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PubMed2006

Female genital schistosomiasis as an evidence of a neglected cause for reproductive ill-health: a retrospective histopathological study from Tanzania.

BACKGROUND: Schistosomiasis affects the reproductive health of women. Described sequelae are ectopic pregnancy, infertility, abortion, and cervical lesions and symptoms mimicking cervical cancer and STIs. There are indications that cervical schistosomiasis lesions could become co-factors for viral infection such as HIV and HPV. METHODS: In a retrospective descriptive histopathological study clinical specimens sent between 1999 and 2005 to the pathology department of a consultant hospital in Tanzania were reviewed to analyse the occurrence and features of schistosomiasis in female genital organs. RESULTS: During the study period, schistosomiasis was histopathologically diagnosed in 423 specimens from different organs (0.7% of all specimens examined in the study period), out of those 40% were specimens from female and male organs. The specimens were sent from 24 hospitals in 13 regions of mainland Tanzania. Female genital schistosomiasis was diagnosed in 125 specimens from 111 patients. The main symptoms reported were bleeding disorders (48%), ulcer (17%), tumor (20%), lower abdominal pain (11%) and infertility (7%). The majority of cases with genital schistosomiasis were diagnosed in cervical tissue (71 cases). The confirmation of cervical cancer was specifically requested for 53 women, but the diagnosis could only be verified for 13 patients (25%), in 40 cases only severe cervical schistosomiasis was diagnosed. Vulval/labial schistosomiasis was seen in specimens from young women. Infertility was reported in four patients with schistosomiasis of the Fallopian tubes. CONCLUSION: Genital schistosomiasis adds to the disease burden of women in all age groups. Pathological consequences due to the involvement of different genital organs can be damaging for the affected women. Clinical unawareness of genital schistosomiasis can lead to misdiagnosis and therefore false and ineffective therapy. In endemic areas cervical schistosomiasis should be considered as differential diagnosis of cancer.

Adolescent↗
PubMed1991

Changes in T cell subsets and T suppressor cell function and their relationship in human schistosomiasis japonica.

The function of spontaneous T suppressor cell (STs) of peripheral blood was examined in 56 patients with schistosomiasis japonica at various stages. The subsets of T cell were simultaneously phenotyped in 46 cases. The percentages of CD3+ (pan T cell), CD4+ (helper/inducer T cell) and CD8+ (suppressor/cytotoxic T cell) in patients with acute schistosomiasis japonica were significantly higher than those in the normal controls. In patients with chronic and advanced schistosomiasis japonica, the percentage of CD8+ T cell and the function of STs were greatly increased, but the percentage of CD3+ T cell and the ratio of CD4+/CD8+ were obviously reduced. All of these markers changed more significantly in patients with advanced schistosomiasis japonica. The percentage of CD8+ T cell in patients with acute schistosomiasis japonica was negatively correlated with the function of STs. In patients with chronic and advanced schistosomiasis japonica the percentage of CD8+ T cell was correlated positively and the ratio of CD4+/CD8+ negatively with the function of STs. The results indicated that the cellular immunity was significantly increased in cases of acute schistosomiasis japonica and decreased in those with chronic or advanced schistosomiasis japonica. The increased CD8+ T cell may be principally cytotoxic T cells in patients with acute schistosomiasis japonica, but suppressor T cells in patients with chronic and advanced schistosomiasis japonica. The subsets of T cells and the function of T suppressor cells may play an important role in the immunoregulation of schistosomiasis japonica.

Adolescent↗
PubMed1998

Financing changes of schistosomiasis control programmes in China 1980-1995: a case study in Songzi county.

