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Benabdelmoumen G, Van der Pluijm RW, Taieb F, Jidar K, Kuhmel L, Lucet C, Buffet P, Hochedez P, Itani O, Consigny PH. Health problems and exposure to infectious risks in returning humanitarian aid workers. J Travel Med 2024; 31:taae050. [PMID: 38552155 DOI: 10.1093/jtm/taae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Humanitarian aid workers are exposed to deployment-related health threats. Identifying subgroups at a higher risk of infection in this diverse population could help optimize prevention. METHODS We carried out a retrospective study based on anonymized data of humanitarian aid workers that visited our clinic for a post-deployment visit between 1 January 2018 and 31 December 2021. We conducted a descriptive analysis of basic demographic data, self-reported risk exposure and health problems encountered during deployment extracted from a standard questionnaire. RESULTS The questionnaire was administered to 1238 aid workers during 1529 post-deployment medical consultations. The median age was 37.2 years (IQR 31.7-44.3), and 718/1529 (47.0%) were female aid workers. The median duration of deployment was 6 months (IQR 3-12 months). Most deployments (1321/1529 (86.4%)) were for a medical organization and in Sub-Saharan Africa (73.2%). The most common risk exposures were contact with freshwater in schistosomiasis endemic regions (187/1308 (14.3%)), unprotected sexual contact with a person other than a regular partner (138/1529 (9.0%)), suspected rabies exposure (56/1529 (3.7%)) and accidental exposure to blood (44/1529 (2.9%)). Gastrointestinal problems (487/1529 (31.9%)), malaria (237/1529 (15.5%)) and respiratory tract infections (94/1529 (6,2%)) were the most encountered health problems. Fifteen volunteers (1%) were hospitalized during deployment and 19 (1.2%) repatriated due to health problems. Adherence to malaria chemoprophylaxis was poor, only taken according to the prescription in 355 out of 1225 (29.0%) of aid workers for whom prophylaxis was indicated. CONCLUSION Humanitarian aid workers deployed abroad encounter significant rates of health problems and report a high level of risk exposure during their deployment, with the risks being greatest among younger people, those deployed to rural areas, and those working for non-medical organizations. These findings help guide future pre-deployment consultations, to increase awareness and reduce risk behaviour during deployment, as well as focus on adherence to medical advice such as malaria chemoprophylaxis.
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Affiliation(s)
| | | | - Fabien Taieb
- Institut Pasteur, Centre Médical, 75015 Paris, France
| | - Kaoutar Jidar
- Institut Pasteur, Centre Médical, 75015 Paris, France
| | - Lucie Kuhmel
- Institut Pasteur, Centre Médical, 75015 Paris, France
| | - Cora Lucet
- Institut Pasteur, Centre Médical, 75015 Paris, France
| | - Pierre Buffet
- Institut Pasteur, Centre Médical, 75015 Paris, France
| | | | - Oula Itani
- Institut Pasteur, Centre Médical, 75015 Paris, France
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Iriarte C, Marks DH. Cutaneous schistosomiasis: epidemiological and clinical characteristics in returning travelers. Int J Dermatol 2023; 62:376-386. [PMID: 36096120 DOI: 10.1111/ijd.16389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/15/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022]
Abstract
The clinical manifestations of parasitic diseases are well-covered in the infectious disease literature; however, cutaneous manifestations often receive limited attention. There is a need to update existing knowledge and improve reporting of disease characteristics. Given continued increases in travel and transportation, more individuals are acquiring cutaneous infections while traveling abroad. Schistosomiasis is the second most important tropical disease among returning travelers and affects more than 200 million individuals worldwide. The literature classically describes three forms of skin disease in those infected with Schistosoma: the immediate pruritic eruption of cercarial dermatitis, the urticarial response of Katayama syndrome, and the granulomatous lesions of late cutaneous schistosomiasis. Over the last two decades, more atypical presentations have been described. Travelers returning from Africa, South America, and Asia are at highest risk given these are the continents in which the parasite is endemic. This review highlights the cutaneous manifestations of schistosomiasis, with a focus on international travelers with atypical presentations. Additionally, genital schistosomiasis will be reviewed given its significant morbidity. The aim of this review is to update the current body of literature. Dermatologists and other physicians evaluating the skin should be aware of the following principles regarding schistosomal infections: (i) the importance of an early skin biopsy in making the diagnosis; (ii) the necessity of adding schistosomiasis to the differential diagnosis for zosteriform lesions; (iii) the resemblance of chronic cutaneous schistosomiasis of the genitals to sexually transmitted infections; and (iv) the need to revise definitions for early and late infection, specifically for cutaneous disease.
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Affiliation(s)
- Christopher Iriarte
- Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Dustin H Marks
- Department of Dermatology, Stanford University, Palo Alto, CA, USA
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3
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Inceboz T. One Health Concept against Schistosomiasis: An Overview. Infect Dis (Lond) 2022. [DOI: 10.5772/intechopen.106912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Schistosomiasis (bilharziasis) is a parasitic disease caused by Schistosoma spp. that belongs to trematode worms. These worms are known as “blood parasites”. This disease is included in “neglected tropical diseases” and “water-borne diseases”. The main species are Schistosoma (S.) haematobium, S. japonicum, S. mansoni, S. intercalatum, S. mekongi, S. guineensis and S. intercalatum, though there are more than 20 different species. The parasite in the definitive host may affect many organs and systems. The disease may become chronic and lasts 3–8 years and even up to 20–30 years. The definitive host is primarily human; however, in endemic areas animals such as monkeys, cattle, horses, rodents, cats, dogs are reservoirs. According to World Health Organization (WHO), schistosomiasis affects 250 million people, and causes 1.9 million deaths yearly in endemic areas. Moreover, due to global warming, the spread of the disease may increase. The effective way to fight against schistosomiasis is following the “one-health system”. Indeed, to overcome or “eradicate” this disease, we have to strive against different forms at different evolutionary stages of the worm such as, forms in humans, domestic or wild animals, and freshwater snails. If we combine the knowledge of professionals, we may achieve this goal.
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Biber A, Petersil N, Naaman E, Neuberger A, Schwartz E. Unusual and severe complications of acute schistosomiasis in travelers. Open Forum Infect Dis 2022; 9:ofac443. [PMID: 36172058 PMCID: PMC9512705 DOI: 10.1093/ofid/ofac443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Abstract
Acute schistosomiasis (ASC) is a hypersensitivity reaction seen mostly in nonimmune travelers and manifests mainly with fever, urticaria, and respiratory symptoms. We describe unusual severe presentations of ASC in 3 patients, including hip-monoarthritis, peri-myocarditis, and optic neuritis. In all 3 patients, clinical symptoms appeared or worsened after praziquantel administration.
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Affiliation(s)
- Asaf Biber
- The Center for Geographic Medicine and Tropical diseases, The Chaim Sheba Medical Center , Ramat Gan , Israel
- Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Neta Petersil
- Infectious Diseases Institute, Rambam Health Care Campus , Haifa , Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology , Haifa , Israel
| | - Efrat Naaman
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology , Haifa , Israel
- Department of Ophthalmology, Rambam Health Care Campus , Haifa , Israel
| | - Ami Neuberger
- Infectious Diseases Institute, Rambam Health Care Campus , Haifa , Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology , Haifa , Israel
| | - Eli Schwartz
- The Center for Geographic Medicine and Tropical diseases, The Chaim Sheba Medical Center , Ramat Gan , Israel
- Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
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Clinical Spectrum of Schistosomiasis: An Update. J Clin Med 2021; 10:jcm10235521. [PMID: 34884223 PMCID: PMC8672275 DOI: 10.3390/jcm10235521] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/17/2021] [Accepted: 11/25/2021] [Indexed: 11/18/2022] Open
Abstract
Schistosomiasis is a helminthic infection and one of the neglected tropical diseases (NTDs). It is caused by blood flukes of the genus Schistosoma. It is an important public health problem, particularly in poverty-stricken areas, especially those within the tropics and subtropics. It is estimated that at least 236 million people worldwide are infected, 90% of them in sub-Saharan Africa, and that this disease causes approximately 300,000 deaths annually. The clinical manifestations are varied and affect practically all organs. There are substantial differences in the clinical presentation, depending on the phase and clinical form of schistosomiasis in which it occurs. Schistosomiasis can remain undiagnosed for a long period of time, with secondary clinical lesion. Here, we review the clinical profile of schistosomiasis. This information may aid in the development of more efficacious treatments and improved disease prognosis.
