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Pach S, Webb EL, Edielu A, Nagawa R, Anguajibi V, Mpooya S, Wu H, Colt S, Mawa P, Richter J, Friedman JF, Bustinduy AL. Baseline Liver Ultrasound Findings in Preschool Children From the Praziquantel in Preschoolers Trial in Lake Albert, Uganda. Pediatr Infect Dis J 2024; 43:14-20. [PMID: 37922490 PMCID: PMC10842963 DOI: 10.1097/inf.0000000000004119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
BACKGROUND Periportal fibrosis is a late-stage manifestation of chronic infection with Schistosoma mansoni . Praziquantel (PZQ), the only drug available for the treatment of schistosomiasis, has limited effect in treating established morbidity. Preschool-age children (PSAC) are not considered to be an at-risk population for severe morbidity. However, the prevalence of periportal fibrosis in PSAC in S. mansoni endemic settings is unknown. METHODS As part of a phase II clinical trial comparing different dosing regimens of PZQ in children age 12-47 months infected with S. mansoni in Uganda ("praziquantel in preschoolers" trial), we present baseline results assessing liver ultrasound (US) findings as per the WHO Niamey Protocol. RESULTS A total of 7/347 (2%) PSAC had Image Pattern C with pipe stems and echogenic rings suggestive of periportal fibrosis, 29/347 (8%) had Image Pattern B and 58 (17%) had evidence of periportal thickening There were higher adjusted odds of periportal thickening with older age [odds ratio (OR): 1.04; 95% confidence interval (CI): 1.00-1.07], primary maternal education (OR: 1.04; 95% CI: 1.00-1.07) and being taken to the lake weekly (OR: 3.02; 95% CI: 1.19-7.63). A further 44/347 children (13%) had a rounded caudal liver edge which was associated with high S. mansoni infection intensity (adjusted OR: 3.31; 95% CI: 1.46-7.51). CONCLUSIONS Incipient schistosomiasis-related liver morbidity was detected in young children enrolled in the praziquantel in preschoolers trial. Adequate age-adjusted reference measurements for liver ultrasound findings in very small children are lacking but urgently needed. Schistosomiasis-related fibrosis may be delayed or averted with early and repeated PZQ treatment.
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Affiliation(s)
| | - Emily L Webb
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Andrew Edielu
- From the Department of Clinical Research
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Roy Nagawa
- J.B International Medical Centre, Kampala, Uganda
| | | | | | - Hannah Wu
- Center for International Health Research, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island
| | - Susannah Colt
- Center for International Health Research, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island
| | - Patrice Mawa
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joachim Richter
- Global Health Center, Institute of International Health, Charite Universitätsmedizin, Corporate Member of Free and Humboldt University, Berlin, Germany
- Swiss Tropical and Public Health Institute, Basle, Switzerland
| | - Jennifer F Friedman
- Center for International Health Research, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island
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Chau P, Yoon JS, Moses D, Pather N. A systematic review and meta-analysis of portal vein morphometry in pediatric and adult populations: Drawing the line between normal and abnormal findings. Eur J Radiol 2023; 168:111016. [PMID: 37742371 DOI: 10.1016/j.ejrad.2023.111016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 07/13/2023] [Accepted: 07/26/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE The morphometry of the hepatic portal vein is of clinical importance, particularly in pre-operative assessments, surgical management, and diagnoses of liver conditions. This systematic review and meta-analysis aimed to characterize the morphometry of the normal portal vein in both pediatric and adult patients. METHODS The study, conducted using the PRISMA guidelines and registered with PROSPERO, utilized the MEDLINE, EMBASE, SCOPUS and Web of Science databases up to May 2020, and updated to May 2023. All studies reporting extractable data on diameter, length, and cross-sectional area (CSA) of the main, left, and right portal veins (PV, LPV, RPV, respectively) were included. The AQUA Tool was used to assess the quality of the included studies. Data analysis included subgroup analyses based on geographical location, sex, age, and imaging modality. RESULTS A total of 122 studies with 11,637 subjects were eligible for inclusion. Overall, the pooled mean diameter of the PV (PVD) was 10.09 mm (95% CI: 9.56-10.62). Significant differences in diameter were found between pediatric (6.60 mm; 95% CI: 5.38-7.82) and adult (10.72 mm; 95% CI: 10.25-11.19) subjects. Additionally, there was a significantly larger PVD measurement from computed tomography (CT) than other imaging modalities: CT, 13.28 mm (95% CI: 11.71-14.84); magnetic resonance imaging (MRI), 10.50 mm (95% CI: 9.35-11.66) and ultrasound (US), 9.81 mm (95% CI: 9.47-10.16). The mean diameters of the LPV and RPV were 8.27 mm (95% CI: 6.78-9.77) and 8.33 mm (95% CI: 6.70-9.95), respectively. Mean PV length in adults is 48.63 mm (95% CI: 35.63-61.64). Mean CSA of the PV was 1.09 cm2. CONCLUSIONS The study obtained aim to improve the understanding of portal vein anatomy, especially with relevance to surgical interventions of the liver in both pediatric and adult patients. Measurements from ultrasound imaging closely approximates the generated pooled PVD mean for pediatric and adult patients. CT imaging, however, significantly exceeded the established 13 mm threshold for adults. For pediatric patients, a threshold of 8 mm is proposed as a diagnostic upper limit for a normal PVD. Although not significant, the PVD decreased from the portal confluence towards its bifurcation.
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Affiliation(s)
- Patrick Chau
- Department of Anatomy, School of Biomedical Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Ji Soo Yoon
- Department of Anatomy, School of Biomedical Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Daniel Moses
- Department of Radiology, Prince of Wales Hospital, Sydney, Australia
| | - Nalini Pather
- Department of Anatomy, School of Biomedical Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia; Academy of Medical Education, Medical School, Faculty of Medicine, University of Queensland, Australia; Medical Education, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.
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Baeta-Corral R, De la Fuente M, Giménez-Llort L. Sex-dependent worsening of NMDA-induced responses, anxiety, hypercortisolemia, and organometry of early peripheral immunoendocrine impairment in adult 3xTg-AD mice and their long-lasting ontogenic modulation by neonatal handling. Behav Brain Res 2023; 438:114189. [PMID: 36343697 DOI: 10.1016/j.bbr.2022.114189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 10/23/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
The neuroimmunomodulation hypothesis for Alzheimer's disease (AD) postulates that alterations in the innate immune system triggered by damage signals result in adverse effects on neuronal functions. The peripheral immune system and neuroimmunoendocrine communication are also impaired. Here we provide further evidence using a longitudinal design that also studied the long-lasting effects of an early life sensorial intervention (neonatal handling, from postnatal day 1-21) in 6-month-old (early stages of the disease) male and female 3xTg-AD mice compared to age- and sex-matched non-transgenic (NTg) mice with normal aging. The behavioral patterns elicited by the direct exposure to an open field, and the motor depression response evoked by NMDA (25 mg/kg, i.p) were found correlated to the organometry of peripheral immune-endocrine organs (thymus involution, splenomegaly, and adrenal glands' hypertrophy) and increased corticosterone levels, suggesting their potential value for diagnostic and biomonitoring.The NMDA-induced immediate and depressant motor activity and endocrine (corticosterone) responses were sensitive to sex and AD-genotype, suggesting worse endogenous susceptibility/neuroprotective response to glutamatergic excitotoxicity in males and in the AD-genotype. 3xTg-AD females showed a reduced immediate response, whereas the NTg showed higher responsiveness to subsequent NMDA-induced depressant effect than their male counterparts. The long-lasting ontogenic modulation by handling was shown as a potentiation of NMDA-depressant effect in NTg males and females, while sex × treatment effects were found in 3xTg-AD mice. Finally, NMDA-induced corticosterone showed sex, genotype and interaction effects with sexual dimorphism enhanced in the AD-genotype, suggesting different endogenous vulnerability/neuroprotective capacities and modulation of the neuroimmunoendocrine system.
