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da Trindade MAO, Fonseca ÁLS, Dias IHL, de Sousa SRM, Enk MJ, Lima KVB, de Paula Souza E Guimarães RJ. Geospatial analysis and prevalence of Schistosoma mansoni and soil-transmitted helminth infections in an endemic area in Eastern Brazilian Amazon. Trop Med Int Health 2024. [PMID: 38659108 DOI: 10.1111/tmi.13993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVES This study evaluated the occurrence of Schistosoma mansoni and soil-transmitted helminths in an endemic area in the Eastern Brazilian Amazon, analysing prevalence and spatial distribution. METHODS The study was conducted in four localities of Primavera Municipality, in Pará state. Data was obtained from the Decit 40/2012 project and the participants were divided into five age range categories for evaluation: children, adolescents, young adults, adults and elderly individuals. For the diagnostic tests, Kato-Katz slides were prepared to detect S. mansoni and soil-transmitted helminths eggs. The spatial distribution map and the Kernel Density Estimation were performed to assess the presence and location of infections. RESULTS Stool samples revealed the presence of hookworms, S. mansoni, Ascaris lumbricoides and Trichuris trichiura eggs. Mono-, bi- and poly-parasitic infections were observed, with a significant prevalence of hookworm monoparasitism. CONCLUSIONS The high frequency of children infected with soil-transmitted helminths confirms their significance as an ongoing public health problem in the poorest municipalities of Brazil. The Geographic Information System plays a crucial role in environmental surveillance and in the control of epidemics and endemic diseases, enabling accurate assessment and informed decision-making for their control.
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Affiliation(s)
| | - Álvaro Luan Santana Fonseca
- Programa de Pós-Graduação Strictu Sensu em Biologia Parasitária na Amazônia, Universidade do Estado do Pará (UEPA), Belém, Brazil
| | - Isabelle Helena Lima Dias
- Programa de Pós-Graduação Strictu Sensu em Biologia Parasitária na Amazônia, Universidade do Estado do Pará (UEPA), Belém, Brazil
| | | | - Martin Johannes Enk
- Laboratório de Parasitoses Intestinais e Esquistossomose (LPIE), Seção de Parasitologia, Instituto Evandro Chagas/SVSA/MS, Ananindeua, Brazil
| | - Karla Valéria Batista Lima
- Programa de Pós-Graduação Strictu Sensu em Biologia Parasitária na Amazônia, Universidade do Estado do Pará (UEPA), Belém, Brazil
- Laboratório de Biologia Molecular, Seção de Bacteriologia e Micologia, Instituto Evandro Chagas/SVSA/MS, Ananindeua, Brazil
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Silva LSAD, Dias IHL, Fonseca ÁLS, Enk MJ, Nogueira JFC, Guimarães RJDPSE, Goveia CDO. Epidemiological profile of human toxocariasis in patients examined at Evandro Chagas Institute (IEC/SVSA/MS) between 2014 and 2019. Comp Immunol Microbiol Infect Dis 2024; 105:102112. [PMID: 38142560 DOI: 10.1016/j.cimid.2023.102112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Toxocariasis is caused by nematodes of Toxocara genus, which infest dogs and cats, with humans serving as paratenic hosts. METHODS The epidemiological profile of patients examined for toxocariasis between October 2014 and October 2019 at Evandro Chagas Institute (IEC) was outlined. The frequency of anti-T. canis IgG antibodies were evaluated using the Enzyme Linked Immunosorbent Assay (ELISA) method. RESULTS From a total of 734 samples, 56% were from male (p < 0.05). Regarding age, the group with the most solicitations were from ≤11 years old individuals (p < 0.05). Pará state had the highest number of exams requested (92%), with the majority from residents of urban areas, accounting for 81.5% of samples (p < 0.05). The overall toxocariasis seroprevalence was 41.8%, the male sex being the most frequent with 60.9% (p < 0.05). The most affected age group was ≤11 years old, with a total of 67.8% of positive samples (p < 0.05). CONCLUSION The high rates obtained emphasize the need for complementary studies on toxocariasis in Brazil, especially in Pará state, contributing to epidemiological surveillance actions in the control of this infection. Besides, health campaigns for domestic and stray animals, also can contribute to a more effective surveillance in controlling parasitic infections and encourages the One Health approach.
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Affiliation(s)
| | - Isabelle Helena Lima Dias
- Programa de Pós-Graduação em Biologia Parasitária na Amazônia (PPGBPA), Universidade do Estado do Pará (UEPA) 2623, Belém, PA, Brazil.
| | - Álvaro Luan Santana Fonseca
- Programa de Pós-Graduação em Biologia Parasitária na Amazônia (PPGBPA), Universidade do Estado do Pará (UEPA) 2623, Belém, PA, Brazil
| | - Martin Johannes Enk
- Laboratório de Parasitoses Intestinais e Esquistossomose, Instituto Evandro Chagas s/n, Ananindeua PA, Brazil
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Menezes CA, Montresor LC, Jangola STG, de Mattos AC, Domingues ALC, Júnior AM, Silva CCM, Barbosa CS, de Mendonça CLF, Massara CL, Fonseca CT, de Oliveira EJ, Gomes ECDS, da Silva EF, Bezerra FSDM, Silva-Jr FP, de Siqueira IC, Silva JRME, Heller L, Farias LP, Beck LCNH, Santos MCS, Lima MG, Mourão MDM, Enk MJ, Fernandez MA, Katz N, Carvalho ODS, Parreiras PM, Neves RH, Gava SG, de Oliveira SA, Thiengo SC, Favre TC, Graeff-Teixeira C, Pieri OS, Caldeira RL, da Silva-Pereira RA, Rocha RS, Oliveira RR. FioSchisto's expert perspective on implementing WHO guidelines for schistosomiasis control and transmission elimination in Brazil. Front Immunol 2023; 14:1268998. [PMID: 38143743 PMCID: PMC10739458 DOI: 10.3389/fimmu.2023.1268998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/17/2023] [Indexed: 12/26/2023] Open
Abstract
The World Health Organization (WHO) recognizes schistosomiasis as one of the Neglected Tropical Diseases targeted for global elimination in the 2030 Agenda of the Sustainable Development Goals. In Brazil, schistosomiasis mansoni is considered a public health problem, particularly prevalent among vulnerable populations living in areas with poor environmental and sanitary conditions. In 2022, the WHO published a Guideline encompassing recommendations to assist national programs in endemic countries in achieving morbidity control, eliminating schistosomiasis as a public health problem, and advancing towards interrupting transmission. The perspectives presented here, collectively prepared by members of the Oswaldo Cruz Foundation's (Fiocruz) Schistosomiasis Translational Program (FioSchisto), along with invited experts, examine the feasibility of the WHO recommendations for the Brazilian settings, providing appropriate recommendations for public health policies applicable to the epidemiological reality of Brazil, and suggests future research to address relevant issues. In Brazil, the provision of safe water and sanitation should be the key action to achieve schistosomiasis elimination goals. The agencies involved in measures implementation should act together with the Primary Care teams for planning, executing, monitoring, and evaluating actions in priority municipalities based on their epidemiological indicators. Host snails control should prioritize judicious ecological interventions at breeding sites. The Information, Education, and Communication (IEC) strategy should be associated with water and sanitation and other control actions, actively involving school community. To identify infected carriers, FioSchisto recommends a two-stage approach of immunological and molecular tests to verify transmission interruption during the intervention and beyond. Praziquantel administration should be done under medical supervision at the Primary Care level. MDA should be considered in exceptional settings, as a measure of initial attack strategy in locations presenting high endemicity, always integrated with water and sanitation, IEC, and snail control. To assist decision-making, as well as the monitoring and evaluation of strategic actions, there is a need for an Information System. FioSchisto considers this systematization essential to make investments in strategic research to support the improvement of schistosomiasis control actions. Efforts toward schistosomiasis elimination in Brazil will succeed with a paradigm shift from the vertical prescriptive framework to a community-centered approach involving intersectoral and interdisciplinary collaboration.
