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Sibomana JP, Getaneh FB, Graham B, Giraneza R. Unexpected rapid symptom response after praziquantel to intestinal Schistosoma mansoni symptoms: A case report from Rwanda. SAGE Open Med Case Rep 2023; 11:2050313X231190013. [PMID: 37533487 PMCID: PMC10392147 DOI: 10.1177/2050313x231190013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/10/2023] [Indexed: 08/04/2023] Open
Abstract
The clinical effect of praziquantel on chronic intestinal schistosomiasis in the literature is lacking. We report a patient who presented with 3 years of non-specific abdominal pain and underwent colonoscopy, which revealed colon polyps that, on biopsy, were confirmed to be due to Schistosoma mansoni. The patient was given a single dose of praziquantel, and his abdominal symptoms disappeared within 24 h. Patients with abdominal pain in the setting of chronic Schistosoma infection should be given praziquantel and assess response clinically.
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Affiliation(s)
- Jean Pierre Sibomana
- Department of Medicine, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Medicine, King Faisal Hospital, Kigali, Rwanda
| | - Ferehiwot B Getaneh
- Department of Medicine, University Teaching Hospital of Butare, Butare, po Box 2534 Kigali Rwanda
| | - Brian Graham
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Lung Biology Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Robert Giraneza
- Department of Medicine, University Teaching Hospital of Butare, Butare, po Box 2534 Kigali Rwanda
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Nalunjogi J, Mucching-Toscano S, Sibomana JP, Centis R, D'Ambrosio L, Alffenaar JW, Denholm J, Blanc FX, Borisov S, Danila E, Duarte R, García-García JM, Goletti D, Ong CWM, Rendon A, Thomas TA, Tiberi S, van den Boom M, Sotgiu G, Migliori GB. Impact of COVID-19 on diagnosis of TB, MDR-TB and on mortality in 11 countries in Europe, Northern America and Australia. A Global Tuberculosis Network study. Int J Infect Dis 2023:S1201-9712(23)00076-0. [PMID: 36893943 PMCID: PMC9991328 DOI: 10.1016/j.ijid.2023.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVE Although evidence is growing on the overall impact of the COVID-19 pandemic on tuberculosis (TB) services, global studies based on national data are needed to better quantify the extent of the impact and the countries' preparedness to tackle the two diseases. The aim of this study was to compare the number of people with new diagnosis or recurrence of TB disease, the number of drug-resistant (DR)-TB, and the number of TB deaths in 2020 versus 2019 in 11 countries in Europe, Northern America and Australia. METHODS TB managers or directors of national reference centres of the selected countries provided the agreed-upon variables through a validated questionnaire on a monthly basis. A descriptive analysis compared incidence of TB and drug-resistant TB and mortality of the pre-COVID-19 year (2019) versus the first year of the COVID-19 pandemic (2020). RESULTS Comparing 2020 vs 2019, lower number of TB cases (new diagnosis or recurrence) was notified in all countries (except USA-Virginia and Australia), and less DR-TB notifications (apart from France, Portugal and Spain). The deaths among TB cases were higher in 2020 compared to 2019 in most countries with three countries (France, Netherlands, USA-Virginia) reporting minimal TB-related mortality.
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Affiliation(s)
- Joanitah Nalunjogi
- Lung Institute, Makerere University College of Health Sciences, Upper Mulago Hill, P.O. Box 7749, Kampala, Uganda; Tuberculosis Research Programme (PII-TB), Spanish Society of Pneumology and Thoracic Surgery (SEPAR), C/ de Provença, 108, Bajos 2ª, Barcelona 08029, Spain.
| | | | - Jean Pierre Sibomana
- Pulmonary and Critical Care Department, University of Rwanda/Butare University Teaching Hospital, KN 4 Ave, Kigali, Rwanda.
| | - Rosella Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS (Istituti di Ricovero e Cura a Carattere Scientifico), Via Roncaccio 16, Tradate 21049, Italy.
| | - Lia D'Ambrosio
- Public Health Consulting Group, Via S. Pelli 12, Lugano 6900, Switzerland.