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6
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Mortier C, Aubry C, L'Ollivier C, Gautret P, Lagier JC, Parola P. Schistosoma haematobium infection with pulmonary involvement in a traveller returning from Congo: A case report and systematic review of literature on nodular pulmonary schistosomiasis. Travel Med Infect Dis 2021; 44:102182. [PMID: 34678502 DOI: 10.1016/j.tmaid.2021.102182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/23/2021] [Accepted: 10/18/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Schistosomiasis is highly prevalent in sub-Saharan Africa and diagnosis is difficult for travel medicine practitioners, because it can affect different organs with atypical manifestations. S. haematobium is mostly associated with urinary involvement and rarely with pulmonary lesions. This review aims to summarise the pulmonary forms associated with schistosomiasis, especially with S. haematobium. METHOD Based on a case report of both pulmonary and urogenital schistosomiasis, we performed a systematic literature review of schistosomiasis occurring in migrants and travellers, with a specific focus on pulmonary schistosomiasis. RESULTS Pulmonary schistosomiasis can present two different clinical patterns. On the one hand, there is an acute pattern, which more frequently affects non-immune young travellers within three to eight weeks of their return and, on the other hand, there is a chronic pattern, which has been evolving in recent years and which mostly affects people living in endemic areas or migrating from these countries. Nodular pulmonary lesions are described in both patterns. Genus identification should not focus only on known patterns, and identification of S. haematobium should not be associated exclusively with urinary schistosomiasis. CONCLUSIONS Pulmonary schistosomiasis, even when resulting from S. haematobium, is a rare but existing infection that appears to be spreading with increasing travel and global migration. Physicians need to be more aware of non-specific symptoms that may reveal an atypical presentation of a tropical disease, in order to avoid the chronic complications which can result from parasitic diseases.
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Affiliation(s)
| | | | - Coralie L'Ollivier
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
| | | | - Jean-Christophe Lagier
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Philippe Parola
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.
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7
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Rabinowicz S, Leshem E, Schwartz E. Acute schistosomiasis in paediatric travellers and comparison with their companion adults. J Travel Med 2021; 28:6062386. [PMID: 33398348 DOI: 10.1093/jtm/taaa238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Schistosomiasis in non-immune travellers can cause acute schistosomiasis, a multi-systemic hypersensitivity reaction. Little is known regarding acute schistosomiasis in children. We describe acute schistosomiasis in paediatric travellers and compare them with adult travellers. METHODS A retrospective study of paediatric travellers (0-18 years old) diagnosed with schistosomiasis at Sheba Medical Center. Patients' findings are compared with those of adult travellers from the same travel groups. RESULTS in total, 18 children and 24 adults from five different trips to Tanzania, Uganda, Nigeria and Laos were infected (90% of the exposed travellers). The median bathing time of the infected children was 30 min (interquartile range (IQR) 15-30 min). The most common presentations were respiratory symptoms in 13 (72%), eosinophilia in 13 (72%) and fever in 11 (61%). Acute illness included a median of 2.5 symptoms. Three children required hospitalization and three were asymptomatic. Fatigue was significantly less common in children compared with similarly exposed adults (33% vs 71%, P = 0.03). Rates of hospitalization and steroid treatment were similar. The median eosinophil count in children was 1045 cells/μl (IQR 625-2575), lower than adults [2900 cells/μl (IQR 1170-4584)], P = 0.02. CONCLUSIONS Children may develop acute schistosomiasis following short exposure to contaminated freshwater, demonstrating a high infection rate. Severity seems to be similar to adults, although children report fatigue less commonly and show lower eosinophil counts. The disease should be suspected in children with multi-systemic illness and in asymptomatic children with relevant travel history.
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Affiliation(s)
- Shira Rabinowicz
- Paediatric Neurology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Leshem
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,The Center for Travel Medicine and Tropical Diseases, Sheba Medical Center, Ramat Gan, Israel
| | - Eli Schwartz
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,The Center for Travel Medicine and Tropical Diseases, Sheba Medical Center, Ramat Gan, Israel
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8
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Gillardie ML, Babba O, Mahinc C, Duthel M, de Bengy C, Morineaud C, Rivollier E, Flori P. Molecular approach to the epidemiology of urinary schistosomiasis in France. PLoS Negl Trop Dis 2021; 15:e0009515. [PMID: 34228747 PMCID: PMC8284649 DOI: 10.1371/journal.pntd.0009515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 07/16/2021] [Accepted: 05/28/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The diagnosis of urogenital schistosomiasis is based on the complementarity of serological technique and microscopic examination (ME). Between 2015 and 2019, the number of urinary schistosomiasis tests received in our laboratory increased sharply from 300 to 900 per year. Therefore, we wanted to evaluate the reliability of urine microscopic examination (ME, reference and routine technique) from urine sample by comparing it to other techniques (antigenic technique and PCR). To this end, we optimized two real-time PCRs targeting respectively Schistosoma haematobium (Sh) and Schistosoma mansoni (Sm). METHODOLOGY/PRINCIPAL FINDINGS 914 urine samples from 846 patients suspected of urogenital schistosomiasis were prescribed and analyzed by PCR and also by antigenic technique for the first 143 samples. The antigenic technique evaluated was Schisto POC-CCA, Rapid Medical Diagnostics. These results (antigenic technique and PCR) were compared to ME which was performed from all urines. The percentage of 14% (128/914) positive cases with the PCR technique and the percentage of 6.0% (54/914) positive cases with ME is significantly different (Chi 2 test, p<0.001). These 128 positive PCRs correspond to 120 different patients, 88.3% (106/120) of them were young migrants and 11.7% (14/120) were French patients returning from travel. Among these migrants, more than 75% (80/106) came from French-speaking West Africa. In addition, the Schisto POC-CCA showed a specificity of 39% (46/117), too poor to be used as a screening tool in low or non-endemic areas. CONCLUSION/SIGNIFICANCE Targeted Sh and Sm PCRs in urine are reliable techniques compared to ME (reference technique). In view of our results, we decided to screen urinary schistosomiasis by direct ME always coupled by the PCR technique, which has shown better reliability criteria.
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Affiliation(s)
- Marie-Laure Gillardie
- University of Saint-Etienne, GIMAP-EA-3064, Saint Etienne, France
- Parasitology and Mycology, department of Infectious Agents and Hygiene, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Oussama Babba
- University of Saint-Etienne, GIMAP-EA-3064, Saint Etienne, France
- Parasitology and Mycology, department of Infectious Agents and Hygiene, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Caroline Mahinc
- Parasitology and Mycology, department of Infectious Agents and Hygiene, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Maureen Duthel
- University of Saint-Etienne, GIMAP-EA-3064, Saint Etienne, France
- Parasitology and Mycology, department of Infectious Agents and Hygiene, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Claire de Bengy
- University of Saint-Etienne, GIMAP-EA-3064, Saint Etienne, France
- Parasitology and Mycology, department of Infectious Agents and Hygiene, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Clotilde Morineaud
- Department of Public Health, University Hospital of Poitiers, Poitiers, France
| | - Elisabeth Rivollier
- Department PASS, University Hospital of Saint-Etienne, Saint Etienne, France
| | - Pierre Flori
- University of Saint-Etienne, GIMAP-EA-3064, Saint Etienne, France
- Parasitology and Mycology, department of Infectious Agents and Hygiene, University Hospital of Saint-Etienne, Saint-Etienne, France
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Rey O, Webster BL, Huyse T, Rollinson D, Van den Broeck F, Kincaid-Smith J, Onyekwere A, Boissier J. Population genetics of African Schistosoma species. INFECTION GENETICS AND EVOLUTION 2021; 89:104727. [PMID: 33486128 DOI: 10.1016/j.meegid.2021.104727] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/09/2021] [Accepted: 01/13/2021] [Indexed: 02/06/2023]
Abstract
Blood flukes within the genus Schistosoma (schistosomes) are responsible for the major disease, schistosomiasis, in tropical and sub-tropical areas. This disease is predominantly present on the African continent with more than 85% of the human cases. Schistosomes are also parasites of veterinary importance infecting livestock and wildlife. Schistosoma population genetic structure and diversity are important characteristics that may reflect variations in selection pressures such as those induced by host (mammalian and snail) environments, habitat change, migration and also treatment/control interventions, all of which also shape speciation and evolution of the whole Schistosoma genus. Investigations into schistosome population genetic structure, diversity and evolution has been an area of important debate and research. Supported by advances in molecular techniques with capabilities for multi-locus genetic analyses for single larvae schistosome genetic investigations have greatly progressed in the last decade. This paper aims to review the genetic studies of both animal and human infecting schistosome. Population genetic structures are reviewed at different spatial scales: local, regional or continental (i.e. phylogeography). Within species genetic diversities are discussed compared and the compounding factors discussed, including the effect of mass drug administration. Finally, the ability for intra-species hybridisation questions species integrities and poses many questions in relation to the natural epidemiology of co-endemic species. Here we review molecularly confirmed hybridisation events (in relation to human disease) and discuss the possible impact for ongoing and future control and elimination.
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Affiliation(s)
- O Rey
- Univ. Montpellier, CNRS, IFREMER, UPVD, IHPE, F-66000 Perpignan, France
| | - B L Webster
- Wolfson Wellcome Biomedical Laboratories, Department of Life Sciences, Natural History Museum, London SW7 5BD, United Kingdom; London Centre for Neglected Tropical Disease Research, Imperial College London School of Public Health, London W2 1PG, United Kingdom
| | - T Huyse
- Department of Biology, Royal Museum for Central Africa, Leuvensesteenweg 13, B-3080 Tervuren, Belgium; Laboratory of Biodiversity and Evolutionary Genomics, Department of Biology, KU Leuven, Ch. Deberiotstraat 32, B-3000 Leuven, Belgium
| | - D Rollinson
- Wolfson Wellcome Biomedical Laboratories, Department of Life Sciences, Natural History Museum, London SW7 5BD, United Kingdom; London Centre for Neglected Tropical Disease Research, Imperial College London School of Public Health, London W2 1PG, United Kingdom
| | - F Van den Broeck
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, University of Leuven, Leuven, Belgium; Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - J Kincaid-Smith
- Centre for Emerging, Endemic and Exotic Diseases (CEEED), Department of Pathobiology and Population Sciences (PPS), Royal Veterinary College, University of London, Hawkshead Campus, Herts AL9 7TA, United Kingdom
| | - A Onyekwere
- Univ. Montpellier, CNRS, IFREMER, UPVD, IHPE, F-66000 Perpignan, France
| | - J Boissier
- Univ. Montpellier, CNRS, IFREMER, UPVD, IHPE, F-66000 Perpignan, France.