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Affiliation(s)
| | | | | | | | - Ana Lúcia Coutinho Domingues
- Centro de Ciências da Saúde, Departamento de Medicina Clínica, Universidade Federal de Pernambuco, Recife, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Leo Heller
- Instituto René Rachou, Fundação Oswaldo Cruz - FIOCRUZ, Belo Horizonte, Brazil
| | | | | | | | - Mariana Gomes Lima
- Instituto Oswaldo Cruz, Fundação Oswaldo Cruz - FIOCRUZ, Rio de Janeiro, Brazil
| | | | | | | | - Naftale Katz
- Instituto René Rachou, Fundação Oswaldo Cruz - FIOCRUZ, Belo Horizonte, Brazil
| | | | | | - Renata Heisler Neves
- Faculdade de Ciências Médicas, Universidade Estatual do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sandra Grossi Gava
- Instituto René Rachou, Fundação Oswaldo Cruz - FIOCRUZ, Belo Horizonte, Brazil
| | | | | | | | - Carlos Graeff-Teixeira
- Centro de Ciências da Saúde, Núcleo de Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, Brazil
| | | | | | | | - Roberto Sena Rocha
- Instituto René Rachou, Fundação Oswaldo Cruz - FIOCRUZ, Belo Horizonte, Brazil
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Dias IHL, Fonseca ÁLS, Sousa SRMD, Goveia CDO, Fernandez MA, Enk MJ. Experimental infection with Schistosoma mansoni from Belém, Pará, Brazil: Strains newly isolated vs. laboratory maintained. Exp Parasitol 2023; 252:108573. [PMID: 37380123 DOI: 10.1016/j.exppara.2023.108573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Schistosomiasis is a neglected tropical disease that occurs in locations with inadequate sanitation conditions. The geographic distribution of Schistosoma mansoni trematode depends directly on the presence of its intermediate host, Biomphalaria mollusks. Studies involving recently isolated and laboratory strains are not common due to the difficulty in cycle maintenance. This study evaluated the susceptibility and infectivity responses in intermediate and definitive hosts with strains of S. mansoni, one isolated and kept in laboratory environment for 34 years (BE) and the other recently collected (BE-I) METHODS: For experimental infection, a total of 400 B. glabrata mollusks were divided in four infection groups. Thirty mice were divided in two groups for infection with the two strains. RESULTS It was possible to notice differences about S. mansoni infection in both strains. The laboratory strain was more harmful to freshly collected mollusks. Differences in the patterns of infection in mice could be observed. CONCLUSION Particularities occurred in each group of infection by S. mansoni strains, despite having the same geographic origin. Effects from the parasite-host interaction are visible in terms of infection in definitive and intermediate hosts.
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Affiliation(s)
- Isabelle Helena Lima Dias
- Programa de Pós-Graduação Strictu Sensu em Biologia Parasitária na Amazônia da Universidade do Estado do Pará (UEPA), Belém, Pará, Brazil; Laboratório de Parasitoses Intestinais e Esquistossomose (LPIE), Seção de Parasitologia, Instituto Evandro Chagas/SVS/MS, Ananindeua, Pará, Brazil.
| | - Álvaro Luan Santana Fonseca
- Programa de Pós-Graduação Strictu Sensu em Biologia Parasitária na Amazônia da Universidade do Estado do Pará (UEPA), Belém, Pará, Brazil; Laboratório de Parasitoses Intestinais e Esquistossomose (LPIE), Seção de Parasitologia, Instituto Evandro Chagas/SVS/MS, Ananindeua, Pará, Brazil
| | - Sergei Rodrigo Magalhães de Sousa
- Programa de Pós-Graduação Strictu Sensu em Biologia Parasitária na Amazônia da Universidade do Estado do Pará (UEPA), Belém, Pará, Brazil; Laboratório de Parasitoses Intestinais e Esquistossomose (LPIE), Seção de Parasitologia, Instituto Evandro Chagas/SVS/MS, Ananindeua, Pará, Brazil
| | - Christiane de Oliveira Goveia
- Laboratório de Malacologia (LABMAL), Seção de Parasitologia, Instituto Evandro Chagas/SVS/MS, Ananindeua, Pará, Brazil
| | - Monica Ammon Fernandez
- Laboratório de Referência Nacional para Esquistossomose - Malacologia (LRNEM), Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Martin Johannes Enk
- Programa de Pós-Graduação Strictu Sensu em Biologia Parasitária na Amazônia da Universidade do Estado do Pará (UEPA), Belém, Pará, Brazil; Laboratório de Parasitoses Intestinais e Esquistossomose (LPIE), Seção de Parasitologia, Instituto Evandro Chagas/SVS/MS, Ananindeua, Pará, Brazil
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Lopes KF, Freire ML, Souza Lima DC, Enk MJ, Oliveira E, Geiger SM. Development and evaluation of an indirect ELISA using a multiepitope antigen for the diagnosis of intestinal schistosomiasis. Parasitology 2023; 150:683-692. [PMID: 37092694 PMCID: PMC10410369 DOI: 10.1017/s0031182023000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/29/2023] [Accepted: 04/15/2023] [Indexed: 04/25/2023]
Abstract
The laboratory diagnosis of intestinal schistosomiasis, carried out by detecting parasite eggs in feces, has low sensitivity when applied to individuals with low parasitic load. Serological tests can be more sensitive for the diagnosis of the disease. Therefore, the objective of this work was to develop and evaluate an ELISA-based immunoenzymatic assay, using a Schistosoma mansoni multiepitope antigen (ELISA IgG anti-SmME). For this, the amino acid sequences of S. mansoni cathepsin B and asparaginyl endopeptidase were submitted to the prediction of B cell epitopes and, together with peptide sequences obtained from earlier works, were used in the construction of a minigene. The multiepitope protein was expressed in Escherichia coli and the performance of the ELISA IgG anti-SmME for schistosomiasis was evaluated using serum samples from 107 individuals either egg positive or negative. In addition, 11 samples from individuals with other helminth infections were included. The ELISA IgG anti-SmME showed a sensitivity of 81.1% and a specificity of 46.1%. Further analysis revealed a 77.2% sensitivity in diagnosis of individuals with egg counts of ≤12 epg (eggs per gram feces) and 87.5% for individuals with 13–99 epg. It is worth mentioning that, to our knowledge, this was the first study using a multiepitope recombinant antigen in an ELISA for diagnosis of intestinal schistosomiasis, which demonstrated promising results in the diagnosis of individuals with low parasitic loads.
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Affiliation(s)
- Karine Ferreira Lopes
- Department of Parasitology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- René Rachou Institute – Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | | | - Dayane Costa Souza Lima
- Department of Parasitology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Martin Johannes Enk
- Evandro Chagas Institute – Secretary of Health Vigilance, Ministry of Health, Ananindeua, Pará, Brazil
| | - Edward Oliveira
- René Rachou Institute – Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Stefan Michael Geiger
- Department of Parasitology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Goveia CDO, Caldeira RL, Barata RR, Lemos PDS, Teixeira Nunes MR, Dias IHL, Enk MJ. First report of Biomphalaria tenagophila (d'Orbigny, 1835) (Gastropoda/Planorbidae) in Pará State, Amazon region of Brazil. Exp Parasitol 2023; 247:108482. [PMID: 36801395 DOI: 10.1016/j.exppara.2023.108482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 01/04/2023] [Accepted: 02/10/2023] [Indexed: 02/19/2023]
Abstract
INTRODUCTION Mollusks belonging to Biomphalaria genus are intermediate hosts of Schistosoma mansoni. In the Pará State, Northern Region of Brazil, there are reports of B. glabrata, B. straminea, B. schrammi, B. occidentalis, and B. kuhniana occurrence. Here, we report for the first time the presence of B. tenagophila in Belém, capital of Pará state. METHODS A total of 79 mollusks were collected and examined to search for possible S. mansoni infection. The specific identification was made by morphological and molecular assays. RESULTS No specimens parasitized by trematode larvae were detected. For the first time the presence of B. tenagophila in Belém, capital of Pará state, was reported. CONCLUSION The result increases the knowledge about Biomphalaria mollusks occurrence in the Amazon Region and specifically alerts on the possible role of B. tenagophila in schistosomiasis transmission in Belém.
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Affiliation(s)
- Christiane de Oliveira Goveia
- Instituto Evandro Chagas, Seção de Parasitologia, Laboratório de Malacologia, Ananindeua, PA, Brazil; Programa de Pós-Graduação em Biologia Parasitária na Amazônia - Universidade do Estado do Pará, Belém, PA, Brazil.
| | - Roberta Lima Caldeira
- Fundação Oswaldo Cruz, Instituto René Rachou, Grupo de Pesquisa em Helmintologia e Malacologia Médica, Belo Horizonte, MG, Brazil
| | | | | | | | - Isabelle Helena Lima Dias
- Programa de Pós-Graduação em Biologia Parasitária na Amazônia - Universidade do Estado do Pará, Belém, PA, Brazil
| | - Martin Johannes Enk
- Instituto Evandro Chagas, Seção de Parasitologia, Laboratório de Parasitoses Intestinais e Esquistossomose, PA, Brazil
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Pieri OS, Bezerra FSM, Coelho PMZ, Enk MJ, Favre TC, Graeff-Teixeira C, Oliveira RR, dos Reis MG, Andrade LSDA, Beck LCNH, Favero V, Fialho TRDS, Guimarães RJDPSE, Oliveira BSS, Pascoal VF, Pinheiro MCC, dos Santos RA, Silva LK, de Siqueira IC, de Souza RP, Katz N. Accuracy of the urine point-of-care circulating cathodic antigen assay for diagnosing Schistosomiasis mansoni infection in Brazil: A multicenter study. Rev Soc Bras Med Trop 2023; 56:S0037-86822023000100600. [PMID: 36700600 PMCID: PMC9870275 DOI: 10.1590/0037-8682-0238-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/13/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The World Health Organization recommends a market-ready, urine-based point-of-care diagnostic test for circulating cathodic antigens (CCA) to determine the prevalence of S. mansoni. This study evaluated the performance of the URINE CCA (SCHISTO) ECO TESTE® (POC-ECO), which is currently available in Brazil. METHODS Residents from eight sites with different prevalence estimates provided one urine sample for POC-ECO and one stool sample for Kato-Katz (KK) and Helmintex® (HTX) testing as an egg-detecting reference for infection status. RESULTS None of the study sites had significantly higher POC-ECO accuracy than KK. CONCLUSIONS POC-ECO is not currently recommended in Brazilian schistosomiasis elimination programs.
