Laboratory and field evaluation of a direct filtration technique for recovery of schistosome cercariae

Simplifying Schistosome Surveillance: Using Molecular Cercariometry to Detect and Quantify Cercariae in Water

Avian schistosomes are considered a public health nuisance due to their ability to cause swimmer’s itch when accidentally encountering humans rather than their intended avian hosts. Researchers have been monitoring their presence and abundance through snail collections and cercariometry. Cercariometry methods have evolved over the last several decades to detect individual schistosome species from a single water sample, simplifying the monitoring of these parasites. This methodological evolution coincides with the development of the field of environmental DNA (eDNA) where genetic material is extracted from environmental samples, rather than individual organisms. While there are some limitations with using molecular cercariometry, notably the cost and its inability to differentiate between life cycle stages, it substantially reduces the labor required to study trematode populations. It also can be used in complement with snail collections to understand the composition of avian schistosomes in an environment.

The Life Histories of Intermediate Hosts and Parasites of Schistosoma haematobium and Schistosoma mansoni in the White Nile River, Sudan

Background: The epidemiology of schistosomiasis transmission varies depending on the circumstances of the surrounding water bodies and human behaviors. We aimed to explore cercarial emergence patterns from snails that are naturally affected by human schistosomiasis and non-human trematodes. In addition, this study aimed to explore how schistosomiasis infection affects snail survival, reproduction, and growth. Methods: We measured the survival rate, fecundity, and size of Biomphalaria pfeifferi snails and the cercarial rhythmicity of S. haematobium and S. mansoni. The number of egg masses, eggs per egg mass, and snail deaths were counted for 7 weeks. The survival rate and cumulative hazard were assessed for infected and non-infected snails. Results: S. haematobium and S. mansoni cercariae peaked at 9:00–11:00 a.m. Infection significantly reduced the survival rate of B. pfeifferi, which was 35% and 51% for infected and non-infected snails, respectively (p = 0.02), at 7 weeks after infection. The hazard ratio of death for infected snails compared to non-infected snails was 1.65 (95% confidence interval: 1.35–1.99; p = 0.01). Conclusions: An understanding of the dynamics of schistosomiasis transmission will be helpful for formulating schistosomiasis control and elimination strategies. Cercarial rhythmicity can be reflected in health education, and the reproduction and survival rate of infected snails can be used as parameters for developing disease modeling.

Ultraviolet disinfection of Schistosoma mansoni cercariae in water

BACKGROUND

Schistosomiasis is a parasitic disease that is transmitted by skin contact with waterborne schistosome cercariae. Mass drug administration with praziquantel is an effective control method, but it cannot prevent reinfection if contact with cercariae infested water continues. Providing safe water for contact activities such as laundry and bathing can help to reduce transmission. In this study we examine the direct effect of UV light on Schistosoma mansoni cercariae using ultraviolet light-emitting diodes (UV LEDs) and a low-pressure (LP) mercury arc discharge lamp.

METHODOLOGY

S. mansoni cercariae were exposed to UV light at four peak wavelengths: 255 nm, 265 nm, 285 nm (UV LEDs), and 253.7 nm (LP lamp) using bench scale collimated beam apparatus. The UV fluence ranged from 0-300 mJ/cm2 at each wavelength. Cercariae were studied under a stereo-microscope at 0, 60, and 180 minutes post-exposure and the viability of cercariae was determined by assessing their motility and morphology.

CONCLUSION

Very high UV fluences were required to kill S. mansoni cercariae, when compared to most other waterborne pathogens. At 265 nm a fluence of 247 mJ/cm2 (95% confidence interval (CI): 234-261 mJ/cm2) was required to achieve a 1-log10 reduction at 0 minutes post-exposure. Cercariae were visibly damaged at lower fluences, and the log reduction increased with time post-exposure at all wavelengths. Fluences of 127 mJ/cm2 (95% CI: 111-146 mJ/cm2) and 99 mJ/cm2 (95% CI: 85-113 mJ/cm2) were required to achieve a 1-log10 reduction at 60 and 180 minutes post-exposure at 265 nm. At 0 minutes post-exposure 285 nm was slightly less effective, but there was no statistical difference between 265 nm and 285 nm after 60 minutes. The least effective wavelengths were 255 nm and 253.7 nm. Due to the high fluences required, UV disinfection is unlikely to be an energy- or cost-efficient water treatment method against schistosome cercariae when compared to other methods such as chlorination, unless it can be demonstrated that UV-damaged cercariae are non-infective using alternative assay methods or there are improvements in UV LED technology.