| | - Jan-Willem Alffenaar
- The University of Sydney Pharmacy School, A15, Science Rd, Camperdown 2006, Sydney, New South Wales, Australia; Westmead Hospital, Cnr Hawkesbury Road and, Darcy Rd, Westmead Sydney, New South Wales, Australia; Sydney Institute of Infectious Diseases, The University of Sydney, Camperdown 2006, New South Wales, Sydney, Australia.
| | - Justin Denholm
- Melbourne Health Victorian Tuberculosis Program, the Royal Melbourne Hospital, 300 Grattan St, Parkville, Melbourne, Australia; Peter Doherty Institute for Infection and Immunity, University of Melbourne, 792 Elizabeth Street, Melbourne 3000, Victoria, Australia.
| | - François-Xavier Blanc
- Nantes Université, Centre hospitalier universitaire (CHU) de Nantes, l'institut du thorax, 5 allée de l'Île-Gloriette 44093 Nantes Cedex 01, France.
| | - Sergey Borisov
- Moscow Research and Clinical Center for Tuberculosis Control, Yauzskaya Alleya, 2, Moscow 107564, Russia.
| | - Edvardas Danila
- Clinic of Chest Diseases, Immunology and Allergology, Vilnius University Medical Faculty, Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Santariškių g. 2, Vilnius 08661, Lithuania.
| | - Raquel Duarte
- Reference Centre for MDR-TB in the North of Portugal, Hospital Centre Vila Nova de Gaia, Department of Pneumology. ICBAS - School of Medicine and Biomedical Center, University of Porto, R. Jorge de Viterbo Ferreira 228, Porto 4050-313, Portugal; EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal. Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, Porto 4050-600, Portugal.
| | - José-María García-García
- Tuberculosis Research Programme (PII-TB), Spanish Society of Pneumology and Thoracic Surgery (SEPAR), C/ de Provença, 108, Bajos 2ª, Barcelona 08029, Spain.
| | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases (INMI) 'L. Spallanzani' - Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Via Portuense, 292, Rome 00149, Italy.
| | - Catherine W M Ong
- Institute for Health Innovation & Technology (iHealthtech), National University of Singapore, MD6, 14 Medical Drive #14-01 Singapore 117599.; Division of Infectious Diseases, Department of Medicine, National University Hospital Singapore, 5 Lower Kent Ridge Rd, Singapore 119074; Infectious Disease Translational Research Programme, Department of Medicine, National University of Singapore, Yong Loo Lin School of Medicine, 10 Medical Dr, Singapore 117597.
| | - Adrian Rendon
- Facultad de Medicina, Servicio de Neumologia, Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias (CIPTIR), Universidad Autonoma de Nuevo Leon, Av. Francisco I. Madero y, Mitras Centro, Monterrey 64460, N.L., Mexico..
| | - Tania A Thomas
- Division of Infectious Diseases and International Health, University of Virginia, 400 Emmet Street South, Charlottesville, VA 22903, Virginia, USA.
| | - Simon Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, Garrod Building, Turner St, London E1 2AD, London, UK; Royal London Hospital, Barts Health National Health Service Trust, the Royal Hospital, Whitechapel Rd, London E1 1BB, UK.
| | - Martin van den Boom
- World Health Organization, Regional Office for the Eastern Mediterranean Region, Monazamet El Seha El Alamia Str, Extension of Abdel Razak El Sanhouri Street, P.O. Box 7608, Nasr City Cairo 11371, Egypt.
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Piazza Università 21, Sassari, Italy.
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS (Istituti di Ricovero e Cura a Carattere Scientifico), Via Roncaccio 16, Tradate 21049, Italy.