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Affiliation(s)
- Otavio Sarmento Pieri
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Educação em Ambiente e Saúde, Rio de Janeiro, RJ, Brasil.
| | | | | | - Martin Johannes Enk
- 4Instituto Evandro Chagas, Laboratório de Parasitoses Intestinais, Esquistossomose e Malacologia, Secção de Parasitologia, Ananindeua, PA, Brasil.
| | - Tereza Cristina Favre
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Educação em Ambiente e Saúde, Rio de Janeiro, RJ, Brasil.
| | - Carlos Graeff-Teixeira
- Universidade Federal do Espírito Santo, Centro de Ciências da Saúde, Unidade de Doenças Infecciosas, Vitória, ES, Brasil. ,Pontifícia Universidade Católica do Rio Grande do Sul, Laboratório de Parasitologia Biomédica, Porto Alegre, RS, Brasil.
| | | | - Mitermayer Galvão dos Reis
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Salvador, BA, Brasil. ,Universidade Federal da Bahia, Faculdade de Medicina, Salvador, BA, Brasil. ,Yale University, School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, CT, United States of America.
| | | | | | - Vivian Favero
- Pontifícia Universidade Católica do Rio Grande do Sul, Laboratório de Parasitologia Biomédica, Porto Alegre, RS, Brasil.
| | | | | | | | - Vanessa Fey Pascoal
- Pontifícia Universidade Católica do Rio Grande do Sul, Laboratório de Parasitologia Biomédica, Porto Alegre, RS, Brasil.
| | | | | | | | | | - Renata Perotto de Souza
- Pontifícia Universidade Católica do Rio Grande do Sul, Laboratório de Parasitologia Biomédica, Porto Alegre, RS, Brasil.
| | - Naftale Katz
- Fundação Oswaldo Cruz, Instituto René Rachou, Belo Horizonte, MG, Brasil.
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Favre TC, Beck LCNH, Bezerra FSM, Graeff-Teixeira C, Coelho PMZ, Enk MJ, Katz N, Oliveira RR, Reis MGD, Pieri OS. Reliability of point-of-care circulating cathodic antigen assay for diagnosing schistosomiasis mansoni in urine samples from an endemic area of Brazil after one year of storage at -20 degrees Celsius. Rev Soc Bras Med Trop 2022; 55:e0389. [PMID: 35239906 PMCID: PMC8909435 DOI: 10.1590/0037-8682-0389-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/24/2021] [Indexed: 11/22/2022] Open
Abstract
Background The World Health Organization recommends reliable point-of-care (POC) diagnostic testing to eliminate schistosomiasis. Lateral flow immunoassay that detects schistosome circulating cathodic antigen (CCA) in urine to establish prevalence thresholds for intervention in endemic areas is recommended. Stored urine may be useful if surveying at-risk populations is delayed or interrupted by unforeseen circumstances, such as the current COVID-19 pandemic. This study evaluated the manufacturer’s claim that Schistosoma mansoni infection can be reliably diagnosed in urine samples stored at -20°C for one year. Methods Two-hundred-forty-two subjects from an endemic site in Brazil provided one urine sample each for testing with URINE CCA (SCHISTO) ECO TESTE® (POC-ECO) and one stool sample each for testing with Kato-Katz (KK) and Helmintex® (HTX) as a robust reference standard for infection status. At least 2 ml of urine from each participant was stored at -20°C; after one year, 76 samples were randomly selected for POC-ECO retesting. Results: The POC-ECO agreement between freshly collected and stored urine was inadequate considering trace results as positive (Cohen’s kappa coefficient κ = 0.08) and negative (κ = 0.36). POC-ECO accuracy was not significantly greater than that of routine KK (54%; 95% confidence interval: 42.1%-65.5%). Conclusions The precision and accuracy of POC-ECO have to be optimized in both freshly collected and stored urine before it can be recommended for use in control programs in Brazil.
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Affiliation(s)
| | | | | | - Carlos Graeff-Teixeira
- Universidade Federal do Espírito Santo, Brasil; Pontifícia Universidade Católica do Rio Grande do Sul, Brasil
| | | | | | | | | | - Mitermayer Galvão dos Reis
- Fundação Oswaldo Cruz, Brasil; Universidade Federal da Bahia, Brasil; Yale University, United States of America
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Mesquita CR, Enk MJ, Guimarães RJDPSE. Spatial analysis studies of endemic diseases for health surveillance: Application of scan statistics for surveillance of tuberculosis among residents of a metropolitan municipality aged 60 years and above. Cien Saude Colet 2021; 26:5149-5156. [PMID: 34787206 DOI: 10.1590/1413-812320212611.3.09132020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/24/2020] [Indexed: 11/21/2022] Open
Abstract
Health surveillance aims to monitor adverse health events, and to set disease prevention and control goals, especially for communicable diseases, such as tuberculosis (TB). Older people have a higher risk of TB, due to their specific characteristics, whichpredispose them to infectious disease. Thus, the objective of this study was to demonstrate the importance of scan statistics for detecting spatiotemporal clusters of TB. We conducted a quantitative is an ecological, descriptive study, with a quantitative approach, using the spatial analysis techniques, specifically scan statistics. The study was conducted in the municipality of Belém, Pará, in Brazil using data on 1,134 new cases of TB diagnosed in individuals aged ≥60 years from 2011 to 2015.The data were analyzed using SaTScan software. The analysis of the spatiotemporal dynamics of TB in the municipality showed thatthe high-risk areas includedthe most densely populated neighborhoods, highlighting the priority of theseareas for disease control measures. Spatial analysis can be used to guide more effective interventions according to the characteristics of the location and the local population.
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Affiliation(s)
- Cristal Ribeiro Mesquita
- Programa de Pós-Graduação em Epidemiologia e Vigilância em Saúde, Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministério da Saúde. Rodovia BR-316 KM 7 s/n, Levilândia. 67030-000 Ananindeua PA Brasil.
| | - Martin Johannes Enk
- Programa de Pós-Graduação em Epidemiologia e Vigilância em Saúde, Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministério da Saúde. Rodovia BR-316 KM 7 s/n, Levilândia. 67030-000 Ananindeua PA Brasil.
| | - Ricardo José de Paula Souza E Guimarães
- Programa de Pós-Graduação em Epidemiologia e Vigilância em Saúde, Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministério da Saúde. Rodovia BR-316 KM 7 s/n, Levilândia. 67030-000 Ananindeua PA Brasil.
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Graeff-Teixeira C, Favero V, Pascoal VF, de Souza RP, Rigo FDV, Agnese LHD, Bezerra FSM, Coelho PMZ, Enk MJ, Favre TC, Katz N, Oliveira RR, Dos Reis MG, Pieri OS. Low specificity of point-of-care circulating cathodic antigen (POCCCA) diagnostic test in a non-endemic area for schistosomiasis mansoni in Brazil. Acta Trop 2021; 217:105863. [PMID: 33587944 DOI: 10.1016/j.actatropica.2021.105863] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 02/08/2023]
Abstract
A point-of-care test for detecting schistosome circulating cathodic antigen in urine (POCCCA) has been proposed for mapping infection and defining prevalence thresholds for mass drug administration (MDA). However, there is increasing evidence that POCCCA may yield false-positive results, which requires rigorous specificity evaluation in non-endemic areas. POCCCA was applied in an area known to be free from infection and devoid of any condition for schistosomiasis transmission as part of a multicentre study to evaluate the performance of POCCCA in Brazil's low or potentially endemic settings. Besides POCCCA detection in urine, a search for eggs in stool was performed by Kato-Katz (KK) and Helmintex (HTX) methods. One-hundred-and-seventy-four participants returned urine samples, 140 of which delivered stool samples. All these were HTX-negative for Schistosoma mansoni, and all 118 tested with KK were negative for both S. mansoni and soil-transmitted helminths. POCCCA results from freshly collected urine yielded a specificity of 62.1% (95% CI: 53.6% - 70.2%), taking trace outcomes as positive according to the manufacturer's instructions. Retesting urine from the 140 HTX-negatives after one-year storage at -20 °C with two new POCCCA batches simultaneously yielded significantly different specificities (34.3%; 95%CI: 26.5% - 42.8% and 75.0%; 95% CI: 67.0% - 81.9%). These two batches had a weak agreement (Cohen's kappa: 0.56; 95%CI: 0.44-0.68) among the 174 urine samples retested. At present, POCCCA cannot be recommended either as a cut-off point for MDA or a reliable diagnostic tool for treatment of the infection carriers (selective chemotherapy) in low endemic areas and at final stages of transmission interruption. Manufacturers should be required to optimize production standardization and to assure quality and reproducibility of the test. Extended rigorous performance evaluations by different users from different regions are needed before POCCCA is widely recommended.
