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Kayuni SA, Musaya J, Stothard JR. Highlighting male genital schistosomiasis in Malawi. Trends Parasitol 2024:S1471-4922(24)00118-1. [PMID: 38821840 DOI: 10.1016/j.pt.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 06/02/2024]
Abstract
Highlighting recent literature, we review the epidemiological and clinical importance of male genital schistosomiasis (MGS) in Malawi. We then discuss why individual disease management is an unmet public health challenge and outline how future interventions should be better set within routine services of HIV and men's sexual and reproductive health clinics.
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Affiliation(s)
- Sekeleghe A Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital Campus, Blantyre 3, Malawi
| | - Janelisa Musaya
- Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital Campus, Blantyre 3, Malawi
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.
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Roure S, Vallès X, Pérez-Quílez O, López-Muñoz I, Chamorro A, Abad E, Valerio L, Soldevila L, España S, Hegazy AHA, Fernández-Rivas G, Gorriz E, Herena D, Oliveira M, Miralles MC, Conde C, Montero-Alia JJ, Fernández-Pedregal E, Miranda-Sánchez J, Llibre JM, Isnard M, Bonet JM, Estrada O, Prat N, Clotet B. Male genitourinary schistosomiasis-related symptoms among long-term Western African migrants in Spain: a prospective population-based screening study. Infect Dis Poverty 2024; 13:23. [PMID: 38449032 PMCID: PMC10919049 DOI: 10.1186/s40249-024-01190-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/29/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Schistosomiasis is highly endemic in sub-Saharan Africa and frequently imported to Europe. Male urogenital manifestations are often neglected. We aimed to ascertain the prevalence of genitourinary clinical signs and symptoms among long-term African migrants in a non-endemic European country using a serology test. METHODS We carried out a prospective, community-based cross-sectional study of adult male migrants from sub-Saharan Africa living in Spain. Schistosoma serology tests and microscopic urine examinations were carried out, and clinical data were obtained from an electronic medical record search and a structured questionnaire. RESULTS We included 388 adult males, mean age 43.5 years [Standard Deviation (SD) = 12.0, range: 18-76]. The median time since migration to the European Union was 17 [Interquartile range (IQR): 11-21] years. The most frequent country of origin was Senegal (N = 179, 46.1%). Of the 338, 147 (37.6%) tested positive for Schistosoma. Parasite eggs were present in the urine of only 1.3%. Nine genitourinary clinical items were significantly associated with positive Schistosoma serology results: pelvic pain (45.2%; OR = 1.57, 95% CI: 1.0-2.4), pain on ejaculation (14.5%; OR = 1.85, 95% CI: 1.0-3.5), dyspareunia (12.4%; OR = 2.45, 95% CI: 1.2-5.2), erectile dysfunction (9.5%; OR = 3.10, 95% CI: 1.3-7.6), self-reported episodes of infertility (32.1%; OR = 1.69, 95% CI: 1.0-2.8), haematuria (55.2%; OR = 2.37, 95% CI: 1.5-3.6), dysuria (52.1%; OR = 2.01, 95% CI: 1.3-3.1), undiagnosed syndromic STIs (5.4%), and orchitis (20.7%; OR = 1.81, 95% CI: 1.0-3.1). Clinical signs tended to cluster. CONCLUSIONS Urogenital clinical signs and symptoms are prevalent among male African long-term migrants with a positive Schistosoma serology results. Genital involvement can be frequent even among those with long periods of non-residence in their sub-Saharan African countries of origin. Further research is needed to develop diagnostic tools and validate therapeutic approaches to chronic schistosomiasis.
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Affiliation(s)
- Sílvia Roure
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain.
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain.
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, c/ Can Ruti s/n, 08916, Badalona, Spain.