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Affiliation(s)
- R Baeta-Corral
- Institut de Neurociències, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - M De la Fuente
- Department of Genetics, Physiology, and Microbiology, School of Biology, Complutense University, 28040 Madrid, Spain
| | - L Giménez-Llort
- Institut de Neurociències, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain.
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Tabios IKB, Sato MO, Tantengco OAG, Fornillos RJC, Kirinoki M, Sato M, Rojo RD, Fontanilla IKC, Chigusa Y, Medina PMB, Kikuchi M, Leonardo LR. Diagnostic Performance of Parasitological, Immunological, Molecular, and Ultrasonographic Tests in Diagnosing Intestinal Schistosomiasis in Fieldworkers From Endemic Municipalities in the Philippines. Front Immunol 2022; 13:899311. [PMID: 35774791 PMCID: PMC9237846 DOI: 10.3389/fimmu.2022.899311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Schistosomiasis remains to ha/ve a significant public health impact in the Philippines. The Kato-Katz (K-K) technique is the reference standard and most used technique for definitive diagnosis of intestinal schistosomiasis for control programs in endemic regions. However, this has a very low sensitivity when applied in areas of low endemicity and patients with light infection. Hence, this study determined the diagnostic performance of immunological, molecular, parasitological, and ultrasonographic tests in diagnosing intestinal schistosomiasis in endemic municipalities in the Philippines. We performed a community-based cross-sectional study to determine the positivity of schistosomiasis in Leyte, Philippines. The diagnostic performance of five different detection techniques: (1) three stool K-K with duplicate smears; (2) soluble egg antigen IgG ELISA; (3) urine point-of-care circulating cathodic antigen (POC-CCA) test; (4) detection of Schistosoma japonicum circulating DNA (SjcDNA) in serum and urine samples; (5) focused abdominal ultrasound (US), were also obtained in this study. Multiple stool examinations enhanced the sensitivity of K-K from 26.2% (95% CI [16.4, 38.8]) with single stool to 53.8% (95% CI [41.1, 66.1]) and 69.2% (95% CI [56.4, 80.0]) with two and three stools from consecutive days, respectively. Among the SjcDNA nucleic acid amplification test (NAAT)-based detection assays, loop-mediated isothermal amplification (LAMP) PCR using sera had the highest sensitivity at 92.3% (95% CI [82.2, 97.1]) with LAMP consistently identifying more positive cases in both serum and urine samples. This study showed that single stool K-K, which remains the only diagnostic test available in most endemic areas in the Philippines, had low sensitivity and failed to identify most patients with light infection. SjcDNA detection assay and POC-CCA urine test were more sensitive than stool microscopy in detecting schistosomiasis. On the other hand, US was less sensitive than the widely utilized K-K technique in diagnosing schistosomiasis. This study emphasizes the need to revisit the use of single stool K-K in the surveillance and case detection of schistosomiasis in endemic areas of the Philippines. The availability of advanced and more sensitive diagnostic tests will help better control, prevent, and eliminate schistosomiasis in the country.
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Affiliation(s)
- Ian Kim B. Tabios
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines
- College of Medicine, University of the Philippines Manila, Manila, Philippines
- Laboratory of Tropical Medicine and Parasitology, Dokkyo Medical University, Tochigi, Japan
- *Correspondence: Marcello Otake Sato, ; Ian Kim B. Tabios,
| | - Marcello Otake Sato
- Laboratory of Tropical Medicine and Parasitology, Dokkyo Medical University, Tochigi, Japan
- *Correspondence: Marcello Otake Sato, ; Ian Kim B. Tabios,
| | | | - Raffy Jay C. Fornillos
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines
| | - Masashi Kirinoki
- Laboratory of Tropical Medicine and Parasitology, Dokkyo Medical University, Tochigi, Japan
| | - Megumi Sato
- Graduate School of Health Sciences, Niigata University, Niigata City, Japan
| | - Raniv D. Rojo
- College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Ian Kendrich C. Fontanilla
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines
| | - Yuichi Chigusa
- Center for International Cooperation, Dokkyo Medical University, Tochigi, Japan
| | - Paul Mark B. Medina
- Department of Biochemistry and Molecular Biology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Mihoko Kikuchi
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Lydia R. Leonardo
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines
- Office of Research Coordination, University of the East, Manila, Philippines
- College of Arts and Sciences, University of the Philippines Manila, Manila, Philippines
- University of the East Ramon Magsaysay Graduate School, Quezon City, Philippines
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Ayé P, Phongluxa K, Vonghachack Y, Sayasone S, Oroth R, Odermatt P. Patients with severe schistosomiasis mekongi morbidity demonstrating ongoing transmission in Southern Lao People's Democratic Republic. Acta Trop 2020; 204:105323. [PMID: 31891706 DOI: 10.1016/j.actatropica.2019.105323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/18/2019] [Accepted: 12/27/2019] [Indexed: 02/08/2023]
Abstract
Chronic infection with Schistosoma mekongi may result in severe hepatosplenic morbidity. We report on eight patients with severe morbidity due to S. mekongi infection. The patients were diagnosed, treated and followed-up between 2007 and 2010 in Khong district, Southern Lao People's Democratic Republic (Lao PDR), eight years after the end of a control intervention. S. mekongi control programmes aimed to prevent morbidity and mortality associated with infection. The patients were visited and interviewed annually. In addition, clinical and abdominal ultrasound examinations were performed and faecal and blood samples were examined. The patients' ages ranged from 6 to 66 years. Of the eight patients, three were children and five were adults. The four youngest patients (aged 6-27 years) significantly improved after praziquantel treatment. One patient (age 46 years) worsened between 2007 and 2010. Two patients died due to bleeding of the oesophageal varices. One patient was lost to follow-up. The leading clinical signs were ascites, splenomegaly, collateral veins on the abdomen and a poor general nutrition status. Ultrasonography disclosed advanced liver fibrosis patterns in all patients; in seven patients, fibrosis pattern E or F was revealed, as per the Niamey protocol (pattern A normal, pattern B to F pathological with increasing severity). Stool microscopy revealed that five patients were co-infected with hookworm and Opisthorchis viverrini. The youngest patient (aged 6 years) was born after the schistosomiasis control program had ended. From her severe morbidity, we can conclude that S. mekongi transmission was on-going in Khong district, and that even in areas with low S. mekongi transmission intensities, severe morbidity from schistosomiasis can develop quickly. Early diagnosis and treatment are imperative, and close monitoring is required.
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Sayasone S, Kling K, Southisavath P, Utzinger J, Oroth R, Odermatt P. Morbidity associated with Schistosoma mekongi and concurrent helminth infection in Lao People's Democratic Republic. Acta Trop 2020; 204:105324. [PMID: 31891705 DOI: 10.1016/j.actatropica.2019.105324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/19/2019] [Accepted: 12/27/2019] [Indexed: 11/24/2022]
Abstract
In 2006, some 7 years after the halt of a multi-year schistosomiasis control programme, a study was conducted in the southern part of Lao People's Democratic Republic to determine the morbidity associated with Schistosoma mekongi and concurrent helminth infection. In two S. mekongi-endemic districts, Khong and Mounlapamok, 640 individuals aged 9-40 years were randomly selected. Two stool samples were obtained from each participant and subjected to the Kato-Katz technique for helminth diagnosis. Morbidity was assessed by clinical examination and abdominal ultrasonography. Multiple logistic regression analysis was employed to relate S. mekongi infection with morbidity indicators. In Khong district, S. mekongi prevalence was 13-fold higher than in Mounlapamok district (57.7% vs. 4.4%, p < 0.001). Likewise, we observed significantly more often palpated hepatomegaly (15.5% vs. 5.4%) and splenomegaly (9.6% vs. 0.4%). Abdominal ultrasonography revealed that, in Khong district, liver and spleen morbidity occurred more frequently (e.g., enlarged left liver lobe: 89.2% vs. 68.7%, p < 0.001). Single species infection with S. mekongi was associated with enlarged peri-portal vein (adjusted odds ratio (aOR) 47.7, 95% confidence interval (CI) 4.2-85.7, p = 0.002), as was S. mekongi-Opisthorchis viverrini co-infection (aOR 2.2, 95% CI 1.1-4.5, p = 0.020). In conclusion, our study shows that in 2006, several years after the halt of the Lao schistosomiasis control programme that emphasised preventive chemotherapy, S. mekongi infection again had reached high prevalence rates. Infection with S. mekongi was associated with substantial hepatosplenic morbidity. Schistosomiasis control measures were re-instigated in 2010. In view of the ultimate goal to eliminate schistosomiasis, rigorous surveillance and public health responses tailored to the social-ecological settings and long-term programme commitment are warranted.
