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Zulu G, Sikasunge CS, Welte TM, Simuunza MC, Stelzle D, Schmidt V, Hachangu A, Mutale W, Masuku M, Chembensofu M, da Costa CP, Mwape KE, Winkler AS, Phiri IK. Epidemiology of intestinal helminthiasis with an emphasis on taeniasis in Chipata district of the Eastern province of Zambia. PLoS Negl Trop Dis 2023; 17:e0011561. [PMID: 37983246 PMCID: PMC10695371 DOI: 10.1371/journal.pntd.0011561] [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: 07/31/2023] [Revised: 12/04/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Intestinal helminth infections are among the most common infections worldwide and have a negative impact on the health, education, nutrition and economic development of affected populations. This study aimed to estimate the prevalence of intestinal helminthiasis, including T. solium taeniasis, using a large-scale community-based study in Chiparamba area of Chipata District in the Eastern province of Zambia. METHODS/PRINCIPAL FINDINGS A cross-sectional study was conducted between June 2019 and December 2022 in a rural community of 25 randomly selected villages known to be at risk for T. solium infection. Stool samples were examined for intestinal helminths using the formol-ether concentration technique and further tested for taeniasis by copro antigen-ELISA (copro Ag-ELISA). Descriptive statistical analyses were conducted, and associations between the disease prevalence of active infections and individual- and village-level variables were determined using the chi-square or Fisher's exact test. Predictors of an individual being positive for either taeniasis or other soil-transmitted helminths were determined using binary logistic regression. A total of 2762 stool samples were examined. One hundred ninety-five (7.1%) tested positive for at least one helminthic parasite on microscopy, with hookworm being the most frequent 84 (3.0%), followed by S. mansoni, 66 (2.4%). For taeniasis, 11 (0.4%) participants were positive for Taenia spp. microscopically, while 241 (8.7%) tested positive via copro Ag-ELISA. On bivariate analysis, male sex was significantly associated with the prevalence of intestinal parasites (p = 0.012) but not with that of taeniasis based on copro Ag-ELISA results. Village level differences were significant for infection with intestinal helminths as well as for taeniasis positivity on copro Ag-ELISA (p <0.001). CONCLUSION Intestinal helminths, including T. solium taeniasis, are prevalent in Chiparamba area of Chipata district in the eastern province of Zambia, supporting the clear need for further targeted public health interventions for surveillance and control.
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Affiliation(s)
- Gideon Zulu
- Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Chummy S. Sikasunge
- Department of Para-clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Tamara M. Welte
- Department of Neurology, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Epilepsy Centre, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
- Centre for Global Health, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Martin C. Simuunza
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Dominik Stelzle
- Department of Neurology, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Centre for Global Health, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Veronika Schmidt
- Department of Neurology, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Centre for Global Health, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Alex Hachangu
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Wilbroad Mutale
- Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Maxwell Masuku
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Mwelwa Chembensofu
- Department of Para-clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Clarissa Prazeres da Costa
- Centre for Global Health, School of Medicine and Health, Technical University of Munich, Munich, Germany
- German Center for Infection Research (DZIF), Munich site, Munich, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Kabemba E. Mwape
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Andrea S. Winkler
- Department of Neurology, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Centre for Global Health, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Isaac K. Phiri
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
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Halwiindi H, Chooka L, Phiri MM, Tapisha B, Masenga SK, Mudenda J, Chimfwembe K, Mugode M, Hamooya BM. Reach and uptake of mass drug administration for worm infections through health facility-, school-, and community-based approaches in two districts of Zambia: a call for scale-up. Epidemiol Infect 2023; 151:e183. [PMID: 37288508 PMCID: PMC10644052 DOI: 10.1017/s0950268823000912] [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: 08/09/2022] [Revised: 05/11/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023] Open
Abstract
Helminthiases cause significant health deficiencies among children. Mass administration of anthelminthic drugs has had significant results to counter these effects. We assessed the effects on and determinants of treatment coverage of community-directed treatment among children in Zambia, using cross-sectional survey data, and using chi-square test and multilevel mixed-effects model. Of 1,416 children, 51.5% were males and 48.5% were females, while 52.7%, were school-age, and 47.3% were preschool-age. Overall treatment coverage was 53.7% (95% confidence interval (CI) 51.1, 56.4). More preschool-age children were treated compared to school-age ones, 65.2% versus 43.4%, P < 0.001. Similarly, more children under community-directed intervention were treated compared to regular mass drug administration (65.2% versus 51.1 %, P < 0.001). Treatment among school-age participants was associated with being male (Adjusted Odds Ratio (AOR 1.83, 95%CI 1.23-2.72), receiving community-directed treatment (AOR 5.53; 95%CI 3.41-8.97), and shorter distance to health facility (AOR 2.20; 95%CI 1.36-3.56). Among preschool-aged participants, treatment was associated with being residents of Siavonga district (AOR 0.03; 95%CI 0.01-0.04) and shorter distance to health facility (AOR 0.35; 95%CI 0.21-0.59). Community-directed treatment can be used to increase treatment coverage, thereby contribute to 2030 vision of ending epidemics of neglected tropical diseases.
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Affiliation(s)
| | - Lubombo Chooka
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Masauso Moses Phiri
- School of Medicine, Department of Pathology and Microbiology, University of Zambia, Lusaka, Zambia
| | - Buumba Tapisha
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Sepiso K. Masenga
- School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
| | - Jolezya Mudenda
- School of Medicine, Department of Pathology and Microbiology, University of Zambia, Lusaka, Zambia
| | | | - Mwitwa Mugode
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Benson M. Hamooya
- School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
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Tembo R, Muleya W, Yabe J, Kainga H, Nalubamba KS, Zulu M, Mwaba F, Saad SA, Kamwela M, Mukubesa AN, Monde N, Kallu SA, Mbewe N, Phiri AM. Prevalence and Molecular Identification of Schistosoma haematobium among Children in Lusaka and Siavonga Districts, Zambia. Trop Med Infect Dis 2022; 7:tropicalmed7090239. [PMID: 36136650 PMCID: PMC9505432 DOI: 10.3390/tropicalmed7090239] [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: 08/15/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 11/25/2022] Open
Abstract
Schistosomiasis remains a public health concern in Zambia. Urinary schistosomiasis caused by Schistosoma haematobium is the most widely distributed infection. The aim of the current study was to determine the prevalence and risk factors of urinary schistosomiasis and identify the strain of S. haematobium among children in the Siavonga and Lusaka districts in Zambia. Urine samples were collected from 421 primary school children and S. haematobium eggs were examined under light microscopy. A semi-structured questionnaire was used to obtain information on the socio-demographic characteristics and the potential risk factors for urinary schistosomiasis. DNA of the parasite eggs was extracted from urine samples and the internal transcribed spacer gene was amplified, sequenced and phylogenetically analysed. The overall prevalence of S. haematobium was 9.7% (41/421) (95% CI: 7.16–13.08), male participants made up 6.2% (26/232) (95% CI: 4.15–9.03), having a higher burden of disease than female participants who made up 3.5% (15/421) (95% CI: 2.01–5.94). The age group of 11–15 years had the highest overall prevalence of 8.3% (35/421) (5.94–11.48). Participants that did not go fishing were 0.008 times less likely to be positive for schistosomiasis while participants whose urine was blood-tinged or cloudy on physical examination and those that lived close to water bodies were 9.98 and 11.66 times more likely to test positive for schistosomiasis, respectively. A phylogenetic tree analysis indicated that S. haematobium isolates were closely related to pure S. haematobium from Zimbabwe and hybrids of S. haematobium × S. bovis from Benin, Senegal and Malawi. The current study shows that urinary schistosomiasis is endemic in the study areas and is associated with water contact, and S. haematobium isolated is closely related to hybrids of S. bovis × S. haematobium strain, indicating the zoonotic potential of this parasite.