| | - Xavier Vallès
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
- Germans Trias i Pujol Research Institute, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Olga Pérez-Quílez
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
| | - Israel López-Muñoz
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
| | - Anna Chamorro
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Elena Abad
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Lluís Valerio
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Laura Soldevila
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Sergio España
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Alaa H A Hegazy
- Microbiology Department, Germans Trias i Pujol University Hospital, c/ Can Ruti s/n, 08916, Badalona, Spain
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, c/ Can Ruti s/n, 08916, Badalona, Spain
- Faculty of Medicine, University of Asyut, El Fateh, Assiut Governorate, 71515, Egypt
| | - Gema Fernández-Rivas
- Microbiology Department, Germans Trias i Pujol University Hospital, c/ Can Ruti s/n, 08916, Badalona, Spain
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Ester Gorriz
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
| | - Dolores Herena
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
| | - Mário Oliveira
- Department of Urology, Germans Trias i Pujol University Hospital, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Maria Carme Miralles
- Canovelles Primary Health Care Unit, Barcelona North Metropolitan Health Directorate, Catalan Institute for Health, C/ Indústria 23, 08420, Canovelles, Spain
| | - Carmen Conde
- Canovelles Primary Health Care Unit, Barcelona North Metropolitan Health Directorate, Catalan Institute for Health, C/ Indústria 23, 08420, Canovelles, Spain
| | - Juan José Montero-Alia
- Primary Health Care Unit Mataró-3 (Rocafonda-Palau), Barcelona North Metropolitan Health Directorate, Catalan Institute for Health, Camí Ral el Ravalet 208, Mataró, 08302, Barcelona, Spain
| | - Elia Fernández-Pedregal
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Jose Miranda-Sánchez
- Barcelona North Metropolitan Primary Care Directorate, Catalan Institute for Health, Ctra. de Barcelona 473, Sabadell, 08204, Barcelona, Spain
| | - Josep M Llibre
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Mar Isnard
- Barcelona North Metropolitan Primary Care Directorate, Catalan Institute for Health, Ctra. de Barcelona 473, Sabadell, 08204, Barcelona, Spain
| | - Josep Maria Bonet
- Barcelona North Metropolitan Primary Care Directorate, Catalan Institute for Health, Ctra. de Barcelona 473, Sabadell, 08204, Barcelona, Spain
| | - Oriol Estrada
- Directorate for Innovation and Interdisciplinary Cooperation, Barcelona North Metropolitan Health Directorate, Catalan Institute for Health, C/ Can Ruti S/N, 08916, Badalona, Spain
| | - Núria Prat
- Barcelona North Metropolitan Primary Care Directorate, Catalan Institute for Health, Ctra. de Barcelona 473, Sabadell, 08204, Barcelona, Spain
| | - Bonaventura Clotet
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
- IrsiCaixa-AIDS Research Institute, Hospital Universitari Germans Trias i Pujol University Hospital, c/ Can Ruti s/n, 08916, Badalona, Spain
- Infectious Diseases Directorate, Barcelona North Metropolitan Health Directorate, Catalan Institute for Health, C/ Can Ruti S/N, 08916, Badalona, Spain
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Kayuni SA, Abdullahi A, Alharbi MH, Makaula P, Lampiao F, Juziwelo L, LaCourse EJ, Kumwenda JJ, Leutscher PDC, Geretti AM, Stothard JR. Prospective pilot study on the relationship between seminal HIV-1 shedding and genital schistosomiasis in men receiving antiretroviral therapy along Lake Malawi. Sci Rep 2023; 13:14154. [PMID: 37644069 PMCID: PMC10465494 DOI: 10.1038/s41598-023-40756-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
Male genital schistosomiasis (MGS) is hypothesized to increase seminal shedding of HIV-1. This prospective pilot study assessed seminal HIV-1 RNA shedding in men on long-term ART with and without a diagnosis of MGS. Study visits occurred at 0, 1, 3, 6 and 12 months. MGS was diagnosed by egg positivity on semen microscopy or PCR of seminal sediment. After optimization of the HIV-RNA assay, we examined 72 paired plasma and semen samples collected from 31 men (15 with and 16 without MGS) over 12 months. HIV-1 RNA was detected in 7/72 (9.7%) seminal samples and 25/72 (34.7%) plasma samples. When comparing sample pairs, 5/72 (6.9%) showed HIV-1 RNA detection only in the seminal sample. Overall, 3/31 (9.7%) participants, all with MGS, had detectable HIV-1 RNA in semen while plasma HIV-1 RNA was undetectable (< 22 copies/mL), with seminal levels ranging up to 400 copies/mL. Two participants showing HIV-1 RNA in seminal fluid from the MGS-negative group also had concomitant HIV-1 RNA detection in plasma. The findings suggest that MGS can be associated with low-level HIV-1 RNA shedding despite virologically suppressive ART. Further studies are warranted to confirm these observations and assess its implications.
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Affiliation(s)
- Sekeleghe A Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK.
- MASM Medi Clinics Limited, Medical Aid Society of Malawi (MASM), Lilongwe, Malawi.
- Malawi Liverpool Wellcome (MLW) Clinical Research Programme, Kamuzu University of Health Sciences (KUHeS), Queen Elizabeth Central Hospital Campus, Chipatala Avenue, Blantyre, Malawi.
- Department of Pathology, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Mahatma Gandhi Road, Blantyre, Malawi.