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Kamdem SD, Kuemkon EM, Kamguia LM, Tchanana GK, Konhawa F, Nche F, Oumarou A, Hamza M, Essomba RG, Kengne M, Ondigui BE, Assoumou MCO, Brombacher F, Nono JK. An ultrasound-based referential of body height-adjusted normal liver organometry in school children from Bokito in rural Cameroon. Sci Rep 2020; 10:2773. [PMID: 32066761 PMCID: PMC7026466 DOI: 10.1038/s41598-020-59613-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/22/2020] [Indexed: 11/16/2022] Open
Abstract
The grading system for ultrasonographic assessment of Schistosoma mansoni morbidity is crucial for evaluation of control programs. This requires prior definition of normal liver organometric ranges in the population from the endemic area. A cross-sectional study was conducted in a S. mansoni endemic area in rural Cameroon. 1002 Participants were screened and 234 of them, free from all common liver-affecting diseases in the area (schistosomiasis, malaria, hepatitis B and C) and with no ultrasonographic signs of liver disease were selected and their liver parameters measured by ultrasonography. All statistics were considered significant for p-values < 0.05. Normal dimensions of livers lobe sizes, portal vein wall thickness and portal vein diameters are reported. The liver organometric data are presented for the entire study population as a whole and separately for males and females as prediction plots, with observed values and fitted regression line with 95% confidence. Reference ranges for liver parameters (size, portal vein thickness and diameter) adjusted for body height established in the current study are novel for Cameroon. The prediction plots generated should improve the accuracy of the assessment of liver morbidity by ultrasonography in the region.
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Affiliation(s)
- Severin Donald Kamdem
- Division of Immunology, Health Science Faculty, University of Cape Town, Cape Town, South Africa
- Cape Town Component, International Centre for Genetic Engineering and Biotechnology, Cape Town, South Africa
- Immunology of Infectious Diseases Unit, South African Medical Research Centre, Cape Town, South Africa
| | - Erve Martial Kuemkon
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Leonel Meyo Kamguia
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Gladys K Tchanana
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
- CIAB EXACT Medical Laboratory, Yaoundé, Cameroon
| | - Francis Konhawa
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Frungwa Nche
- Faculty of medicine and biomedical sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | | | | | - René Ghislain Essomba
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
- National Public Health Laboratory, Ministry of Public Health, Yaoundé, Cameroon
| | - Michel Kengne
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | | | | | - Frank Brombacher
- Division of Immunology, Health Science Faculty, University of Cape Town, Cape Town, South Africa
- Cape Town Component, International Centre for Genetic Engineering and Biotechnology, Cape Town, South Africa
- Immunology of Infectious Diseases Unit, South African Medical Research Centre, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Justin Komguep Nono
- Division of Immunology, Health Science Faculty, University of Cape Town, Cape Town, South Africa.
- Cape Town Component, International Centre for Genetic Engineering and Biotechnology, Cape Town, South Africa.
- Immunology of Infectious Diseases Unit, South African Medical Research Centre, Cape Town, South Africa.
- The Medical Research Centre, Institute of Medical Research and Medicinal Plant Studies, Ministry of Scientific Research and Innovation, Yaoundé, Cameroon.
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Leonardo L, Bergquist R, Utzinger J, Willingham AL, Olveda R, Zhou XN. Milestones of networking and global engagements for the Regional Network on Asian Schistosomiasis and other Helminthic Zoonoses (RNAS +). ADVANCES IN PARASITOLOGY 2019; 105:1-21. [PMID: 31530391 DOI: 10.1016/bs.apar.2019.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This paper introduces the three stages of development of the Regional Network on Asian Schistosomiasis and other Helminthic Zoonoses (RNAS+), namely the preparatory stage, the strengthening stage and the expanding stage. Significant achievements have been made through the help of RNAS+, particularly on research on helminthiases. As scientists, researchers, academics work closer with control authorities, elimination of these diseases is slowly getting nearer and within reach. RNAS+, at present can boast of the following strengths: (i) strong collaboration in the regional research area with support from experts on research and control; (ii) presence of experts in various areas who can improve and promote both research and control; (iii) RNAS+ has been successful in translating research output to field application; (iv) setting up a platform that is capable of advancing the mechanisms of sharing information through its website, databases, publications and meetings; (v) RNAS+ has proved that it is capable of undertaking joint collaborative projects on operational research through multi-country, multi-disease using multi-disciplinary approach and involving different academic and research institutions in the region. Most importantly, experts who are members of RNAS+ are also linked with control programmes of the endemic member countries in the region.
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Affiliation(s)
- Lydia Leonardo
- Institute of Biology, College of Science, University of the Philippines Diliman and University of the East Ramon Magsaysay Graduate School, Quezon City, Philippines.
| | | | - Juerg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Arve Lee Willingham
- One Health Center for Zoonoses and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, St. Kitts, West Indies
| | - Remigio Olveda
- Asian Tropical Foundation, Filinvest Corporate City, Research Institute for Tropical Medicine Compound, Muntinlupa, Philippines
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Beijing, China; Chinese Center for Tropical Diseases Research, Shanghai, China; WHO Collaborating Centre for Tropical Diseases, Shanghai, China; National Center for International Research on Tropical Diseases, Shanghai, China; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China
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Bergquist R, Leonardo L, Zhou XN. From inspiration to translation: Closing the gap between research and control of helminth zoonoses in Southeast Asia. ADVANCES IN PARASITOLOGY 2019; 105:111-124. [PMID: 31530392 DOI: 10.1016/bs.apar.2019.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Poverty magnifies limitations resulting from traditional biases and environmental risks in endemic areas. Any approach towards disease control needs to recognise that socially embedded vulnerabilities can be as powerful as externally imposed infections. Important for RNAS was networking across borders, not just on schistosomiasis but on the whole spectrum of endemic helminthiases, and this bore fruit in the form of the expansion of RNAS into the 'Regional Network on Asian Schistosomiasis and other Helminth Zoonoses (RNAS+)', which focuses on technical standardization, supporting the growth of research capacity and the further development of networking. Administration is lean and largely virtual with the focus on connecting members via the Internet, providing databases and administrative back-up. The strategy emphasizes ways and means to alleviate the spectre of disease and poverty from the endemic areas through boosting research on target diseases and supporting collaboration between basic and operational research on the one hand and control/elimination activities on the other. RNAS+ also benefits from continuing input from outside research institutions in areas outside Southeast Asia. This paper is aiming to identify the priority actions to close the gap between researcher and policy makers.