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Affiliation(s)
- Rabecca Tembo
- Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka P.O. Box 50110, Zambia
- Department of Clinical Sciences, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 32379, Zambia
- Africa Center of Excellence for Infectious Diseases of Humans, University of Zambia, Lusaka P.O Box 32379, Zambia
- Correspondence: ; Tel.: 26-097-8363-271
| | - Walter Muleya
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 32379, Zambia
| | - John Yabe
- Department of Para Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 32379, Zambia
- School of Veterinary Medicine, University of Namibia, P.O. Box 13301, Windhoek 1005, Namibia
| | - Henson Kainga
- Department of Veterinary Epidemiology and Public Health, Faculty of Veterinary Medicine, Lilongwe University of Agriculture and Natural Resources, Lilongwe 207203, Malawi or
- Department of Disease Control, School of Veterinary Medicine, Zambia Animals, University of Zambia, Lusaka P.O. Box 32379, Zambia
| | - King S. Nalubamba
- Department of Clinical Sciences, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 32379, Zambia
| | - Mildred Zulu
- Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka P.O. Box 50110, Zambia
- Africa Center of Excellence for Infectious Diseases of Humans, University of Zambia, Lusaka P.O Box 32379, Zambia
| | - Florence Mwaba
- Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka P.O. Box 50110, Zambia
- Africa Center of Excellence for Infectious Diseases of Humans, University of Zambia, Lusaka P.O Box 32379, Zambia
| | - Shereen Ahmed Saad
- Africa Center of Excellence for Infectious Diseases of Humans, University of Zambia, Lusaka P.O Box 32379, Zambia
- Department of Para Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 32379, Zambia
- Department of Clinical Studies, College of Veterinary Science, University of Bahr El Ghazal, Wau P.O. Box 10739, South Sudan
| | - Moses Kamwela
- Department of Pharmacology, Faculty of Pharmacy, Lusaka Apex Medical University, Lusaka P.O. Box 31909, Zambia
| | - Andrew N. Mukubesa
- Department of Disease Control, School of Veterinary Medicine, Zambia Animals, University of Zambia, Lusaka P.O. Box 32379, Zambia
| | - Ngula Monde
- Department of Biomedical Sciences, Tropical Diseases Research Centre, Ndola P.O. Box 71769, Zambia
| | - Simegnew Adugna Kallu
- Department of Disease Control, School of Veterinary Medicine, Zambia Animals, University of Zambia, Lusaka P.O. Box 32379, Zambia
- College of Veterinary Medicine, Haramaya University, Dire Dawa P.O. Box 138, Ethiopia
| | - Natalia Mbewe
- Department of Disease Control, School of Veterinary Medicine, Zambia Animals, University of Zambia, Lusaka P.O. Box 32379, Zambia
- Department of Basic and Clinical Nursing Sciences, School of Nursing Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Andrew M. Phiri
- Department of Clinical Sciences, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 32379, Zambia
- Africa Center of Excellence for Infectious Diseases of Humans, University of Zambia, Lusaka P.O Box 32379, Zambia
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Gender-related differences in prevalence, intensity and associated risk factors of Schistosoma infections in Africa: A systematic review and meta-analysis. PLoS Negl Trop Dis 2021; 15:e0009083. [PMID: 34788280 PMCID: PMC8635327 DOI: 10.1371/journal.pntd.0009083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 12/01/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Schistosomiasis remains a global-health problem with over 90% of its burden concentrated in Africa. Field studies reflect the complex ways in which socio-cultural and socio-economic variables, affect the distribution of Schistosoma infections across different populations. This review set out to systematically investigate and quantify the differences in Schistosoma infection burdens between males and females in Africa for two of the most prevalent Schistosoma species-Schistosoma mansoni and Schistosoma haematobium. METHODOLOGY We searched (from inception to 11th March 2020) Embase, MEDLINE, PubMed, and Web of Science for relevant studies on schistosomiasis. We included studies that report S. mansoni and/or S. haematobium prevalence and/or intensity data distributed between males and females. We conducted meta-analyses on the male to female (M:F) prevalence of infection ratios. Subgroup analyses were performed according to study baseline prevalence, sample size and the lower and upper age limit of study participants. We also present a descriptive analysis of differential risk and intensity of infection across males and females. Evidence for differences in the prevalence of schistosomiasis infection between males and females is presented, stratified by Schistosoma species. RESULT We identified 128 relevant studies, with over 200,000 participants across 23 countries. Of all the reported differences in the prevalence of infection between males and females, only 41% and 34% were statistically significant for S. mansoni and S. haematobium, respectively. Similar proportions of studies (27% and 34% for for S. haematobium and S. mansoni, respectively) of the reported differences in intensity of infection between males and females were statistically significant. The meta-analyses summarized a higher prevalence of infection in males; pooled random-effects weighted M:F prevalence of infection ratios were 1.20 (95% CI 1.11-1.29) for S. haematobium and 1.15 (95% CI 1.08-1.22) for S. mansoni. However, females are underrespresented in some of the studies. Additionally, there was significant heterogeneity across studies (Higgins I2 statistic (p-values < 0.001, I2values>95%)). Results of the subgroup analysis showed that the baseline prevalence influenced the M:F prevalence ratios for S. haematobium and S. mansoni, with higher M:F prevalence of infection ratios in settings with a lower baseline prevalence of infection. Across the studies, we identified four major risk factors associated with infection rates: occupational and recreational water contact, knowledge, socio-economic factors and demographic factors. The effect of these risk factors on the burden of infection in males and females varied across studies. CONCLUSIONS We find evidence of differences in prevalence of infection between males and females which may reflect differences in gender norms and water contact activities, suggesting that policy changes at the regional level may help ameliorate gender-related disparities in schistosomiasis infection burden. Collecting, robustly analysing, and reporting, sex-disaggregated epidemiological data, is currently lacking, but would be highly informative for planning effective treatment programmes and establishing those most at risk of schistosomiasis infections.
