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Kołodziej P, Szostakowska B, Lass A, Sulima M, Sikorska K, Kocki J, Krupski W, Starownik D, Bojar P, Szumiło J, Kasztelan-Szczerbińska B, Cichoż-Lach H, Bogucki J, Szymańska M, Fota-Markowska H, Bogucka-Kocka A. Chronic intestinal schistosomiasis caused by co-infection with Schistosoma intercalatum and Schistosoma mansoni. THE LANCET. INFECTIOUS DISEASES 2024; 24:e196-e205. [PMID: 37783223 DOI: 10.1016/s1473-3099(23)00486-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/23/2023] [Accepted: 07/19/2023] [Indexed: 10/04/2023]
Abstract
The Grand Round concerns a 24-year-old man from Zimbabwe who was studying and living in Poland. The patient had been complaining of abdominal pain, fatigue, alternating diarrhoea and constipation, and presence of blood in his stool for 3 years. The patient had the following diagnostic tests: colonoscopy, CT scan, histopathology, and parasitological and molecular tests. Results of the examinations showed that the cause of the patient's complaints was chronic intestinal schistosomiasis due to the co-infection with Schistosoma intercalatum and Schistosoma mansoni. The patient had two cycles of praziquantel therapy (Biltricide) and responded well to the treatment. In the Grand Round, we describe full diagnostics as well as clinical and therapeutic management in the patient with S intercalatum and S mansoni co-infection. This case allows us to draw attention to cases of forgotten chronic tropical diseases (including rare ones) in patients from regions with a high endemic index staying in non-endemic regions of the world for a long time. Co-infection with S intercalatum and S mansoni should be considered as a very rare clinical case.
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Affiliation(s)
- Przemysław Kołodziej
- Department of Biology and Genetics, Medical University of Lublin, Lublin, Poland.
| | - Beata Szostakowska
- Department of Tropical Parasitology, Medical University of Gdańsk, Gdańsk, Poland.
| | - Anna Lass
- Department of Tropical Parasitology, Medical University of Gdańsk, Gdańsk, Poland
| | - Małgorzata Sulima
- Division of Tropical and Parasitic Diseases, Medical University of Gdańsk, Gdańsk, Poland
| | - Katarzyna Sikorska
- Division of Tropical and Parasitic Diseases, Medical University of Gdańsk, Gdańsk, Poland
| | - Janusz Kocki
- Department of Clinical Genetics, Medical University of Lublin, Lublin, Poland
| | - Witold Krupski
- Department of Medical Radiology, Medical University of Lublin, Lublin, Poland
| | - Dorota Starownik
- Independent Public Clinical Hospital No. 4 in Lublin, Medical University of Lublin, Lublin, Poland
| | - Paweł Bojar
- Department of Pathomorphology, Beskid Oncology Centre-John Paul II Memorial City Hospital in Bielsko-Biala, Bielsko-Biała, Poland
| | - Justyna Szumiło
- Department of Clinical Pathomorphology, Medical University of Lublin, Lublin, Poland
| | | | - Halina Cichoż-Lach
- Department of Gastroenterology with Endoscopy Unit, Medical University of Lublin, Lublin, Poland
| | - Jacek Bogucki
- Department of Organic Chemistry, Medical University of Lublin, Lublin, Poland
| | - Magdalena Szymańska
- Department of Biology and Genetics, Medical University of Lublin, Lublin, Poland
| | | | - Anna Bogucka-Kocka
- Department of Biology and Genetics, Medical University of Lublin, Lublin, Poland
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Pham K, Mtalitinya GS, Aristide C, Airewele EA, Nyakaru DK, McMahon P, Mulaki GM, Corstjens PLAM, J de Dood C, van Dam GJ, Changalucha JM, Mazigo HD, Lee MH, Jaka H, Downs JA. Effects of Schistosoma mansoni and praziquantel treatment on the lower gastrointestinal mucosa: A cohort study in Tanzania. Acta Trop 2023; 238:106752. [PMID: 36410422 PMCID: PMC9884117 DOI: 10.1016/j.actatropica.2022.106752] [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: 12/03/2021] [Revised: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 11/20/2022]
Abstract
Schistosomes infect over 200 million people worldwide, but few studies have characterized the effects of Schistosoma mansoni infection and effective treatment on the lower gastrointestinal mucosa. In this prospective cohort study, we compared the clinical findings on sigmoidoscopy and laboratory measures in Tanzanian adults with and without S. mansoni infection at baseline and 6 months after praziquantel treatment. Grading of the endoscopic findings was done using the Mayo Scoring System for Assessment of Ulcerative Colitis Activity. Schistosome infection was confirmed by stool microscopy and serum circulating anodic antigen (CAA). Baseline comparisons were performed in Stata using Fisher's exact and Wilcoxon rank-sum tests, and pre- and post-treatment comparisons using Wilcoxon matched-pairs signed-rank and McNemar's tests. We investigated the clinical characteristics of 48 individuals: 32 with and 16 without S. mansoni infection. Infected individuals had greater severity of sigmoid and rectal mucosal abnormalities and higher Mayo scores and serum eosinophils (all p < 0.05) than uninfected individuals at initial evaluation. At 6 months, 28 individuals completed repeat blood tests and sigmoidoscopy. Of these, 14 cleared their baseline infection (n = 7) or experienced a greater than 7-fold decrease in serum CAA (n = 7). Follow-up sigmoidoscopies revealed some improvements in sigmoid and rectal mucosal findings, although Mayo scores were not significantly lower. Both the median erythrocyte sedimentation rates (32.5→12.5 mm/hr) and percent of eosinophils (7.1→3.1%) decreased in this group from baseline to follow-up. S. mansoni infection was associated with mild-to-moderate lower gastrointestinal mucosal abnormalities that were grossly visible during sigmoidoscopy, and these improved partially 6 months after effective treatment with praziquantel. Additional studies, of longer duration and focused on both clinical and mucosal immunologic effects of S. mansoni, could provide additional insight.