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Affiliation(s)
| | - Lydia Leonardo
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines; University of the East Ramon Magsaysay Graduate School, Quezon City, Philippines
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China; Chinese Center for Tropical Diseases Research, Shanghai, China; WHO Collaborating Centre for Tropical Diseases, Shanghai, China; National Center for International Research on Tropical Diseases, Shanghai, China; Key Laboratory of Parasite and Vector Biology, Ministry of Health, China; Shanghai, China
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Chow KU, Luxembourg B, Seifried E, Bonig H. Spleen Size Is Significantly Influenced by Body Height and Sex: Establishment of Normal Values for Spleen Size at US with a Cohort of 1200 Healthy Individuals. Radiology 2015; 279:306-13. [PMID: 26509293 DOI: 10.1148/radiol.2015150887] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To define height- and sex-corrected normal values for spleen length and volume determined with ultrasonography (US). MATERIALS AND METHODS The authors performed a retrospective data review of stem cell donors who had provided written informed consent for stem cell donation and use of anonymized data and biologic materials for scientific and quality control purposes. Spleen length, spleen volume, and anthrophometric data were correlated in 1230 healthy volunteers to identify variables that affect spleen size. Multiple linear regression analysis was performed to weight effects of various variables on spleen size. Linear regression through the 95th percentile for men and women of different height cohorts generated the formula for the upper limit of normal for spleen length and volume. For validation, the upper limit of normal was calculated for each volunteer and compared with the observed value. Formulae to calculate the additional percentiles were similarly generated and validated. A cohort of 75 volunteers was analyzed twice to assess the stability of spleen length and volume over time. RESULTS Spleen length and volume were significantly and independently associated with sex (length: P < .001; volume: P = .012), body height (P < .001 for both), and weight (P < .001 for both), with men and taller and heavier individuals having longer and larger spleens. The spleen length of 20 of 324 women (6%) and 234 of 906 men (26%) exceeded the previously reported upper limit of normal of 12 cm. Repeat measurements indicated that spleen length (median difference, 0.10 cm; range, -1.8 to 1.7 cm) and volume (median difference, 3 cm(3); range, -106 to 142 cm(3)) were quite stable. A mobile application that performs these calculations is available for download. CONCLUSION The authors define height- and sex-corrected normal values for spleen length and volume for women with a body height of 155-179 cm and men with a body height of 165-199 cm and propose validated algorithms to gauge the percentile of an individual's spleen size.
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Affiliation(s)
- Kai Uwe Chow
- From the Ambulantes Krebszentrum, Private Practice for Hematology and Oncology, Frankfurt, Germany (K.U.C.); German Red Cross Blood Service Baden-Württemberg-Hesse, Frankfurt, Germany (B.L., E.S., H.B.); Institute for Transfusion Medicine and Immunohematology, Goethe University, Sandhofstrasse 1, 60528 Frankfurt, Germany (E.S., H.B.); and Department of Medicine, Division of Hematology, University of Washington, Seattle, Wash (H.B.)
| | - Beate Luxembourg
- From the Ambulantes Krebszentrum, Private Practice for Hematology and Oncology, Frankfurt, Germany (K.U.C.); German Red Cross Blood Service Baden-Württemberg-Hesse, Frankfurt, Germany (B.L., E.S., H.B.); Institute for Transfusion Medicine and Immunohematology, Goethe University, Sandhofstrasse 1, 60528 Frankfurt, Germany (E.S., H.B.); and Department of Medicine, Division of Hematology, University of Washington, Seattle, Wash (H.B.)
| | - Erhard Seifried
- From the Ambulantes Krebszentrum, Private Practice for Hematology and Oncology, Frankfurt, Germany (K.U.C.); German Red Cross Blood Service Baden-Württemberg-Hesse, Frankfurt, Germany (B.L., E.S., H.B.); Institute for Transfusion Medicine and Immunohematology, Goethe University, Sandhofstrasse 1, 60528 Frankfurt, Germany (E.S., H.B.); and Department of Medicine, Division of Hematology, University of Washington, Seattle, Wash (H.B.)
| | - Halvard Bonig
- From the Ambulantes Krebszentrum, Private Practice for Hematology and Oncology, Frankfurt, Germany (K.U.C.); German Red Cross Blood Service Baden-Württemberg-Hesse, Frankfurt, Germany (B.L., E.S., H.B.); Institute for Transfusion Medicine and Immunohematology, Goethe University, Sandhofstrasse 1, 60528 Frankfurt, Germany (E.S., H.B.); and Department of Medicine, Division of Hematology, University of Washington, Seattle, Wash (H.B.)
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Patzak M, Porzner M, Oeztuerk S, Mason RA, Wilhelm M, Graeter T, Kratzer W, Haenle MM, Akinli AS. Assessment of liver size by ultrasonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:399-404. [PMID: 24638913 DOI: 10.1002/jcu.22151] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 11/08/2013] [Accepted: 02/20/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND To determine liver span sonographically in a randomly selected population sample and identify factors that affect liver size. METHODS A total of 1,789 subjects (963 females, 826 males; mean age 41.8 ± 12.8 years) underwent sonographic examination of the liver in the midclavicular line to determine liver span. Subjects underwent physical examination and blood tests and completed a standardized interview questionnaire. RESULTS The average liver span in the midclavicular line for the overall collective was 15.0 ± 1.5 cm; the average for females was 14.9 ± 1.6 cm and 15.1 ± 1.5 cm for males. Liver span exceeded 16 cm in 24.3% of subjects. Results of the multivariate analysis showed that, of the factors potentially influencing liver span, gender, age, body mass index, body height, fatty liver (p < 0.0001), waist-to-hip ratio (p = 0.015), and metabolic syndrome (p = 0.032) are significant. By contrast, diabetes mellitus, alcohol consumption, tobacco consumption, physical activity, and laboratory findings showed no influence. CONCLUSIONS Sonographic measurement of liver span in the midclavicular line is a simple method for routine clinical use. Gender, age, body mass index, waist-to-hip ratio, body height, hepatic steatosis, and metabolic syndrome are factors associated with liver span.
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Affiliation(s)
- Monika Patzak
- Department of Internal Medicine I, Center for Internal Medicine, University Medical Center Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Zheng YB, Huang ZL, Wu ZB, Zhang M, Gu YR, Su YJ, Lin CS, Zhu RH, Lin BL, Gao ZL. Dynamic changes of clinical features that predict the prognosis of acute-on-chronic hepatitis B liver failure: a retrospective cohort study. Int J Med Sci 2013; 10:1658-64. [PMID: 24151437 PMCID: PMC3804791 DOI: 10.7150/ijms.6415] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 09/09/2013] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The natural history of acute-on-chronic hepatitis B liver failure (ACHBLF) is complex and highly variable. However, the global clinical characteristics of this entity remain ill-defined. We aimed to investigate the dynamic patterns of the natural progression as well as their impact on the outcomes of ACHBLF. METHODS The clinical features and disease states were retrospectively investigated in 54 patients with ACHBLF at the China South Hepatology Center. The clinical and laboratory profiles including hepatic encephalopathy (HE), hepatorenal syndrome (HRS), and spontaneous bacterial peritonitis (SBP) were evaluated. The disease state estimated by the model for end-stage liver disease (MELD) score and the dynamic patterns during the clinical course of ACHBLF were extrapolated. RESULTS Twenty-two patients died during the 3-month follow-up period (40.74%). The patients were predominantly male (88.89%). Baseline characteristics showed that there were significant differences in only hepatitis B virus (HBV) DNA levels and platelet count between the deceased and surviving patients (P=0.014 and P=0.012, respectively). Other baseline characteristics were similar in both groups. The dynamic state of the MELD score gradually increased from an initial hepatic flare until week 4 of ACHBLF progression. There were notable changes of the dynamic state of the MELD score at two time points (week 2 and week 4) during ACHBLF progression. The MELD scores were significantly greater in the death group (24.80 ± 2.99) than in the survival group (19.49±1.96, P<0.05) during the clinical course of ACHBLF; the MELD scores of the survival group began to decrease from week 4, while they continued to rise and eventually decreased as more patients died. The gradients of the ascent and descent stages could predict exactly the severity and prognosis of ACHBLF. CONCLUSIONS The natural progression of ACHBLF could be divided approximately into four stages including ascent, plateau, descent, and convalescence stages according to different trends of liver failure progression, respectively. Thus, the special patterns of the natural progression of ACHBLF may be regarded as a significant predictor of the 3-month mortality of ACHBLF.