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Sinkala E, Ahmed HY, Sibomana JP, Lee MH, Kassa B, Kumar R, Mazimba S, Binegdie AB, Mpisa S, Wamundila K, Graham BB, Hilton JF. Rationale and design of a screening study to detect schistosomiasis-associated pulmonary hypertension in Ethiopia and Zambia. Pulm Circ 2022; 12:e12072. [PMID: 35514775 PMCID: PMC9063961 DOI: 10.1002/pul2.12072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/28/2022] [Accepted: 03/27/2022] [Indexed: 11/05/2022] Open
Abstract
Schistosomiasis is a major cause of pulmonary arterial hypertension (PAH) worldwide, but the prevalence and risk factors for schistosomiasis-associated PAH (SchPAH) development are not well understood. Schistosomiasis-associated hepatosplenic disease (SchHSD) is thought to be a major risk factor for PAH development. Herein, we describe our plans for prospectively screening SchHSD subjects for clinical evidence of PAH at two major academic medical centers and national referral hospitals in Addis Ababa, Ethiopia and Lusaka, Zambia. The screening study will primarily be conducted by echocardiography, in addition to clinical assessments. Plasma samples will be drawn and banked for subsequent analysis based on preclinical animal model rationale. If successful, this study will demonstrate feasibility of conducting prospective cohort studies of SchPAH screening in schistosomiasis-endemic regions of Africa, and provide initial data on clinic-based disease prevalence and potential mechanistic biomarkers underlying disease pathogenesis.
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Affiliation(s)
- Edford Sinkala
- Hepatology Clinic, Department of MedicineUniversity of Zambia Teaching HospitalLusakaZambia
| | - Hanan Yusuf Ahmed
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Tikur Anbessa Specialized Hospital, College of Health SciencesUniversity of Addis AbabaAddis AbabaEthiopia
| | - Jean Pierre Sibomana
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Tikur Anbessa Specialized Hospital, College of Health SciencesUniversity of Addis AbabaAddis AbabaEthiopia
- Department of Medicine, Butare University Teaching HospitalUniversity of RwandaButareRwanda
| | - Michael H. Lee
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Biruk Kassa
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Rahul Kumar
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Sula Mazimba
- Department of Medicine, Division of CardiologyUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | - Amsalu B. Binegdie
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Tikur Anbessa Specialized Hospital, College of Health SciencesUniversity of Addis AbabaAddis AbabaEthiopia
| | - Sydney Mpisa
- Hepatology Clinic, Department of MedicineUniversity of Zambia Teaching HospitalLusakaZambia
| | - Kawana Wamundila
- Hepatology Clinic, Department of MedicineUniversity of Zambia Teaching HospitalLusakaZambia
| | - Brian B. Graham
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Joan F. Hilton
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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Sibomana JP, Campeche A, Carvalho-Filho RJ, Correa RA, Duani H, Pacheco Guimaraes V, Hilton JF, Kassa B, Kumar R, Lee MH, Loureiro CMC, Mazimba S, Mickael C, Oliveira RKF, Ota-Arakaki JS, Rezende CF, Silva LCS, Sinkala E, Ahmed HY, Graham BB. Schistosomiasis Pulmonary Arterial Hypertension. Front Immunol 2020; 11:608883. [PMID: 33362796 PMCID: PMC7758287 DOI: 10.3389/fimmu.2020.608883] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a disease of the lung blood vessels that results in right heart failure. PAH is thought to occur in about 5% to 10% of patients with hepatosplenic schistosomiasis, particularly due to S. mansoni. The lung blood vessel injury may result from a combination of embolization of eggs through portocaval shunts into the lungs causing localized Type 2 inflammatory response and vessel remodeling, triggering of autonomous pathology that becomes independent of the antigen, and high cardiac output as seen in portopulmonary hypertension. The condition is likely underdiagnosed as there is little systematic screening, and risk factors for developing PAH are not known. Screening is done by echocardiography, and formal diagnosis requires invasive right heart catheterization. Patients with Schistosoma-associated PAH show reduced functional capacity and can be treated with pulmonary vasodilators, which improves symptoms and may improve survival. There are animal models of this disease that might help in understanding disease pathogenesis and identify novel targets to screen and treatment. Pathogenic mechanisms include Type 2 immunity and activation and signaling in the TGF-β pathway. There are still major uncertainties regarding Schistosoma-associated PAH development, course and treatment.