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Furch BD, Mwakamui S, Sianongo S, Zyambo K, Heimburger DC, Koethe JR, Kelly P. Contribution of Schistosoma mansoni to systemic inflammation and microbial translocation among people with HIV in Zambia. Trans R Soc Trop Med Hyg 2021; 116:179-186. [PMID: 34263318 DOI: 10.1093/trstmh/trab103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/31/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Schistosoma mansoni is hyperendemic in many rural areas of Zambia where up to 77% of people are positive for infection via serologic evaluation. Zambia also has a high prevalence of HIV infection. Individually, S. mansoni and HIV infection impair gastrointestinal barrier integrity and induce inflammation, but the effects of coinfection are not well understood. We set out to test the hypothesis that HIV would exacerbate intestinal barrier failure in patients with S. mansoni infection. METHODS Adults attending medical outpatient clinics in Kaoma, Western Province, Zambia, were enrolled in a case-control study to determine the relative contributions of schistosomiasis and HIV to microbial translocation (measured as soluble CD14 [sCD14] and lipopolysaccharide binding protein [LBP]) and inflammation (measured as CRP). RESULTS Among 152 adults evaluated, 74 (49%) were HIV-seropositive, 45 (29%) were shedding schistosome ova (Kato-Katz), 120 (81%) were seropositive for schistosome antibodies (i.e. prior or current infection, with or without egg shedding) and 16 (11%) were HIV/schistosome coinfected (defined by Kato-Katz). HIV infection was associated with higher circulating sCD14 concentrations (p=0.003 by Kruskal-Wallis test), but schistosomiasis was not. HIV infection was associated with greater exposure to schistosomes assessed serologically (OR=2.48, 95% CI 1.05 to 5.86; p=0.03), but reduced likelihood of egg shedding (OR 0.47, 95% CI 0.21 to 1.01; p=0.03). CONCLUSIONS There was no evidence for a compounding or synergistic effect of coinfection on microbial translocation that appeared to be correlated with HIV infection. Further studies are needed to understand how the increase in LBP secondary to HIV infection may decrease schistosome egg excretion in coinfected individuals.
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Affiliation(s)
- Briana D Furch
- Tropical Gastroenterology & Nutrition Group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia.,Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Simutanyi Mwakamui
- Tropical Gastroenterology & Nutrition Group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia
| | - Sandie Sianongo
- University Teaching Hospital, Nationalist Rd, Lusaka, Zambia
| | - Kanekwa Zyambo
- Tropical Gastroenterology & Nutrition Group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia
| | - Douglas C Heimburger
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA.,Department of Internal Medicine, University of Zambia School of Medicine Nationalist Rd, Lusaka, Zambia
| | - John R Koethe
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Paul Kelly
- Tropical Gastroenterology & Nutrition Group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia.,Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, Turner Street, London E1 2AD, UK
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Russell HJ, Penney JMS, Linder C, Joekes EC, Bustinduy AL, Stothard JR, Rakotomampianina DAL, Andriamasy EH, Mahary LR, Ranjanoro EP, Rahetilahy AM, Spencer SA. A cross-sectional study of periportal fibrosis and Schistosoma mansoni infection among school-aged children in a hard-to-reach area of Madagascar. Trans R Soc Trop Med Hyg 2021; 114:315-322. [PMID: 32181487 DOI: 10.1093/trstmh/traa009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/14/2019] [Accepted: 01/16/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND A cross-sectional survey was performed to estimate the prevalence of periportal fibrosis in children based on ultrasound examination in the Marolambo district of the Atsinanana region of Madagascar. This is a remote area known to have a high prevalence of intestinal schistosomiasis. METHODS School-aged children (5-14 y) were selected from six villages for parasitological and sonographic examination. Circulating cathodic antigen (CCA) tests and Kato Katz (KK) stool microscopy were performed. Video-clips of liver views were recorded with a SonoSite iViz and interpreted in the UK by comparison with standardised images (WHO protocol). RESULTS The prevalence of schistosomiasis according to CCA testing was 97.8% (269/275) and 73.8% (203/275) by KK. Sonographic evidence of periportal fibrosis was observed in 11.3% (31/275). The youngest children with fibrosis were aged 6 y. Fibrosis was more common in older children (p=0.03) but was not associated with either infection intensity category (p=0.07) or gender (p=0.67). CONCLUSIONS Findings of periportal fibrosis among children in these hard-to-reach villages suggests chronic Schistosoma mansoni infection from a very young age. This may reflect other similarly remote schistosomiasis-endemic areas and reinforces the need to investigate morbidity in neglected communities to understand the true extent of disease burden in endemic countries.
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Affiliation(s)
- Hannah J Russell
- University of Manchester Medical School, Manchester, M13 9PL, UK.,Red House, Guilsfield, Powys, Wales, SY21 9NH
| | - James M StJ Penney
- University of Manchester Medical School, Manchester, M13 9PL, UK.,University Hospital Monklands, NHS Lanarkshire, Glasgow, Scotland, ML6 0JS
| | - Cortland Linder
- University of Manchester Medical School, Manchester, M13 9PL, UK.,Maidstone and Tunbridge Wells Hospital, Maidstone and Tunbridge Wells NHS Trust, Kent, England, TN2 4QJ
| | | | - Amaya L Bustinduy
- Clinical Research Department, London School of Tropical Medicine and Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | | | | | | | - Lalarizo R Mahary
- Faculté de Médecine, Université d'Antananarivo, Antananarivo, Madagascar.,Department of Immunology, Joseph Ravoahangy University Hospital Centre, Antananarivo, Madagascar
| | - Elodie P Ranjanoro
- Faculté de Médecine, Université d'Antananarivo, Antananarivo, Madagascar.,Compassion Madagascar University Hospital, Antananarivo, Madagascar
| | | | - Stephen A Spencer
- University of Manchester Medical School, Manchester, M13 9PL, UK.,Infectious Diseases, North Bristol NHS Trust, Bristol, BS10 5NB, UK
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Aula OP, McManus DP, Jones MK, Gordon CA. Schistosomiasis with a Focus on Africa. Trop Med Infect Dis 2021; 6:109. [PMID: 34206495 PMCID: PMC8293433 DOI: 10.3390/tropicalmed6030109] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 12/19/2022] Open
Abstract
Schistosomiasis is a common neglected tropical disease of impoverished people and livestock in many developing countries in tropical Africa, the Middle East, Asia, and Latin America. Substantial progress has been made in controlling schistosomiasis in some African countries, but the disease still prevails in most parts of sub-Saharan Africa with an estimated 800 million people at risk of infection. Current control strategies rely primarily on treatment with praziquantel, as no vaccine is available; however, treatment alone does not prevent reinfection. There has been emphasis on the use of integrated approaches in the control and elimination of the disease in recent years with the development of health infrastructure and health education. However, there is a need to evaluate the present status of African schistosomiasis, primarily caused by Schistosoma mansoni and S. haematobium, and the factors affecting the disease as the basis for developing more effective control and elimination strategies in the future. This review provides an historical perspective of schistosomiasis in Africa and discusses the current status of control efforts in those countries where the disease is endemic.