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Affiliation(s)
- Yu-Bao Zheng
- 1. Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University
- 2. Key Laboratory of Tropical Disease Control (Sun Yat-Sen University), Ministry of Education, Guangdong, China. No 600 Tianhe Road, Guangzhou 510630, Guangdong Province, PR China
| | - Zhan Lian Huang
- 1. Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University
- 2. Key Laboratory of Tropical Disease Control (Sun Yat-Sen University), Ministry of Education, Guangdong, China. No 600 Tianhe Road, Guangzhou 510630, Guangdong Province, PR China
| | - Zhe Bin Wu
- 1. Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University
- 2. Key Laboratory of Tropical Disease Control (Sun Yat-Sen University), Ministry of Education, Guangdong, China. No 600 Tianhe Road, Guangzhou 510630, Guangdong Province, PR China
| | - Min Zhang
- 1. Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University
- 2. Key Laboratory of Tropical Disease Control (Sun Yat-Sen University), Ministry of Education, Guangdong, China. No 600 Tianhe Road, Guangzhou 510630, Guangdong Province, PR China
| | - Yu Rong Gu
- 1. Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University
- 2. Key Laboratory of Tropical Disease Control (Sun Yat-Sen University), Ministry of Education, Guangdong, China. No 600 Tianhe Road, Guangzhou 510630, Guangdong Province, PR China
| | - Yu Jie Su
- 1. Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University
- 2. Key Laboratory of Tropical Disease Control (Sun Yat-Sen University), Ministry of Education, Guangdong, China. No 600 Tianhe Road, Guangzhou 510630, Guangdong Province, PR China
| | - Chao Shuang Lin
- 1. Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University
- 2. Key Laboratory of Tropical Disease Control (Sun Yat-Sen University), Ministry of Education, Guangdong, China. No 600 Tianhe Road, Guangzhou 510630, Guangdong Province, PR China
| | - Rui Hua Zhu
- 1. Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University
- 2. Key Laboratory of Tropical Disease Control (Sun Yat-Sen University), Ministry of Education, Guangdong, China. No 600 Tianhe Road, Guangzhou 510630, Guangdong Province, PR China
| | - Bin Liang Lin
- 1. Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University
- 2. Key Laboratory of Tropical Disease Control (Sun Yat-Sen University), Ministry of Education, Guangdong, China. No 600 Tianhe Road, Guangzhou 510630, Guangdong Province, PR China
| | - Zhi Liang Gao
- 1. Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University
- 2. Key Laboratory of Tropical Disease Control (Sun Yat-Sen University), Ministry of Education, Guangdong, China. No 600 Tianhe Road, Guangzhou 510630, Guangdong Province, PR China
- ✉ Corresponding author: Prof. Zhi-liang Gao, MD, Professor of Medicine, Chief, Department of Infectious Diseases, 3rd Affiliated Hospital of Sun Yat-sen University, 600# tianhe Road, GuangZhou, 510630, China. Tel: +8620-85252373; Fax: +8620-85252250;
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Sayasone S, Rasphone O, Vanmany M, Vounatsou P, Utzinger J, Tanner M, Akkhavong K, Hatz C, Odermatt P. Severe Morbidity Due to Opisthorchis viverrini and Schistosoma mekongi Infection in Lao People's Democratic Republic. Clin Infect Dis 2012; 55:e54-7. [DOI: 10.1093/cid/cis528] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Schistosomiasis research in the dongting lake region and its impact on local and national treatment and control in China. PLoS Negl Trop Dis 2011; 5:e1053. [PMID: 21912706 PMCID: PMC3166040 DOI: 10.1371/journal.pntd.0001053] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Schistosomiasis is a chronic and debilitating parasitic disease that has often been neglected because it is a disease of poverty, affecting poor rural communities in the developing world. This is not the case in the People's Republic of China (PRC), where the disease, caused by Schistosoma japonicum, has long captured the attention of the Chinese authorities who have, over the past 50–60 years, undertaken remarkably successful control programs that have substantially reduced the schistosomiasis disease burden. The Dongting Lake region in Hunan province is one of the major schistosome-endemic areas in the PRC due to its vast marshland habitats for the Oncomelania snail intermediate hosts of S. japonicum. Along with social, demographic, and other environmental factors, the recent completion and closure of the Three Gorges dam will most likely increase the range of these snail habitats, with the potential for re-emergence of schistosomiasis and increased transmission in Hunan and other schistosome-endemic provinces being a particular concern. In this paper, we review the history and the current status of schistosomiasis control in the Dongting Lake region. We explore the epidemiological factors contributing to S. japonicum transmission there, and summarise some of the key research findings from studies undertaken on schistosomiasis in Hunan province over the past 10 years. The impact of this research on current and future approaches for sustainable integrated control of schistosomiasis in this and other endemic areas in the PRC is emphasised.
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Fabre V, Wu H, PondTor S, Coutinho H, Acosta L, Jiz M, Olveda R, Cheng L, White ES, Jarilla B, McGarvey ST, Friedman JF, Kurtis JD. Tissue inhibitor of matrix-metalloprotease-1 predicts risk of hepatic fibrosis in human Schistosoma japonicum infection. J Infect Dis 2011; 203:707-14. [PMID: 21199883 DOI: 10.1093/infdis/jiq099] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Schistosomes infect 200 million individuals annually and cause significant hepatic fibrosis in up to 20%. Little is known regarding the mechanisms of schistosome-associated hepatic fibrosis in humans, and few biomarkers for risk of fibrosis have been identified. METHODS We treated 611 Schistosoma japonicum-infected Filipinos with praziquantel (PZQ) and performed ultrasound to quantify hepatic fibrosis at baseline and 12 months after PZQ treatment. We developed a multiplexed assay (FibroPlex) that quantifies predictors and effect modifiers of fibrosis. We measured FibroPlex analytes produced by peripheral blood mononuclear cells stimulated with schistosome egg antigen 4 weeks after PZQ treatment and related these levels to risk of fibrosis 1 year after PZQ treatment. RESULTS After adjusting for potential confounders, including baseline grade of fibrosis, individuals with detectable tissue inhibitor of matrix-metalloprotease-1 (TIMP-1) had a 3.5-fold greater risk of fibrosis 1 year after PZQ treatment, compared with individuals with undetectable levels (odds ratio, 3.48; 95% confidence interval, 1.41-8.43; P = .007). DISCUSSION Because TIMP-1 inhibits most matrix metalloproteases, which are responsible for collagen degradation, these data suggest that schistosome-associated hepatic fibrosis results, in part, from excessive inhibition of collagen remodeling. These data further suggest that TIMP-1 is a promising biomarker for assessing risk of hepatic fibrosis in schistosomiasis and, potentially, other infectious and noninfectious causes of liver disease.
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Affiliation(s)
- Valeria Fabre
- Department of Medicine, Memorial Hospital of Rhode Island, Brown University Medical School, Providence, RI, USA.
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Carlton EJ, Hsiang M, Zhang Y, Johnson S, Hubbard A, Spear RC. The impact of Schistosoma japonicum infection and treatment on ultrasound-detectable morbidity: a five-year cohort study in Southwest China. PLoS Negl Trop Dis 2010; 4:e685. [PMID: 20502515 PMCID: PMC2872638 DOI: 10.1371/journal.pntd.0000685] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 03/26/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ultrasonography allows for non-invasive examination of the liver and spleen and can further our understanding of schistosomiasis morbidity. METHODOLOGY/PRINCIPAL FINDINGS We followed 578 people in Southwest China for up to five years. Participants were tested for Schistosoma japonicum infection in stool and seven standard measures of the liver and spleen were obtained using ultrasound to evaluate the relationship between schistosomiasis infection and ultrasound-detectable pathology, and the impact of targeted treatment on morbidity. Parenchymal fibrosis, a network pattern of the liver unique to S. japonicum, was associated with infection at the time of ultrasound (OR 1.40, 95% CI: 1.03-1.90) and infection intensity (test for trend, p = 0.002), adjusting for age, sex and year, and more strongly associated with prior infection status and intensity (adjusted OR 1.84, 95% CI: 1.30-2.60; test for trend: p<0.001 respectively), despite prompt treatment of infections. While declines in parenchymal fibrosis over time were statistically significant, only 28% of individuals with severe parenchymal fibrosis (grades 2 or 3) at enrollment reversed to normal or grade 1 within five years. Other liver abnormalities were less consistently associated with S. japonicum infection. CONCLUSIONS/SIGNIFICANCE Parenchymal fibrosis is an appropriate measure of S. japonicum morbidity and can document reductions in disease following control efforts. Other ultrasound measures may have limited epidemiological value in regions with similar infection levels. Because severe fibrosis may not reverse quickly following treatment, efforts to reduce exposure to S. japonicum should be considered in combination with treatment to prevent schistosomiasis morbidity.