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Affiliation(s)
- Khanh Pham
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA.
| | | | | | | | | | - Paige McMahon
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| | | | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Claudia J de Dood
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Humphrey D Mazigo
- Department of Parasitology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Myung Hee Lee
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| | - Hyasinta Jaka
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; Department of Internal Medicine, Mwanza College of Health and Allied Sciences, Mwanza, Tanzania
| | - Jennifer A Downs
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA; Weill Bugando School of Medicine, Mwanza, Tanzania
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Tamarozzi F, Ursini T, Hoekstra PT, Silva R, Costa C, Gobbi F, Monteiro GB, Motta L, van Dam GJ, Corstjens PL, van Lieshout L, Buonfrate D. Evaluation of microscopy, serology, circulating anodic antigen (CAA), and eosinophil counts for the follow-up of migrants with chronic schistosomiasis: a prospective cohort study. Parasit Vectors 2021; 14:149. [PMID: 33750443 PMCID: PMC7941883 DOI: 10.1186/s13071-021-04655-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/23/2021] [Indexed: 12/16/2022] Open
Abstract
Background An accurate test for the diagnosis and post-treatment follow-up of patients with schistosomiasis is needed. We assessed the performance of different laboratory parameters, including the up-converting reporter particle technology lateral flow assay to detect circulating anodic antigen (UCP-LF CAA), for the post-treatment follow-up of schistosomiasis in migrants attending a dedicated outpatient clinic in a non-endemic country. Methods Routine anti-Schistosoma serology results and eosinophil counts were obtained of patients with positive urine/stool microscopy and/or PCR (confirmed cases) or only positive serology (possible cases), and at least one follow-up visit at 6 (T6) or 12 (T12) months after praziquantel treatment. All sera samples were tested with the UCP-LF CAA assay. Results Forty-eight patients were included, 23 confirmed and 25 possible cases. The percentage seropositivity and median antibody titers did not change significantly during follow-up. UCP-LF CAA was positive in 86.9% of confirmed and 20% of possible cases. The percentage positivity and median CAA levels decreased significantly post-treatment, with only two patients having positive CAA levels at T12. Conclusions The UCP-LF CAA assay proved useful for the diagnosis of active infection with Schistosoma spp. and highly valuable for post-treatment monitoring in migrants, encouraging the development of a commercial test.![]()
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Affiliation(s)
- Francesca Tamarozzi
- Department of Infectious-Tropical Diseases and Microbiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Viale Luigi Rizzardi 4, 37024, Negrar di Valpolicella, Verona, Italy
| | - Tamara Ursini
- Department of Infectious-Tropical Diseases and Microbiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Viale Luigi Rizzardi 4, 37024, Negrar di Valpolicella, Verona, Italy
| | - Pytsje T Hoekstra
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ronaldo Silva
- Department of Infectious-Tropical Diseases and Microbiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Viale Luigi Rizzardi 4, 37024, Negrar di Valpolicella, Verona, Italy
| | - Cecilia Costa
- Dipartimento medico di malattie infettive, Ospedale Maggiore della Carità, Novara, Italy
| | - Federico Gobbi
- Department of Infectious-Tropical Diseases and Microbiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Viale Luigi Rizzardi 4, 37024, Negrar di Valpolicella, Verona, Italy
| | - Gerardo B Monteiro
- Department of Infectious-Tropical Diseases and Microbiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Viale Luigi Rizzardi 4, 37024, Negrar di Valpolicella, Verona, Italy
| | - Leonardo Motta
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Paul L Corstjens
- Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Dora Buonfrate
- Department of Infectious-Tropical Diseases and Microbiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Viale Luigi Rizzardi 4, 37024, Negrar di Valpolicella, Verona, Italy.
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