| | - Adam Abdullahi
- Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, MA, USA
- Cambridge Institute of Therapeutic Immunology and Infectious Diseases, University of Cambridge, Cambridge, UK
| | - Mohammad H Alharbi
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
- Ministry of Health, Buraydah, 52367, Saudi Arabia
| | - Peter Makaula
- Malawi Liverpool Wellcome (MLW) Clinical Research Programme, Kamuzu University of Health Sciences (KUHeS), Queen Elizabeth Central Hospital Campus, Chipatala Avenue, Blantyre, Malawi
- Research for Health, Environment and Development (RHED), Mangochi, Malawi
| | - Fanuel Lampiao
- Physiology Unit, Department of Biomedical Sciences, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Mahatma Gandhi Road, Blantyre, Malawi
| | - Lazarus Juziwelo
- National Schistosomiasis and Soil-Transmitted Helminths Control Programme, Community Health Sciences Unit, Ministry of Health, Lilongwe, Malawi
| | - E James LaCourse
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Johnstone J Kumwenda
- Department of Internal Medicine, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Mahatma Gandhi Road, Blantyre, Malawi
| | - Peter Derek Christian Leutscher
- Centre for Clinical Research, North Denmark Regional Hospital and Department of Clinical Medicine, Aalborg University, Aalborg, Region Nordjylland, Denmark
| | - Anna Maria Geretti
- Department of Infectious Diseases, Fondazione PTV, University of Rome Tor Vergata, Rome, Italy
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
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Kayuni SA, Alharbi MH, Shaw A, Fawcett J, Makaula P, Lampiao F, Juziwelo L, LaCourse EJ, Verweij JJ, Stothard JR. Detection of male genital schistosomiasis (MGS) by real-time TaqMan® PCR analysis of semen from fishermen along the southern shoreline of Lake Malawi. Heliyon 2023; 9:e17338. [PMID: 37539175 PMCID: PMC10394912 DOI: 10.1016/j.heliyon.2023.e17338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 08/05/2023] Open
Abstract
Background Male genital schistosomiasis (MGS) is an underappreciated complication of schistosomiasis, first described in 1911. However, its epidemiology, diagnostic testing and case management are not well understood in sub-Saharan Africa. To shed new light on MGS prevalence in Malawi, a longitudinal cohort study was conducted among adult fishermen along the southern shoreline of Lake Malawi using detection of schistosome DNA in participants' semen by real-time TaqMan® PCR analyses. Methods Upon recruitment of 376 participants, 210 submitted urine samples and 114 semen samples for parasitological tests. Thereafter, the available semen samples were subsequently analysed by real-time TaqMan® PCR. Praziquantel (PZQ) treatment was provided to all participants with follow-ups attempted at 1, 3, 6 and 12-months' intervals. Results At baseline, real-time PCR detected a higher MGS cohort prevalence of 26.6% (n = 64, Ct-value range: 18.9-37.4), compared to 10.4% by semen microscopy. In total, 21.9% of participants (n = 114) were detected with MGS either by semen microscopy and/or by real-time PCR. Subsequent analyses at 1-, 3-, 6- and 12-month follow-ups indicated variable detection dynamics. Conclusions This first application of a molecular method, to detect MGS in sub-Saharan Africa, highlights the need for development of such molecular diagnostic tests which should be affordable and locally accessible. Our investigation also notes the persistence of MGS over a calendar year despite praziquantel treatment.
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Affiliation(s)
- Sekeleghe A. Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
- MASM Medi Clinics Limited, Medical Society of Malawi (MASM), P. O. Box 31659, Lilongwe 3, Malawi
- Malawi Liverpool Wellcome (MLW) Clinical Research Programme, Kamuzu University Of Health Sciences (KUHeS), Queen Elizabeth Central Hospital campus, Chipatala Avenue, Blantyre, Malawi
| | - Mohammad H. Alharbi
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
- Ministry of Health, Buraydah 52367, Saudi Arabia
| | - Alexandra Shaw
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
| | - Joanna Fawcett
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
| | - Peter Makaula
- Malawi Liverpool Wellcome (MLW) Clinical Research Programme, Kamuzu University Of Health Sciences (KUHeS), Queen Elizabeth Central Hospital campus, Chipatala Avenue, Blantyre, Malawi
- Research for Health, Environment and Development (RHED), Mangochi, Malawi
| | - Fanuel Lampiao
- Physiology Department, College of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Lazarus Juziwelo
- National Schistosomiasis and STH Control Programme, Community Health Sciences Unit, Ministry of Health, Lilongwe, Malawi
| | - E. James LaCourse
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
| | - Jaco J. Verweij
- Elisabeth TweeSteden Hospital Tilburg, Microvida Laboratory for Medical Microbiology and Immunology, Hilvarenbeekseweg 60, Tilburg, the Netherlands
| | - J. Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
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Basile G, Tamarozzi F, Salas-Coronas J, Soriano-Pérez MJ, Luzón-García P, Moro L, Antinori S, Arsuaga M, Bartoloni A, Tomasoni LR, Gobbi FG, Köhler C, Salvador F, Bocanegra C, Zammarchi L. Management of imported complicated urogenital schistosomiasis in Europe: a TropNet retrospective study. J Travel Med 2023; 30:6956960. [PMID: 36547229 DOI: 10.1093/jtm/taac150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Schistosomiasis is a neglected tropical disease caused by trematodes of the genus Schistosoma. Schistosoma haematobium causes urogenital schistosomiasis (UGS), a chronic disease characterized by pathology of the urogenital tract leading to potentially severe morbidity for which the treatment is poorly standardized. We conducted a survey in TropNet centres on the clinical presentations and management strategies of complicated urogenital schistosomiasis (cUGS). METHODS We reviewed the clinical records of patients seen at TropNet centres over a 20-year timespan (January 2001-December 2020). Case definition for cUGS included the presence of urogenital cancer, obstructive uropathy, kidney insufficiency of all grades and female or male genital involvement leading to infertility. Collected data included demographic information, patient category (traveller or migrant), imaging data, microbiological data (serology results and presence/absence of eggs in urine), histological features and outcome at last visit recorded. RESULTS Eight centres contributed with at least one case. Overall, 31 patients matched the inclusion criteria. Sub-Saharan Africa was the most likely place of infection for included patients. Median age was 30.6 years (range 21-46, interquartile ranges, IQR 27-33). Most patients (28/31, 90.3%) were males. Hydronephrosis was the most frequent complication, being present in 18 (58.1%) patients, followed by cancer, present in 5 patients (16.1%); 27 patients (87.1%) required surgical management of some sort. Use of praziquantel varied across centres, with six different regimens employed. DISCUSSION Very few cases of cUGSs were found in our survey, possibly indicating underdiagnosis of this condition. Hydronephrosis was the most frequently observed urogenital complication, and most patients required invasive procedures. Infection by S. haematobium can result in considerable morbidity, resulting in clinically challenging presentations requiring a multidisciplinary approach. As such, development of common protocols for early diagnosis and treatment is urgently needed.