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10
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Suri V, Bhalla A. Tropical Infections in Returning Travelers. Indian J Crit Care Med 2021; 25:S175-S183. [PMID: 34345135 PMCID: PMC8327792 DOI: 10.5005/jp-journals-10071-23873] [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] [Indexed: 11/26/2022] Open
Abstract
In the modern era, the relative ease and faster speed of travel have made the world a global village. An increasing number of people are traveling to distant and sometimes exotic locations for vacation/leisure or at times for business purposes. Along with the experiences of far-fetched lands, sometimes they bring bugs/organisms that are not native to their motherland. This makes the diagnosis and management of illnesses in a traveler challenging. In this review, we have tried to outline a management protocol for travelers returning with fever, with specific emphasis on trypanosomiasis and schistosomiasis. How to cite this article: Suri V, Bhalla A. Tropical Infections in Returning Travelers. Indian J Crit Care Med 2021;25(Suppl 2):S175–S183.
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Affiliation(s)
- Vikas Suri
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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11
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Hauptmann S, Gabler W, Tappe D. Histopathological and molecular diagnosis of orofacial schistosomiasis with an odontogenic cyst: An unusual case. HUMAN PATHOLOGY: CASE REPORTS 2020. [DOI: 10.1016/j.ehpc.2020.200456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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12
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Casacuberta-Partal M, Janse JJ, van Schuijlenburg R, de Vries JJC, Erkens MAA, Suijk K, van Aalst M, Maas JJ, Grobusch MP, van Genderen PJJ, de Dood C, Corstjens PLAM, van Dam GJ, van Lieshout L, Roestenberg M. Antigen-based diagnosis of Schistosoma infection in travellers: a prospective study. J Travel Med 2020; 27:5822102. [PMID: 32307517 PMCID: PMC7359925 DOI: 10.1093/jtm/taaa055] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Travellers infected with Schistosoma spp. might be pauci- or even asymptomatic on first presentation. Therefore, schistosomiasis may remain undiagnosed in this population. Active infection, as evidenced by the presence of the tissue-dwelling worm, can be demonstrated via the detection of adult worm-derived circulating anodic antigen (CAA) utilising a robust well-described lateral flow-(LF) based test applying background-free up-converting reporter particles (UCP). In this prospective study, we assessed the diagnostic value of serum and urine UCP-LF CAA test in comparison with two Schistosoma-specific serological assays detecting antibodies against adult worm antigen-immuno fluorescence assay (AWA-IFA) and against soluble egg antigen-enzyme-linked immunosorbent assay (SEA-ELISA) antigens in travellers. METHODS Samples were collected from 106 Dutch travellers who reported freshwater contact in sub-Saharan Africa and who were recruited up to 2 years after return. Subjects were asked to complete a detailed questionnaire on travel history, water contact, signs and symptoms compatible with schistosomiasis. RESULTS Two travellers were positive by serum CAA and an additional one by urine CAA. A total of 22/106 (21%) samples were antibody positive by AWA-IFA and 9/106 (9%) by SEA-ELISA. At follow-up 6 weeks and 6 months after praziquantel treatment, all seropositives remained antibody positive whereas CAA was cleared. Seropositivity could not be predicted by the type of fresh water-related activity, country visited or symptoms reported. CONCLUSION The low number of UCP-LF CAA positives suggests that in travellers, active infections often do not establish or have very low worm burden. Based on our high seroconversion rates, we conclude that the AWA-IFA assay is the most sensitive test to detect schistosome exposure. Given the lack of predictive symptoms or risk factors, we recommend schistosomiasis screening at least by serology in all travellers with reported freshwater contact in high-endemic areas.
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Affiliation(s)
- Miriam Casacuberta-Partal
- Department of Parasitology, Leiden University Medical Centre, L4-Q, PO Box 9600, 2333 ZA Leiden, The Netherlands
| | - Jacqueline J Janse
- Department of Parasitology, Leiden University Medical Centre, L4-Q, PO Box 9600, 2333 ZA Leiden, The Netherlands
| | - Roos van Schuijlenburg
- Department of Parasitology, Leiden University Medical Centre, L4-Q, PO Box 9600, 2333 ZA Leiden, The Netherlands
| | - Jutte J C de Vries
- Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Marianne A A Erkens
- Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Kitty Suijk
- Department of Infectious Diseases, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Mariëlle van Aalst
- Centre of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centres, AMC, University of Amsterdam, 1100 DD Amsterdam, The Netherlands
| | - Jaap J Maas
- Occupational Health and Safety Service, Amsterdam University Medical Centres, AMC, University of Amsterdam, 1100 DD Amsterdam, The Netherlands
| | - Martin P Grobusch
- Centre of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centres, AMC, University of Amsterdam, 1100 DD Amsterdam, The Netherlands
| | - Perry J J van Genderen
- Institute for Tropical Diseases, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Claudia de Dood
- Department of Cell and Chemical Biology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Centre, L4-Q, PO Box 9600, 2333 ZA Leiden, The Netherlands
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Centre, L4-Q, PO Box 9600, 2333 ZA Leiden, The Netherlands.,Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Meta Roestenberg
- Department of Parasitology, Leiden University Medical Centre, L4-Q, PO Box 9600, 2333 ZA Leiden, The Netherlands.,Department of Infectious Diseases, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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13
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Balahbib A, Amarir F, Bouhout S, Adlaoui EB, Rhajaoui M, Sadak A. Retrospective study on imported schistosomiasis in Morocco between 2005 and 2017. Trop Doct 2020; 50:317-321. [PMID: 32501173 DOI: 10.1177/0049475520928195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Since 2004, no indigenous cases of schistosomiasis have been found in Morocco; only imported cases have been detected. The aim of the present study was to describe and analyse the epidemiological profile of imported schistosomiasis between 2005 and 2017, and, by this, attract attention to the probability of a reintroduction of this disease. During this period, 27 cases were recorded in Morocco, with a male predominance (13:1). All cases reported were found among African immigrants from Mauritania (37%), Mali (18%) and Senegal (15%). Schistosoma heamatobium was the most dominant specie. Most cases were reported in Rabat and Agadir, where there are many snail habitats. To prevent a re-emergence of the disease, the main challenge would be to consolidate and maintain a sustainable surveillance and control system of the importation of bilharzia. The frequency of asymptomatic schistosomiasis justifies a systematic health check-up for all travellers, migrants and immigrants.
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Affiliation(s)
- Abdelaali Balahbib
- Ph.D student Laboratory of Biodiversity, Ecology and genome, Faculty of Sciences, Mohammed V University in Rabat, Morocco.,Ph.D student, National Reference Laboratory of Schistosomiasis and Malacology, National Institute of Hygiene, Agdal, Rabat, Morocco
| | - Fatima Amarir
- Professor, Laboratory of Immunity and Biodiversity, Department of Biology, Faculty of Sciences Aïn Chock, University Hassan II, Casablanca, Morocco
| | - Souad Bouhout
- Doctor, Direction of Epidemiology and Disease Control (DELM), Ministry of Health, Rabat, Morocco
| | - El Bachir Adlaoui
- Doctor, National Reference Laboratory of Schistosomiasis and Malacology, National Institute of Hygiene, Agdal, Rabat, Morocco
| | - Mohamed Rhajaoui
- Doctor, National Reference Laboratory of Schistosomiasis and Malacology, National Institute of Hygiene, Agdal, Rabat, Morocco
| | - Abderrahim Sadak
- Professor, Laboratory of Biodiversity, Ecology and genome, Faculty of Sciences, Mohammed V University in Rabat, Morocco
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14
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Comelli A, Riccardi N, Canetti D, Spinicci M, Cenderello G, Magro P, Nicolini LA, Marchese V, Zammarchi L, Castelli F, Bartoloni A, Di Biagio A, Caligaris S, Gaiera G. Delay in schistosomiasis diagnosis and treatment: a multicenter cohort study in Italy. J Travel Med 2020; 27:5588084. [PMID: 31616948 DOI: 10.1093/jtm/taz075] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Barriers to access to care, different diagnostic strategies and low awareness remain challenging issues in the fight against schistosomiasis.Our study aims to examine management of schistosomiasis in migrants attending large tertiary hospitals in Italy, in order to call for a comprehensive approach. METHODS A retrospective review of schistosomiasis cases was carried out between January 1, 2016, and December 31, 2017, in five large Infectious Disease Centers in Italy. We included all patients diagnosed with schistosomiasis. We differentiated among (i) asymptomatic patients diagnosed by serology either as healthy 'migrant evaluation' or as 'late evaluation' in patients followed because of a different infection and (ii) patients tested because of a suggestive clinical presentation. Patients characteristics and clinical data were recorded. RESULTS One hundred forty-nine patients were included, 137 (91.9%) were male, the median age was 26 years and 70% of them came from Sub-Saharan Africa.Thirty-eight asymptomatic patients (25.5%) were diagnosed by serology [15, (10.1%) among 'migrant evaluation' and 23 (15.4%) among 'late evaluation' group], and 111 (74.5%) presented with signs/symptoms.The median diagnostic delay from arrival in Italy was 31 months: 110 for asymptomatic group and 16 months for symptomatic patients. Among the 111 symptomatic patients, 41 individuals were already followed in our clinics, and they never underwent screening before appearance of evident disease. Among patients with positive serology who were tested by microscopy, 32/86 (37.2%) had confirmed diagnosis. Forty-five (37.8%) patients presented radiologic abnormalities. Praziquantel was the treatment of choice (70.1% for 3 days and 29.9% in a single-day dose), and 77 (51.7%) were lost to follow-up. CONCLUSIONS In our centers, a high proportion of patients were tested late after arrival, and most of them presented with clinical apparent disease. Well-defined strategies and implementation of recent guidelines are needed to improve early diagnosis and to overcome heterogeneity of practice.
