Acquired resistance against Schistosoma bovis after single or repeated low-level primary infections in goats

New insights into the molecular epidemiology and population genetics of Schistosoma mansoni in Ugandan pre-school children and mothers

Significant numbers of pre-school children are infected with Schistosoma mansoni in sub-Saharan Africa and are likely to play a role in parasite transmission. However, they are currently excluded from control programmes. Molecular phylogenetic studies have provided insights into the evolutionary origins and transmission dynamics of S. mansoni, but there has been no research into schistosome molecular epidemiology in pre-school children. Here, we investigated the genetic diversity and population structure of S. mansoni in pre-school children and mothers living in lakeshore communities in Uganda and monitored for changes over time after praziquantel treatment. Parasites were sampled from children (<6 years) and mothers enrolled in the longitudinal Schistosomiasis Mothers and Infants Study at baseline and at 6-, 12- and 18-month follow-up surveys. 1347 parasites from 35 mothers and 45 children were genotyped by direct sequencing of the cytochrome c oxidase (cox1) gene. The cox1 region was highly diverse with over 230 unique sequences identified. Parasite populations were genetically differentiated between lakes and non-synonymous mutations were more diverse at Lake Victoria than Lake Albert. Surprisingly, parasite populations sampled from children showed a similar genetic diversity to those sampled from mothers, pointing towards a non-linear relationship between duration of exposure and accumulation of parasite diversity. The genetic diversity six months after praziquantel treatment was similar to pre-treatment diversity. Our results confirm the substantial genetic diversity of S. mansoni in East Africa and provide significant insights into transmission dynamics within young children and mothers, important information for schistosomiasis control programmes.

Many pre-school children in sub-Saharan Africa are infected with the parasite Schistosoma mansoni, which causes intestinal schistosomiasis. However, there has been no work published on the molecular epidemiology of Schistosoma in children under six or the role that these children play in parasite transmission. We analysed the genetic structure of parasite populations collected from mothers and young children living on the shores of Lakes Albert and Victoria in Uganda. Parasite populations were different at the two lakes indicating that there is little flow of parasite genes between the lakes. We were surprised to discover a large amount of genetic variation in parasites sampled from both children and mothers, suggesting that genetic variation is not directly related to duration of exposure to infested water. In addition, we found some evidence that young children are involved in S. mansoni transmission. The substantial genetic variation of S. mansoni in young children suggests that these parasites could be operating as a source of a variety of genetic traits, including drug susceptibility. Overall our findings offer significant insights into population genetics of S. mansoni in pre-school children and their mothers and provide important information for effective control of intestinal schistosomiasis.

Schistosoma mansoni Infections in young children: when are schistosome antigens in urine, eggs in stool and antibodies to eggs first detectable?

Background

In Uganda, control of intestinal schistosomiasis with preventive chemotherapy is typically focused towards treatment of school-aged children; the needs of younger children are presently being investigated as in lakeshore communities very young children can be infected. In the context of future epidemiological monitoring, we sought to compare the detection thresholds of available diagnostic tools for Schistosoma mansoni and estimate a likely age of first infection for these children.

Methods and Findings

A total of 242 infants and preschool children (134 boys and 108 girls, mean age 2.9 years, minimum 5 months and maximum 5 years) were examined from Bugoigo, a well-known disease endemic village on Lake Albert. Schistosome antigens in urine, eggs in stool and host antibodies to eggs were inspected to reveal a general prevalence of 47.5% (CI₉₅ 41.1–54.0%), as ascertained by a positive criterion from at least one diagnostic method. Although children as young as 6 months old could be found infected, the average age of infected children was between 3¼–3¾ years, when diagnostic techniques became broadly congruent.

Conclusion

Whilst different assays have particular (dis)advantages, direct detection of eggs in stool was least sensitive having a temporal lag behind antigen and antibody methods. Setting precisely a general age of first infection is problematic but if present Ugandan policies continue, a large proportion of infected children could wait up to 3–4 years before receiving first medication. To better tailor treatment needs for this younger ageclass, we suggest that the circulating cathodic antigen urine dipstick method to be used as an epidemiological indicator.

In sub-Saharan Africa, intestinal schistosomiasis is a debilitating disease caused by a worm infection. To arrest disease progression, de-worming medications are given out, often en masse, to school-aged children. In Uganda, however, much younger children can be infected, and in lakeshore communities both infants and pre-school children can already show signs and symptoms of intestinal schistosomiasis. To change de-worming practices, further information on the occurrence of infections in these younger is needed for evidence-based decision making. Our study applied current methods of disease diagnosis to better define the ‘age of first infection’ and estimate general infection prevalence within a disease-endemic village. Up to 50% of young children were clearly shown to have schistosomiasis and could likely wait up to 3–4 years before obtaining first treatment if present de-worming policies are not changed. In the context of identifying future treatment needs, we propose that antigen detection methods are most suitable.

Persistent immune responses in late infection and after treatment in experimental Schistosoma bovis infections in goats

This study explored host immune responses and their possible relationship to the anti-fecundity phenomenon in Schistosoma bovis-infected goats. The design comprised a primary infection with or without treatment at week (wk) 13, and with or without challenge at wk 36. Necropsy was performed at 36 or 52wk. Serum levels of anti-egg IgG, and anti-worm IgG and IgM, were measured by ELISA. In chronic infection, anti-worm antibodies stayed high, reflecting persisting worm burdens, whereas anti-egg IgG remained high despite minimized egg excretion. After treatment, anti-worm IgM and anti-egg IgG were minimized, but anti-worm IgG remained above the values of the uninfected controls. Histopathology showed lowered numbers of perioval granulomas in chronic infection and resolution of liver fibrosis with time, but intestinal lymphoplasmacytic perivasculitis and hepatic eosinophilic infiltrates were maintained at wk 52. Significant splenic plasmacytosis persisted after treatment. The results indicated that persistent immune responses, in chronically infected and in treated goats, may explain sustained worm fecundity depression at challenge infection.