To assess the financing changes of schistosomiasis control programmes in China and estimate the impact of these changes on patients' treatment-seeking behaviour and control of schistosomiasis, a survey was conducted in five schistosomiasis-endemic areas of the lake regions, Hubei province, in 1996. This paper reports financing changes and their impact on the incidence and prevalence of schistosomiasis from one of the five areas as a case study. By examining the surveillance and financial data from 1980 to 1995, and through focus group discussions we found that the schistosomiasis control programmes in People's Republic of China have gone through dramatic financing changes from 1980 to 1995, when the transitions of China's social, economic, and political systems happened. The proportions of funding to schistosomiasis control programmes from high level governmental agencies, county budgets, and services revenue changed from 60%, 23%, and 17%, respectively, in 1980-1987 to 0.7%, 22.3%, and 72% in 1995. The percentages of expenditure of schistosomiasis control activities, salaries and bonuses, and other activities unrelated to schistosomiasis control, were 53.5%, 14.4, and 17.2% in 1980. These percentages changed to 7.7%, 33.3%, and 53.3%, respectively, in 1995. The preponderant role of the state in organizing, financing, and delivery of the services was replaced with the new system which is more influenced by the market economy. The incidence and the prevalence of schistosomiasis in the study area have increased year by year from 1980 to 1990, although there has been a tendency to decrease after 1991 but not to the low pre1980 levels. The collapse of the community-based medical system in rural areas and the dramatic financing changes of schistosomiasis control programmes have created major difficulties for schistosomiasis control in China.

China↗
PubMedDate not supplied

Immunoglobulin classes (IgG, IgA and IgM) and acute phase proteins in pregnant women with urinary schistosomiasis.

BACKGROUND: S. haematobium have been implicated in female genital schistosomiasis (FGS), ectopic pregnancy and infertility. The presence of schistosome eggs in urine has been reported to correlate with FGS but host immune response in FGS is yet to be determined. This gap in knowledge is addressed by this study. MATERIALS AND METHODS: Serum levels of three immunoglobulin classes (IgG, IgA and IgM) and three acute phase proteins (transferrin, alpha 2-macroglobulin, and haptoglobin) were determined by using single radial immunodiffusion technique in one hundred and eight Nigerian women aged between 15 and 30 years. They were made up of thirty pregnant women with urinary schistosomiasis (P+USS), thirty-six pregnant women without USS (P-USS), eighteen non-pregnant women with USS (NP+USS) and twenty-four healthy non-pregnant women without urinary schistosomiasis (NP-USS). RESULTS AND CONCLUSIONS: IgG, IgA and IgM were significantly raised in pregnant women with urinary schistosomiasis compared with non-pregnant women without urinary schistosomiasis (p < 0.01 in each case). The level of transferrin was significantly increased in non-pregnant subjects with urinary schistosomiasis compared with non-pregnant women without urinary schistosomiasis (p <0.01) suggesting the possibility of iron deficiency in these subjects. Alpha-2 macroglobulin was significantly elevated in pregnant subjects with urinary schistosomiasis compared with non-USS subjects, while the mean serum haptoglobin level was significantly higher in pregnant women without urinary schistosomiasis compared to pregnant subjects with urinary schistosomiasis. The results indicate that USS or pregnancy changes different aspects of humoral immunity, thus the co-existence of pregnancy and S. haematobium infection may influence each other.

Acute-Phase Proteins↗
PubMed2005

Evaluation of CD4(+)/CD8(+) status and urinary tract infections associated with urinary schistosomiasis among some rural Nigerians.