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Affiliation(s)
- Oyime Poise Aula
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane 4006, Australia;
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
| | - Donald P. McManus
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane 4006, Australia;
| | - Malcolm K. Jones
- School of Veterinary Sciences, University of Queensland, Gatton 4343, Australia;
| | - Catherine A. Gordon
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane 4006, Australia;
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8
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Abozeid KH, El-Badawy MF, Mahmoud S, Shohayeb MM. In vitro Effects of Punica granatum Ellagitannins on Adult Worms of Schistosoma mansoni. Res Rep Trop Med 2020; 11:73-80. [PMID: 33117051 PMCID: PMC7547181 DOI: 10.2147/rrtm.s248604] [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: 02/06/2020] [Accepted: 07/22/2020] [Indexed: 11/23/2022] Open
Abstract
Schistosomiasis ranks second behind malaria in terms of overall morbidity and mortality. We evaluated the lethal effect of Punica granatum ellagitannins, extracted from the fruit rind, placenta and barks of the root and stem, on adult worms of Schistosoma mansoni (S. mansoni). All four ellagitannins were lethal to S. mansoni adult worms. However, while the rind ellagitannins were the most potent, placental ellagitannins were the least. Rind ellagitannins were capable of killing 40% of adult worms at a concentration of 25µg/mL after 5 days. The killing of 100% of the worms was achievable by rind ellagitannins at a concentration of 50µg/mL after 5 days. The LD50S of the rind ellagitannins after 96h and 120h were 41.25 µg/mL and 28.73 respectively. Ellagitannins-treated worms suffered from erosions, wrinkles, swellings and losses, degenerations of the surface tubercles and tegument. In addition, ellagitannins induced deformation and degradation of oral and ventral suckers and degenerations in the muscles of worms. Ellagitannins also caused a separation of coupled worms and reduction of their motility. Data obtained suggest that ellagitannins of pomegranate could be considered as a cheap candidate for the treatment of schistosomiasis.
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Affiliation(s)
- Khalid H Abozeid
- Department of Microbiology, College of Medicine, Taif University, Taif, Kingdom of Saudi Arabia
| | - Mohamed F El-Badawy
- Department of Microbiology and Immunology, Faculty of Pharmacy, University of Sadat City, Sadat City, Menoufia Governorate, Egypt.,Division of Pharmaceutical Microbiology, Department of Pharmaceutics and Industrial Pharmacy, College of Pharmacy, Taif University, Taif, Kingdom of Saudi Arabia
| | - Soheir Mahmoud
- Parasitology Department, Theodor Bilharz Research Institute, Imbaba, Giza, Egypt
| | - Mohamed M Shohayeb
- Department of Microbiology and Biotechnology, Faculty of Pharmacy, Delta University for Science and Technology, Gamasa, Egypt
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9
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Sinkala E, Vinikoor M, Miyanda Siyunda A, Zyambo K, Besa E, Nsokolo B, Wandeler G, Foster GR, Kelly P. Hepatosplenic schistosomiasis in Zambian adults is characterized by increased liver stiffness: A nested case-control study. Heliyon 2020; 6:e04534. [PMID: 32760834 PMCID: PMC7393539 DOI: 10.1016/j.heliyon.2020.e04534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/20/2019] [Accepted: 07/20/2020] [Indexed: 01/26/2023] Open
Abstract
Cirrhosis commonly complicates portal hypertension worldwide but in Zambia hepatosplenic schistosomiasis (HSS) dominates as the cause of portal hypertension. We need easier and non-invasive ways to assess HSS. Transient elastography (TE), a measure of liver stiffness can diagnose liver cirrhosis. TE remains unexplored in HSS patients, who generally have normal liver parenchyma. We aimed to explore liver stiffness in HSS. This nested case control study was conducted at the University Teaching Hospital, Lusaka, Zambia between January 2015 and January 2016. We enrolled 48 adults with HSS and 22 healthy controls. We assessed liver stiffness using TE while plasma hyaluronan was used to assess liver fibrosis. Plasma tumor necrosis factor receptor 1 (TNFR1) and soluble cluster of differentiation 14 (sCD14) were used to assess inflammation. The median (interquartile range) liver stiffness was higher in patients, 9.5 kPa (7.8, 12.8) than in controls, 4.7 kPa (4.0, 5.4), P < 0.0001. We noted linear correlations of hyaluronan and TNFR1 with the liver stiffness, P = 0.0307 and P = 0.0003 respectively. HSS patients seem to have higher liver stiffness than healthy controls. TE may be useful in identifying fibrosis in HSS. The positive correlations of inflammatory markers with TE suggest that HSS has both periportal and parenchymal pathophysiology.
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Affiliation(s)
- Edford Sinkala
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia,Tropical Gastroenterology & Nutritional Group, Department of Internal Medicine, University of Zambia, Lusaka, Zambia,Corresponding author.
| | - Michael Vinikoor
- Department of Medicine, University of Alabama at Birmingham, Birmingham, USA,Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Kanekwa Zyambo
- Tropical Gastroenterology & Nutritional Group, Department of Internal Medicine, University of Zambia, Lusaka, Zambia
| | - Ellen Besa
- Tropical Gastroenterology & Nutritional Group, Department of Internal Medicine, University of Zambia, Lusaka, Zambia
| | - Bright Nsokolo
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia,Tropical Gastroenterology & Nutritional Group, Department of Internal Medicine, University of Zambia, Lusaka, Zambia
| | - Gilles Wandeler
- Institute of Social and Preventive Medicine, University of Bern, Switzerland,Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Graham R. Foster
- Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, UK
| | - Paul Kelly
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia,Tropical Gastroenterology & Nutritional Group, Department of Internal Medicine, University of Zambia, Lusaka, Zambia,Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, UK
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10
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Sinkala E, Vinikoor M, Zyambo K, Besa E, Nsokolo B, Kelly P. Propranolol Reduces Portal Vein Diameter in Schistosomal Liver Disease with Portal Hypertension: A Prospective Cohort Study. Am J Trop Med Hyg 2020; 102:832-837. [PMID: 32067625 PMCID: PMC7124927 DOI: 10.4269/ajtmh.19-0452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Hepatosplenic schistosomiasis (HSS) complicates portal hypertension, leading to life-threatening variceal bleeding. Variceal bleeding is associated with increased portal vein diameter (PVD). Beta-blockers prevent variceal bleeding. It is unclear whether beta-blockers such as propranolol can reduce PVD in HSS. We aimed to explore the effect of propranolol on PVD in HSS. A longitudinal study was conducted at the University Teaching Hospital, Zambia, as an extension of a clinical trial of rifaximin undertaken to test the hypothesis that rifaximin could reduce bacterial translocation in HSS. We randomized 85 adults to either rifaximin and standard care, or propranolol-based standard care only for 42 days. We then followed up all the patients on propranolol up to day 180. We used ultrasound to measure PVD at baseline and day 180. The primary outcome was reduction in PVD. Beta-blockade and splenic size reduction were secondary outcomes. Portal vein diameter reduced after 180 days of propranolol therapy from median 12 mm (interquartile range (IQR): 11–14) to median 10 mm (IQR: 9–13) (P < 0.001). The pulse rate reduced from baseline median 70 beats/minute (IQR: 66–80) to 65 beats/minute (IQR: 60–70) by day 180 (P = 0.006). Hemoglobin levels improved from baseline median 8 g/dL (IQR: 6–11) to 12 g/dL (10–14) (P < 0.001). Splenic size remained unchanged. Propranolol led to the reduction in PVD over 180 days. This suggests that ultrasound could be useful in monitoring response and compliance to beta-blockers, especially in resource-constraint areas where portal hypertension measurement facilities are unavailable.