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Affiliation(s)
- Elizabeth J Carlton
- Department of Environmental Health Sciences, University of California, Berkeley, California, United States of America.
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Hsiang MS, Carlton EJ, Zhang Y, Zhong B, Dongchuan Q, Cohen PA, Stewart CC, Spear RC. Use of ultrasonography to evaluate Schistosoma japonicum-related morbidity in children, Sichuan Province, China, 2000-2007. Am J Trop Med Hyg 2010; 82:103-11. [PMID: 20065003 PMCID: PMC2803517 DOI: 10.4269/ajtmh.2010.09-0061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 09/28/2009] [Indexed: 11/07/2022] Open
Abstract
Liver ultrasonography is a convenient way to evaluate Schistosoma japonicum-related morbidity; however, no consensus standards exist, and data on use in Chinese children are scant. We describe 7 years of ultrasound findings in a prospective cohort of 151 children from an endemic area in Sichuan Province, China and evaluate technical aspects of the ultrasound methodology. Although prevalence of infection decreased over time, prevalence of hepatomegaly increased, which was likely caused by re-infections. The prevalence of late findings such as parenchymal fibrosis and splenomegaly were rare and did not increase over time; however, when present, they were associated with stunting. The use of adult thresholds versus height-adjusted standards underestimated pathology in children. Reliability of all measures except parenchymal grade was poor to fair. Our findings highlight the importance of early intervention and screening. We also suggest methodological refinements to improve reliability of ultrasonography for large-scale assessment of S. japonicum-related subclinical morbidity in children.
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Affiliation(s)
- Michelle S Hsiang
- Global Health Sciences, University of California, San Francisco, California 94105, USA.
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Anemia of inflammation is related to cognitive impairment among children in Leyte, the Philippines. PLoS Negl Trop Dis 2009; 3:e533. [PMID: 19847303 PMCID: PMC2761538 DOI: 10.1371/journal.pntd.0000533] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Accepted: 09/18/2009] [Indexed: 12/15/2022] Open
Abstract
Background Many studies have addressed the relationship between iron deficiency anemia (IDA) and cognitive impairment, but none have evaluated the role of non-iron deficiency anemia (NIDA). One of the main causes of NIDA in developing countries is AI, largely due to infectious diseases, whereby iron is shunted away from bio-available forms to storage forms, making it less accessible for use by host tissues. The objective of this study was to determine the effect of NIDA, due largely to AI in this context, on cognitive function after adjustment for potential confounders. Methodology This cross-sectional study was conducted in Leyte, The Philippines among 322 children ages 7–18 years. Blood samples were collected and analyzed at the time of cognition testing. Three stool samples were collected and evaluated by the Kato Katz method for quantitative assessment for Schistosoma japonicum and geo-helminth infection. Socio-economic status (SES) was evaluated by survey. Linear regression models were used to quantify the adjusted relationship between performance in different cognitive domains and both IDA and NIDA. Principal Findings After adjusting for age, sex, SES and nutritional status, children in the NIDA had lower scores on the PNIT (P = <0.05) and the WRAML memory domain (P<0.05) compared to children in the non-anemic group. Children in the IDA had lower performance on the PNIT compared to the non-anemic group after controlling for potential confounders (P<0.05). Conclusions NIDA, predominantly due to AI in this context, was related to lower performance on two tests of cognitive function. This is likely due to decreased delivery of iron to host tissues in this context, including the CNS. Past studies have demonstrated that iron deficiency anemia is related to deficits in cognitive fucntioning in children, and treating iron deficiency anemia with iron supplementation can improve cognition. Anemia of inflammation is another type of anemia caused by many diseases of lesser-developed countries including bacterial and parasitic infections. Anemia of inflammation is characterized by disordered iron metabolism, such that iron is sequestered in storage forms, preventing its use from tissues that require it. We hypothesized that decreased iron delivery to the brain in the context of anemia of inflammation might lead to decreased cognitive performance. This study found that children with anemia of inflammation had decreased cognitive performance in specific domains, compared to subjects with no anemia. True total body iron deficiency anemia was related to lower performance in the same domains. The only treatment option for anemia of inflammation is treatment of the underlying disease. Iron supplementation will not prevent cognitive deficits in children with anemia of inflammation. Interventions aimed towards maximizing the cognitive development of children in lesser-developed countries will need to focus on the prevention and treatment of bacterial and parasitic infections.
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Coquet B, Sandoz B, Savoie PH, Thollon L, Serre T, Brunet C. Anthropometric characterization of spleen in children. Surg Radiol Anat 2009; 32:25-30. [PMID: 19669612 DOI: 10.1007/s00276-009-0535-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 07/25/2009] [Indexed: 12/27/2022]
Abstract
PURPOSE This paper aims to characterize the 3D geometry of the child spleen which is still unknown. METHODS An anthropological measurement protocol, based upon 3D modeling using spleen-computed tomography data, was set up. Characteristic measurements were defined to allow dimensions and spatial localization description from classical anatomical landmarks (11th dorsal vertebra and 10th left rib). RESULTS Growth patterns showed a global enlargement without significant changes in distance to anatomical bone points. CONCLUSIONS This preliminary study describes a validated measurement protocol based on 3D reconstructions and gives description of the child spleen during growth.
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Affiliation(s)
- Benjamin Coquet
- Department of Digestive Surgery, Hôpital Nord, Chemin Bourrely, Marseille Cedex, France
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Burke ML, Jones MK, Gobert GN, Li YS, Ellis MK, McManus DP. Immunopathogenesis of human schistosomiasis. Parasite Immunol 2009; 31:163-76. [PMID: 19292768 DOI: 10.1111/j.1365-3024.2009.01098.x] [Citation(s) in RCA: 274] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Schistosomiasis continues to be a significant cause of parasitic morbidity and mortality worldwide. This review considers the basic features of the pathology and clinical outcomes of hepatointestinal and genitourinary schistosomiasis, presents an overview of the numerous studies on animal models that have clarified many of the immunopathological features, and provides insight into our current understanding of the immunopathogenesis and genetic control of human schistosomiasis. In murine schistosomiasis, pathology is induced by a CD4(+) Th2 driven granulomatous response directed against schistosome eggs lodged in the host liver. The Th2 cytokines IL-4 and IL-13 drive this response, whereas IL-10, IL13Ralpha2, IFN-gamma and a subset of regulatory T-cells act to limit schistosome induced pathology. A variety of cell types including hepatic stellate cells, alternatively activated macrophages and regulatory T-cells have also been implicated in the pathogenesis of schistosomiasis. Current knowledge suggests the immunopathogenic mechanisms underlying human schistosomiasis are likely to be similar. The review also considers the future development of anti-pathology schistosome vaccines. As fibrosis is an important feature of many other diseases such as Crohn's disease and sarcoidosis, a comprehensive understanding of the cellular and molecular mechanisms involved in schistosomiasis may also ultimately contribute to the development an effective disease intervention strategy for other granulofibrotic diseases.