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Affiliation(s)
- Gregorio Basile
- Department of Experimental and Clinical Medicine, University of Florence, Florence, 50134 Italy
| | - Francesca Tamarozzi
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024, Italy
| | | | | | - Pilar Luzón-García
- Tropical Medicine Unit, Hospital Universitario Poniente, Almería, 04700, Spain
| | - Lucia Moro
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024, Italy
| | - Spinello Antinori
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, Milan, 20157, Italy
| | - Marta Arsuaga
- Imported Diseases and International Health Referral Unit, High Level Isolation Unit, La Paz-Carlos III University Hospital, Madrid, 28029, Spain
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, 50134 Italy
- Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, 50134, Italy
| | - Lina Rachele Tomasoni
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, 25125, Italy
| | - Federico Giovanni Gobbi
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024, Italy
| | - Carsten Köhler
- Institute of Tropical Medicine, Travel Medicine and Human parasitology, Center of Competence, Baden-Württtemberg, Universität und Universitätsklinikum Tübingen, Tübingen, 72074, Germany
| | - Fernando Salvador
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, 08035, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Cristina Bocanegra
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, 08035, Spain
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, 50134 Italy
- Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, 50134, Italy
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Kayuni SA, Al-Harbi MH, Makaula P, Injesi B, Mainga B, Lampiao F, Juziwelo L, LaCourse EJ, Stothard JR. Pathological Abnormalities Observed on Ultrasonography among Fishermen Associated with Male Genital Schistosomiasis (MGS) along the South Lake Malawi Shoreline in Mangochi District, Malawi. Trop Med Infect Dis 2022; 7:tropicalmed7080169. [PMID: 36006261 PMCID: PMC9415567 DOI: 10.3390/tropicalmed7080169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022] Open
Abstract
Schistosome eggs cause granulomata and pathological abnormalities, detectable with non-invasive radiological techniques such as ultrasonography which could be useful in male genital schistosomiasis (MGS). As part of our novel MGS study among fishermen along Lake Malawi, we describe pathologies observed on ultrasonography and praziquantel (PZQ) treatment over time. Fishermen aged 18+ years were recruited, submitted urine and semen for parasitological and molecular testing, and thereafter, transabdominal pelvic and scrotal ultrasonography, assessing pathologies in the prostate, seminal vesicles, epididymis and testes. Standard PZQ treatment and follow-up invitation at 1-, 3-, 6- and 12-months’ time-points were offered. A total of 130 recruited fishermen underwent ultrasonography at baseline (median age: 32.0 years); 27 (20.9%, n = 129) had S. haematobium eggs in urine (median: 1.0 egg/10 mL), 10 (12.3%, n = 81) in semen (defined as MGS, median: 2.9 eggs/mL ejaculate) and 16 (28.1%, n = 57) had a positive seminal Schistosoma real-time PCR. At baseline, 9 fishermen (6.9%, n = 130) had abnormalities, with 2 positive MGS having prostatic and testicular nodules. Fewer abnormalities were observed on follow-up. In conclusion, pathologies detected in male genitalia by ultrasonography can describe MGS morbidity in those with positive parasitological and molecular findings. Ultrasonography advances and accessibility in endemic areas can support monitoring of pathologies’ resolution after treatment.