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Affiliation(s)
- Agnese Comelli
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Niccolò Riccardi
- Clinic of Infectious Diseases, Vita-Salute San Raffaele University, Milan, Italy
| | - Diana Canetti
- Clinic of Infectious Diseases, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giovanni Cenderello
- Infectious Diseases Unit, EO Ospedali Galliera, Genoa, Italy.,Infectious Diseases Unit, ASL-1 Imperiese, Sanremo, Italy
| | - Paola Magro
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | | | - Valentina Marchese
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Castelli
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Antonio Di Biagio
- Infectious Diseases Unit, Policlinico San Martino Hospital, Genoa, Italy
| | - Silvio Caligaris
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Giovanni Gaiera
- Clinic of Infectious Diseases, Vita-Salute San Raffaele University, Milan, Italy
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15
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Saelens G, Gabriël S. Currently Available Monitoring and Surveillance Systems for Taenia spp., Echinococcus spp., Schistosoma spp., and Soil-Transmitted Helminths at the Control/Elimination Stage: A Systematic Review. Pathogens 2020; 9:E47. [PMID: 31935916 PMCID: PMC7168685 DOI: 10.3390/pathogens9010047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/02/2020] [Accepted: 01/02/2020] [Indexed: 12/13/2022] Open
Abstract
An increasing global focus on neglected tropical diseases (NTDs) has resulted in the set up of numerous control and elimination activities worldwide. This is partly true for Taenia solium taeniasis/cysticercosis, the most important foodborne parasitic infection. Despite substantial progress, adequate monitoring and surveillance (M&S) are required to sustain a status of control/elimination. This is often lacking, especially for T. solium. Therefore, the objective was to conduct a systematic literature review of the currently available M&S systems at the control/elimination stage of the four top-ranked helminth NTDs. Specifically, Taenia spp., Echinococcus spp., Schistosoma spp., and soil-transmitted helminths (STHs) were considered to determine if there are any similarities between their M&S systems and whether certain approaches can be adopted from each other. The systematic review demonstrated that rigorous M&S systems have been designed for the control/elimination stage of both STHs and schistosomiasis, particularly in China. On the other hand, a concept of M&S for Taenia spp. and Echinococcus spp. has not been fully developed yet, due to a lack of epidemiological data and the fact that many endemic countries are far away from reaching control/elimination. Moreover, accurate diagnostic tools for all four diseases are still imperfect, which complicates proper M&S. Finally, there is an urgent need to develop and harmonize/standardize M&S activities in order to reliably determine and compare the epidemiological situation worldwide.
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Affiliation(s)
- Ganna Saelens
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke B-9820, Belgium
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16
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Seidelman J, Hendershot EF, Henshaw N, Rein M. Caught on Colonoscopy: Schistosomiasis Manifesting as a Single Colonic Polyp. Am J Med 2018; 131:e441-e443. [PMID: 30059655 DOI: 10.1016/j.amjmed.2018.06.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Jessica Seidelman
- Division of Infectious Diseases and International Health, Department of Medicine.
| | - Edward F Hendershot
- Division of Infectious Diseases and International Health, Department of Medicine
| | | | - Matthew Rein
- Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Duke University, Durham, NC
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17
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Marchese V, Beltrame A, Angheben A, Monteiro GB, Giorli G, Perandin F, Buonfrate D, Bisoffi Z. Schistosomiasis in immigrants, refugees and travellers in an Italian referral centre for tropical diseases. Infect Dis Poverty 2018; 7:55. [PMID: 29907162 PMCID: PMC6004084 DOI: 10.1186/s40249-018-0440-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 05/16/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Schistosomiasis is one of the most important neglected tropical diseases. If unrecognised and untreated, the chronic infection can lead to irreversible complications. METHODS Retrospective observational study aimed at describing clinical history, laboratory findings and imaging presentation of imported schistosomiasis diagnosed at the Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital of Negrar, Verona, Italy from 2010 to 2014. The aim of our study was to assess differences in demographic characteristics, clinical presentation, laboratory data and ultrasound findings between immigrants/visiting friends and relatives (VFR) from endemic countries (endemic group) and expatriates/travellers (non-endemic group). RESULTS A total of 272 patients were retrieved: 234 in the endemic and 38 in the non-endemic group. Most of the patients acquired schistosomiasis in Africa (97.4%). Symptoms were reported by 52.9% of the patients; abdominal pain (36%), macroscopic hematuria (11.3%), and genito-urinary symptoms (7.4%) being the most frequently reported. Increased IgE and blood eosinophilia were observed in 169 (63.8%) and 130 (47.8%) patients, respectively. The proportion of positive serology was 250/272 (91.9%).The Circulating Cathodic Antigen CCA for Schistosoma mansoni was positive in 14/61 individuals (23%). At microscopy, infected subjects were 103/272 (37.9%). The species of Schistosoma found were S. haematobium (47.6%), S. mansoni (46.6%) or both (5.8%). Schistosomiasis was classified as confirmed in 103 (37.9%), probable in 165 (60.6%) and suspected in 4 (1.5%) cases using clinical presentation, laboratory data and ultrasound findings. The infection was further classified based on organ involvement: intestinal (17.9%), hepatosplenic (5.1%), urogenital (48.9%), and indeterminate (43.8%). The comparative analysis of endemic and non-endemic patients highlighted differences in sex and age. Endemic patients had more frequent ova identification (41.9% vs. 13.2%, P < 0.001) and increased IgE (70% vs. 26.3%, P < 0.001) when compared with non-endemic. Multivariate analyses showed that younger age, abnormal ultrasound findings and blood eosinophilia were significantly associated with positive microscopy (OR = 0.94, OR = 2.12, OR = 1.98, respectively). CONCLUSIONS Symptoms, eosinophilia and abnormal ultrasound findings were present in about half of patients, without differences between groups. Many patients had positive serology but negative microscopy, indicating that schistosomiasis might be misdiagnosed. A combination of diagnostic tools may facilitate the diagnosis.
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Affiliation(s)
- Valentina Marchese
- Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar, Italy
- University Department of Infectious and Tropical Diseases & WHO Collaborating Centre for TB/HIV and TB elimination, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Anna Beltrame
- Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar, Italy
| | - Andrea Angheben
- Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar, Italy
| | - Geraldo Badona Monteiro
- Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar, Italy
| | - Giovanni Giorli
- Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar, Italy
| | - Francesca Perandin
- Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar, Italy
| | - Dora Buonfrate
- Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar, Italy
| | - Zeno Bisoffi
- Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar, Italy
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18
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Rodrigues KMDP, Moreira BM. Preventing diseases in round-the-world travelers: a contemporary challenge for travel medicine advice. Rev Soc Bras Med Trop 2018; 51:125-132. [PMID: 29768543 DOI: 10.1590/0037-8682-0418-2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 03/27/2018] [Indexed: 11/22/2022] Open
Abstract
Providing advice for travelers embarking on long-term trips poses a challenge in travel medicine. A long duration of risk exposure is associated with underuse of protective measures and poor adherence to chemoprophylaxis, increasing the chances of acquiring infections. Recently, in our clinic, we observed an increase in the number of travelers undertaking round-the-world trips. These individuals are typically aged around 32 years and quit their jobs to embark on one-to-two-year journeys. Their destinations include countries in two or more continents, invariably Southeast Asia and Indonesia, and mostly involve land travel and visiting rural areas. Such trips involve flexible plans, increasing the challenge, especially with regard to malaria prophylaxis. Advising round-the-world travelers is time-consuming because of the amount of information that must be provided to the traveler. Advisors must develop strategies to commit the traveler to his/her own health, and verify their learnings on disease-prevention measures. Contacting the advisor after the appointment or during the trip can be helpful to clarify unclear instructions or diagnosis made and prescriptions given abroad. Infectious diseases are among the most frequent problems affecting travelers, many of which are preventable by vaccines, medicines, and precautionary measures. The dissemination of counterfeit medicines, particularly antibiotics and antimalarial medicines, emphasizes the need for travelers to carry medicines that they may possibly need on their trip. Additional advice on altitude, scuba diving, and other possible risks may also be given. Considering the difficulties in advising this group, we present a review of the main recommendations on advising these travelers.