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Affiliation(s)
- M L Burke
- The Queensland Institute of Medical Research, Herston, Australia
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Zhou XN, Guo JG, Wu XH, Jiang QW, Zheng J, Dang H, Wang XH, Xu J, Zhu HQ, Wu GL, Li YS, Xu XJ, Chen HG, Wang TP, Zhu YC, Qiu DC, Dong XQ, Zhao GM, Zhang SJ, Zhao NQ, Xia G, Wang LY, Zhang SQ, Lin DD, Chen MG, Hao Y. Epidemiology of schistosomiasis in the People's Republic of China, 2004. Emerg Infect Dis 2007; 13:1470-6. [PMID: 18257989 PMCID: PMC2851518 DOI: 10.3201/eid1310.061423] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Results from the third nationwide cluster sampling survey on the epidemiology of schistosomiasis in the People's Republic of China, conducted by the Ministry of Health in 2004, are presented. A stratified cluster random sampling technique was used, and 239 villages were selected in 7 provinces where Schistosoma japonicum remains endemic. A total of 250,987 residents 6-65 years of age were included in the survey. Estimated prevalence rates in the provinces of Hunan, Hubei, Jiangxi, Anhui, Yunnan, Sichuan, and Jiangsu were 4.2%, 3.8%, 3.1%, 2.2%, 1.7%, 0.9%, and 0.3%, respectively. The highest prevalence rates were in the lake and marshland region (3.8%) and the lowest rates were in the plain region with waterway networks (0.06%). Extrapolation to all residents in schistosome-endemic areas indicated 726,112 infections. This indicates a reduction of 16.1% compared with a nationwide survey conducted in 1995. However, human infection rates increased by 3.9% in settings where transmission is ongoing.
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Affiliation(s)
- Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Shanghai, People's Republic of China.
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Jia TW, Zhou XN, Wang XH, Utzinger J, Steinmann P, Wu XH. Assessment of the age-specific disability weight of chronic schistosomiasis japonica. Bull World Health Organ 2007; 85:458-65. [PMID: 17639243 PMCID: PMC2636356 DOI: 10.2471/blt.06.033035] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2006] [Revised: 12/14/2006] [Accepted: 12/18/2006] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To estimate the age-specific disability weight of chronic schistosomiasis japonica in China. METHODS Between October 2004 and January 2005, residents from two schistosome-endemic counties were screened for Schistosoma japonicum infection using an enzyme-linked immunosorbent assay. Disability and morbidity were assessed in seropositive individuals using the European quality of life questionnaire with an additional cognitive dimension (known as the "EQ-5D plus") and ultrasonography. The age-specific disability weight of chronic schistosomiasis was estimated based on participants self-rated health scores on the visual analogue scale of the questionnaire; the relationships between health status, morbidity and disability weight were explored using multilevel regression models. FINDINGS Of 2843 seropositive individuals, 1419 (49.9%) were classified as having chronic schistosomiasis. Hepatomegaly was found in 76.3% (1082/1419); hepatic fibrosis was found in 73.3% (1040/1419); and splenomegaly was found in 18.6% (264/1419). Diarrhoea was the most common self-reported symptom (46.0%; 653/1419), followed by abdominal pain (32.6%; 463/1419), impaired capacity to work or study (30.7%; 436/1419), and blood in the stool (11.1%; 157/1419). More than half of the respondents reported impairments in at least one dimension of the EQ-5D plus questionnaire, particularly pain or discomfort (47.9%; 675/1410) and anxiety or depression (39.4%; 555/1410). The overall disability weight was 0.191, and age-specific weights ranged from 0.095 among those aged 5-14 years to 0.246 among those aged > 60 years. Multilevel regression models indicated that the disability weight was significantly associated with the participants sex, grade of hepatic fibrosis, the presence of hepatomegaly, abdominal pain, blood in the stool, impaired capacity to work or study, and cognition. CONCLUSION The disability weight attributable to chronic schistosomiasis japonica is high and increases with age. Our findings call for a reappraisal of the disability weights due to chronic schistosomiasis mansoni and schistosomiasis haematobia as well as a re-estimation of the global burden of schistosomiasis.
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Affiliation(s)
- Tie-Wu Jia
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, 207 Rui Jin Er Rd, Shanghai 200025, China
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, 207 Rui Jin Er Rd, Shanghai 200025, China
| | - Xian-Hong Wang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, 207 Rui Jin Er Rd, Shanghai 200025, China
| | - Jürg Utzinger
- Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland
| | - Peter Steinmann
- Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland
| | - Xiao-Hua Wu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, 207 Rui Jin Er Rd, Shanghai 200025, China
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Sonmez G, Ozturk E, Basekim CC, Mutlu H, Kilic S, Onem Y, Kizilkaya E. Effects of altitude on spleen volume: sonographic assessment. JOURNAL OF CLINICAL ULTRASOUND : JCU 2007; 35:182-5. [PMID: 17373686 DOI: 10.1002/jcu.20346] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE To use sonography to determine changes that may arise in splenic volume in humans from regions of lower altitude who begin to live in regions of higher altitude. MATERIALS AND METHODS The study was conducted in the Turkish province of Ağri, at an altitude of 1750 m and included 108 healthy, nonsmoking, disease-free volunteers who had moved from regions at an altitude lower than 500 m. Length, width, and thickness of the spleen were measured using sonography. Splenic volume was calculated using the following standard ellipsoid formula: length x width x thickness x 0.523. Sonographic assessments were repeated at 3 and 6 months along with other blood tests, including hemoglobin, hematocrit, and platelet levels. RESULTS The mean +/- SD splenic volume was 299 +/- 97 cm(3) (range, 116-574 cm(3)). At 3 and 6 months, the splenic volumes decreased significantly compared to their initial values (p < 0.05). An increase in hemoglobin, hematocrit, and platelet count was observed in all subjects. CONCLUSION Our data show that splenic volume in healthy individuals who begins to live at high altitudes decreases gradually.
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Affiliation(s)
- Guner Sonmez
- Department of Radiology, GATA Haydarpasa Teaching Hospital, 81327 Uskudar, Istanbul, Turkey
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Leenstra T, Coutinho HM, Acosta LP, Langdon GC, Su L, Olveda RM, McGarvey ST, Kurtis JD, Friedman JF. Schistosoma japonicum reinfection after praziquantel treatment causes anemia associated with inflammation. Infect Immun 2006; 74:6398-407. [PMID: 16923790 PMCID: PMC1695508 DOI: 10.1128/iai.00757-06] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
There is a relationship between schistosomiasis and anemia, although the magnitude and exact mechanisms involved are unclear. In a cohort of 580 Schistosoma japonicum-infected 7- to 30-year-old patients from Leyte, The Philippines, we evaluated the impact of reinfection with S. japonicum after treatment with praziquantel on the mean hemoglobin level, iron-deficiency (IDA) and non-iron-deficiency anemia (NIDA), and inflammatory markers. All participants were treated at baseline and followed up every 3 months for a total of 18 months. At each follow-up, participants provided stools to quantify reinfection and venous blood samples for hemograms and measures of iron status and inflammation. After 18 months, reinfection with S. japonicum was associated with a lower mean hemoglobin level (-0.39 g/dl; 95% confidence interval [95% CI], -0.63 to -0.16) and 1.70 (95% CI, 1.10 to 2.61) times higher odds of all-cause anemia than those without reinfection. Reinfection was associated with IDA for high reinfection intensities only. Conversely, reinfection was associated with NIDA for all infection intensities. Reinfection was associated with serum interleukin-6 responses (P<0.01), and these responses were associated with NIDA (P=0.019) but not with IDA (P=0.29). Our results provide strong evidence for the causal relationship between S. japonicum infection and anemia. Rapidly reinfected individuals did not have the positive treatment effect on hemoglobin seen in nonreinfected individuals. The principle mechanism involved in S. japonicum-associated anemia is that of proinflammatory cytokine-mediated anemia, with iron deficiency playing a role in high-intensity infections. Based on the proposed mechanism, anemia is unlikely to be ameliorated by iron therapy alone.