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Affiliation(s)
- Carlos Graeff-Teixeira
- Infectious Diseases Unit (NDI), Center for Health Sciences, Universidade Federal do Espírito Santo, Vitória, ES, Brazil; Research Group on Biomedical Parasitology, School of Sciences, Pontíficia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Vivian Favero
- Research Group on Biomedical Parasitology, School of Sciences, Pontíficia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Vanessa Fey Pascoal
- Research Group on Biomedical Parasitology, School of Sciences, Pontíficia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Renata Perotto de Souza
- Research Group on Biomedical Parasitology, School of Sciences, Pontíficia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Francine de Vargas Rigo
- Research Group on Biomedical Parasitology, School of Sciences, Pontíficia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Luize Hoffmann Dall Agnese
- Research Group on Biomedical Parasitology, School of Sciences, Pontíficia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | | | - Tereza Cristina Favre
- Oswaldo Cruz Institute, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil.
| | - Naftale Katz
- René Rachou Institute, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, MG, Brazil
| | | | - Mitermayer Galvão Dos Reis
- Gonçalo Muniz Institute, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, BA, Brazil; Faculty of Medicine of Bahia, Federal University of Bahia, Salvador, BA, Brazil; Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, CT, United States of America.
| | - Otavio Sarmento Pieri
- Oswaldo Cruz Institute, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil.
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Sousa SRMD, Nogueira JFC, Dias IHL, Fonseca ÁLS, Favero V, Geiger SM, Enk MJ. The use of the circulating cathodic antigen (CCA) urine cassette assay for the diagnosis and assessment of cure of Schistosoma mansoni infections in an endemic area of the Amazon region. Rev Soc Bras Med Trop 2020; 53:e20190562. [PMID: 32997046 PMCID: PMC7523523 DOI: 10.1590/0037-8682-0562-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/20/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Schistosomiasis is a poverty-related disease that affects people in 78
countries worldwide. This study aimed to evaluate the point-of-care
circulating cathodic antigen (POC-CCA) test performance using sensitive
parasitological methods as a reference standard (RS) in individuals before
and after treatment. METHODS The RS was established by combining the results of 16 Kato-Katz slides and
the Helmintex® method. Positivity rates of the POC-CCA test and
Kato-Katz and Helmintex® methods were calculated before treatment
and 30 days afterward. Furthermore, the sensitivity, specificity, accuracy,
and kappa coefficient before treatment were determined by
comparing the methods. The cure rate was defined 30 days after treatment.
RESULTS Among the 217 participants, the RS detected a total of 63 (29.0%) positive
individuals. The POC-CCA test identified 79 (36.4%) infections. The
evaluation of POC-CCA test performance in relation to the RS revealed a
sensitivity of 61.9%, specificity of 74.0%, accuracy of 70.5%, and
kappa coefficient of 0.33. Out of the 53 remaining
participants after treatment, a total of 45 (81.1%) showed egg negative
results, and 8 (18.9%) were egg positive according to the RS. A total of 5
(9.4%) egg-positive and 37 (69.8%) egg-negative individuals were positive by
the POC-CCA test. CONCLUSIONS Our data show that the POC-CCA test has potential as an auxiliary tool for
the diagnosis of Schistosoma mansoni infection, yielding
better results than 16 Kato-Katz slides from three different stool samples.
However, the immunochromatographic test lacks sufficient specificity and
sensitivity for verifying the cure rate after treatment.
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Affiliation(s)
| | | | | | | | - Vivian Favero
- Pontifícia Universidade Católica do Rio Grande do Sul, Brasil
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Carneiro NFDF, Caldeira AP, Katz N, de Oliveira ÁA, Siqueira LMV, Oliveira E, Silveira MF, Enk MJ, Coelho PMZ. Transmission control of schistosomiasis mansoni in a low endemicity area through a single intervention with rigorous prospection of infected cases treated with praziquantel: evaluation after 7 years of intervention. Rev Inst Med Trop Sao Paulo 2019; 61:e64. [PMID: 31859841 PMCID: PMC6907418 DOI: 10.1590/s1678-9946201961064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/22/2019] [Indexed: 11/22/2022] Open
Abstract
A prospective cohort study with rigorous searching for schistosomiasis cases was conducted among residents of Pedra Preta, Montes Claros, Minas Gerais State, Brazil, seven years after an intervention. Kato-Katz (KK), Saline Gradient, Miracidia Hatch and Polymerase Chain Reaction (PCR) were used as the diagnostic methods in 2008. In the period of 2013-2016, 175 patients remaining in the area were examined using the diagnostic methods Kato-Katz (24 slides, 1 g of feces) and Saline Gradient (2 procedures, 1 g of feces). Sixty-eight out of the 69 infected and treated individuals in 2008 tested negative. The percentage of new cases was 2.29% (4/175), and the 4 infected individuals presented low parasitic load [1, 6, 7 and 19 eggs per gram (EPG)]. All the participants answered epidemiological questionnaires on risky behavior. All residences had pit latrines and domiciliary water supply. The primary transmission focus (lake) was dry for several months. Malacological surveys showed a few non-infected specimens of Biomphalaria glabrata . A clear dominance of Biomphalaria straminea was observed. It can be inferred that a significant decrease in the disease transmission occurred after a single action through an intense search for infected and treated cases under the ecoepidemiological conditions of this area.
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Affiliation(s)
| | | | - Naftale Katz
- Fundação Oswaldo Cruz, Instituto René Rachou, Laboratório de Esquistossomose, Belo Horizonte, Minas Gerais, Brazil
| | - Áureo Almeida de Oliveira
- Fundação Oswaldo Cruz, Instituto René Rachou, Laboratório de Esquistossomose, Belo Horizonte, Minas Gerais, Brazil
| | - Liliane Maria Vidal Siqueira
- Fundação Oswaldo Cruz, Instituto René Rachou, Laboratório de Esquistossomose, Belo Horizonte, Minas Gerais, Brazil
| | - Edward Oliveira
- Fundação Oswaldo Cruz, Instituto René Rachou, Laboratório de Pesquisa Clínica, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Paulo Marcos Zech Coelho
- Fundação Oswaldo Cruz, Instituto René Rachou, Laboratório de Esquistossomose, Belo Horizonte, Minas Gerais, Brazil
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13
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de Sousa SRM, Dias IHL, Fonseca ÁLS, Contente BR, Nogueira JFC, da Costa Oliveira TN, Geiger SM, Enk MJ. Concordance of the point-of-care circulating cathodic antigen test for the diagnosis of intestinal schistosomiasis in a low endemicity area. Infect Dis Poverty 2019; 8:37. [PMID: 31142379 PMCID: PMC6542115 DOI: 10.1186/s40249-019-0551-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/16/2019] [Indexed: 11/25/2022] Open
Abstract
Background The Kato-Katz technique is recommended worldwide for the diagnosis of intestinal schistosomiasis, detecting parasite eggs in feces of infected people. However, new tests have been developed in order to facilitate diagnosis, e.g. by detection of specific antigens secreted by schistosomes, such as the circulating cathodic antigen (CCA). The aim of this study was to evaluate the performance of the point-of-care circulating cathodic antigen test (POC-CCA) compared to the Kato-Katz technique in a low prevalence area in the Amazon Region, located in the municipality of Primavera, State of Pará, Brazil. Methods Positivity rates of the POC-CCA test and the Kato-Katz technique were calculated. The sensitivity, specificity, accuracy and kappa coefficient were determined by comparing both methods. The reference standard was established using 16 Kato-Katz slides, 12 of the first fecal sample, two of the second and two of the third one. The study also included the concordance between POC-CCA results and different numbers and combinations of Kato-Katz slides. Results The prevalence of schistosomiasis according to the reference standard or POC-CCA test reached a rate of 9.4% or 23.9%, respectively, among a total of 372 participants. The positivity rates by the Kato-Katz technique increased from 2.4 to 9.4%, according to the increase in the number of slides examined and fecal samples collected. A sensitivity of 55.6%, specificity 76.9%, accuracy 76% and κ coefficient of 0.06 was observed by comparing one slide of the first sample and POC-CCA. Comparing 6 slides from three different samples, two slides of each, with POC-CCA resulted in a sensitivity of 58.3%, specificity 78.4%, accuracy 77% and κ coefficient of 0.16. Finally, the comparison of 16 slides from three different samples with POC-CCA revealed a sensitivity of 65.7%, specificity 80.4%, accuracy 79%, and κ coefficient of 0.27. Conclusions The immunochromatographic test has the potential to be an important tool to combat schistosomiasis because of its practicality and applicability but should be applied with caution in low prevalence areas and in programs that aim to eliminate this disease. Trial registration CAAE#21824513.9.0000.5091. January 31st, 2014. Electronic supplementary material The online version of this article (10.1186/s40249-019-0551-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sergei Rodrigo Magalhães de Sousa
- Programa de Pós-Graduação Strictu Sensu em Biologia Parasitária na Amazônia da Universidade do Estado do Pará, Tv. Perebebuí, 2623 - Marco, Belém, PA, 66087, Brazil. .,Laboratório de Parasitoses Intestinais, Esquistossomose e Malacologia (LPIEM), Secção de Parasitologia, Instituto Evandro Chagas/SVS/MS, Ananindeua, Pará, Brazil.