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Affiliation(s)
- Karis Maria de Pinho Rodrigues
- Departamento de Medicina Preventiva, Centro de Informação em Saúde para Viajantes (Cives), Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Beatriz Meurer Moreira
- Instituto de Microbiologia Paulo de Goés, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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19
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Nakamura I, Yagi K, Kumagai T, Ohta N. Positive fecal occult blood test as a diagnostic cue for Schistosoma mansoni infection in a developed country. IDCases 2017; 10:108-109. [PMID: 29124010 PMCID: PMC5671391 DOI: 10.1016/j.idcr.2017.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 10/17/2017] [Accepted: 10/17/2017] [Indexed: 11/24/2022] Open
Abstract
The rise in eco-tourism and travel off the beaten track have increased numbers of tourists with schistosomiasis which is seldom seen in developed countries, although this disease is considered a neglected tropical disease especially in poor communities. A Guinean male living in Japan was seen complaining of severe constipation. He was positive for fecal occult blood (FOB) and underwent colonoscopy. Colonoscopy showed petechiae of the rectal mucosa, with pathologic examination of biopsy tissue showing calcified eggs of the genus Schistosoma. Direct examination of eggs in feces and antibody tests of serum confirmed the diagnosis of schistosomiasis. The patient was administered Praziquantel (400 mg/day for 2 days) and FOB and fecal ova tests were negative after treatment. FOB tests have been reported as a useful assessment of morbidities associated with intestinal schistosomiasis. In developed countries, positive FOB result, which is used as a main examination for bowel malignant disease, are not recognized as being due to schistosomiasis. As this tropical disease is rarely present in developed countries, it may be under-diagnosed. Schistosomiasis should be included in the differential diagnosis of patients with positive FOB tests.
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Affiliation(s)
- Itaru Nakamura
- Departments of Infection Prevention and Control, Tokyo Medical University Hospital, Tokyo, 162-0845, Japan
| | - Kenji Yagi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takashi Kumagai
- Environmental Parasitology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobuo Ohta
- Department of Clinical Nutrition, Faculty of Health Science, Suzuka University of Medical Science
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20
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Lingscheid T, Kurth F, Clerinx J, Marocco S, Trevino B, Schunk M, Muñoz J, Gjørup IE, Jelinek T, Develoux M, Fry G, Jänisch T, Schmid ML, Bouchaud O, Puente S, Zammarchi L, Mørch K, Björkman A, Siikamäki H, Neumayr A, Nielsen H, Hellgren U, Paul M, Calleri G, Kosina P, Myrvang B, Ramos JM, Just-Nübling G, Beltrame A, Saraiva da Cunha J, Kern P, Rochat L, Stich A, Pongratz P, Grobusch MP, Suttorp N, Witzenrath M, Hatz C, Zoller T. Schistosomiasis in European Travelers and Migrants: Analysis of 14 Years TropNet Surveillance Data. Am J Trop Med Hyg 2017; 97:567-574. [PMID: 28722637 PMCID: PMC5544096 DOI: 10.4269/ajtmh.17-0034] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 03/30/2017] [Indexed: 02/05/2023] Open
Abstract
Schistosomiasis remains one of the most prevalent parasitic diseases worldwide and the infection is frequently found in travelers and migrants. The European Network for Tropical Medicine and Travel Health conducted a sentinel surveillance study on imported schistosomiasis between 1997 and 2010. This report summarizes epidemiological and clinical data from 1,465 cases of imported schistosomiasis. Direct pathogen detection and serology were the main diagnostic tools applied. Of these, 486 (33%) cases were identified among European travelers, 231 (16%) among long-term expatriates, and 748 (51%) among non-European immigrants. Overall, only 18.6% of travelers had received pretravel advice; 95% of infections were acquired in the African region. On species level, Schistosoma mansoni was identified in 570 (39%) and Schistosoma haematobium in 318 (22%) cases; 57.5% of patients were symptomatic. Acute symptoms were reported in 27% of patients leading to earlier presentation within 3 months. Praziquantel was used in all patients to treat schistosomiasis. Many infections were detected in asymptomatic patients. In 47.4% of asymptomatic patients infection was detected by microscopy and in 39% by serology or antigen testing. Schistosomiasis remains a frequent infection in travelers and migrants to Europe. Travelers should be made aware of the risk of schistosomiasis infection when traveling to sub-Saharan Africa. Posttravel consultations particularly for returning expatriates are useful given the high potential for detecting asymptomatic infections.
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Affiliation(s)
- Tilman Lingscheid
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Kurth
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Clerinx
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Stefania Marocco
- Centro per le Malattie Tropicali, Ospedale S. Cuore, Negrar, Verona, Italy
| | - Begoña Trevino
- Tropical Medicine and International Health Unit, Hospital Vall d’Hebron Drassanes, PROSICS Barcelona, Barcelona, Spain
| | - Mirjam Schunk
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the Ludwig-Maximilians-University (LMU), Munich, Germany
| | - José Muñoz
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Ida E. Gjørup
- Infectious Diseases Unit, Herlev University Hospital, Copenhagen, Denmark
| | - Tomas Jelinek
- Berlin Centre for Travel and Tropical Medicine, Berlin, Germany
| | - Michel Develoux
- Service de Parasitologie, Hôpital Saint-Antoine, Paris, France
| | - Graham Fry
- Tropical Medical Bureau, Dublin, Ireland
| | - Thomas Jänisch
- Department of Infectious Diseases, University Hospital Heideberg, Heidelberg, Germany
| | - Matthias L. Schmid
- Department of Infection and Tropical Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Olivier Bouchaud
- Consultation de médecine tropicale, Hôpital Avicenne, Bobigny, France
| | | | - Lorenzo Zammarchi
- Infectious Diseases Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Kristine Mørch
- Department of Medicine, National Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| | - Anders Björkman
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Heli Siikamäki
- Inflammation Centre, Clinic of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Andreas Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Urban Hellgren
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Malgorzata Paul
- Department and Clinic of Tropical and Parasitic Diseases, Karol Marcinkowski University of Medical Sciences, Poznan, Poland
| | - Guido Calleri
- Travel Medicine Unit, Department of Infectious Diseases, Amedeo di Savoia Hospital-ASLTO2, Turin, Italy
| | - Pavel Kosina
- Department of Infectious Diseases, University Hospital, Hradec Králové, Czech Republic
| | | | - José M. Ramos
- Infectious Diseases Unit, Hospital General Universitario de Elche, Alicante, Spain
| | - Gudrun Just-Nübling
- Department of Internal Medicine II, Section Infectious Diseases and Tropical Medicine, University Hospital Frankfurt, Main, Germany
| | - Anna Beltrame
- Centro per le Malattie Tropicali, Ospedale S. Cuore, Negrar, Verona, Italy
- Clinic of Infectious Diseases, University of Udine, Udine, Italy
| | | | - Peter Kern
- Department of Internal Medicine III, Comprehensive Infectious Diseases Center, Ulm University Hospital, Ulm, Germany
| | - Laurence Rochat
- Department of Ambulatory Care and Community Medicine, Travel Clinic, University Hospital, Lausanne, Switzerland
| | - August Stich
- Abteilung Tropenmedizin, Missionsärztliche Klinik, Würzburg, Germany
| | - Peter Pongratz
- Division of Tropical Medicine and Infectious Diseases, Rostock University Medical Center, Germany
| | - Martin P. Grobusch
- Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Norbert Suttorp
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Witzenrath
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Hatz
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Thomas Zoller
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - TropNet Schistosomiasis Investigator Group
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany
- Institute of Tropical Medicine, Antwerp, Belgium
- Centro per le Malattie Tropicali, Ospedale S. Cuore, Negrar, Verona, Italy
- Tropical Medicine and International Health Unit, Hospital Vall d’Hebron Drassanes, PROSICS Barcelona, Barcelona, Spain
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the Ludwig-Maximilians-University (LMU), Munich, Germany
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Infectious Diseases Unit, Herlev University Hospital, Copenhagen, Denmark
- Berlin Centre for Travel and Tropical Medicine, Berlin, Germany
- Service de Parasitologie, Hôpital Saint-Antoine, Paris, France
- Tropical Medical Bureau, Dublin, Ireland
- Department of Infectious Diseases, University Hospital Heideberg, Heidelberg, Germany
- Department of Infection and Tropical Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Consultation de médecine tropicale, Hôpital Avicenne, Bobigny, France
- Hospital Carlos III, Madrid, Spain
- Infectious Diseases Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Medicine, National Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Inflammation Centre, Clinic of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department and Clinic of Tropical and Parasitic Diseases, Karol Marcinkowski University of Medical Sciences, Poznan, Poland
- Travel Medicine Unit, Department of Infectious Diseases, Amedeo di Savoia Hospital-ASLTO2, Turin, Italy
- Department of Infectious Diseases, University Hospital, Hradec Králové, Czech Republic
- Oslo University Hospital, Ullevål, Norway
- Infectious Diseases Unit, Hospital General Universitario de Elche, Alicante, Spain
- Department of Internal Medicine II, Section Infectious Diseases and Tropical Medicine, University Hospital Frankfurt, Main, Germany
- Clinic of Infectious Diseases, University of Udine, Udine, Italy
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Department of Internal Medicine III, Comprehensive Infectious Diseases Center, Ulm University Hospital, Ulm, Germany
- Department of Ambulatory Care and Community Medicine, Travel Clinic, University Hospital, Lausanne, Switzerland
- Abteilung Tropenmedizin, Missionsärztliche Klinik, Würzburg, Germany
- Division of Tropical Medicine and Infectious Diseases, Rostock University Medical Center, Germany
- Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Nontraditional infectious diseases surveillance systems. Infect Dis (Lond) 2017. [DOI: 10.1002/9781119085751.ch2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Le L, Hsieh MH. Diagnosing Urogenital Schistosomiasis: Dealing with Diminishing Returns. Trends Parasitol 2017; 33:378-387. [PMID: 28094201 DOI: 10.1016/j.pt.2016.12.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 12/09/2016] [Accepted: 12/09/2016] [Indexed: 01/05/2023]
Abstract
Urogenital schistosomiasis, caused by Schistosoma haematobium, is the most prevalent form of schistosomiasis affecting humans, and can result in severe bladder, kidney, ureteral, and genital pathologies. Chronic infection with S. haematobium has been linked with bladder cancer and increased risk for HIV infection. As mass drug administration with praziquantel increases in an attempt to transition from control to elimination of schistosomiasis, the need for updated, more sensitive diagnostic tools becomes more apparent, especially for use in areas of low infection intensity and for individuals with light infections. Here, we review established and investigational diagnostic tests utilized for urogenital schistosomiasis, highlighting new insights and recent advances.