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Affiliation(s)
- Sekeleghe A. Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
- MASM Medi Clinics Limited, Medical Society of Malawi (MASM), Lilongwe P.O. Box 1254, Malawi
- Correspondence: ; Tel.: +265-888-367367
| | - Mohammad H. Al-Harbi
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Peter Makaula
- Research for Health, Environment and Development (RHED), Mangochi P.O. Box 345, Malawi
| | - Boniface Injesi
- MASM Medi Clinics Limited, Medical Society of Malawi (MASM), Lilongwe P.O. Box 1254, Malawi
| | - Bright Mainga
- Laboratory Department, Mangochi District Hospital, Mangochi District Assembly, Mangochi P.O. Box 1854, Malawi
| | - Fanuel Lampiao
- Physiology Department, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Mahatma Gandhi Road, Blantyre 312225, Malawi
| | - Lazarus Juziwelo
- National Schistosomiasis and Soil-Transmitted Helminths Control Programme, Community Health Sciences Unit, Ministry of Health, Lilongwe P.O. Box 30377, Malawi
| | - E. James LaCourse
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - J. Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
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Makaula P, Kayuni SA, Mamba KC, Bongololo G, Funsanani M, Musaya J, Juziwelo LT, Furu P. An assessment of implementation and effectiveness of mass drug administration for prevention and control of schistosomiasis and soil-transmitted helminths in selected southern Malawi districts. BMC Health Serv Res 2022; 22:517. [PMID: 35439991 PMCID: PMC9016207 DOI: 10.1186/s12913-022-07925-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/08/2022] [Indexed: 11/15/2022] Open
Abstract
Background Mass drug administration (MDA) is one of the key interventions recommended by WHO for prevention and control of neglected tropical diseases (NTD). In Malawi, MDA is widely carried out annually since 2009 for prevention and control of schistosomiasis and soil-transmitted helminths (STH). No study has been carried out to assess effectiveness of the MDA approach and to document perceptions of health providers and beneficiaries regarding use of MDA. This study was done to understand how well MDA is being implemented and to identify opportunities for improvement in MDA delivery in Malawi. Methods Designed as a cross-sectional and multi-methods research, the study was carried out in three southern Malawi districts of Chiradzulu, Mangochi and Zomba. In each district, four health centres and 16 villages were randomly selected to participate. A mixed-methods approach to data collection focusing on quantitative data for coverage and knowledge, attitudes and practices assessments; and qualitative data for assessing perceptions of health providers and beneficiaries regarding MDA was used. Quantitative data were processed and analyzed using IBM SPSS software version 26 while qualitative data were analysed using NVivo 12 for Windows. Results Knowledge levels about schistosomiasis and STH in the districts varied according to disease aspects asked about. Majority are more knowledgeable about what schistosomiasis is (78%) and whether STH are treatable with drugs (97%); with least knowledgeable about the organism that transmits schistosomiasis (18%), types of schistosomiasis (11%) and what causes STH (20%). In 2018 and 2019 the districts registered high coverage rates for praziquantel and albendazole using community-based MDA (73–100%) and using school-based MDA (75–91%). Both the health authorities and community members perceived the MDA approach as good because it brings treatment closer to people. Conclusion With the high MDA coverage obtained in communities and schools, the effectiveness of MDA in the target districts is satisfactory. There are, however, several challenges including disproportionate knowledge levels, which are hampering progress towards attainment of the 2030 global NTD goals. There is a need for promotion of community participation and partnerships as well as implementation of other recommended interventions for sustainable prevention and control of schistosomiasis and STH. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07925-3.
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Hoekstra PT, van Dam GJ, van Lieshout L. Context-Specific Procedures for the Diagnosis of Human Schistosomiasis – A Mini Review. FRONTIERS IN TROPICAL DISEASES 2021. [DOI: 10.3389/fitd.2021.722438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Schistosomiasis is a parasitic disease caused by trematode blood flukes of the genus Schistosoma, affecting over 250 million people mainly in the tropics. Clinically, the disease can present itself with acute symptoms, a stage which is relatively more common in naive travellers originating from non-endemic regions. It can also develop into chronic disease, with the outcome depending on the Schistosoma species involved, the duration and intensity of infection and several host-related factors. A range of diagnostic tests is available to determine Schistosoma infection, including microscopy, antibody detection, antigen detection using the Point-Of-Care Circulating Cathodic Antigen (POC-CCA) test and the Up-Converting Particle Lateral Flow Circulating Anodic Antigen (UCP-LF CAA) test, as well as Nucleic Acid Amplification Tests (NAATs) such as real-time PCR. In this mini review, we discuss these different diagnostic procedures and explore their most appropriate use in context-specific settings. With regard to endemic settings, diagnostic approaches are described based on their suitability for individual diagnosis, monitoring control programs, determining elimination as a public health problem and eventual interruption of transmission. For non-endemic settings, we summarize the most suitable diagnostic approaches for imported cases, either acute or chronic. Additionally, diagnostic options for disease-specific clinical presentations such as genital schistosomiasis and neuro-schistosomiasis are included. Finally, the specific role of diagnostic tests within research settings is described, including a controlled human schistosomiasis infection model and several clinical studies. In conclusion, context-specific settings have different requirements for a diagnostic test, stressing the importance of a well-considered decision of the most suitable diagnostic procedure.