Challenges and Opportunities Presented by Current Techniques for Detecting Schistosome Infections in Intermediate Host Snails: A Scoping Review

Schistosomiasis, a neglected tropical disease (NTD), causes morbidity and mortality in over 250 million people globally. And 700 million people are at risk of contracting it. It is caused by a parasite of the genus Schistosoma. Freshwater snails of the family Planorbidae are of public health significance as they are intermediate hosts of these highly infective flukes. Accurate diagnostic techniques to detect schistosome infections in intermediate host snails (IHS) and environmental surveillance are needed to institute measures for the interruption of transmission and eventual elimination. We carried out a systematic review of the literature to assess advantages and limitations of different diagnostic techniques for detecting schistosome infections in snails. Literature from Scopus, Web of Science, and PubMed databases from 2008 to 2020 were searched using combinations of predefined search terms with Boolean operators. The studies revealed that conventional diagnostics are widely used, although they are labor-intensive, have low specificity and sensitivity levels, and cannot detect prepatent infections. Whereas more advanced techniques such as immunological, nucleic-acid amplification, and eDNA diagnostics have high sensitivity and specificity levels, they are costly, hence, not suitable for field applications and large-scale surveys. Our review highlights the importance of designing and developing innovative diagnostics that are high in specificity and sensitivity as well as affordable and technically feasible for use in field laboratories and for large-scale surveys.

Chlorination of Schistosoma mansoni cercariae

BACKGROUND

Schistosomiasis is a water-based disease acquired through contact with cercaria-infested water. Communities living in endemic regions often rely on parasite-contaminated freshwater bodies for their daily water contact activities, resulting in recurring schistosomiasis infection. In such instances, water treatment can provide safe water on a household or community scale. However, to-date there are no water treatment guidelines that provide information on how to treat water containing schistosome cercariae. Here, we rigorously test the effectiveness of chlorine against Schistosoma mansoni cercariae.

METHOD

S. mansoni cercariae were chlorinated using sodium hypochlorite under lab and field condition. The water pH was controlled at 6.5, 7.0 or 7.5, the water temperature at 20°C or 27°C, and the chlorine dose at 1, 2 or 3 mg/l. Experiments were conducted up to contact times of 45 minutes. 100 cercariae were used per experiment, thereby achieving up to 2-log10 inactivations of cercariae. Experiments were replicated under field conditions at Lake Victoria, Tanzania.

CONCLUSION

A CT (residual chlorine concentration x chlorine contact time) value of 26±4 mg·min/l is required to achieve a 2-log10 inactivation of S. mansoni cercariae under the most conservative condition tested (pH 7.5, 20°C). Field and lab-cultivated cercariae show similar chlorine sensitivities. A CT value of 30 mg·min/l is therefore recommended to disinfect cercaria-infested water, though safety factors may be required, depending on water quality and operating conditions. This CT value can be achieved with a chlorine residual of 1 mg/l after a contact time of 30 minutes, for example. This recommendation can be used to provide safe water for household and recreational water activities in communities that lack safe alternative water sources.

The effectiveness of water treatment processes against schistosome cercariae: A systematic review

Background

Schistosomiasis is one of the most disabling neglected tropical diseases, ranking second in terms of years lived with disability. While treatment with the drug praziquantel can have immediate beneficial effects, reinfection can occur rapidly if people are in contact with cercaria-infested water. Water treatment for schistosomiasis control seeks to eliminate viable cercariae from water, thereby providing safe alternative water supplies for recreational and domestic activities including laundry and bathing. This provision may reduce contact with infested water, which is crucial for reducing reinfection following chemotherapy and cutting schistosome transmission.

Methodology

A qualitative systematic review was carried out to summarize the existing knowledge on the effectiveness of water treatment in removing or inactivating human schistosome cercariae. Four online databases were searched. Studies were screened and categorized into five water treatment processes: storage, heating, chlorination, filtration, and ultraviolet (UV) disinfection.

Conclusions

All five water treatment methods can remove or inactivate cercariae in water, and hence produce cercaria-free water. However, reliable design guidelines for treating water do not exist as there are insufficient data. Overall, the review found that cercariae are inactivated when storing water for 10–72 hours (depending on temperature), or with chlorination values of 3–30 mg-min/l. UV fluences between 3–60 mJ/cm² may significantly damage or kill cercariae, and sand filters with 0.18–0.35 mm grain size have been shown to remove cercariae. This systematic review identified 67 studies about water treatment and schistosomiasis published in the past 106 years. It highlights the many factors that influence the results of water treatment experiments, which include different water quality conditions and methods for measuring key parameters. Variation in these factors limit comparability, and therefore currently available information is insufficient for providing complete water treatment design recommendations.