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Affiliation(s)
- Edford Sinkala
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia.,Department of Internal Medicine, Tropical Gastroenterology and Nutritional Group, University of Zambia, Lusaka, Zambia
| | - Michael Vinikoor
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kanekwa Zyambo
- Department of Internal Medicine, Tropical Gastroenterology and Nutritional Group, University of Zambia, Lusaka, Zambia
| | - Ellen Besa
- Department of Internal Medicine, Tropical Gastroenterology and Nutritional Group, University of Zambia, Lusaka, Zambia
| | - Bright Nsokolo
- Department of Internal Medicine, Tropical Gastroenterology and Nutritional Group, University of Zambia, Lusaka, Zambia.,Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Paul Kelly
- Blizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom.,Department of Internal Medicine, Tropical Gastroenterology and Nutritional Group, University of Zambia, Lusaka, Zambia.,Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
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11
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Strahan R, McAdam D, Paul E. Change in schistosomiasis-related liver disease with repeated praziquantel treatment in school children in rural Zambia. Trop Doct 2020; 50:216-221. [PMID: 32356671 DOI: 10.1177/0049475520921281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Repeated praziquantel treatment for schistosomiasis is an effective method to reduce disease burden. Ultrasonographic methods were used to assess the severity of schistosoma mansoni-related liver disease and demonstrate improvement following treatment. We compared data from 733 children in 2010 and 972 children in 2018 to determine the effect of repeated praziquantel treatment on prevalence of liver disease. Three age groups were compared across three liver disease classifications (normal, mild, severe). From 2010 to 2018, there was a significant reduction in prevalence of severe liver disease in all age groups (P = 0.03 for 5-10 years, P < 0.001 for 11-15 years and 16-20 years). In both male and female students, the proportion having a normal liver significantly increased (P < 0.001) from 2010 to 2018, in the 11-15-year-olds and 16-20-year-olds, demonstrating that liver disease significantly reduced in these age groups. This study demonstrates a reduction in schistosomiasis-related morbidity with repeated praziquantel treatment.
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Affiliation(s)
- Rodney Strahan
- Radiology, Chitokoloki Mission Hospital, Chitokoloki, North Western Province, Zambia
| | - David McAdam
- Medical Director, Chitokoloki Mission Hospital, Chitokoloki, North Western Province, Zambia
| | - Eldho Paul
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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12
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Kalinda C, Mutengo M, Chimbari M. A meta-analysis of changes in schistosomiasis prevalence in Zambia: implications on the 2020 elimination target. Parasitol Res 2019; 119:1-10. [PMID: 31773307 DOI: 10.1007/s00436-019-06534-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/28/2019] [Indexed: 12/18/2022]
Abstract
Schistosomiasis affects more than 4 million school-aged children in Zambia, mostly in rural communities due to unsafe water and inadequate sanitation facilities. Although several studies were done in Zambia between 1976 and 2019, empirical estimates of the disease burden remain unavailable. Therefore, appraisal of the current schistosomiasis burden is pertinent in the re-evaluation of schistosomiasis-control strategies in Zambia. A random-effect model was used to estimate the prevalence of schistosomiasis infection in Zambia across different age groups for the period between 1976 and 2019. A literature search was done in the following databases: PubMed, ISI Web of Science, Google Scholar, CINAHL, and African Journals Online. Twenty-eight studies with relevant prevalence data were identified and included in the analysis. The pooled prevalence estimate of Schistosoma haematobium and Schistosoma mansoni across studies for the entire period was 35.5% (95% CI: 25.8-45.9) and 34.9% (95% CI: 20.7-50.6), respectively. Prevalence estimates among school-aged children for S. haematobium and S. mansoni were 32.2% (95% CI: 21.1-44.7) and 18.1% (95% CI: 3.0-38.4), respectively. The reported pooled prevalence estimate for S. haematobium among the adults was 54% (95% CI: 23.2-83.7). Only two studies collected information from preschool aged children. Substantial heterogeneity (I2 = 100%, p < 0.0001) was observed among the studies. Although a reduction in disease prevalence was observed from 1990 to 2010, this was not sustained after 2010. In this meta-analysis, S. haematobium was more prevalent compared to S. mansoni, with more cases observed among school-aged children (SAC). Thus, control programs should target age groups that are highly infected or are at high risk of infection.
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Affiliation(s)
- Chester Kalinda
- University of Namibia, Katima Mulilo Campus, Box 1096, Katima Mulilo, Namibia. .,Department of Public Health, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Howard College Campus, Durban, 4001, South Africa.
| | - Mable Mutengo
- Institute of Basic and Biomedical Sciences, Levy Mwanawasa Medical University, P.O Box 33991, Lusaka, Zambia
| | - Moses Chimbari
- Department of Public Health, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Howard College Campus, Durban, 4001, South Africa
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13
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Nascimento GL, Pegado HM, Domingues ALC, Ximenes RADA, Itria A, Cruz LN, Oliveira MRFD. The cost of a disease targeted for elimination in Brazil: the case of schistosomiasis mansoni. Mem Inst Oswaldo Cruz 2019; 114:e180347. [PMID: 30652735 PMCID: PMC6340134 DOI: 10.1590/0074-02760180347] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/10/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Schistosomiasis mansoni is a poverty-related parasitic infection that has a
variety of clinical manifestations. We consider the disability and deaths
caused by schistosomiasis unacceptable for a tool-ready disease. Its
condition in Brazil warrants an analysis that will enable better
understanding of the local health losses and contribute to the complex
decision-making process. OBJECTIVE This study estimates the cost of schistosomiasis in Brazil in 2015. METHODS We conducted a cost of illness study of schistosomiasis mansoni in Brazil in
2015 based on a prevalence approach and from a societal perspective. The
study included 26,499 schistosomiasis carriers, 397 hepatosplenic cases, 48
cases with the neurological form, 284 hospitalisations, and 11,368.26 years
of life lost (YLL) of which 5,187 years are attributable to economically
active age groups. RESULTS The total cost of schistosomiasis mansoni in Brazil was estimated to be US$
41,7million in 2015 with 94.61% of this being indirect costs. CONCLUSIONS The economic burden of schistosomiasis mansoni in Brazil is high and results
in the loss of productivity. Its persistence in Brazil is a challenge to
public health and requires inter-sectorial interventions in areas such as
indoor water supply, basic sanitation, and education.