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Stothard JR, Webster BL. Acute Schistosomiasis: Which Molecular Diagnostic Test Is Best and Why. Clin Infect Dis 2021; 72:1699-1700. [PMID: 32215645 DOI: 10.1093/cid/ciaa319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/24/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Bonnie L Webster
- Department of Life Sciences, Natural History Museum, London, United Kingdom
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Kayuni SA, Alharbi MH, Makaula P, Lampiao F, Juziwelo L, LaCourse EJ, Stothard JR. Male Genital Schistosomiasis Along the Shoreline of Lake Malawi: Baseline Prevalence and Associated Knowledge, Attitudes and Practices Among Local Fishermen in Mangochi District, Malawi. Front Public Health 2021; 9:590695. [PMID: 34095041 PMCID: PMC8175656 DOI: 10.3389/fpubh.2021.590695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Male genital schistosomiasis (MGS) is an often-overlooked chronic consequence of urogenital schistosomiasis (UGS) associated with Schistosoma haematobium eggs and associated pathologies in the genital system of afflicted men. Despite the first formal description of MGS in 1911 by Madden, its epidemiology, diagnostic testing and case management of today are not well-described. However, since several interactions between MGS and the Human Immunodeficiency Virus (HIV) are known, there is renewed public health interest in MGS across sub-Saharan Africa (SSA). To shed new light upon MGS in Malawi, a longitudinal cohort study was set up among fishermen along the southern shoreline of Lake Malawi in Mangochi District, Malawi, to document its prevalence and assess mens' knowledge, attitudes and practices (KAP). After providing informed written consent, fishermen (n = 376) aged 18+ years (median age: 30 years, range: 18-70 years) were recruited and submitted urine and semen for point-of-care (POC) field and laboratory diagnostic parasitological tests. Individual questionnaires were administered to assess their KAP, with praziquantel (PZQ) treatment provided to all participants. Baseline prevalence of MGS (S. haematobium eggs in semen) was 10.4% (n = 114, median: 5.0 eggs per ml, range: 0.1-30.0) while for UGS (S. haematobium eggs in urine) was 17.1% (n = 210, median: 2.3 eggs per 10 ml, range: 0.1-186.0) and 3.8% were positive by POC circulating cathodic antigen (POC-CCA), indicative of a Schistosoma mansoni infection. Just under 10% of participants reported having experienced symptoms associated with MGS, namely genital or coital pain, or haemospermia. A total of 61.7% reported previous difficulties in accessing PZQ therapy, with 34.8% having received PZQ therapy before. There was a significant correlation between MGS infection and the frequency of fishing in a week (rho = -0.25, n = 100, p = 0.01). In conclusion, MGS is prevalent among local fishermen yet knowledge of the disease is poor. We therefore call for improved availability and accessibility to MGS diagnostics, PZQ treatment within ongoing control interventions. This will improve the lives and reproductive health of men, their partners and communities in this shoreline environment of Lake Malawi.
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Affiliation(s)
- Sekeleghe A Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom.,MASM Medi Clinics Limited, Medical Aid Society of Malawi (MASM), Blantyre, Malawi
| | - Mohammad H Alharbi
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Peter Makaula
- Research for Health, Environment and Development (RHED), Mangochi, Malawi
| | - Fanuel Lampiao
- Physiology Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Lazarus Juziwelo
- National Schistosomiasis and STH Control Programme, Community Health Sciences Unit, Ministry of Health, Lilongwe, Malawi
| | - E James LaCourse
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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11
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Masong MC, Wepnje GB, Marlene NT, Gamba V, Mengue MT, Kouokam E, Stothard JR, Ekobo ALS. Female Genital Schistosomiasis (FGS) in Cameroon: A formative epidemiological and socioeconomic investigation in eleven rural fishing communities. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000007. [PMID: 36962084 PMCID: PMC10022362 DOI: 10.1371/journal.pgph.0000007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/15/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Female Genital Schistosomiasis (FGS) is most often caused by presence of Schistosoma haematobium eggs lodged in the female reproductive tract which results in chronic fibrosis and scarring. In Cameroon, despite high community prevalences of urine-patent S. haematobium infections, FGS has yet to be studied in depth. To shed light on the clinical prevalence and socioeconomic effects of FGS, we undertook a formative community-based epidemiological and qualitative survey. METHOD A cross sectional multidisciplinary study of 304 girls and women from 11 remote rural fishing communities in Cameroon was undertaken using parasitological sampling, clinical colposcopy, and interviews. The lived experiences of those with FGS were documented using a process of ethnography with participant observation and in-depth interviews. RESULT Amongst 304 women and girls aged >5 years (Median age: 18; Interquartile range: 9.6-28), 198 females were eligible for FGS testing and 58 adult women were examined by clinical colposcopy. Of these, 34 were positive for FGS (proportion: 58.6%; 95% CI: 45.8-70.4), younger girls showing a higher FGS prevalence, and older women not shedding eggs showing a pattern for cervical lesions from earlier infection. In a subset of women with FGS selected purposively (12/58), in-depth interviews with participant observation revealed out-of-pocket expenditures of up to 500USD related health spending for repeated diagnosis and treatment of gynecological illnesses, and 9 hours daily lost reproductive labour. Psychosocial unrest, loss in social capital, and despair were linked with sub-fertility and persistent vaginal itch. CONCLUSION With our first formative evidence on prevalence, socioeconomic effects and experiences of FGS amongst women and girls in Cameroon, we have clarified to a new level of detail the deficit in provision of and access to peripheral health services in remote areas of Cameroon. Using this information, there is now strong evidence for national programs and services on women's health and schistosomiasis to update and revise policies targeted on prevention and management of FGS. We therefore stress the need for regular provision of Praziquantel treatment to adolescent girls and women in S. haematobium endemic areas, alongside better access to tailored diagnostic services that can detect FGS and appropriately triage care at primary health level.