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Affiliation(s)
- Tjalling Leenstra
- Center for International Health Research, Lifespan Hospitals, and Department of Pediatrics, Brown University Medical School, 55 Claverick Street, Suite 102, Providence, RI 02903, USA.
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Berhe N, Geitung JT, Medhin G, Gundersen SG. Large scale evaluation of WHO's ultrasonographic staging system of schistosomal periportal fibrosis in Ethiopia. Trop Med Int Health 2006; 11:1286-94. [PMID: 16903891 DOI: 10.1111/j.1365-3156.2006.01665.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To evaluate the recent WHO's ultrasonographic diagnostic staging system of schistosomal periportal thickening/fibrosis and to assess intra/inter-observer variation associated with its use. METHODS Local standard of portal branch wall thickness (PBWT) for height was established using 150 healthy subjects. Intra and inter-observer variation in image pattern identification and PBWT measurements were assessed in 94 and 35 subjects, respectively, with differing stages of periportal thickening fibrosis. WHO's diagnostic criteria were evaluated in 2,451 community members (1,277 males, 1,174 females; mean age 18.8 years) with an overall Schistosoma mansoni prevalence estimate of 65.9%. RESULTS There were no significant inter/intra-observer variations in image pattern identification and PBWT measurements. Based on Ethiopian PBWT-for-height standard, 128/2,451 (5.2%) had insipient, 46/2,451 (1.9%) had possible/probable and 112/2451 (4.6%) had definite/advanced periportal thickening/fibrosis. Comparable figures were obtained using the Senegalese PBWT-for-height standard and there was good agreement between Ethiopian and Senegalese healthy control-based diagnostic criteria in classifying the 286 subjects into stages of periportal thickening/fibrosis (kappa = 0.87, P < 0.001). CONCLUSIONS With further improvement, the WHO's ultrasonographic diagnostic criteria can be used in health institutions and community surveys. Image pattern based assessment is simple and more reproducible than PBWT based assessment of periportal thickening/fibrosis. The latter is, however, more useful in clarifying the status of an individual with doubtful image pattern, and in monitoring post-treatment outcome of periportal thickening/fibrosis. Considering the comparability of PBWT-for-height standards, setting one international standard of PBWT-for-height is more practical than developing local standards for each endemic area.
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Affiliation(s)
- Nega Berhe
- Institute of Pathobiology, Addis Ababa University, Ethiopia.
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Leenstra T, Acosta LP, Langdon GC, Manalo DL, Su L, Olveda RM, McGarvey ST, Kurtis JD, Friedman JF. Schistosomiasis japonica, anemia, and iron status in children, adolescents, and young adults in Leyte, Philippines 1. Am J Clin Nutr 2006; 83:371-9. [PMID: 16469997 DOI: 10.1093/ajcn/83.2.371] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Observational and interventional evidence supports a relation between human schistosomiasis and anemia; however, the exact causal mechanisms remain unclear. Eggs translocating across the intestinal or bladder wall may result in extracorporeal blood loss with subsequent iron deficiency. Alternatively, anemia may result from cytokine-mediated dyserythropoiesis, as seen in anemia of inflammation. OBJECTIVES By evaluating the cross-sectional relation between the intensity of Schistosoma japonicum infection, hemoglobin concentration, and iron status in 7-30-y-old persons from S. japonicum-endemic rice-farming villages in the province of Leyte, Philippines, we assessed the relative contribution of iron deficiency and anemia of inflammation to schistosomiasis-associated anemia. DESIGN We enrolled 627 S. japonicum-infected and 111 S. japonicum-uninfected persons. We obtained stool samples to quantify S. japonicum infection and venous blood samples for hemograms and measures of iron status and inflammation. RESULTS Intensity of S. japonicum infection was independently associated with hemoglobin (beta = -0.24; 95% CI: -0.31, -0.17). Persons with high-intensity infection had a greater risk of iron deficiency anemia (adjusted prevalence odds ratio: 6.6; 95% CI: 2.9, 14.7), but there was no evidence of this relation in low-intensity infections. In contrast, anemia without iron deficiency was prevalent across all intensities (adjusted prevalence odds ratio: 3.8; 95% CI: 1.5, 9.5). CONCLUSIONS Storage iron deficiency is a major contributor to anemia in high-intensity S. japonicum infection. A high prevalence of anemia without iron deficiency, exclusion of other mechanisms of anemia, and the evidence of low bioavailable iron suggest that anemia of inflammation contributes to S. japonicum-associated anemia at all infection intensities.
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Affiliation(s)
- Tjalling Leenstra
- International Health Institute, Brown University, Providence, RI 02903, USA.
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Wu WL, Wang JR, Wen LY, Huang YY, Xu XF, Yu WM. Surveillance and control of post-transmission schistosomiasis in Jiaxing prefecture, Zhejiang province, China. Acta Trop 2005; 96:282-7. [PMID: 16198300 DOI: 10.1016/j.actatropica.2005.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A surveillance system has been put in place in the Zhejiang province since achieving there the criteria for transmission interruption of schistosomiasis japonica. Suspected patients and special high-risk groups (e.g. the so called 'floating population' and children under 14 years of age) are screened for Schistosoma japonicum using serological tests. Those with positive serological result are subjected to faecal examination and if S. japonicum eggs are found they are treated with praziquantel and followed by regular re-examination until complete cure, i.e. absence of S. japonicum eggs in faecal samples. Patients with advanced schistosomiasis japonica are continuously followed-up. Implementation of the surveillance system from 1995 to 2002 detected two S. japonicum-infected persons; one came from Anhui province and the other from Jiangsu province, but no new infection occurred among local residents. The number of patients with advanced schistosomiasis japonica decreased from 1524 in 1995 to 906 by the end of 2002; a reduction of 40.6%. However, post-transmission schistosomiasis still continues to weigh on the medial resources. We conclude that the surveillance system in Zhejiang province is effective and a useful means for monitoring the endemic situation of schistosomiasis. Hence, it is recommended to be pursued in the years to come.
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Affiliation(s)
- Wen-Lin Wu
- The First Affiliated Hospital to Jiaxing Medical College, Jiaxing 314000, China
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Zheng M, Cai WM, Zhao JK, Zhu SM, Liu RH. Determination of serum levels of YKL-40 and hyaluronic acid in patients with hepatic fibrosis due to schistosomiasis japonica and appraisal of their clinical value. Acta Trop 2005; 96:148-52. [PMID: 16188216 DOI: 10.1016/j.actatropica.2005.07.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The objectives of this study were (i) to evaluate the serum levels of human cartilage glycoprotein 39 (YKL-40) and hyaluronic acid (HA) in people infected with Schistosoma japonicum, and (ii) to determine their clinical value. A total of 563 people were subjected to ultrasonography, and 60 patients were identified with either mild (n=30) or severe (n=30) hepatic fibrosis. In addition, 28 healthy subjects were included as controls. Blood sera of these 88 people were examined with regard to the levels of YKL-40 and HA. The former was measured by enzyme-linked immunosorbent assay, and serum HA was determined by a commercially available radioimmunoassay method. On the basis of the ultrasonographic investigations, HA levels in normal, mild, and severe cases of hepatic fibrosis were 83.0+/-35.7, 216.1+/-77.9 and 212.6+/-80.9 microg/ml, respectively. When the same sera were tested for YKL-40, 49.0+/-10.4, 92.3+/-18.5 and 172.1+/-35.9 microg/ml, respectively, were recorded in the three groups. Thus, the serum levels of YKL-40 are not only increased in patients infected with S. japonicum but they are also correlated with the stage of hepatic fibrosis. In conclusion, it appears that YKL-40 is more sensitive than HA in measuring the degree of hepatic fibrosis due to schistosomiasis, which warrants further investigation.
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Affiliation(s)
- Min Zheng
- Institute of Infectious Diseases, First Affiliated Hospital, Medical School, Zhejiang University, Hangzhou 310003, China.
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