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Affiliation(s)
| | | | | | | | - Alexander Itria
- Universidade Federal de Goiás, Goiânia, GO, Brasil.,Instituto de Avaliação de Tecnologias em Saúde, Porto Alegre, RS, Brasil
| | | | - Maria Regina Fernandes de Oliveira
- Universidade de Brasília, Núcleo de Medicina Tropical, Brasília, DF, Brasil.,Instituto de Avaliação de Tecnologias em Saúde, Porto Alegre, RS, Brasil
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14
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Aruleba RT, Adekiya TA, Oyinloye BE, Masamba P, Mbatha LS, Pretorius A, Kappo AP. PZQ Therapy: How Close are we in the Development of Effective Alternative Anti-schistosomal Drugs? Infect Disord Drug Targets 2019; 19:337-349. [PMID: 30599112 PMCID: PMC7046992 DOI: 10.2174/1871526519666181231153139] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/24/2018] [Accepted: 12/25/2018] [Indexed: 11/22/2022]
Abstract
Today schistosomiasis, caused mainly by the three major schistosome species (S. mansoni, S. haematobium and S. japonicum), has for many decades and still continues to be on a rapid and swift rise globally, claiming thousands of lives every year and leaving 800 million people at the risk of infection. Due to the high prevalence of this disease and the steady increase in the infection rates, praziquantel (PZQ) remains the only effective drug against this acute disease although it has no effect on the juvenile schistosome parasite. However, no significant approaches have been made in recent years in the discovery of new or alternative drugs and unfortunately, resistance to this drug has been reported in some parts of the world. Therefore, it is imperative to develop a new drug for this debilitating disease. In this review, a brief history of past, present, and new promising anti-schistosomal drugs is presented.
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Affiliation(s)
- Raphael Taiwo Aruleba
- Biotechnology and Structural Biology (BSB) Group, Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa
| | - Tayo Alex Adekiya
- Biotechnology and Structural Biology (BSB) Group, Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa
| | - Babatunji Emmanuel Oyinloye
- Biotechnology and Structural Biology (BSB) Group, Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa
- Department of Biochemistry, Afe Babalola University, PMB 5454, Ado-Ekiti 360001, Nigeria
| | - Priscilla Masamba
- Biotechnology and Structural Biology (BSB) Group, Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa
| | - Londiwe Simphiwe Mbatha
- Biotechnology and Structural Biology (BSB) Group, Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa
| | - Ashley Pretorius
- Bioinformatics Research Group (BRG), DST/Mintek Nanotechnology Innovation Centre, Biolabels Node, Department of Biotechnology, University of the Western Cape, Bellville 7535, South Africa
| | - Abidemi Paul Kappo
- Biotechnology and Structural Biology (BSB) Group, Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa
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15
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Shehata MA, Chama MF, Funjika E. Prevalence and intensity of Schistosoma haematobium infection among schoolchildren in central Zambia before and after mass treatment with a single dose of praziquantel. Trop Parasitol 2018; 8:12-17. [PMID: 29930901 PMCID: PMC5991037 DOI: 10.4103/tp.tp_32_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2017] [Indexed: 12/21/2022] Open
Abstract
Introduction Urinary schistosomiasis caused by Schistosoma haematobium is common in some parts of Lusaka Province, Zambia, where water contact activity is high and sanitation is poor. We conducted a longitudinal study in Ng'ombe Compound of Lusaka, between 2007 and 2015, to observe the prevalence and intensity of S. haematobium infection among community primary school children, before and after receiving a single dose of praziquantel. Materials and Methods A total of 975 (445 females and 530 males) pupils, aged 9-16 years, were tested for S. haematobium at baseline. After mass treatment with praziquantel in 2010, 1570 pupils (785 females and 785 males), aged 9-15 years, were examined for S. haematobium eggs, from 2011 to 2015. Results At baseline, 279 out of 975 of the children were infected, with light infections constituting 84.9% and 15.1% classified as heavy infection. After mass treatment with praziquantel, the prevalence rate dropped, slightly, to 20.3% (63 out of 310) in 2011. However, it increased the following years up to 38% (133 out of 350) in 2015, with prevalence rates higher in males than females. The average number of heavy infection cases increased to 24.3% (120 out of 494) after treatment, reducing cases of light infections to 75.7% (374 out of 494). Conclusion This study revealed that mass treatment with a single dose of praziquantel was not sufficient to significantly reduce the transmission of schistosomiasis. Further studies will need to evaluate whether multiple praziquantel treatments will be more therapeutically effective in limiting future incidences.
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Affiliation(s)
- Mohamed A Shehata
- Department of Biological Sciences, The University of Zambia, Zambia, United Kingdom
| | - Mubanga F Chama
- Department of Chemistry, School of Natural Sciences, The University of Zambia, Zambia, United Kingdom.,Tropical Gastroenterology and Nutrition Group, School of Medicine, The University of Zambia, Zambia, United Kingdom
| | - Evelyn Funjika
- Department of Chemistry, School of Natural Sciences, The University of Zambia, Zambia, United Kingdom.,Tropical Gastroenterology and Nutrition Group, School of Medicine, The University of Zambia, Zambia, United Kingdom.,Faculty of Life Sciences, The University of Manchester, Manchester, United Kingdom
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16
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Schistosomiasis in Zambia: a systematic review of past and present experiences. Infect Dis Poverty 2018; 7:41. [PMID: 29706131 PMCID: PMC5925830 DOI: 10.1186/s40249-018-0424-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 04/10/2018] [Indexed: 02/04/2023] Open
Abstract
Background The speedy rate of change in the environmental and socio-economics factors may increase the incidence, prevalence and risk of schistosomiasis infections in Zambia. However, available information does not provide a comprehensive understanding of the biogeography and distribution of the disease, ecology and population dynamics of intermediate host snails. The current study used an information-theoretical approach to understand the biogeography and prevalence schistosomiasis and identified knowledge gaps that would be useful to improve policy towards surveillance and eradication of intermediate hosts snails in Zambia. Methods To summarise the existing knowledge and build on past and present experiences of schistosomiasis epidemiology for effective disease control in Zambia, a systematic search of literature for the period 2000–2017 was done on PubMed, Google Scholar and EBSCOhost. Using the key words: ‘Schistosomiasis’, ‘Biomphalaria’, ‘Bulinus’, ‘Schistosoma mansoni’, ‘Schistosoma haematobium’, and ‘Zambia’, in combination with Booleans terms ‘AND’ and ‘OR’, published reports/papers were obtained and reviewed independently for inclusion. Results Thirteen papers published in English that fulfilled the inclusion criteria were selected for the final review. The papers suggest that the risk of infection has increased over the years and this has been attributed to environmental, socio-economic and demographic factors. Furthermore, schistosomiasis is endemic in many parts of the country with infection due to Schistosoma haematobium being more prevalent than that due to S. mansoni. This review also found that S. haematobium was linked to genital lesions, thus increasing risks of contracting other diseases such as HIV and cervical cancer. Conclusions For both S. haematobium and S. mansoni, environmental, socio-economic, and demographic factors were influential in the transmission and prevalence of the disease and highlight the need for detailed knowledge on ecological modelling and mapping the distribution of the disease and intermediate host snails for effective implementation of control strategies. Electronic supplementary material The online version of this article (10.1186/s40249-018-0424-5) contains supplementary material, which is available to authorized users.