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Affiliation(s)
- Makia Christine Masong
- Department of Social Sciences and Management, Catholic University of Central Africa, Yaoundé, Cameroon
| | | | - Ntsinda Tchoffo Marlene
- Department of Social Sciences and Management, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Victoria Gamba
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Marie-Therese Mengue
- Department of Social Sciences and Management, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Estelle Kouokam
- Department of Social Sciences and Management, Catholic University of Central Africa, Yaoundé, Cameroon
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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12
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Kayuni SA, O'Ferrall AM, Baxter H, Hesketh J, Mainga B, Lally D, Al-Harbi MH, LaCourse EJ, Juziwelo L, Musaya J, Makaula P, Stothard JR. An outbreak of intestinal schistosomiasis, alongside increasing urogenital schistosomiasis prevalence, in primary school children on the shoreline of Lake Malawi, Mangochi District, Malawi. Infect Dis Poverty 2020; 9:121. [PMID: 32867849 PMCID: PMC7456765 DOI: 10.1186/s40249-020-00736-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/07/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Intestinal schistosomiasis was not considered endemic in Lake Malawi until November 2017 when populations of Biomphalaria pfeifferi were first reported; in May 2018, emergence of intestinal schistosomiasis was confirmed. This emergence was in spite of ongoing control of urogenital schistosomiasis by preventive chemotherapy. Our current study sought to ascertain whether intestinal schistosomiasis is transitioning from emergence to outbreak, to judge if stepped-up control interventions are needed. METHODS During late-May 2019, three cross-sectional surveys of primary school children for schistosomiasis were conducted using a combination of rapid diagnostic tests, parasitological examinations and applied morbidity-markers; 1) schistosomiasis dynamics were assessed at Samama (n = 80) and Mchoka (n = 80) schools, where Schistosoma mansoni was first reported, 2) occurrence of S. mansoni was investigated at two non-sampled schools, Mangochi Orphan Education and Training (MOET) (n = 60) and Koche (n = 60) schools, where B. pfeifferi was nearby, and 3) rapid mapping of schistosomiasis, and B. pfeifferi, conducted across a further 8 shoreline schools (n = 240). After data collection, univariate analyses and Chi-square testing were performed, followed by binary logistic regression using generalized linear models, to investigate epidemiological associations. RESULTS In total, 520 children from 12 lakeshore primary schools were examined, mean prevalence of S. mansoni by 'positive' urine circulating cathodic antigen (CCA)-dipsticks was 31.5% (95% confidence interval [CI]: 27.5-35.5). Upon comparisons of infection prevalence in May 2018, significant increases at Samama (relative risk [RR] = 1.7, 95% CI: 1.4-2.2) and Mchoka (RR = 2.7, 95% CI: 1.7-4.3) schools were observed. Intestinal schistosomiasis was confirmed at MOET (18.3%) and Koche (35.0%) schools, and in all rapid mapping schools, ranging from 10.0 to 56.7%. Several populations of B. pfeifferi were confirmed, with two new eastern shoreline locations noted. Mean prevalence of urogenital schistosomiasis was 24.0% (95% CI: 20.3-27.7). CONCLUSIONS We notify that intestinal schistosomiasis, once considered non-endemic in Lake Malawi, is now transitioning from emergence to outbreak. Once control interventions can resume after coronavirus disease 2019 (COVID-19) suspensions, we recommend stepped-up preventive chemotherapy, with increased community-access to treatments, alongside renewed efforts in appropriate environmental control.
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Affiliation(s)
- Sekeleghe A Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK.,Medi Clinic Limited, Medical Aid Society of Malawi (MASM), 22 Lower Sclatter Road, P.O. Box 1254, Blantyre, Malawi
| | - Angus M O'Ferrall
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
| | - Hamish Baxter
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
| | - Josie Hesketh
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
| | - Bright Mainga
- Laboratory Department, Mangochi District Hospital, P.O. Box 42, Mangochi, Malawi
| | - David Lally
- Malawi Liverpool Wellcome Trust Programme of Clinical Tropical Research, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Blantyre, Malawi
| | | | - E James LaCourse
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
| | - Lazarus Juziwelo
- National Schistosomiasis and STH Control Programme, Ministry of Health, Lilongwe, Malawi
| | - Janelisa Musaya
- Malawi Liverpool Wellcome Trust Programme of Clinical Tropical Research, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Blantyre, Malawi.,Department of Basic Medical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Peter Makaula
- Research for Health Environment and Development, P.O. Box 345, Mangochi, Malawi
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK.