| | - Isabelle Helena Lima Dias
- Programa de Pós-Graduação Strictu Sensu em Biologia Parasitária na Amazônia da Universidade do Estado do Pará, Tv. Perebebuí, 2623 - Marco, Belém, PA, 66087, Brazil.,Laboratório de Parasitoses Intestinais, Esquistossomose e Malacologia (LPIEM), Secção de Parasitologia, Instituto Evandro Chagas/SVS/MS, Ananindeua, Pará, Brazil
| | - Álvaro Luan Santana Fonseca
- Programa de Pós-Graduação Strictu Sensu em Biologia Parasitária na Amazônia da Universidade do Estado do Pará, Tv. Perebebuí, 2623 - Marco, Belém, PA, 66087, Brazil.,Laboratório de Parasitoses Intestinais, Esquistossomose e Malacologia (LPIEM), Secção de Parasitologia, Instituto Evandro Chagas/SVS/MS, Ananindeua, Pará, Brazil
| | - Bianca Rodrigues Contente
- Programa de Pós-Graduação Strictu Sensu em Biologia Parasitária na Amazônia da Universidade do Estado do Pará, Tv. Perebebuí, 2623 - Marco, Belém, PA, 66087, Brazil.,Laboratório de Parasitoses Intestinais, Esquistossomose e Malacologia (LPIEM), Secção de Parasitologia, Instituto Evandro Chagas/SVS/MS, Ananindeua, Pará, Brazil
| | - Joyce Favacho Cardoso Nogueira
- Programa de Pós-Graduação Strictu Sensu em Biologia Parasitária na Amazônia da Universidade do Estado do Pará, Tv. Perebebuí, 2623 - Marco, Belém, PA, 66087, Brazil.,Laboratório de Parasitoses Intestinais, Esquistossomose e Malacologia (LPIEM), Secção de Parasitologia, Instituto Evandro Chagas/SVS/MS, Ananindeua, Pará, Brazil
| | - Tatyellen Natasha da Costa Oliveira
- Programa de Pós-Graduação Strictu Sensu em Biologia Parasitária na Amazônia da Universidade do Estado do Pará, Tv. Perebebuí, 2623 - Marco, Belém, PA, 66087, Brazil
| | - Stefan Michael Geiger
- Departamento de Parasitologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Martin Johannes Enk
- Programa de Pós-Graduação Strictu Sensu em Biologia Parasitária na Amazônia da Universidade do Estado do Pará, Tv. Perebebuí, 2623 - Marco, Belém, PA, 66087, Brazil.,Laboratório de Parasitoses Intestinais, Esquistossomose e Malacologia (LPIEM), Secção de Parasitologia, Instituto Evandro Chagas/SVS/MS, Ananindeua, Pará, Brazil
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14
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Massara CL, Murta FLG, Enk MJ, Araújo ADD, Modena CM, Carvalho ODS. [Characterization of printed educational materials about schistosomiasis used in health education in endemic areas in Brazil]. Epidemiologia e Serviços de Saúde 2018; 25:575-584. [PMID: 27869928 DOI: 10.5123/s1679-49742016000300013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 01/21/2016] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE to characterize printed educational materials about schistosomiasis produced at federal, state and municipal levels in Brazil. METHODS the educational materials were characterized considering the following categories: 'format', 'parasite and intermediate host', 'definitive host (ill)' and 'disease'. RESULTS 60 materials were assessed, three had no information about risk activities and 41 indicated more than one popular name for the disease, thus allowing greater reach among the target audience in diverse endemic areas; the biological cycle was missing or incorrect in 53 materials; the intermediate host (snail) was incorrectly illustrated, with use of stereotyped images in 39 and no image in one material; diagnosis was mentioned in 36 materials. CONCLUSION the printed educational materials assessed had incorrect content which may compromise health education efforts; little attention was paid to schistosomiasis diagnosis.
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Affiliation(s)
- Cristiano Lara Massara
- Centro de Pesquisas René Rachou, Grupo de Pesquisas em Helmintologia e Malacologia Médica, Belo Horizonte-MG, Brasil
| | - Felipe Leão Gomes Murta
- Centro de Pesquisas René Rachou, Grupo de Pesquisas em Helmintologia e Malacologia Médica, Belo Horizonte-MG, Brasil
| | | | - Amanda Domingues de Araújo
- Centro de Pesquisas René Rachou, Grupo de Pesquisas em Helmintologia e Malacologia Médica, Belo Horizonte-MG, Brasil
| | - Celina Maria Modena
- Centro de Pesquisas René Rachou, Grupo de Pesquisas Políticas Públicas e Direitos Humanos em Saúde e Saneamento, Belo Horizonte - MG, Brasil
| | - Omar Dos Santos Carvalho
- Centro de Pesquisas René Rachou, Grupo de Pesquisas em Helmintologia e Malacologia Médica, Belo Horizonte-MG, Brasil
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15
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Menezes RADO, Gomes MDSM, Mendes AM, Couto ÁARDA, Nacher M, Pimenta TS, de Sousa ACP, Baptista ARDS, de Jesus MI, Enk MJ, Cunha MG, Machado RLD. Enteroparasite and vivax malaria co-infection on the Brazil-French Guiana border: Epidemiological, haematological and immunological aspects. PLoS One 2018; 13:e0189958. [PMID: 29293589 PMCID: PMC5749708 DOI: 10.1371/journal.pone.0189958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/05/2017] [Indexed: 11/30/2022] Open
Abstract
Malaria-enteroparasitic co-infections are known for their endemicity. Although they are prevalent, little is known about their epidemiology and effect on the immune response. This study evaluated the effect of enteroparasite co-infections with malaria caused by Plasmodium vivax in a border area between Brazil and French Guiana. The cross sectional study took place in Oiapoque, a municipality of Amapá, on the Amazon border. Malaria was diagnosed using thick blood smears, haemoglobin dosage by an automated method and coproparasitology by the Hoffman and Faust methods. The anti-PvMSP-119 IgG antibodies in the plasma were evaluated using ELISA and Th1 (IFN-γ, TNF-α and IL-2), and Th2 (IL-4, IL-5 and IL-10) cytokine counts were performed by flow cytometry. The participants were grouped into those that were monoinfected with vivax malaria (M), vivax malaria-enteroparasite co-infected (CI), monoinfected with enteroparasite (E) and endemic controls (EC), who were negative for both diseases. 441 individuals were included and grouped according to their infection status: [M 6.9% (30/441)], [Cl 26.5% (117/441)], [E 32.4% (143/441)] and [EC 34.2% (151/441)]. Males prevailed among the (M) 77% (23/30) and (CI) 60% (70/117) groups. There was a difference in haemoglobin levels among the different groups under study for [EC-E], [EC-Cl], [E-M] and [Cl-M], with (p < 0.01). Anaemia was expressed as a percentage between individuals [CI-EC (p < 0.05)]. In terms of parasitaemia, there were differences for the groups [CI-M (p < 0.05)]. Anti-PvMSP-119 antibodies were detected in 51.2% (226/441) of the population. The level of cytokines evaluation revealed a large variation in TNF-α and IL-10 concentrations in the co-infected group. In this study we did not observe any influence of coinfection on the acquisition of IgG antibodies against PvMSP119, as well as on the profile of the cytokines that characterize the Th1 and Th2 patterns. However, co-infection increased TNF-α and IL-10 levels.