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17
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Sinkala E, Zyambo K, Besa E, Kaonga P, Nsokolo B, Kayamba V, Vinikoor M, Zulu R, Bwalya M, Foster GR, Kelly P. Rifaximin Reduces Markers of Inflammation and Bacterial 16S rRNA in Zambian Adults with Hepatosplenic Schistosomiasis: A Randomized Control Trial. Am J Trop Med Hyg 2018; 98:1152-1158. [PMID: 29436337 PMCID: PMC5928821 DOI: 10.4269/ajtmh.17-0637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cirrhosis is the dominant cause of portal hypertension globally but may be overshadowed by hepatosplenic schistosomiasis (HSS) in the tropics. In Zambia, schistosomiasis seroprevalence can reach 88% in endemic areas. Bacterial translocation (BT) drives portal hypertension in cirrhosis contributing to mortality but remains unexplored in HSS. Rifaximin, a non-absorbable antibiotic may reduce BT. We aimed to explore the influence of rifaximin on BT, inflammation, and fibrosis in HSS. In this phase II open-label trial (ISRCTN67590499), 186 patients with HSS in Zambia were evaluated and 85 were randomized to standard care with or without rifaximin for 42 days. Changes in markers of inflammation, BT, and fibrosis were the primary outcomes. BT was measured using plasma 16S rRNA, lipopolysaccharide-binding protein, and lipopolysaccharide, whereas hyaluronan was used to measure fibrosis. Tumor necrosis factor receptor 1 (TNFR1) and soluble cluster of differentiation 14 (sCD14) assessed inflammation. 16S rRNA reduced from baseline (median 146 copies/µL, interquartile range [IQR] 9, 537) to day 42 in the rifaximin group (median 63 copies/µL, IQR 12, 196), P < 0.01. The rise in sCD14 was lower (P < 0.01) in the rifaximin group (median rise 122 ng/mL, IQR-184, 783) than in the non-rifaximin group (median rise 832 ng/mL, IQR 530, 967). TNFR1 decreased (P < 0.01) in the rifaximin group (median -39 ng/mL IQR-306, 563) but increased in the non-rifaximin group (median 166 ng/mL, IQR 3, 337). Other markers remained unaffected. Rifaximin led to a reduction of inflammatory markers and bacterial 16S rRNA which may implicate BT in the inflammation in HSS.
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Affiliation(s)
- Edford Sinkala
- Department of Internal Medicine, Tropical Gastroenterology & Nutritional Group, University of Zambia, Lusaka, Zambia.,Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Kanekwa Zyambo
- Department of Internal Medicine, Tropical Gastroenterology & Nutritional Group, University of Zambia, Lusaka, Zambia
| | - Ellen Besa
- Department of Internal Medicine, Tropical Gastroenterology & Nutritional Group, University of Zambia, Lusaka, Zambia
| | - Patrick Kaonga
- Department of Internal Medicine, Tropical Gastroenterology & Nutritional Group, University of Zambia, Lusaka, Zambia.,Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Bright Nsokolo
- Department of Internal Medicine, Tropical Gastroenterology & Nutritional Group, University of Zambia, Lusaka, Zambia.,Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Violet Kayamba
- Department of Internal Medicine, Tropical Gastroenterology & Nutritional Group, University of Zambia, Lusaka, Zambia.,Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Michael Vinikoor
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rabison Zulu
- Paediatric Centre of Excellence Laboratory, University Teaching Hospital, Lusaka, Zambia
| | - Martin Bwalya
- Paediatric Centre of Excellence Laboratory, University Teaching Hospital, Lusaka, Zambia
| | - Graham R Foster
- Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Paul Kelly
- Paediatric Centre of Excellence Laboratory, University Teaching Hospital, Lusaka, Zambia.,Department of Internal Medicine, Tropical Gastroenterology & Nutritional Group, University of Zambia, Lusaka, Zambia.,Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
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18
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Mutengo MM, Mduluza T, Kelly P, Mwansa JCL, Kwenda G, Musonda P, Chipeta J. Low IL-6, IL-10, and TNF- α and High IL-13 Cytokine Levels Are Associated with Severe Hepatic Fibrosis in Schistosoma mansoni Chronically Exposed Individuals. J Parasitol Res 2018; 2018:9754060. [PMID: 29610679 PMCID: PMC5828471 DOI: 10.1155/2018/9754060] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/21/2017] [Indexed: 01/29/2023] Open
Abstract
Several studies have attributed the etiopathogenesis of chronic Schistosoma mansoni related hepatic fibrosis to unregulated immune responses against trapped parasite ova in the host. However, there is limited data on immune profiles associated with varying degrees of the disease in a population under chronic exposure to the parasite. We therefore investigated the role of selected T-helper (Th)1, Th2, and Th17 cytokines in relation to hepatic fibrosis severity among individuals resident in a hyper-Schistosoma mansoni endemic region of Western Zambia. Two hundred and forty-four S. mansoni infected individuals with and without fibrosis were analysed for cytokine profiles. Based on hepatic fibrosis stage as determined by ultrasound, participants were categorized into Group 0, Group I, Group II, and Group III. Cytokines were measured in S. mansoni egg stimulated whole blood culture supernatants using the BD Cytometric Bead Array kits. Compared to the nonfibrotic group, participants in the severe hepatic fibrotic group produced less interleukin- (IL-) 6, IL-10, and tumour necrosis factor-alpha (TNF-α). On the other hand, IL-13 was significantly elevated in this group compared to the nonfibrotic group (p < 0.001). Our results suggest that low IL-6, IL-10, and TNF-α and high IL-13 levels may influence S. mansoni disease progression.