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Affiliation(s)
- Loc Le
- Biomedical Research Institute, Rockville, Maryland, USA.
| | - Michael H Hsieh
- Biomedical Research Institute, Rockville, Maryland, USA; Division of Urology, Children's National Health System, Washington, DC, USA; The George Washington University, Washington, DC, USA
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23
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Approach to Eosinophilia in a Traveler from the Tropics. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00113-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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24
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Abou-Shady OM, Mohammed SS, Attia SS, Yusuf HAS, Helmy DO. Therapeutic effect of mefloquine on Schistosoma mansoni in experimental infection in mice. J Parasit Dis 2016; 40:259-67. [PMID: 27413290 PMCID: PMC4927471 DOI: 10.1007/s12639-014-0489-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 05/15/2014] [Indexed: 11/25/2022] Open
Abstract
Schistosomiasis is one of the most prevalent parasitic infections worldwide. Praziquantel is the drug of choice for treatment of schistosomiasis for its high efficacy. The present work was carried out on 160 mice to evaluate the therapeutic effect of mefloquine on experimental schistosomiasis mansoni. Mice were classified into 3 groups; group I (20 infected non-treated mice), group II included 60 infected mice which were further divided into group IIm (20 mice treated with 400 mg/kg mefloquine), group IIp (20 mice treated with 1,000 mg/kg/2 days praziquantel) and group IIpm (20 mice treated with 200 mg/kg mefloquine and 500 mg/kg praziquantel), group III included 80 non-infected mice subdivided into group IIIn (20 non-treated mice), group IIIm (20 mice treated with 400 mg/kg mefloquine), group IIIp (20 mice treated with 1,000 mg/kg/2 days praziquantel), group IIIpm (20 mice treated with 200 mg mefloquine and 500 mg praziquantel). Mefloquine significantly reduced worm burden, tissue egg load, number of liver granulomas and increased the percent of dead ova within granulomas. Combination of mefloquine and praziquantel gave better curative effects than praziquantel or mefloquine given alone.
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Affiliation(s)
| | | | - Samar Sayed Attia
- />Medical Parasitology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Dina Omar Helmy
- />Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Mucocutaneous manifestations of helminth infections: Trematodes and cestodes. J Am Acad Dermatol 2016; 73:947-57; quiz 957-8. [PMID: 26568338 DOI: 10.1016/j.jaad.2014.11.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 11/06/2014] [Accepted: 11/17/2014] [Indexed: 11/23/2022]
Abstract
In the 21st century, despite increased international travel for vacation, work, and medical missions and immigration into the United States, there is little published in the dermatology literature regarding the cutaneous manifestations of helminth infections. It has been estimated that 20% to 70% of international travelers suffer from some travel-related health problem. Approximately 17% of travelers seek medical care because of cutaneous disorders, many related to infectious etiologies. This review will focus on cutaneous diseases caused by helminth infections. Part I of the review focused on nematode infections; part II will focus on trematode and cestode infections. Nematodes are roundworms that cause diseases with cutaneous manifestations, such as cutaneous larval migrans, onchocerciasis, filariasis, gnathostomiasis, loiasis, dracunculiasis, strongyloidiasis, ascariasis, streptocerciasis, dirofilariasis, and trichinosis. Tremadotes, also known as flukes, cause schistosomiasis, paragonimiasis, and fascioliasis. Cestodes (tapeworms) are flat, hermaphroditic parasites that cause diseases such as sparganosis, cysticercosis, and echinococcus.
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Coron N, Le Govic Y, Kettani S, Pihet M, Hemery S, de Gentile L, Chabasse D. Early Detection of Schistosoma Egg-Induced Pulmonary Granulomas in a Returning Traveler. Am J Trop Med Hyg 2016; 94:611-4. [PMID: 26787142 DOI: 10.4269/ajtmh.15-0765] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 11/30/2015] [Indexed: 11/07/2022] Open
Abstract
We report the case of a French traveler who developed acute pulmonary schistosomiasis 2 months after visiting Benin. He presented with a 1-month history of fever, cough, and thoracic pain. Initial investigations revealed hypereosinophilia and multiple nodular lesions on chest computed tomography scan. Lung biopsies were performed 2 months later because of migrating chest infiltrates and increasing eosinophilia. Histological examination showed schistosomal egg-induced pulmonary granulomas with ova exhibiting a prominent terminal spine, resembling Schistosoma haematobium. However, egg shells were Ziehl-Neelsen positive, raising the possibility of a Schistosoma intercalatum or a Schistosoma guineensis infection. Moreover, involvement of highly infectious hybrid species cannot be excluded considering the atypical early pulmonary oviposition. This case is remarkable because of the rarity of pulmonary schistosomiasis, its peculiar clinical presentation and difficulties in making species identification. It also emphasizes the need to consider schistosomiasis diagnosis in all potentially exposed travelers with compatible symptoms.
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Affiliation(s)
- Noémie Coron
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire, Institut de Biologie en Santé, Angers, France; Groupe d'Etude des Interactions Hôte-Pathogène, L'UNAM Université, Université d'Angers, Angers, France; Laboratoire d'Anatomo-Cytopathologie, Centre de Pathologie de l'Ouest, Angers, France; Maison Médicale des Spécialistes, Village Santé Angers Loire, Trélazé, France
| | - Yohann Le Govic
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire, Institut de Biologie en Santé, Angers, France; Groupe d'Etude des Interactions Hôte-Pathogène, L'UNAM Université, Université d'Angers, Angers, France; Laboratoire d'Anatomo-Cytopathologie, Centre de Pathologie de l'Ouest, Angers, France; Maison Médicale des Spécialistes, Village Santé Angers Loire, Trélazé, France
| | - Sami Kettani
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire, Institut de Biologie en Santé, Angers, France; Groupe d'Etude des Interactions Hôte-Pathogène, L'UNAM Université, Université d'Angers, Angers, France; Laboratoire d'Anatomo-Cytopathologie, Centre de Pathologie de l'Ouest, Angers, France; Maison Médicale des Spécialistes, Village Santé Angers Loire, Trélazé, France
| | - Marc Pihet
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire, Institut de Biologie en Santé, Angers, France; Groupe d'Etude des Interactions Hôte-Pathogène, L'UNAM Université, Université d'Angers, Angers, France; Laboratoire d'Anatomo-Cytopathologie, Centre de Pathologie de l'Ouest, Angers, France; Maison Médicale des Spécialistes, Village Santé Angers Loire, Trélazé, France
| | - Sandrine Hemery
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire, Institut de Biologie en Santé, Angers, France; Groupe d'Etude des Interactions Hôte-Pathogène, L'UNAM Université, Université d'Angers, Angers, France; Laboratoire d'Anatomo-Cytopathologie, Centre de Pathologie de l'Ouest, Angers, France; Maison Médicale des Spécialistes, Village Santé Angers Loire, Trélazé, France
| | - Ludovic de Gentile
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire, Institut de Biologie en Santé, Angers, France; Groupe d'Etude des Interactions Hôte-Pathogène, L'UNAM Université, Université d'Angers, Angers, France; Laboratoire d'Anatomo-Cytopathologie, Centre de Pathologie de l'Ouest, Angers, France; Maison Médicale des Spécialistes, Village Santé Angers Loire, Trélazé, France
| | - Dominique Chabasse
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire, Institut de Biologie en Santé, Angers, France; Groupe d'Etude des Interactions Hôte-Pathogène, L'UNAM Université, Université d'Angers, Angers, France; Laboratoire d'Anatomo-Cytopathologie, Centre de Pathologie de l'Ouest, Angers, France; Maison Médicale des Spécialistes, Village Santé Angers Loire, Trélazé, France
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Flores MS, Hickey PW, Fields JH, Ottolini MG. A "Syndromic" Approach for Diagnosing and Managing Travel-Related Infectious Diseases in Children. Curr Probl Pediatr Adolesc Health Care 2015; 45:231-43. [PMID: 26253891 PMCID: PMC7106018 DOI: 10.1016/j.cppeds.2015.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Michelle S Flores
- Department of Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Patrick W Hickey
- Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Joshua H Fields
- Department of Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Martin G Ottolini
- Department of Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814; Office of Curriculum, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
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Rochat L, Bizzini A, Senn N, Bochud PY, Genton B, de Vallière S. Acute schistosomiasis: a risk underestimated by travelers and a diagnosis frequently missed by general practitioners-a cluster analysis of 42 travelers. J Travel Med 2015; 22:168-73. [PMID: 25604932 DOI: 10.1111/jtm.12187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/11/2014] [Accepted: 10/17/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND In 2011, a patient was admitted to our hospital with acute schistosomiasis after having returned from Madagascar and having bathed at the Lily waterfalls. On the basis of this patient's indication, infection was suspected in 41 other subjects. This study investigated (1) the knowledge of the travelers about the risks of schistosomiasis and their related behavior to evaluate the appropriateness of prevention messages and (2) the diagnostic workup of symptomatic travelers by general practitioners to evaluate medical care of travelers with a history of freshwater exposure in tropical areas. METHODS A questionnaire was sent to the 42 travelers with potential exposure to schistosomiasis. It focused on pre-travel knowledge of the disease, bathing conditions, clinical presentation, first suspected diagnosis, and treatment. RESULTS Of the 42 questionnaires, 40 (95%) were returned, among which 37 travelers (92%) reported an exposure to freshwater, and 18 (45%) were aware of the risk of schistosomiasis. Among these latter subjects, 16 (89%) still reported an exposure to freshwater. Serology was positive in 28 (78%) of 36 exposed subjects at least 3 months after exposure. Of the 28 infected travelers, 23 (82%) exhibited symptoms and 16 (70%) consulted their general practitioner before the information about the outbreak had spread, but none of these patients had a serology for schistosomiasis done during the first consultation. CONCLUSIONS The usual prevention message of avoiding freshwater contact when traveling in tropical regions had no impact on the behavior of these travelers, who still went swimming at the Lily waterfalls. This prevention message should, therefore, be either modified or abandoned. The clinical presentation of acute schistosomiasis is often misleading. General practitioners should at least request an eosinophil count, when confronted with a returning traveler with fever. If eosinophilia is detected, it should prompt the search for a parasitic disease.
