnacker, The Netherlands.
- Delft University of Technology, Delft, The Netherlands.
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10
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A review on innovative optical devices for the diagnosis of human soil-transmitted helminthiasis and schistosomiasis: from research and development to commercialization. Parasitology 2023; 150:137-149. [PMID: 36683384 PMCID: PMC10090604 DOI: 10.1017/s0031182022001664] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Diagnosis of soil-transmitted helminth (STH) and schistosome infections relies largely on conventional microscopy which has limited sensitivity, requires highly trained personnel and is error-prone. Rapid advances in miniaturization of optical systems, sensors and processors have enhanced research and development of digital and automated microscopes suitable for the detection of these diseases in resource-limited settings. While some studies have reported proof-of-principle results, others have evaluated the performance of working prototypes in field settings. The extensive commercialization of these innovative devices has, however, not yet been achieved. This review provides an overview of recent publications (2010–2022) on innovative field applicable optical devices which can be used for the diagnosis of STH and schistosome infections. Using an adapted technology readiness level (TRL) scale taking into account the WHO target product profile (TPP) for these diseases, the developmental stages of the devices were ranked to determine the readiness for practical applications in field settings. From the reviewed 18 articles, 19 innovative optical devices were identified and ranked. Almost all of the devices (85%) were ranked with a TRL score below 8 indicating that, most of the devices are not ready for commercialization and field use. The potential limitations of these innovative devices were discussed. We believe that the outcome of this review can guide the end-to-end development of automated digital microscopes aligned with the WHO TPP for the diagnosis of STH and schistosome infections in resource-limited settings.
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11
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Limited efficacy of repeated praziquantel treatment in Schistosoma mansoni infections as revealed by highly accurate diagnostics, PCR and UCP-LF CAA (RePST trial). PLoS Negl Trop Dis 2022; 16:e0011008. [PMID: 36548444 PMCID: PMC9822103 DOI: 10.1371/journal.pntd.0011008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 01/06/2023] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Most studies assessing praziquantel (PZQ) efficacy have used relatively insensitive diagnostic methods, thereby overestimating cure rate (CR) and intensity reduction rate (IRR). To determine accurately PZQ efficacy, we employed more sensitive DNA and circulating antigen detection methods. METHODOLOGY A sub-analysis was performed based on a previously published trial conducted in children from Côte d'Ivoire with a confirmed Schistosoma mansoni infection, who were randomly assigned to a standard (single dose of PZQ) or intense treatment group (4 repeated doses of PZQ at 2-week intervals). CR and IRR were estimated based on PCR detecting DNA in a single stool sample and the up-converting particle lateral flow (UCP-LF) test detecting circulating anodic antigen (CAA) in a single urine sample, and compared with traditional Kato-Katz (KK) and point-of-care circulating cathodic antigen (POC-CCA). PRINCIPAL FINDINGS Individuals positive by all diagnostic methods (i.e., KK, POC-CCA, PCR, and UCP-LF CAA) at baseline were included in the statistical analysis (n = 125). PCR showed a CR of 45% (95% confidence interval (CI) 32-59%) in the standard and 78% (95% CI 66-87%) in the intense treatment group, which is lower compared to the KK results (64%, 95% CI 52-75%) and 88%, 95% CI 78-93%). UCP-LF CAA showed a significantly lower CR in both groups, 16% (95% CI 11-24%) and 18% (95% CI 12-26%), even lower than observed by POC-CCA (31%, 95% CI 17-35% and 36%, 95% CI 26-47%). A substantial reduction in DNA and CAA-levels was observed after the first treatment, with no further decrease after additional treatment and no significant difference in IRR between treatment groups. CONCLUSION/SIGNIFICANCE The efficacy of (repeated) PZQ treatment was overestimated when using egg-based diagnostics (i.e. KK and PCR). Quantitative worm-based diagnostics (i.e. POC-CCA and UCP-LF CAA) revealed that active Schistosoma infections are still present despite multiple treatments. These results stress the need for using accurate diagnostic tools to monitor different PZQ treatment strategies, in particular when moving toward elimination of schistosomiasis. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov, NCT02868385.
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Hoekstra PT, Madinga J, Lutumba P, van Grootveld R, Brienen EAT, Corstjens PLAM, van Dam GJ, Polman K, van Lieshout L. Diagnosis of Schistosomiasis without a Microscope: Evaluating Circulating Antigen (CCA, CAA) and DNA Detection Methods on Banked Samples of a Community-Based Survey from DR Congo. Trop Med Infect Dis 2022; 7:tropicalmed7100315. [PMID: 36288056 PMCID: PMC9608707 DOI: 10.3390/tropicalmed7100315] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
Detection of Schistosoma eggs in stool or urine is known for its low sensitivity in diagnosing light infections. Alternative diagnostics with better sensitivity while remaining highly specific, such as real-time PCR and circulating antigen detection, are progressively used as complementary diagnostic procedures but have not yet replaced microscopy. This study evaluates these alternative methods for the detection of Schistosoma infections in the absence of microscopy. Schistosomiasis presence was determined retrospectively in 314 banked stool and urine samples, available from a previous survey on the prevalence of taeniasis in a community in the Democratic Republic of the Congo, using real-time PCR, the point-of-care circulating cathodic antigen (POC-CCA) test, as well as the up-converting particle lateral flow circulating anodic antigen (UCP-LF CAA) test. Schistosoma DNA was present in urine (3%) and stool (28%) samples, while CCA (28%) and CAA (69%) were detected in urine. Further analysis of the generated data indicated stool-based PCR and the POC-CCA test to be suitable diagnostics for screening of S. mansoni infections, even in the absence of microscopy. A substantial proportion (60%) of the 215 CAA-positive cases showed low antigen concentrations, suggesting that even PCR and POC-CCA underestimated the “true” number of schistosome positives.
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Affiliation(s)
- Pytsje T. Hoekstra
- Department of Parasitology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Correspondence:
| | - Joule Madinga
- Institute of Health and Society, Université Catholique de Louvain, 1348 Brussels, Belgium
- Department of Biomedical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Pascal Lutumba
- Institut National de Recherche Biomédicale, Kinshasa 1197, Democratic Republic of the Congo
- Department of Tropical Medicine, University of Kinshasa, Kinshasa 7948, Democratic Republic of the Congo
| | - Rebecca van Grootveld
- Department of Clinical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Eric A. T. Brienen
- Department of Parasitology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Paul L. A. M. Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Govert J. van Dam
- Department of Parasitology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Katja Polman
- Department of Biomedical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
- Department of Health Sciences, VU University Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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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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