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13
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Stothard JR, Kayuni SA, Al-Harbi MH, Musaya J, Webster BL. Future schistosome hybridizations: Will all Schistosoma haematobium hybrids please stand-up! PLoS Negl Trop Dis 2020; 14:e0008201. [PMID: 32614820 PMCID: PMC7332241 DOI: 10.1371/journal.pntd.0008201] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- J. Russell Stothard
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
| | - Sekeleghe A. Kayuni
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- MASM Medi Clinics Limited, Medical Society of Malawi (MASM), Blantyre, Malawi
| | - Mohammad H. Al-Harbi
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Ministry of Health, Qassim, Kingdom of Saudi Arabia
| | - Janelisa Musaya
- Department of Pathology, College of Medicine, University of Malawi, Blantyre, Malawi
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital College of Medicine, Blantyre, Malawi
| | - Bonnie L. Webster
- Parasites and Vectors Division, Life Sciences Department, Natural History Museum, London, United Kingdom
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14
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Faust CL, Osakunor DNM, Downs JA, Kayuni S, Stothard JR, Lamberton PHL, Reinhard-Rupp J, Rollinson D. Schistosomiasis Control: Leave No Age Group Behind. Trends Parasitol 2020; 36:582-591. [PMID: 32430274 DOI: 10.1016/j.pt.2020.04.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 01/11/2023]
Abstract
Despite accelerating progress towards schistosomiasis control in sub-Saharan Africa, several age groups have been eclipsed by current treatment and monitoring strategies that mainly focus on school-aged children. As schistosomiasis poses a threat to people of all ages, unfortunate gaps exist in current treatment coverage and associated monitoring efforts, preventing subsequent health benefits to preschool-aged children as well as certain adolescents and adults. Expanding access to younger ages through the forthcoming pediatric praziquantel formulation and improving treatment coverage in older ages is essential. This should occur alongside formal inclusion of these groups in large-scale monitoring and evaluation activities. Current omission of these age groups from treatment and monitoring exacerbates health inequities and has long-term consequences for sustainable schistosomiasis control.
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Affiliation(s)
- Christina L Faust
- Wellcome Centre for Integrative Parasitology, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK.
| | - Derick N M Osakunor
- Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, King's Buildings, Charlotte Auerbach Road, Edinburgh EH9 3FL, UK
| | - Jennifer A Downs
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Sekeleghe Kayuni
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; MASM Medi Clinics Limited, Medical Aid Society of Malawi (MASM), Blantyre, Malawi
| | - J Russell Stothard
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Poppy H L Lamberton
- Wellcome Centre for Integrative Parasitology, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK
| | | | - David Rollinson
- Global Schistosomiasis Alliance, Natural History Museum, London SW7 5BD, UK
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15
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Kayuni SA, LaCourse EJ, Makaula P, Lampiao F, Juziwelo L, Fawcett J, Shaw A, Alharbi MH, Verweij JJ, Stothard JR. Case Report: Highlighting Male Genital Schistosomiasis (MGS) in Fishermen from the Southwestern Shoreline of Lake Malawi, Mangochi District. Am J Trop Med Hyg 2020; 101:1331-1335. [PMID: 31701858 DOI: 10.4269/ajtmh.19-0562] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Urogenital schistosomiasis causes morbidity within the genitalia but is underreported and infrequently examined in men. To draw attention to male genital schistosomiasis (MGS), a longitudinal cohort study was conducted among fishermen along the southwestern shoreline of Lake Malawi. A case series of five participants is presented inclusive of questionnaire interviews, parasitological examinations, ultrasonography, and provision of a standard dose (40 mg/kg) of praziquantel (PZQ) treatment at baseline, 1-, 3-, 6-, and 12-month follow-up time points. Eggs of Schistosoma haematobium were observed in urine or semen across all time points; parasitological diagnostics were bolstered by real-time PCR for Schistosoma DNA in semen and by portable ultrasonography to document putative MGS-associated morbidity. We highlight the importance of developing standard diagnostic tests for MGS and increasing the accessibility of PZQ treatment to men, especially those in at-risk endemic areas.
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Affiliation(s)
- Sekeleghe A Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,MASM Medi Clinics Limited, Medical Society of Malawi (MASM), Blantyre, Malawi
| | - E James LaCourse
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Peter Makaula
- Research for Health Environment and Development (RHED), Mangochi, Malawi
| | - Fanuel Lampiao
- Physiology Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Lazarus Juziwelo
- National Schistosomiasis and STH Control Program, Community Health Sciences Unit (CHSU), Ministry of Health, Lilongwe, Malawi
| | - Joanna Fawcett
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Alexandra Shaw
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mohammad H Alharbi
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jaco J Verweij
- Elisabeth-TweeSteden Hospital Tilburg, Laboratory for Medical Microbiology and Immunology, Tilburg, The Netherlands
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Abstract
Only with the completion of the life cycles of Fasciola hepatica in 1883 and 30 years later those of Schistosoma japonicum (1913), Schistosoma haematobium and Schistosoma mansoni (1915) did research on schistosomiasis really get underway. One of the first papers by Cawston in 1918, describing attempts to establish the means of transmission of S. haematobium in Natal, South Africa, forms the historical perspective against which to judge where we are now. Molecular biology techniques have produced a much better definition of the complexity of the schistosome species and their snail hosts, but also revealed the extent of hybridization between human and animal schistosomes that may impact on parasite adaptability. While diagnostics have greatly improved, the ability to detect single worm pair infections routinely, still falls short of its goal. The introduction of praziquantel ~1982 has revolutionized the treatment of infected individuals and led directly to the mass drug administration programmes. In turn, the severe pathological consequences of high worm burdens have been minimized, and for S. haematobium infections the incidence of associated squamous cell carcinoma has been reduced. In comparison, the development of effective vaccines has yet to come to fruition. The elimination of schistosomiasis japonica from Japan shows what is possible, using multiple lines of approach, but the clear and present danger is that the whole edifice of schistosome control is balanced on the monotherapy of praziquantel, and the development of drug resistance could topple that.
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