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Affiliation(s)
- Jean Pierre Sibomana
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Tikur Anbessa Specialized Hospital, College of Health Sciences, University of Addis Ababa, Addis Ababa, Ethiopia
- Department of Medicine, Butare University Teaching Hospital, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Aloma Campeche
- Division of Gastroenterology, Department of Medicine, Santa Casa Hospital, Salvador, Bahia, Brazil
| | - Roberto J. Carvalho-Filho
- Division of Gastroenterology, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Ricardo Amorim Correa
- Internal Medicine/Pulmonary Division, Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Helena Duani
- Internal Medicine/Infectious Diseases Division, Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Virginia Pacheco Guimaraes
- Pulmonary Department, Hospital Júlia Kubistchek, Fundação Hospitalar of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Joan F. Hilton
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Biruk Kassa
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Rahul Kumar
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Michael H. Lee
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | | | - Sula Mazimba
- Division of Cardiology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Claudia Mickael
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Rudolf K. F. Oliveira
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Jaquelina S. Ota-Arakaki
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Camila Farnese Rezende
- Pulmonary Medicine, Hospital das Clinicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luciana C. S. Silva
- Internal Medicine Department, Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Edford Sinkala
- Hepatology Clinic, Department of Medicine, University of Zambia Teaching Hospital, Lusaka, Zambia
| | - Hanan Yusuf Ahmed
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Tikur Anbessa Specialized Hospital, College of Health Sciences, University of Addis Ababa, Addis Ababa, Ethiopia
| | - Brian B. Graham
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
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Sibomana JP, McNamara RL, Walker TD. Patient, clinician and logistic barriers to blood pressure control among adult hypertensives in rural district hospitals in Rwanda: a cross-sectional study. BMC Cardiovasc Disord 2019; 19:231. [PMID: 31638907 PMCID: PMC6805529 DOI: 10.1186/s12872-019-1203-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/24/2019] [Indexed: 11/06/2022] Open
Abstract
Background Hypertension management in rural, resource-poor settings is difficult. Detailed understanding of patient, clinician and logistic factors which pose barriers to effective blood pressure control could enable strategies to improve control to be implemented. Methods This cross-sectional, multifactorial, observational study was conducted at four rural Rwandan district hospitals, examining patient, clinician and logistic factors. Questionnaires were administered to consenting adult outpatient hypertensive patients, obtaining information on sociodemographic factors, past management for hypertension, and adherence (by Morisky Medication Adherence 8-item Scale (MMAS-8). Treating clinicians identified local difficulties in providing hypertension management from a standard World Health Organisation list and nominated their preferred treatment regimens. Blood pressure measurements and other clinical data were collected during the study visit and used to determine blood pressure control, according to goals from JNC-8 guidelines. Medication availability and cost at each hospital’s pharmacy were reviewed as logistic barriers to treatment. Results The 112 participating patients were 80% female, with only 41% having completed primary education. Self-reported adherence by the MMAS-8 was high in 77% (86/112) and significantly associated) with literacy, lack of medication side effects and the particular hospital and pharmacy attended (all p < 0.05). However, of 89 patients with blood pressure data, only 26 (29%) had achieved goal blood pressure. No patient factor were statistically associated with poor blood pressure control. Among 30 participating clinicians, deficiencies in knowledge were evident; 43% (13/30) and 37% (11/30) chose a loop diuretic as their prescribed medication and as an ideal medication, respectively, for a newly diagnosed hypertensive patient without comorbidities, counter to JNC 8 recommendations, and 50% (15/30) identified clinician non-adherence to hypertension guidelines as a barrier. In the pharmacies, common anti-hypertensive medications were affordably available (> 6 out of 8 examined medications available in all pharmacies, cost <US$0.50 per month); however, clinicians perceived medication cost and availability to be barriers to care. Conclusions Clinician-based factors are a major barrier to blood pressure control in rural district hospitals in Rwanda, and blood pressure control overall was poor. Patient and logistic barriers to blood pressure were not evident in this study.
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Affiliation(s)
- J P Sibomana
- Department of Internal Medicine, University of Rwanda, BP 111, Muhanga, Southern Province, Rwanda.
| | - R L McNamara
- Yale University School of Medicine, New Haven, CT, USA
| | - T D Walker
- Department of Internal Medicine, University of Rwanda, BP 111, Muhanga, Southern Province, Rwanda.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
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