Schistosomiasis control currently focuses on preventive chemotherapy (PC) with praziquantel, which is effective, safe, and inexpensive. However, this treatment does not prevent subsequent reinfection. As schistosomiasis control targets become more ambitious and move towards elimination, interest is increasing in the potentially complementary roles of water, sanitation, and hygiene (WASH) interventions which may disrupt transmission of the parasite, thereby slowing reinfection following treatment. Water treatment for schistosomiasis control seeks to eliminate viable schistosome cercariae from water. We carried out a systematic review to summarize the existing knowledge on the effectiveness of water treatment for the removal or inactivation of cercariae, by processes including chlorination, filtration, UV disinfection, heating, and water storage. This is the first review of its kind and provides a concise summary of what is known to-date regarding water treatment against cercariae of different Schistosoma species. The review also identifies gaps in knowledge and provides crucial and timely guidance for the control and elimination of schistosomiasis, by highlighting the requirements for designing effective and sustainable water infrastructure for schistosomiasis-endemic regions.

Chronobiology of trematode cercarial emergence: from data recovery to epidemiological, ecological and evolutionary implications

One major challenge for parasites with complex cycles consists to succeed in the transmission from one host to the next host. To maximize the probability of encountering the right host, numerous trematode species have selected various emergence rhythms occurring during the escape of the short-lived cercariae from the mollusc host. Cercarial shedding patterns are beautiful examples of adaptation of the parasite for a successful rendezvous with its subsequent host. In this review, after an analysis of the technical and statistical aspects specific to such studies, we compile the knowledge and unresolved issues we have about the synchronization of these rhythms, their genetic support and the role of the host physiology or activity. We are also interested on how cercarial rhythmicity influences cercarial densities in waters of transmission sites and then the risk of host infection in case of schistosomiasis. Ecological significance of the inter- and intra-specific diversity of these rhythms is emphasized as well as the evolutionary implication of new chronotypes resulting from the capture of new host species and promoting reproductive isolation and alloxenic speciation. Currently, genome sequence data now available for some trematodes such as the schistosomes provide an unprecedented resource for new research approaches that should contribute identification of the genes and mechanisms involved in determining the cercarial shedding rhythms observed.

Detection of Schistosoma mansoni cercariae in plankton samples by PCR

A PCR assay on the basis of a tandemly repeated DNA sequence was employed for the detection of Schistosoma mansoni in artificial plankton samples. It was highly specific, since as few as 1fg DNA from this species were sufficient to obtain a clear signal, while 10pg DNA of Schistosoma rodhaini were required and no PCR products were obtained with even 10ng DNA of planktonic organisms and any other trematode species tested. In areas with transmission of different Schistosoma species 10pg DNA should be used for amplification, which would allow detection of 20 S. mansoni cercariae in 0.05g plankton without interference caused by DNA of other Schistosoma species. In other areas 10ng DNA from plankton samples can be amplified, detecting less than one S. mansoni cercaria specifically in 0.05g plankton. This assay might help to identify S. mansoni in samples from field studies, where a multitude of different organisms hinder a correct species identification.

Cercariometry for detection of transmission sites for schistosomiasis

Cercariometry provided information on diurnal fluctuation, seasonal and spatial distribution of cercariae in the suitable natural water bodies. There was an apparent mismatch between the results of cercariometry and snail sampling. Water, which cercariometry showed to contain cercariae was potentially infective, although the resultant worm load of sentinel rodents may not bear a linear relationship with cercarial density. Cercariometry has some weakness in practices and analysis of data, however, it provides the valuable information on the active transmission sites of schistosomiasis.

Water contact behavior and schistosomiasis in an upper Egyptian village

Preliminary findings of a study of the role of microspatial behavior and local ecological circumstances in the persistence of Schistosoma haematobium infection in El Ayaisha village, Upper Egypt, are presented. Twelve types of water contact activities were studied in three cohorts of 274,324 and 392 male students aged 5-16 during a 2-year period. Swimming and playing resulted in more frequent and intensive contact with potentially infective water and in more pollution of snail habitats with schistosome eggs than any other type of activity. Irrigation was probably not a major cause of S. haematobium infection in schoolboys and drinking water and fishing carried the smallest risk for this age group. Mapping and discriminate analysis of infection and transmission indicators revealed spatial associations between water contact, schistosome transmission and infection among the various age groups. The highest egg excretion rates in individuals and the highest prevalence rates were noted in the neighborhoods nearest to the canals. Water contact and contamination of water by the heavily infected school age boys is seasonally concentrated during the summer, when intermediate host snails and infective cercariae are also most common in the water. Frequency, type and duration of water contact change with age together with types of water bodies used, causing corresponding changes in exposure risk. Nevertheless, other factors, including acquired immunity, preexisting infections, chemotherapy and the effect of the study on the normal water contact behavior of the study population must also be evaluated. Contact with the Nile and the canals by the general nonschool population of El Ayaisha was studied to verify the observations among the schoolboys and to study socially linked activities and the transmission potential of the various transmission sites. Results are evaluated in regard to the feasibility of various schistosomiasis control measures in El Ayaisha.