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Affiliation(s)
- Rubens Alex de Oliveira Menezes
- Postgraduate Program in the Biology of Infectious and Parasitic Agents, Federal University of Pará (UFPA), Belém, Pará State, Brazil
- Laboratory of morphofunctional and parasitic studies with impact on health (LEMPIS), Federal University of Amapá (UNIFAP), Macapa, Amapá State, Brazil
- * E-mail:
| | | | - Anapaula Martins Mendes
- UNIFAP/Oiapoque Binational Campus, Federal University of Amapá, Oiapoque, Amapá State, Brazil
| | | | - Mathieu Nacher
- Centre d’Investigation Clinique, CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Tamirys Simão Pimenta
- Postgraduate Program in Neuroscience and Cell Biology, UFPA, Belém, Pará State, Brazil
- Evandro Chagas Institute/Brazilian Secretariat of Health Surveillance (SVS)/Brazilian Ministry of Health (MS), Ananindeua, Pará State, Brazil
| | - Aline Collares Pinheiro de Sousa
- Evandro Chagas Institute/Brazilian Secretariat of Health Surveillance (SVS)/Brazilian Ministry of Health (MS), Ananindeua, Pará State, Brazil
| | | | - Maria Izabel de Jesus
- Evandro Chagas Institute/Brazilian Secretariat of Health Surveillance (SVS)/Brazilian Ministry of Health (MS), Ananindeua, Pará State, Brazil
| | - Martin Johannes Enk
- Evandro Chagas Institute/Brazilian Secretariat of Health Surveillance (SVS)/Brazilian Ministry of Health (MS), Ananindeua, Pará State, Brazil
| | - Maristela Gomes Cunha
- Postgraduate Program in the Biology of Infectious and Parasitic Agents, Federal University of Pará (UFPA), Belém, Pará State, Brazil
- Laboratory of Microbiology and Immunology, Federal University of Pará (UFPA), Belém, Pará State, Brazil
| | - Ricardo Luiz Dantas Machado
- Postgraduate Program in the Biology of Infectious and Parasitic Agents, Federal University of Pará (UFPA), Belém, Pará State, Brazil
- Evandro Chagas Institute/Brazilian Secretariat of Health Surveillance (SVS)/Brazilian Ministry of Health (MS), Ananindeua, Pará State, Brazil
- Fluminense Federal University, Niterói, Rio de Janeiro State, Brazil
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Sousa SRMD, Carvalho ADQ, Cardoso JFN, Coelho PMZ, Geiger SM, Enk MJ. Schistosomiasis in the Amazon region: is the current diagnostic strategy still appropriate? Rev Soc Bras Med Trop 2017; 50:848-852. [DOI: 10.1590/0037-8682-0097-2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 08/24/2017] [Indexed: 11/21/2022] Open
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Murta FLG, Massara CL, Nogueira JFC, dos Santos Carvalho O, de Mendonça CLF, Pinheiro VAO, Enk MJ. Ecotourism as a source of infection with Schistosoma mansoni in Minas Gerais, Brazil. Trop Dis Travel Med Vaccines 2016; 2:3. [PMID: 28883947 PMCID: PMC5588611 DOI: 10.1186/s40794-016-0019-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 02/03/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In recent years, a new pattern of schistosomiasis transmission has been described which is related to recreational activities associated with rural or ecological tourism and migratory flows and accompanying changes in social dynamics in Brazil. The objective of this report is to describe two schistosomiasis outbreaks that occurred during the practice of rural tourism in Minas Gerais, Brazil, and review this pattern of transmission within the wider context of schistosomiasis control. FINDINGS The first outbreak was characterized by its high infection rate, showing that 59 % of the exposed eco-tourists became positive for infection with Schistosoma mansoni. In addition, all three disease transmitting species of intermediate host snails were found in the area. In the second outbreak, all members of one tourist family were infected and reported contact with water in a well-known tourist area. The malacological survey in the region revealed an infection rate with S. mansoni of 8.3 % among the collected snails. CONCLUSIONS Infection of urban dwellers that report contact with contaminated water associated with ecotourism represents a new pattern of disease transmission and dissemination. The infection with the disease at these occasions finds its expression in outbreaks of acute schistosomiasis among internal tourists to rural areas. Therefore, epidemiological surveillance in endemic areas should be aware of this schistosomiasis transmission pattern, and a multidisciplinary approach, most of all sanitation and health education measures, is required in order increase the efficiency of control strategies.
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Affiliation(s)
| | - Cristiano Lara Massara
- Laboratory of Helminthology and Medical, Malacology-René Rachou Research Center, Fiocruz, Minas Brazil
| | - Joyce Favacho Cardoso Nogueira
- Laboratory of Intestinal Parasites, Schistosomiasis and Malacology, Evandro Chagas Institute, Ananindeua, Brazil & Secretary of Health Surveillance, Ministry of Health, Rio de Janeiro, Brazil
| | - Omar dos Santos Carvalho
- Laboratory of Helminthology and Medical, Malacology-René Rachou Research Center, Fiocruz, Minas Brazil
| | | | | | - Martin Johannes Enk
- Laboratory of Intestinal Parasites, Schistosomiasis and Malacology, Evandro Chagas Institute, Ananindeua, Brazil & Secretary of Health Surveillance, Ministry of Health, Rio de Janeiro, Brazil
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18
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Siqueira LMV, Gomes LI, Oliveira E, Oliveira ERD, Oliveira ÁAD, Enk MJ, Carneiro NF, Rabello A, Coelho PMZ. Evaluation of parasitological and molecular techniques for the diagnosis and assessment of cure of schistosomiasis mansoni in a low transmission area. Mem Inst Oswaldo Cruz 2015; 110:209-14. [PMID: 25946244 PMCID: PMC4489451 DOI: 10.1590/0074-02760140375] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 01/26/2015] [Indexed: 11/22/2022] Open
Abstract
This study evaluated parasitological and molecular techniques for the diagnosis and
assessment of cure of schistosomiasis mansoni. A population-based study was performed
in 201 inhabitants from a low transmission locality named Pedra Preta, municipality
of Montes Claros, state of Minas Gerais, Brazil. Four stool samples were analysed
using two techniques, the Kato-Katz® (KK) technique (18 slides) and the
TF-Test®, to establish the infection rate. The positivity rate of 18 KK
slides of four stool samples was 28.9% (58/201) and the combined parasitological
techniques (KK+TF-Test®) produced a 35.8% positivity rate (72/201).
Furthermore, a polymerase chain reaction (PCR)-ELISA assay produced a positivity rate
of 23.4% (47/201) using the first sample. All 72 patients with positive
parasitological exams were treated with a single dose of Praziquantel® and
these patients were followed-up 30, 90 and 180 days after treatment to establish the
cure rate. Cure rates obtained by the analysis of 12 KK slides were 100%, 100% and
98.4% at 30, 90 and 180 days after treatment, respectively. PCR-ELISA revealed cure
rates of 98.5%, 95.5% and 96.5%, respectively. The diagnostic and assessment of cure
for schistosomiasis may require an increased number of KK slides or a test with
higher sensitivity, such as PCR-ELISA, in situations of very low parasite load, such
as after therapeutic interventions.
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Affiliation(s)
| | - Luciana Inácia Gomes
- Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, MG, Brasil
| | - Edward Oliveira
- Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, MG, Brasil
| | | | | | | | | | - Ana Rabello
- Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, MG, Brasil
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Massara CL, Enk MJ, Caldeira RL, Mendonça CLFD, Scholte RGC, Carvalho ODS. OCORRÊNCIA DE MOLUSCOS DO GÊNERO Biomphalaria EM PARQUES DA CIDADE DE BELO HORIZONTE, MINAS GERAIS, BRASIL. Rev Patol Trop 2012. [DOI: 10.5216/rpt.v41i4.21705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Siqueira LMV, Coelho PMZ, Oliveira ÁAD, Massara CL, Carneiro NFDF, Lima ACL, Enk MJ. Evaluation of two coproscopic techniques for the diagnosis of schistosomiasis in a low-transmission area in the state of Minas Gerais, Brazil. Mem Inst Oswaldo Cruz 2012; 106:844-50. [PMID: 22124557 DOI: 10.1590/s0074-02762011000700010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 09/20/2011] [Indexed: 11/21/2022] Open
Abstract
This population study, which evaluated two parasitological methods for the diagnosis of schistosomiasis mansoni, was performed in a low-transmission area in Pedra Preta, Montes Claros, Minas Gerais, Brazil. A total of 201 inhabitants of the rural area participated in this research. Four stool samples were obtained from all participants and analysed using the Kato-Katz method (18 slides) and a commercial test, the TF-Test®, which was performed quantitatively. The data were analysed to determine prevalence, the sensitivity of the diagnostic methods, the worm burden and the definition of the "gold standard", which was obtained by totalling the results of all samples examined using the Kato-Katz technique and the TF-Test®. The results showed that the prevalence obtained from the examination of one Kato-Katz slide (the methodology adopted by the Brazilian control programme) was 8% compared to 35.8% from the "gold standard", which was a 4.5-fold difference. This result indicates that the prevalence of schistosomiasis in so-called low-transmission areas is significantly underestimated.
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Affiliation(s)
- Liliane Maria Vidal Siqueira
- Laboratório de Esquistossomose, Instituto de Pesquisas René Rachou-Fiocruz, Belo Horizonte, MG, Brasil, 30190-002
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Enk MJ, Oliveira e Silva G, Rodrigues NB. Diagnostic accuracy and applicability of a PCR system for the detection of Schistosoma mansoni DNA in human urine samples from an endemic area. PLoS One 2012; 7:e38947. [PMID: 22701733 PMCID: PMC3372502 DOI: 10.1371/journal.pone.0038947] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 05/14/2012] [Indexed: 11/18/2022] Open
Abstract
Schistosomiasis caused by Schistosoma mansoni, one of the most neglected human parasitoses in Latin America and Africa, is routinely confirmed by microscopic visualization of eggs in stool. The main limitation of this diagnostic approach is its lack of sensitivity in detecting individual low worm burdens and consequently data on infection rates in low transmission settings are little reliable. According to the scientific literature, PCR assays are characterized by high sensitivity and specificity in detecting parasite DNA in biological samples. A simple and cost effective extraction method for DNA of Schistosoma mansoni from urine samples in combination with a conventional PCR assay was developed and applied in an endemic area. This urine based PCR system was tested for diagnostic accuracy among a population of a small village in an endemic area, comparing it to a reference test composed of three different parasitological techniques. The diagnostic parameters revealed a sensitivity of 100%, a specificity of 91.20%, positive and negative predictive values of 86.25% and 100%, respectively, and a test accuracy of 94.33%. Further statistical analysis showed a k index of 0.8806, indicating an excellent agreement between the reference test and the PCR system. Data obtained from the mouse model indicate the infection can be detected one week after cercariae penetration, opening a new perspective for early detection and patient management during this stage of the disease. The data indicate that this innovative PCR system provides a simple to handle and robust diagnostic tool for the detection of S. mansoni DNA from urine samples and a promising approach to overcome the diagnostic obstacles in low transmission settings. Furthermore the principals of this molecular technique, based on the examination of human urine samples may be useful for the diagnosis of other neglected tropical diseases that can be detected by trans-renal DNA.