BACKGROUND: Data on urinary schistosomiasis in Nigeria are mainly epidemological. The knowledge of co-infections of urinary schistosomiasis and other pathogens are important epidemiological tools for the control and health benefits of the rural dwellers. The granulomatous reactions in urinary schistosomiasis is CD4(+) dependent. The CD8(+) is cytotoxic to parasites and it is activated by CD4(+). These parameters therefore participate in the immune responses to urinary schistosomiasis. OBJECTIVE: In this study, we evaluated the polyparasitism involving urinary schistosomiasis and urinary tract co - infections among some rural Nigerians. The CD4(+):CD8(+) ratio and status with age groups in years were also investigated. METHODS: Parasitological investigation using ova on urine was carried out on 216 volunteers. The urine samples were examined for bacteriuria and subsequently subjected to standard microbiological urine culture. CD4(+)/CD8(+) were determined using the CD T 4 Dynabead techniques. Data were analysed using MicroSoft Excel. RESULTS: The inhabitants with light infections of urinary schistosomiasis as indicated by <50 ova /10 ml of urine had a mean CD4(+):CD8(+) ratio of 1.57 while those with heavy infections as shown by >50 ova/10 ml of urine had a relatively lower CD4(+):CD8(+) ratio of 1.03. In all, the overall CD4+:CD8+ ratio of 1.23 was recorded with the mean CD4+ count of 257.96 cells/microL and the mean CD8(+) count of 210.45 cells/microL. Comparatively, the control uninfected subjects had a CD4(+):CD8(+) ratio of 5.97. The CD4(+) and the CD8(+) counts were correlated with the ova of S. haematobium in their urine samples at r = 0.0108 and r = 0.516 respectively. The bacteriuria, urinary schistosomiasis and urinary tract co-infections, namely: Escherichia coli, Proteus, Pseudomonas aeroginosa, Staphylococcus epidermidis and Staph. Saprophyticus were reported in the urine cultures of 48(22.0%) volunteers. CONCLUSION: The mean overall CD4(+):CD8(+) ratio of urinary schistosomiasis infected persons is 1.23 which is above the normal CD4(+):CD8(+) ratio of 1. The CD4(+):CD8(+) ratio and counts of the urinary schistosomiasis infected inhabitants were lower than the uninfected inhabitants. The positive correlation between the CD4(+):CD8(+) and the S. haematobium ova shows a relationship which indicate an increase of the CD4(+):CD8(+) as the intensity of infection increases. We report polyparasitism of S. haematobium and urinary tracts co-infections among some rural inhabitants in Ikpeshi, Nigeria. It is therefore imperative to incorporate the management of urinary tract infections in urinary schistosomiasis control programme.

Adolescent↗
PubMed2006

[Acute schistosomiasis in French travellers].

OBJECTIVE: The clinical presentation of acute schistosomiasis in travellers differs from those observed with chronic schistosomiasis in people from endemic areas. The objective of this study is to describe the main clinical and biological characteristics of the acute schistosomiasis in French travellers. METHODS: Retrospective study conducted in 42 hospital laboratories of parasitology in France, based on a questionnaire filled out for each case of schistosomiasis diagnosed in subjects non-originating from an endemic country and returning from of a stay in Africa, between 2000 and 2004. RESULTS: Seventy-seven cases of acute schistosomiasis diagnosed between 2000 and 2004 were reported by 15 of the 33 laboratories having taken part in the study. The patients were 26 years old on average and 60% were contaminated in West Africa. Seventy patients (91%) presented at least one symptom at the moment of the diagnosis, but only 44 (57%) presented sufficiently intense symptoms to justify a medical consultation spontaneously. The most frequently reported clinical signs were fever (44%), diarrhoea (40%), pruritus (25%), cough (21%) and hematuria (20%). Hypereosinophilia (82%), elevated liver enzymes and positive serology were respectively reported in 82, 23 and 90% of the cases. Ova were found in the urines or the stool in 60% of the cases. Eleven patients were hospitalized. DISCUSSION: Acute schistosomiasis must be evoked in patients returning from endemic country and presenting with non-specific symptoms; including patients whose bathes in contaminated water was limited to a short contact of the feet in a river. The high frequency of the asymptomatic or paucisymptomatic forms exposes the infected people to a delayed diagnosis and therefore to an evolution towards the chronic form of schistosomiasis. The increase in tourism towards the endemic areas could be accompanied by an increase in the frequency of the schistosomiasis, and encourages setting-up an active monitoring of acute schistosomiasis.

Acute Disease↗
PubMed2002

Approach to surveillance and consolidation during past 15 years after elimination of schistosomiasis in Shanghai.