Treatment efficacy and regulatory host responses in chronic experimental Schistosoma bovis infections in goats

The aim of this study was to elucidate the regulatory responses and the long-term effect of praziquantel treatment in chronically Schistosoma bovis-infected West African Dwarf goats. Forty-two goats were used and the design comprised a primary infection followed by treatment at week 13, challenge infection at week 36 and termination at week 52. Dependent variables included clinico-pathological data, worm numbers, faecal and tissue egg counts, and gross pathology of the liver. The results showed that primary infections remained suppressed for up to 52 weeks and, although challenge infections imposed on 36-week-old primary infections established fully, the impairment of their egg production capacity provided protection against clinico-pathological consequences measured by body weight and haemoglobin levels. The study also confirmed a high efficacy (97.7%) of praziquantel for treatment of S. bovis infection in goats and showed that anthelminthic removal of primary infections does not interfere with the ability of the goat to elicit a marked resistance to a subsequent challenge infection. Although treated goats had more fibrous scarring of livers than untreated goats, no negative effects of liver lesions were reflected in weight gains of treated goats. This study provides strong evidence for the beneficial effects of anthelminthic treatment of young domestic stock as an element of treatment and preventive programmes.

Egg-hatching inhibition in mice immunized with recombinant Schistosoma bovis 28 kDa glutathione S-transferase

The capacity of a recombinant glutathione S-transferase from Schistosoma bovis (rSb 28GST) to protect BALB/c mice against homologous and heterologous infections with, respectively, S. bovis or Schistosoma mansoni has been studied. Two injections of the rSb 28GST and an intravenous boost resulted in a marked specific IgG response on the day of experimental challenge with S. bovis or S. mansoni cercariae. Immunization of BALB/c mice led to a reduction in egg maturation and egg viability after infection with S. bovis or S. mansoni. Adult worm recoveries after an S. bovis challenge infection and tissue egg densities (intestine and liver) in S. mansoni challenge infection were also reduced in the immunized groups, but these differences were not statistically significant. No association between in vitro inhibition of GST enzymatic activity induced by immunized mouse sera and worm burden reduction was recorded. The analysis of the immune response, on the day of perfusion, showed the production of immunoglobulin (Ig)G1, IgG2a and IgG2b specific antibodies and the production of interleukin (IL)-4 and IL-5 by spleen cells after rSb 28GST stimulation. These data suggest that rSb 28GST immunization induces a moderate effect upon egg maturation and egg hatching, suggesting the involvement of similar mechanisms of action and common, but not exclusive, targets during S. bovis and S. mansoni infections. As a consequence, immunization with rSb 28GST may prove useful in affecting the pathology and transmission of African schistosomes.

Schistosoma japonicum infection in the pig: the effect of a patent primary infection on a challenge infection

The response of pigs to a challenge infection of Schistosoma japonicum following a primary infection was assessed using parasitological parameters and eosinophil counts. Twenty-five Danish Landrace/Yorkshire/Duroc crossbred pigs were divided into four groups. Group A (n = 10) received a primary infection, group B (n = 5) received both a primary and challenge infection, group C (n = 5) received a challenge control infection and group D (n = 5) received no infection serving as helminth-free controls. A dose of 850 cercariae was administered by intramuscular injection at the primary infection (week 0) and challenge infection (week 12). The pigs were perfused at week 21, except for half of the group A pigs which were slaughtered at week 12. Challenge infection did not result in higher worm burdens or tissue egg counts in group B than group A at week 21 and mature/immature worm ratios were similar for the two groups. In addition, no increases in faecal egg counts or eosinophil counts were observed in group B after challenge infection. The results indicate that pigs are able to mount a very rapid and effective response to reinfection with S. japonicum following a patent primary infection resulting in prevention of establishment of challenge infection schistosomes. An anti-worm effect appears to be the main feature of this regulatory host response.

Tissue response of goats to single or repeated low-level doses and to a massive challenge dose of Schistosoma bovis

The inflammatory tissue response to Schistosoma bovis in the small intestine and liver of goats was studied by light microscopy 32 weeks after they had been exposed to 10 weekly ('trickle') doses of 200 cercariae or to a single dose of 400 cercariae, and 32 weeks after the same dosing schedules followed by a challenge exposure to 2000 cercariae in week 16 of the experiment, and 16 weeks after a single exposure to 2000 cercariae in week 16 (challenge control). The tissue egg counts in the small intestine were highest in the challenge control group and comparable in the other groups, and corresponded well with the numbers of inflammatory foci per histological section of gut wall. The tissue egg counts in the liver were also highest in the challenge control group, but diffuse hepatic portal fibrosis was more pronounced in the groups with a primary exposure followed by a challenge. The intestinal pathology was compatible with a smaller component of vigorous and acute inflammatory reactions to the eggs in the older than in the more recent infections. The magnitude and morphological characteristics of the inflammatory tissue response did not differ markedly between the goats exposed to the trickle infections and the single doses, and they were not substantially affected by the challenge infection.