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Affiliation(s)
- Laurence Rochat
- Travel Clinic, Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland
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Thakur KT, Zunt JR. Approach to the international traveler with neurological symptoms. FUTURE NEUROLOGY 2015. [DOI: 10.2217/fnl.14.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT International travelers commonly contract illnesses while abroad, with the highest risk in those who spend extended time in developing countries. As travel to worldwide destinations becomes more accessible, neurologists should be aware of travel-related infections and noninfectious conditions presenting with neurological manifestations. Travelers may present with a myriad of neurologic symptoms, including confusion, headache, weakness and sensory symptoms. In this review, we discuss the general approach to the returning traveler with neurological symptoms and discuss the differential diagnosis of symptoms commonly encountered in practice.
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Affiliation(s)
- Kiran T Thakur
- Division of Neuroinfectious Disease & Neuroimmunology, Department of Neurology, Johns Hopkins Hospital, 600 North Wolfe Street, Meyer 6–113, Baltimore, MD 21205, USA
| | - Joseph R Zunt
- Department of Neurology, Global Health, Medicine (Infectious Diseases) & Epidemiology, University of Washington, Seattle, WA, USA
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31
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Coltart CEM, Chew A, Storrar N, Armstrong M, Suff N, Morris L, Chiodini PL, Whitty CJM. Schistosomiasis presenting in travellers: a 15 year observational study at the Hospital for Tropical Diseases, London. Trans R Soc Trop Med Hyg 2015; 109:214-20. [DOI: 10.1093/trstmh/tru195] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Freedman DO. Infections in Returning Travelers. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7158178 DOI: 10.1016/b978-1-4557-4801-3.00324-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mendelson M, Han PV, Vincent P, von Sonnenburg F, Cramer JP, Loutan L, Kain KC, Parola P, Hagmann S, Gkrania-Klotsas E, Sotir M, Schlagenhauf P. Regional variation in travel-related illness acquired in Africa, March 1997-May 2011. Emerg Infect Dis 2014; 20:532-41. [PMID: 24655358 PMCID: PMC3966389 DOI: 10.3201/eid2004.131128] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.
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Hagmann SHF, Han PV, Stauffer WM, Miller AO, Connor BA, Hale DC, Coyle CM, Cahill JD, Marano C, Esposito DH, Kozarsky PE. Travel-associated disease among US residents visiting US GeoSentinel clinics after return from international travel. Fam Pract 2014; 31:678-87. [PMID: 25261506 PMCID: PMC4624308 DOI: 10.1093/fampra/cmu063] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND US residents make 60 million international trips annually. Family practice providers need to be aware of travel-associated diseases affecting this growing mobile population. OBJECTIVE To describe demographics, travel characteristics and clinical diagnoses of US residents who present ill after international travel. METHODS Descriptive analysis of travel-associated morbidity and mortality among US travellers seeking care at 1 of the 22 US practices and clinics participating in the GeoSentinel Global Surveillance Network from January 2000 to December 2012. RESULTS Of the 9624 ill US travellers included in the analysis, 3656 (38%) were tourist travellers, 2379 (25%) missionary/volunteer/research/aid workers (MVRA), 1580 (16%) travellers visiting friends and relatives (VFRs), 1394 (15%) business travellers and 593 (6%) student travellers. Median (interquartile range) travel duration was 20 days (10-60 days). Pre-travel advice was sought by 45%. Hospitalization was required by 7%. Compared with other groups of travellers, ill MVRA travellers returned from longer trips (median duration 61 days), while VFR travellers disproportionately required higher rates of inpatient care (24%) and less frequently had received pre-travel medical advice (20%). Illnesses of the gastrointestinal tract were the most common (58%), followed by systemic febrile illnesses (18%) and dermatologic disorders (17%). Three deaths were reported. Diagnoses varied according to the purpose of travel and region of exposure. CONCLUSIONS Returning ill US international travellers present with a broad spectrum of travel-associated diseases. Destination and reason for travel may help primary health care providers to generate an accurate differential diagnosis for the most common disorders and for those that may be life-threatening.
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Affiliation(s)
- Stefan H F Hagmann
- Division of Pediatric Infectious Diseases, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, NY, USA,
| | - Pauline V Han
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - William M Stauffer
- Department of Medicine and Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Andy O Miller
- Division of Infectious Diseases, Bronx-Lebanon Hospital Center, Bronx, NY, USA, Present address: Division of Infectious Diseases, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Bradley A Connor
- Division of Gastroenterology and Hepatology, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA
| | - DeVon C Hale
- Department of Internal Medicine, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Christina M Coyle
- Division of Infectious Diseases, Jacobi Medical Center, Albert-Einstein College of Medicine, Bronx, NY, USA
| | - John D Cahill
- St. Luke's Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, Salt Lake City, UT, USA and
| | - Cinzia Marano
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA, Present address: GlaxoSmithKline Biologicals, Brussels, Belgium
| | - Douglas H Esposito
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abstract
Schistosomiasis is the second most common socio-economically devastating parasitic disease after malaria, affecting about 240 million residents of developing countries. In Africa, it predominantly manifests as urogenital disease, and the main infective agent is Schistosoma hematobium. Endemicity is propagated by poor socio-economic status and environmental degradation due to rapid urbanization. Recreational swimming is a potent medium for the spread of disease in children and adolescents. Most affected individuals are asymptomatic. The male and female worms are equipped with an extraordinary capacity for immune evasion and are able to co-habit for several decades within the pelvic venous plexus. Eggs deposited in the bladder wall resist elimination by type 1 T lymphocytes. Instead, they are sustained by pro-fibrogenic encapsulation (as modulated by type 2 helper cells). Progressive bladder disease results in obstructive uropathy and predisposes to (mostly) squamous cell carcinoma. Schistosomal glomerulopathy manifests as a clinical spectrum of asymptomatic proteinuria, nephrosis and/or nephritic syndrome. Findings on renal biopsy may be influenced by co-morbidity with Salmonella bacteria, amyloidosis and hepatitis C infection. Potentially fatal Katayama fever and spinal radiculopathy may ensue in tourists visiting an endemic zone. Early detection by urine microscopy is hampered by low urinary excretion rates of the parasite eggs. Although useful in travelers with newly acquired disease, the results of the serological antibody assay may be false positive in residents of an endemic zone. Cystoscopy, however, may be invaluable. Due to its safety, effectiveness and once-daily dosing, praziquantel is the drug of choice. An integrated approach that includes mass chemotherapy, environmental health programs and public health education is the most cost-effective preventive strategy.