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Affiliation(s)
- Mable M. Mutengo
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka, Zambia
- University of Zambia, Lusaka, Zambia
| | - Takafira Mduluza
- Department of Biochemistry, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe
| | - Paul Kelly
- Department of Internal Medicine, School of Medicine, University of Zambia, Lusaka, Zambia
| | - James C. L. Mwansa
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka, Zambia
- University of Zambia, Lusaka, Zambia
| | - Geoffrey Kwenda
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Patrick Musonda
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
| | - James Chipeta
- Department of Pediatrics and Child Health, School of Medicine, University of Zambia, Lusaka, Zambia
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Kaonga P, Kaimoyo E, Besa E, Zyambo K, Sinkala E, Kelly P. Direct Biomarkers of Microbial Translocation Correlate with Immune Activation in Adult Zambians with Environmental Enteropathy and Hepatosplenic Schistosomiasis. Am J Trop Med Hyg 2017; 97:1603-1610. [PMID: 29140241 PMCID: PMC5817780 DOI: 10.4269/ajtmh.17-0365] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Microbial translocation is a poorly understood consequence of several disorders such as environmental enteropathy (EE) and hepatosplenic schistosomiasis (HSS). Herein, we compared biomarkers of microbial origin and immune activation in adults with these disorders and in healthy controls. A cross-sectional study was conducted in participants with EE recruited from Misisi compound, Lusaka, Zambia; HSS patients and healthy controls from the University Teaching Hospital, Lusaka. Plasma lipopolysaccharides (LPSs) was measured by limulus amoebocyte lysate assay, plasma 16S ribosomal RNA (16S rRNA) gene copy number was quantified by quantitative real-time polymerase chain reaction, Toll-like receptor ligand (TLRL) activity by QUANTI-Blue detection medium, and cytokines from cell culture supernatant by Cytometric Bead Array. In univariate analysis LPS, 16S rRNA gene copy number, and TLR activity were all high and correlated with each other and with cytokines tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), IL-10, and IL-4 secreted by the RAW-Blue cells. After controlling for baseline characteristic, biomarkers of microbial translocation in blood were predictors of TNF-α, IL-6, and IL-10 activation in cell culture supernatant from EE participants and HSS patients but not in healthy controls. TLR activity showed the strongest correlation with TNF-α. These data provide correlative evidence that microbial translocation contributes to systemic cytokine activation in two disorders common in the tropics, with total TLR ligand estimation showing the strongest correlation with TNF-α (r = 0.66, P < 0.001).
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Affiliation(s)
- Patrick Kaonga
- Tropical Gastroenterology and Nutrition Group, The University of Zambia School of Medicine, Lusaka, Zambia.,Department of Internal Medicine, The University of Zambia School of Medicine, Lusaka, Zambia
| | - Evans Kaimoyo
- Department of Biological Sciences, The University of Zambia, Lusaka, Zambia
| | - Ellen Besa
- Tropical Gastroenterology and Nutrition Group, The University of Zambia School of Medicine, Lusaka, Zambia
| | - Kanekwa Zyambo
- Tropical Gastroenterology and Nutrition Group, The University of Zambia School of Medicine, Lusaka, Zambia
| | - Edford Sinkala
- Department of Internal Medicine, The University Teaching Hospital, Lusaka, Zambia
| | - Paul Kelly
- Blizard Institute Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom.,Tropical Gastroenterology and Nutrition Group, The University of Zambia School of Medicine, Lusaka, Zambia
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Sinkala E, Kapulu MC, Besa E, Zyambo K, Chisoso NJ, Foster GR, Kelly P. Hepatosplenic schistosomiasis is characterised by high blood markers of translocation, inflammation and fibrosis. Liver Int 2016; 36:145-50. [PMID: 26058680 DOI: 10.1111/liv.12891] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 06/04/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Cirrhosis is the main cause of portal hypertension worldwide but schistosomiasis dominates in much of the tropics. The seroprevalence of Schistosoma mansoni is up to 77% in endemic parts of Zambia. Morbidity is attributed to portal hypertension causing variceal bleeding which can be fatal. Bacterial translocation is associated with portal hypertension in cirrhosis but this is almost unexplored in hepatosplenic schistosomiasis. Liver biopsy is usually used to assess fibrosis although it is invasive and prone to sampling error. We aimed to investigate translocation, fibrosis and inflammatory makers in a case-control study of schistosomiasis at the University Teaching Hospital, Lusaka, Zambia. METHODS Patients had oesophageal varices, but were negative for human immunodeficiency virus, hepatitis B and C viruses. Plasma lipopolysaccharide binding protein was used as a marker of translocation while hyaluronan and laminin measured liver fibrosis. Inflammatory markers were measured in blood. Controls were patients with non-specific abdominal pain who had normal endoscopy. RESULTS Median (interquartile range) lipopolysaccharide binding protein was elevated in patients [44.3 ng/ml (35.7, 57.1)] compared to controls [30.7 ng/ml (30.4, 35.5), P < 0.0001]. Hyaluronan was higher in patients [111.6 ng/ml (39.1, 240.3)] compared to controls [21.0 ng/ml (12.4, 37.6), P < 0.0001] and so was laminin [2.2 μg/ml (1.0, 3.7)] compared to controls [0.9 μg/ml (0.7, 1.2), P = 0.0015]. Inflammatory markers, except C-reactive protein, were elevated in patients. CONCLUSIONS These data suggest that the bacterial translocation contributes to systemic inflammation in hepatosplenic schistosomiasis. Elevated fibrotic markers suggest they may be useful in diagnosing and monitoring periportal fibrosis.
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Affiliation(s)
- Edford Sinkala
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia.,Tropical Gastroenterology & Nutrition Group, Department of Medicine, University of Zambia, Lusaka, Zambia
| | - Melissa C Kapulu
- Tropical Gastroenterology & Nutrition Group, Department of Medicine, University of Zambia, Lusaka, Zambia.,Biological Sciences Department, School of Natural Sciences, University of Zambia, Lusaka, Zambia
| | - Ellen Besa
- Tropical Gastroenterology & Nutrition Group, Department of Medicine, University of Zambia, Lusaka, Zambia
| | - Kanekwa Zyambo
- Tropical Gastroenterology & Nutrition Group, Department of Medicine, University of Zambia, Lusaka, Zambia
| | - Ng'andu J Chisoso
- Paediatric Centre of Excellence Laboratory, University Teaching Hospital, Lusaka, Zambia
| | - Graham R Foster
- Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, UK
| | - Paul Kelly
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia.,Tropical Gastroenterology & Nutrition Group, Department of Medicine, University of Zambia, Lusaka, Zambia.,Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, UK
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