Shanghai was one of the most heavily endemic areas of schistosomiasis in the People's Republic of China. A schistosomiasis control program was started in 1955. In 1975, schistosomiasis was under effective control and in 1985, the criteria for schistosomiasis elimination in the whole municipality area were reached. Some 99.99% of the original schistosomiasis patients had been treated and cured. The positive rate of stool examination among the human population was reduced to 0.03%. Since 1986, after the elimination of schistosomiasis, an overall surveillance and consolidation work was unfolded in Shanghai. The general goals and strategy are: actively implementing the policy 'putting prevention first' in health work; conscientiously carrying out the principal 'integrated management and control in a scientific way' in schistosomiasis control in the People's Republic of China; and to sustain the achievements of elimination of schistosomiasis in the whole city area. The specific methods are as follows: (1) adhering to integrated control and management; and (2) carrying out control work in a scientific way and putting the main direction of attack as a key problem. By the year 2000, the whole city area had remained free from acute schistosome infection as well as infected snails for 26 consecutive years, free from new infection both in humans and in cattle for 22 consecutive years and the achievement of elimination of schistosomiasis had been consolidated for 15 consecutive years.

China↗
PubMed2006

Implementation of human schistosomiasis control: Challenges and prospects.

Schistosomiasis is a major disease of public health importance in humans occurring in over 70 countries of the tropics and sub-tropics. In this chapter, the history of the control of schistosomiasis is briefly discussed and current methods of control of schistosomiasis are reviewed; including mollusciciding, biological control of the intermediate snail hosts, the development of drugs to kill the adult worms, provision of clean water and health education, with a focus on the African situation. Since an effective vaccine against schistosomiasis is lacking, the emphasis today is placed on the drug praziquantel (PZQ). The marked reduction in the cost of PZQ together with the support of the Bill and Melinda Gates Foundation has enabled the drug to be used more widely in sub-Saharan Africa. Nevertheless, with the possibility of resistance to praziquantel emerging, the potential role of other drugs, such as artemether, in the control of schistosomiasis is examined. The World Health Organization (WHO) anticipates that at least 75% of all schoolchildren at risk of morbidity from schistosomiasis will be treated by 2010, with the aim of reversing morbidity. The importance of recent international initiatives such as the Schistosomiasis Control Initiative (SCI) working in Mali, Niger, Burkina Faso, Zambia, Tanzania and Uganda is recognised. There are benefits to integrating the control of schistosomiasis with other disease control programmes, such as gastrointestinal helminths and/or lymphatic filariasis (LF), since this markedly reduces the cost of delivery of the treatment. Countries that are situated on the perimeter of the distribution of schistosomiasis have either achieved or have made progress towards the elimination of the disease. For control programmes to be successful in areas such as sub-Saharan Africa, it is absolutely essential that these programmes are sustainable. Thus, it will be vital for Ministries of Health and Education to budget for the control of diseases of poverty in addition to school health, and to utilise funds from a range of sources, such as, government funds, pooled donor contributions, or bilateral and international agencies.

Albendazole↗
PubMed1996

High prevalence of islet cell antibody and defective insulin release in children with schistosomiasis.

The importance of islet cell antibodies (ICA) as a predictor of insulin dependent diabetes mellitus (IDDM) has been emphasized by several investigators since 1974. The ICA was also detected in patients with various immune-mediated diseases such as auto-immune thyroiditis. Schistosomiasis is a wide-spread helminthic disease which affects more than 200 million patients all over the world. Immunological abnormalities and pancreatic affection are features of the disease. We studied the prevalence of ICA in 40 children with schistosomiasis (20 males and 20 females), 14 children with IDDM, and 30 of the non-diabetic siblings of patients with IDDM, and evaluated the oral glucose tolerance and early release of insulin after an i.v. load of glucose in children with schistosomiasis, diabetics' siblings, and 10 normal age-matched controls. The age of onset of IDDM and duration of the disease were 6.5 +/- 2.3 and 4.1 +/- 1.2, respectively, and the age of onset and duration of schistosomiasis were 8.3 +/- 2.7 and 2.5 +/- 1.5 years, respectively. Sex, consanguinity, history of previous virus diseases (mumps, measles and rubella), and sex maturity rating did not differ among the three study groups; however, children with schistosomiasis were significantly older. The prevalence of ICA was 50 per cent in children with IDDM, 13 per cent in the diabetics' siblings, and 25 per cent of children with schistosomiasis. Glucose tolerance was normal in children with schistosomiasis and diabetics' siblings. Early release of insulin after i.v. glucose load was significantly lower in children with schistosomiasis compared to the other two groups. In conclusion, the high prevalence of ICA and the decreased early release of insulin in response to an i.v. glucose load in children with schistosomiasis suggest that auto-immune aggression against the islet cells contributes in the pathogenesis of pancreatic disease in these patients, and might increase the risk for developing glucose intolerance and diabetes.