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Affiliation(s)
- Martin Johannes Enk
- Laboratório de Esquistossomose, Centro de Pesquisas René Rachou, FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil.
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Enk MJ, Lima ACL, Barros HDS, Massara CL, Coelho PMZ, Schall VT. Factors related to transmission of and infection with Schistosoma mansoni in a village in the South-eastern Region of Brazil. Mem Inst Oswaldo Cruz 2011; 105:570-7. [PMID: 20721510 DOI: 10.1590/s0074-02762010000400037] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 10/08/2009] [Indexed: 11/21/2022] Open
Abstract
In this transversal study, factors related to infection with and transmission of Schistosoma mansoni were explored. Based on stool examinations of two Kato-Katz smears of a single sample, the prevalences of schistosomiasis and geohelminths were established. In a multivariable analysis, sets of demographic, socio-economic and water contact pattern variables were tested for strength of relation with infection. Males presented a 3.39-times higher risk for infection than females. The age groups between 10-19 years and 20-30 years showed risks of infection 7.1- and 7.5-times higher, respectively, than the control age group between 0-10 years. Individuals practicing leisure activities had a 1.96-times higher risk than those without these activities. The malacological survey identified snails of the species Biomphalaria glabrata, Biomphalaria straminea and Biomphalaria tenagophila. Two exemplars of B. glabrata (0.53%) proved positive for S. mansoni. The socio-economic improvements observed in the locality suggest a protective and preventive effect towards infection with schistosomiasis, which requires further investigation with a longitudinal and more detailed study design. Considering our findings, a proposal for an integrated control program should be based on two pillars: one horizontal, which involves social empowerment and health education, and another more vertical, which delivers treatment and infrastructure improvements.
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Affiliation(s)
- Martin Johannes Enk
- Laboratório de Helmintologia e Malacologia Médica, Instituto de Pesquisas René Rachou, Fiocruz, Belo Horizonte, MG, Brazil.
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Enk MJ, Amaral GL, Costa e Silva MF, Silveira-Lemos D, Teixeira-Carvalho A, Martins-Filho OA, Correa-Oliveira R, Gazinnelli G, Coelho PMZ, Massara CL. Rural tourism: a risk factor for schistosomiasis transmission in Brazil. Mem Inst Oswaldo Cruz 2011; 105:537-40. [PMID: 20721505 DOI: 10.1590/s0074-02762010000400032] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 10/08/2009] [Indexed: 11/22/2022] Open
Abstract
This paper reports an outbreak of acute schistosomiasis among 38 tourists who rented a country house in the district of Igarapé, the metropolitan region of Belo Horizonte, Brazil, during a holiday period in 2006. A total number of 32 individuals were positive for Schistosoma mansoni. Results of stool examinations revealed individual S. mansoni egg counts per gram of faeces (epg) ranging from 4-768 epg with a geometric mean egg count of 45. The most frequent clinical symptoms were abdominal pain (78.1%), headache (75%), fever (65.6%), dry cough (65.2%) and both diarrhoea and asthenia (59.4%). A malacological survey of the area, where 22 specimens of Biomphalaria glabrata were collected, revealed three (13.6%) specimens eliminating Schistosoma cercariae. This investigation re-confirms a recently described pattern of schistosomiasis infection, resulting in the acute form of the disease and connected to rural tourism, which contributes to the spread of the disease among the middle-class and into non-endemic areas. The lack of specific knowledge about acute schistosomiasis among health services causes an increased number of unnecessary diagnostic procedures and delays in accurate diagnosis and treatment, resulting in considerable discomfort for the patients.
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Affiliation(s)
- Martin Johannes Enk
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Instituto de Pesquisas René Rachou, Fiocruz, Belo Horizonte, MG, Brasil.
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Gomes LI, Marques LHDS, Enk MJ, de Oliveira MC, Coelho PMZ, Rabello A. Development and evaluation of a sensitive PCR-ELISA system for detection of schistosoma infection in feces. PLoS Negl Trop Dis 2010; 4:e664. [PMID: 20421918 PMCID: PMC2857640 DOI: 10.1371/journal.pntd.0000664] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 03/09/2010] [Indexed: 11/18/2022] Open
Abstract
Background A PCR-enzyme-linked immunosorbent assay (PCR-ELISA) was developed to overcome the need for sensitive techniques for the efficient diagnosis of Schistosoma infection in endemic settings with low parasitic burden. Methodology/Principal Findings This system amplifies a 121-base pair tandem repeat DNA sequence, immobilizes the resultant 5′ biotinylated product on streptavidin-coated strip-well microplates and uses anti-fluorescein antibodies conjugated to horseradish peroxidase to detect the hybridized fluorescein-labeled oligonucleotide probe. The detection limit of the Schistosoma PCR-ELISA system was determined to be 1.3 fg of S. mansoni genomic DNA (less than the amount found in a single cell) and estimated to be 0.15 S. mansoni eggs per gram of feces (fractions of an egg). The system showed good precision and genus specificity since the DNA target was found in seven Schistosoma DNA samples: S. mansoni, S. haematobium, S. bovis, S. intercalatum, S. japonicum, S. magrebowiei and S. rhodaini. By evaluating 206 patients living in an endemic area in Brazil, the prevalence of S. mansoni infection was determined to be 18% by examining 12 Kato-Katz slides (41.7 mg/smear, 500 mg total) of a single fecal sample from each person, while the Schistosoma PCR-ELISA identified a 30% rate of infection using 500-mg of the same fecal sample. When considering the Kato-Katz method as the reference test, artificial sensitivity and specificity rates of the PCR-ELISA system were 97.4% and 85.1%, respectively. The potential for estimating parasitic load by DNA detection in feces was assessed by comparing absorbance values and eggs per gram of feces, with a Spearman correlation coefficient of 0.700 (P<0.0001). Conclusions/Significance This study reports the development and field evaluation of a sensitive Schistosoma PCR-ELISA, a system that may serve as an alternative for diagnosing Schistosoma infection. Schistosomiasis is a neglected disease caused by worms of the genus Schistosoma. The transmission cycle requires contamination of bodies of water by parasite eggs present in excreta, specific snails as intermediate hosts and human contact with water. Fortunately, relatively safe and easily administrable drugs are available and, as the outcome of repeated treatment, a reduction of severe clinical forms and a decrease in the number of infected persons has been reported in endemic areas. The routine method for diagnosis is the microscopic examination but it fails when there are few eggs in the feces, as usually occurs in treated but noncured persons or in areas with low levels of transmission. This study reports the development of the PCR-ELISA system for the detection of Schistosoma DNA in human feces as an alternative approach to diagnose light infections. The system permits the enzymatic amplification of a specific region of the DNA from minute amounts of parasite material. Using the proposed PCR-ELISA approach for the diagnosis of a population in an endemic area in Brazil, 30% were found to be infected, as compared with the 18% found by microscopic fecal examination. Although the technique requires a complex laboratory infrastructure and specific funding it may be used by control programs targeting the elimination of schistosomiasis.
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Affiliation(s)
- Luciana Inácia Gomes
- Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (Fiocruz), Belo Horizonte, Minas Gerais, Brazil
| | - Letícia Helena dos Santos Marques
- Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (Fiocruz), Belo Horizonte, Minas Gerais, Brazil
| | - Martin Johannes Enk
- Laboratório de Esquistossomose, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (Fiocruz), Belo Horizonte, Minas Gerais, Brazil
| | - Maria Cláudia de Oliveira
- Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (Fiocruz), Belo Horizonte, Minas Gerais, Brazil
| | - Paulo Marcos Zech Coelho
- Laboratório de Esquistossomose, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (Fiocruz), Belo Horizonte, Minas Gerais, Brazil
| | - Ana Rabello
- Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (Fiocruz), Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
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Enk MJ, Lima ACL, Drummond SC, Schall VT, Coelho PMZ. The effect of the number of stool samples on the observed prevalence and the infection intensity with Schistosoma mansoni among a population in an area of low transmission. Acta Trop 2008; 108:222-8. [PMID: 18973744 DOI: 10.1016/j.actatropica.2008.09.016] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Revised: 09/17/2008] [Accepted: 09/23/2008] [Indexed: 11/17/2022]
Abstract
Examination of faecal material by Kato Katz (KK) technique is a widely used approach for the diagnosis of intestinal schistosomiasis, particularly in epidemiological surveys. However, this technique lacks diagnostic sensitivity in individuals with low infection intensity or in low endemic areas. In the total population (TP) of 1265 individuals prevalence and infection intensity were established by examining two KK slides. A representative subset of 305 individuals, denominated experimental group (EG), was defined to assess the comparative advantage of an increased sampling effort using the KK technique. In addition stools of the participants of the EG were examined by the formol ether centrifugation technique. The proportion of all positive stool examinations detected by both methods among the experimental group served as reference value for prevalence (diagnostic 'gold' standard). Prevalence of schistosomiasis among TP based on two KK slides was 12.5%. Prevalence among the EG varied from 13.8%, based on one KK slide, over 27.2 based on 10 KK slides of three stool samples to 35.4% as value for the diagnostic 'gold' standard. The comparison of values for prevalence, stratified by age, revealed significant elevated numbers for all age groups, and interestingly, an extension of the highest prevalence levels until an age of 50 years. The overall infection intensity in eggs per gram (epg), calculated as geometric mean, was 83 epg for the TP based on one KK slide, 78 epg for the GE based on one KK slide and 28 epg based on 10 KK slides of three stool samples. In summary our data demonstrate that control programmes based on the examination of a single KK slide, as it is the case in Brazil, tend to underestimate significantly the prevalence and overestimate infection intensity. This applies especially for low endemic areas, where the efficacy and cost-effectiveness of such programmes become questionable. Our data also indicate that the possible solution of this problem lies in targeted mass treatment including age groups with the highest proportions of those infected. This will give high sensitivity together with sustainability and suitability under field conditions.