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Affiliation(s)
- Oluwatoyin F Bamgbola
- Division of Pediatric Nephrology, Children's Hospital of New Orleans, Louisiana State University Health Science Center, 200 Henry Clay Avenue, New Orleans, LA, 70118, USA,
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Bernin H, Lotter H. Sex bias in the outcome of human tropical infectious diseases: influence of steroid hormones. J Infect Dis 2014; 209 Suppl 3:S107-13. [PMID: 24966190 DOI: 10.1093/infdis/jit610] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Numerous investigations have revealed a bias toward males in the susceptibility to and severity of a variety of infectious diseases, especially parasitic diseases. Although different external factors may influence the exposure to infection sources among males and females, one recurrent phenomenon indicative of a hormonal influence is the simultaneous increase in disease occurrence and hormonal activity during the aging process. Substantial evidence to support the influence of hormones on disease requires rigorously controlled human population studies, as well as the same sex dimorphism being observed under controlled laboratory conditions. To date, only very few studies conducted have fulfilled these criteria. Herein, we introduce tropical infectious diseases, including amebiasis, malaria, leishmaniasis, toxoplasmosis, schistosomiasis, and paracoccidioidomycosis, in which hormones are suspected to play a role in disease processes. We summarize the most recent findings from epidemiologic studies in humans and from hormone replacement studies in animal models, as well as data regarding the influence of hormones on immune responses underlying the pathology of the diseases.
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Affiliation(s)
- Hannah Bernin
- Department of Molecular Parasitology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Hanna Lotter
- Department of Molecular Parasitology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
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Comparative analysis of the diagnostic performance of adult, cercarial and egg antigens assessed by ELISA, in the diagnosis of chronic human Schistosoma mansoni infection. Parasitol Res 2014; 113:3467-76. [DOI: 10.1007/s00436-014-4017-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 06/30/2014] [Indexed: 11/25/2022]
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Cnops L, Soentjens P, Clerinx J, Van Esbroeck M. A Schistosoma haematobium-specific real-time PCR for diagnosis of urogenital schistosomiasis in serum samples of international travelers and migrants. PLoS Negl Trop Dis 2013; 7:e2413. [PMID: 24009791 PMCID: PMC3757062 DOI: 10.1371/journal.pntd.0002413] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 07/27/2013] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Diagnosis of urogenital schistosomiasis by microscopy and serological tests may be elusive in travelers due to low egg load and the absence of seroconversion upon arrival. There is need for a more sensitive diagnostic test. Therefore, we developed a real-time PCR targeting the Schistosoma haematobium-specific Dra1 sequence. METHODOLOGY/PRINCIPAL FINDINGS The PCR was evaluated on urine (n = 111), stool (n = 84) and serum samples (n = 135), and one biopsy from travelers and migrants with confirmed or suspected schistosomiasis. PCR revealed a positive result in 7/7 urine samples, 11/11 stool samples and 1/1 biopsy containing S. haematobium eggs as demonstrated by microscopy and in 22/23 serum samples from patients with a parasitological confirmed S. haematobium infection. S. haematobium DNA was additionally detected by PCR in 7 urine, 3 stool and 5 serum samples of patients suspected of having schistosomiasis without egg excretion in urine and feces. None of these suspected patients demonstrated other parasitic infections except one with Blastocystis hominis and Entamoeba cyst in a fecal sample. The PCR was negative in all stool samples containing S. mansoni eggs (n = 21) and in all serum samples of patients with a microscopically confirmed S. mansoni (n = 22), Ascaris lumbricoides (n = 1), Ancylostomidae (n = 1), Strongyloides stercoralis (n = 1) or Trichuris trichuria infection (n = 1). The PCR demonstrated a high specificity, reproducibility and analytical sensitivity (0.5 eggs per gram of feces). CONCLUSION/SIGNIFICANCE The real-time PCR targeting the Dra1 sequence for S. haematobium-specific detection in urine, feces, and particularly serum, is a promising tool to confirm the diagnosis, also during the acute phase of urogenital schistosomiasis.
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Affiliation(s)
- Lieselotte Cnops
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
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40
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Lim PL. Schistosoma haematobium in China, ex-Africa: new populations at risk? J Travel Med 2013; 20:211-3. [PMID: 23809068 DOI: 10.1111/jtm.12031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 09/25/2012] [Accepted: 10/01/2012] [Indexed: 10/26/2022]
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Abstract
Schistosomiasis is increasingly encountered among travelers returning from the tropics, mainly from Africa. Schistosoma-infected travelers have served as sentinels for the existence of unknown foci of transmission even outside Africa. Acute schistosomiasis (also termed Katayama syndrome) is the common manifestation among travelers and may follow exposure to any of the Schistosoma species. Neuroschistosomiasis is a rare complication but may result in severe disability. Diagnosis in travelers is hampered by the poor sensitivity of microscopy in urine and stool, especially during acute infections, while seroconversion may be delayed for a period of weeks. During acute schistosomiasis, symptomatic treatment is the only available therapy, while for chronic schistosomiasis, praziquantel is the only drug available, despite reports of emerging resistance to it. Since the potential for exposure to Schistosoma through travel will probably continue to increase, it is clear that new, sensitive diagnostic methods and drugs affecting the parasite in all its stages are needed.
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Ross AGP, Olds GR, Cripps AW, Farrar JJ, McManus DP. Enteropathogens and chronic illness in returning travelers. N Engl J Med 2013; 368:1817-25. [PMID: 23656647 DOI: 10.1056/nejmra1207777] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Allen G P Ross
- Griffith Health Institute, Griffith University, Gold Coast, QLD, Australia.
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Abstract
BACKGROUND Schistosomiasis is a tropical disease caused by worms of the genus Schistosoma. It is endemic in the Caribbean Islands, the middle east, eastern Asia, South America, and Africa. In nonendemic areas, physicians should be aware of this condition in travelers returning from endemic areas and in immigrants. The main disease-causing species are Schistosoma haematobium, Schistosoma mansoni, and Schistosoma japonicum. Neuroschistosomiasis is an ectopic form of the disease that is mainly associated with S. japonicum infection. Involvement of the central nervous system (CNS) in S. mansoni infection is neglected and underestimated. Neuroschistosomiasis mansoni can be classified into cerebral, spinal, and encephalomyelitic forms in the course of an acute or chronic infection. REVIEW SUMMARY We review the CNS involvement by S. mansoni infection with an emphasis on life cycle, epidemiology, pathophysiology and immunology, clinical manifestations, diagnostic criteria, differential diagnosis, current treatment guidelines, and prognosis. CONCLUSIONS Although an underreported CNS infection, found mainly in underdeveloped countries, neuroschistosomiasis mansoni still causes significant incapacity and morbidity. Hence, neurologists should become familiar with this infection worldwide and include it in the differential diagnosis of CNS involvement in travelers returning from endemic areas and in immigrants.
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Abstract
Malaria, diarrhea, respiratory infections, and cutaneous larva migrans are common travel-related infections observed in children and adolescents returning from trips to developing countries. Children visiting friends and relatives are at the highest risk because few visit travel clinics before travel, their stays are longer, and the sites they visit are more rural. Clinicians must be able to prepare their pediatric-age travelers before departure with preventive education, prophylactic and self-treating medications, and vaccinations. Familiarity with the clinical manifestations and treatment of travel-related infections will secure prompt and effective therapy.
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Logan S, Armstrong M, Moore E, Nebbia G, Jarvis J, Suvari M, Bligh J, Chiodini PL, Brown M, Doherty T. Acute schistosomiasis in travelers: 14 years' experience at the Hospital for Tropical Diseases, London. Am J Trop Med Hyg 2013; 88:1032-4. [PMID: 23530076 DOI: 10.4269/ajtmh.12-0646] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We report 79 cases of acute schistosomiasis. Most of these cases were young, male travelers who acquired their infection in Lake Malawi. Twelve had a normal eosinophil count at presentation and 11 had negative serology, although two had neither eosinophilia nor positive serology when first seen. Acute schistosomiasis should be considered in any febrile traveler with a history of fresh water exposure in an endemic area once malaria has been excluded.
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Affiliation(s)
- Sarah Logan
- Hospital for Tropical Diseases, Mortimer Market Centre, London, United Kingdom.
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Cavalcanti MG, Silva LF, Peralta RHS, Barreto MGM, Peralta JM. Schistosomiasis in areas of low endemicity: a new era in diagnosis. Trends Parasitol 2013; 29:75-82. [PMID: 23290589 DOI: 10.1016/j.pt.2012.11.003] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 11/13/2012] [Accepted: 11/26/2012] [Indexed: 01/02/2023]
Abstract
Parasitological detection of Schistosoma is the cornerstone of schistosomiasis diagnosis in areas of transmission worldwide. However, a steep decrease of sensitivity in low-endemicity areas (LEAs) compromises estimation of schistosomiasis. Despite the restricted utilization of molecular and immunodiagnostic techniques, recent improvements and advances have been contributing to change this scenario, especially in LEAs. Nonetheless, the main issue in a new era of diagnosis overcomes technical advances per se and relates to the loss of 'gold standards' in schistosomiasis diagnosis in LEAs. Here, we review and discuss the current role of molecular and immunodiagnostic methods in schistosomiasis management.
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Affiliation(s)
- Marta G Cavalcanti
- Serviço de Doenças Infecciosas e Parasitárias, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, RJ 21941-913, Brazil
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Abstract
Liver disease is an important source of morbidity among ill returning travelers. Jaundice is one of the most common and obvious symptoms of liver disease, the differential diagnosis of which is extensive, especially in travelers. Jaundice in travelers can arise from both infectious and noninfectious causes. We herein summarize the most common parasitic etiologies that may lead to jaundice in the returned traveler, visitors of friends and relatives, or new immigrants, and describe the etiology, epidemiology, and pathogenesis of clinical features of each.
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Affiliation(s)
- Wilson W Chan
- Calgary Laboratory Services, Calgary, Alberta, Canada
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