Autoantibodies↗
PubMed2002

Further evidence for association of hepatitis C infection with parenteral schistosomiasis treatment in Egypt.

BACKGROUND: Hepatitis C virus (HCV) infection and schistosomiasis are major public health problems in the Nile Delta of Egypt. To control schistosomiasis, mass treatment campaigns using tartar emetic injections were conducted in the 1960s through 1980s. Evidence suggests that inadequately sterilized needles used in these campaigns contributed to the transmission of HCV in the region. To corroborate this evidence, this study evaluates whether HCV infections clustered within houses in which household members had received parenteral treatment for schistosomiasis. METHODS: A serosurvey was conducted in a village in the Nile Delta and residents were questioned about prior treatment for schistosomiasis. Sera were evaluated for the presence of antibodies to HCV. The GEE2 approach was used to test for clustering of HCV infections, where correlation of HCV infections within household members who had been treated for schistosomiasis was the parameter of interest. RESULTS: A history of parenteral treatment for schistosomiasis was observed to cluster within households, OR for clustering: 2.44 (95% CI: 1.47-4.06). Overall, HCV seropositivity was 40% (321/796) and was observed to cluster within households that had members who had received parenteral treatment for schistosomiasis, OR for clustering: 1.76 (95% CI: 1.05-2.95). No such evidence for clustering was found in the remaining households. CONCLUSION: Clustering of HCV infections and receipt of parenteral treatment for schistosomiasis within the same households provides further evidence of an association between the schistosomiasis treatment campaigns and the high HCV seroprevalence rates currently observed in the Nile delta of Egypt.

Egypt↗
PubMedDate not supplied

Schistosomiasis in expatriates in the Arusha region of Tanzania.

BACKGROUND: In 1996 the seroprevalence of schistosomiasis in expatriates and travelers who had contact with Lake Malawi, a fresh water source thought to be schistosomiasis-free, was measured at 32%. Clinicians in Arusha, Tanzania, questioned the prevalence of Schistosoma infection in expatriates living in the Arusha region, and how schistosomiasis might relate to symptoms of chronic fatigue in Arusha expatriates. METHOD: We performed a cross-sectional survey of 80 expatriates living in the Arusha region of Tanzania to determine the seroprevalence of schistosome infection. Whole blood was analyzed by the Falcon assay screening test-enzyme-linked immunosorbent assay (FAST-ELISA) for the presence of species-specific Schistosoma mansoni and Schistosoma haematobium antibodies to microsomal antigens of adult Schistosoma worms, followed by confirmatory enzyme-linked immunoelectrotransfer blot (Western blot). Volunteers answered a questionnaire which included length of residence in Arusha, risk factors, symptoms, and previous diagnosis of schistosomiasis. RESULTS: Of the 80 expatriates sampled, 8 (10%) were positive for schistosomiasis (6 to S. mansoni only, 1 to S. haematobium, 1 to both species). Significant risk factors, elicited by questionnaire, included longer residence in the Arusha region (p =.020), history of fatigue (p =.010) and myalgias (p =.047), and previous diagnosis of schistosomiasis by stool or urine ova (p =.0007). CONCLUSION: The lower seroprevalence of schistosomiasis in Arusha expatriates, compared with expatriates and travelers to Lake Malawi, suggests a regional variation of rate of schistosomiasis infection. Although a history of fatigue and myalgias was related to seropositivity, there is no strong evidence that schistosomiasis infection is the cause of chronic fatigue in Arusha expatriates.

Blotting, Western↗