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Affiliation(s)
- Martin Johannes Enk
- Laboratory of Schistosomiasis, René Rachou Research Center/Oswaldo Cruz Foundation, Av. Augusto de Lima 1715, Belo Horizonte, Minas Gerais, Brazil.
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Massara CL, Amaral GL, Caldeira RL, Drummond SC, Enk MJ, Carvalho ODS. Esquistossomose em área de ecoturismo do Estado de Minas Gerais, Brasil. CAD SAUDE PUBLICA 2008; 24:1709-12. [DOI: 10.1590/s0102-311x2008000700025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Accepted: 04/28/2008] [Indexed: 11/22/2022] Open
Abstract
Neste trabalho, são discutidos os modos de transmissão da esquistossomose na localidade de São José da Serra, com 500 habitantes, no Município de Jaboticatubas, Minas Gerais, Brasil. A região ao redor recebe, durante todo o ano, milhares de pessoas para a prática de ecoturismo. A ocorrência de esquistossomose aguda em um casal que viajou para essa área, no carnaval de 2007, motivou este estudo. Exames de fezes foram feitos em 268 moradores, 53,6% da população total. Trinta e cinco (13%) estavam eliminando ovos nas fezes. Comparando os resultados coproscópicos com os de um inquérito feito em 2005, observa-se um aumento da proporção de positivos de 9,6% para 12,5%, entre 56 pessoas que participaram em ambos os estudos. Foram coletados 65 exemplares de Biomphalaria glabrata, sendo 1 (1,5%) positivo. No inquérito malacológico realizado em 2005, em 182 biomphalarias, nenhum exemplar foi encontrado positivo. Esses dados indicam a ocorrência de transmissão ativa de esquistossomose na área, revelando a necessidade de planejamento coordenado no desenvolvimento do setor turístico, incluindo a implantação de programas educativos integrados para a comunidade e, principalmente, para os turistas.
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Enk MJ, Schall VT, Lima ACL, Coelho PMZ, Massara CL. A Combined Strategy to Improve the Control of Schistosoma mansoni in Areas of Low Prevalence in Brazil. Am J Trop Med Hyg 2008. [DOI: 10.4269/ajtmh.2008.78.140] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Enk MJ, Lima ACL, Massara CL, Coelho PMZ, Schall VT. A combined strategy to improve the control of Schistosoma mansoni in areas of low prevalence in Brazil. Am J Trop Med Hyg 2008; 78:140-146. [PMID: 18187797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Results of stool examinations for infections with Schistosoma mansoni among schoolchildren, living in a village of Minas Gerais State, Brazil, were used as an indicator to identify schistosomiasis-positive individuals within the entire population. This new approach is based on dividing the community into schoolchildren, members of households of schistosomiasis-positive and -negative schoolchildren, and members of households without schoolchildren. Each subgroup was evaluated comparing different sampling efforts with the predetermined "gold standard" to find the best relationship between detection rate and sampling effort. Consequently these results were combined, and a proposal for a new strategy, valid for an entire community, was elaborated. This alternative approach during the screening process permits to treat a similar proportion of positives as detected with 6 Kato-Katz slides of 3 stool samples, with 3-fold reduced sampling effort, enhancing the efficiency of schistosomiasis control programs in low-endemic areas.
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Affiliation(s)
- Martin Johannes Enk
- Laboratory of Schistosomiasis, Department of Scientific Support-Unit for Biostatistics, René Rachou Research Center/Oswaldo Cruz Foundation, Avenida Augusto de Lima 1715, Belo Horizonte, Minas Gerais, Brazil.
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Massara CL, Peixoto SV, Enk MJ, da Silva Barros H, dos Santos Carvalho O, Sakurai E, Schall V. Evaluation of an improved approach using residences of schistosomiasis-positive school children to identify carriers in an area of low endemicity. Am J Trop Med Hyg 2006; 74:495-9. [PMID: 16525112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
School children were used as indicators for the identification of schistosomiasis-positive family members in a area of low endemicity. This study was designed to improve current schistosomiasis control programs by applying this strategy to identify schistosomiasis-positive individuals in a more efficient way. The initial prevalence among school children was 8.6%. However, the prevalence among the family members of these school children increased to 15.5%. In contrast to these findings the prevalence in family members of schistosomiasis-negative school children was 3.8%. Although the applied methodology showed a relatively low sensitivity (50.0%), the high negative predictive value (87.7%) indicates that a few positive family members of school children with a negative stool result will be missed. This shows that this method of evaluation could be a strategy for a more efficient and cheaper identification of schistosomiasis-positive individuals in areas of low endemicity.
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Affiliation(s)
- Cristiano Lara Massara
- Laboratory of Intestinal Helminthiasis, Laboratory of Epidemiology and Medical Anthropology, and Laboratory Health Education, Oswaldo Cruz Foundation, René Rachou Research Center, Belo Horizonte, Minas Gerais, Brazil.
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Massara CL, Peixoto SV, Barros HDS, Enk MJ, Carvalho ODS, Schall V. Factors associated with schistosomiasis mansoni in a population from the municipality of Jaboticatubas, State of Minas Gerais, Brazil. Mem Inst Oswaldo Cruz 2004; 99:127-34. [PMID: 15486649 DOI: 10.1590/s0074-02762004000900023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Jaboticatubas is a municipality in the metropolitan region of Belo Horizonte which has been a target of a wide media release as "the capital of schistosomiasis" since the 1960's. In order to give support to a work based on an integrated control, we sought to identify the disease determinants at the site. A transversal study was carried out aimed at identifying prevalence rates of the disease and factors associated with the infection in the district of São José de Almeida, and two close localities, Cipó Velho and São José da Serra, all of them located in the municipality of Jaboticatubas. A parasitological survey was performed, applying the Kato-Katz method with two slides per sample in 1186 schoolchildren which represents 77% of all registered pupils in four public schools in 2001. Among these schoolchildren a number of 101 (8.6%) proved positive for Schistosoma mansoni eggs in their stool samples. A total of 64 families, whose schoolchildren had shown to be positive for schistosomiasis, also undertook examinations. As negative control, a random sample was collected from the 206 families, whose children had proven negative for schistosomiasis. The prevalence among 270 families (1304 people) was 12%. To assess those who continued to have contact with possibly contaminated water, 1061 (81.4%) people of the 270 families were interviewed. A multivariate analysis identified the following factors associated with the infection: time of residence in the area (short period), garbage disposal (use of deserted areas), gender (male), age (from 10 to 29 years), and water contact (daily and weekly). Further analysis of these factors revealed a close correlation between water contact and the disease, with a positive significant frequency concerning almost all those items. Depending on gender and age significant variations of water contact patterns associated with leisure and professional activities were found. A malacological survey on water collections in the area identified snails of the species Biomphalaria straminea and B. glabrata. The latter showed 17 (0.6%) specimens positive for S. mansoni. Qualitative studies have complemented such evidences, which allowed us to design a reference picture and specific indicators of the disease for the local population. Those data provided the essential information to continue the development of an already ongoing educative process, as well as projects on environmental improvements.
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Affiliation(s)
- Cristiano Lara Massara
- Laboratório de Helmintoses Instestinais, Centro de Pesquisas René Rachou-Fiocruz, Av. Augusto de Lima 1715, 30190-002 Belo Horizonte, MG, Brazil.
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Abstract
Infection with Ascaris lumbricoides constitutes one of the most common helmintic diseases in the world, especially in tropical and subtropical regions. Transmission of this disease involves environmental contamination with eggs, and therefore, is classified as a soil-transmitted disease. The public health importance of ascariasis is made evident by the high number of infected individuals suffering its consequences, which can become severe, depending on the worm burden. Since the introduction of benzimidazoles, chemotherapy has improved significantly, offering fast and direct effects at relatively low cost, as a result of the simple and safe application of these drugs. Unfortunately, the effects are not long-lasting or permanent. The intervention with chemotherapy alone constitutes a fast and efficient way to reduce the worm burden in a population of high prevalence, but does not avoid reinfection. Therefore, the option of integrated control programmes based on chemotherapy in combination with sanitation and health education, together with strong community involvement, must be considered in order to ensure the positive long-term effects of such programmes.
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