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Jones S, Juhász A, Makaula P, Cunningham LJ, Archer J, Nkolokosa C, Namacha G, Kambewa E, Lally D, Kapira DR, Chammudzi P, Kayuni SA, Musaya J, Stothard JR. A first report of Pseudosuccinea columella (Say, 1817), an alien intermediate host for liver fluke, in Malawi. Parasit Vectors 2024; 17:186. [PMID: 38605395 PMCID: PMC11007905 DOI: 10.1186/s13071-024-06241-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
Starting in October 2021, quarterly malacological surveys have been undertaken in Malawi, with the sampling of 12 specified freshwater habitats throughout a calendar year. Each survey monitors the presence of aquatic intermediate snail hosts of medical and veterinary importance. In March 2023, the alien lymnaeid species Pseudosuccinea columella was encountered for the first time in the surveys, in Nsanje District. This species identity was later confirmed upon DNA analysis of mitochondrial ribosomal 16S sequences. In July 2023, P. columella was also noted at single sites within Mangochi and Chikwawa Districts, and again in Nsanje District, with an additional location observed. Of particular importance, our sampled location in Mangochi District was directly connected to Lake Malawi, which expands the species list of invasive molluscs in this lake. While P. columella is a well-known intermediate snail host for human and animal fascioliasis, screening collected snails for trematode cercariae, alongside molecular xenomonitoring, did not yield equivocal evidence of active fluke infection. However, the newly recognized presence of this alien intermediate snail host within Lake Malawi, and along the Shire River Valley, flags a new concern in altered local transmission potential for human and animal fascioliasis.
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Affiliation(s)
- S Jones
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK.
| | - A Juhász
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
- Semmelweis University, Budapest, Hungary
| | - P Makaula
- Malawi-Liverpool-Wellcome (MLW) Clinical Research Programme, Blantyre, Malawi
| | - L J Cunningham
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - J Archer
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - C Nkolokosa
- Malawi-Liverpool-Wellcome (MLW) Clinical Research Programme, Blantyre, Malawi
| | - G Namacha
- Malawi-Liverpool-Wellcome (MLW) Clinical Research Programme, Blantyre, Malawi
| | - E Kambewa
- Malawi-Liverpool-Wellcome (MLW) Clinical Research Programme, Blantyre, Malawi
| | - D Lally
- Malawi-Liverpool-Wellcome (MLW) Clinical Research Programme, Blantyre, Malawi
| | - D R Kapira
- Malawi-Liverpool-Wellcome (MLW) Clinical Research Programme, Blantyre, Malawi
| | - P Chammudzi
- Malawi-Liverpool-Wellcome (MLW) Clinical Research Programme, Blantyre, Malawi
| | - S A Kayuni
- Malawi-Liverpool-Wellcome (MLW) Clinical Research Programme, Blantyre, Malawi
| | - J Musaya
- Malawi-Liverpool-Wellcome (MLW) Clinical Research Programme, Blantyre, Malawi
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
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Archer J, Yeo SM, Gadd G, Pennance T, Cunningham LJ, Juhàsz A, Jones S, Chammudzi P, Kapira DR, Lally D, Namacha G, Mainga B, Makaula P, LaCourse JE, Kayuni SA, Musaya J, Stothard JR, Webster BL. Development, validation, and pilot application of a high throughput molecular xenomonitoring assay to detect Schistosoma mansoni and other trematode species within Biomphalaria freshwater snail hosts. Curr Res Parasitol Vector Borne Dis 2024; 5:100174. [PMID: 38618156 PMCID: PMC11010794 DOI: 10.1016/j.crpvbd.2024.100174] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/27/2024] [Accepted: 03/14/2024] [Indexed: 04/16/2024]
Abstract
Schistosomiasis is a neglected tropical disease (NTD) caused by infection with parasitic trematodes of the genus Schistosoma that can lead to debilitating morbidity and mortality. The World Health Organization recommend molecular xenomonitoring of Biomphalaria spp. freshwater snail intermediate hosts of Schistosoma mansoni to identify highly focal intestinal schistosomiasis transmission sites and monitor disease transmission, particularly in low-endemicity areas. A standardised protocol to do this, however, is needed. Here, two previously published primer sets were selected to develop and validate a multiplex molecular xenomonitoring end-point PCR assay capable of detecting S. mansoni infections within individual Biomphalaria spp. missed by cercarial shedding. The assay proved highly sensitive and highly specific in detecting and amplifying S. mansoni DNA and also proved highly sensitive in detecting and amplifying non-S. mansoni trematode DNA. The optimised assay was then used to screen Biomphalaria spp. collected from a S. mansoni-endemic area for infection and successfully detected S. mansoni infections missed by cercarial shedding as well as infections with non-S. mansoni trematodes. The continued development and use of molecular xenomonitoring assays such as this will aid in improving disease control efforts, significantly reducing disease-related morbidities experienced by those in schistosomiasis-endemic areas.
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Affiliation(s)
- John Archer
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
- Wolfson Wellcome Biomedical Laboratories, Department of Zoology, Natural History Museum, Cromwell Road, London, SW7 5HD, UK
| | - Shi Min Yeo
- Wolfson Wellcome Biomedical Laboratories, Department of Zoology, Natural History Museum, Cromwell Road, London, SW7 5HD, UK
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Grace Gadd
- Wolfson Wellcome Biomedical Laboratories, Department of Zoology, Natural History Museum, Cromwell Road, London, SW7 5HD, UK
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Tom Pennance
- Wolfson Wellcome Biomedical Laboratories, Department of Zoology, Natural History Museum, Cromwell Road, London, SW7 5HD, UK
- College of Osteopathic Medicine of the Pacific – Northwest, Western University of Health Sciences, Lebanon, OR, 97355, USA
| | - Lucas J. Cunningham
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Alexandra Juhàsz
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
- Institute of Medical Microbiology, Semmelweis University, Budapest, H-1089, Hungary
| | - Sam Jones
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Priscilla Chammudzi
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, Blantyre, P.O. Box 30096, Malawi
- Department of Pathology, School of Medicine and Oral Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, 360, Malawi
| | - Donales R. Kapira
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, Blantyre, P.O. Box 30096, Malawi
- Department of Pathology, School of Medicine and Oral Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, 360, Malawi
| | - David Lally
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, Blantyre, P.O. Box 30096, Malawi
- Department of Pathology, School of Medicine and Oral Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, 360, Malawi
| | - Gladys Namacha
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, Blantyre, P.O. Box 30096, Malawi
- Department of Pathology, School of Medicine and Oral Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, 360, Malawi
| | - Bright Mainga
- Laboratory Department, Mangochi District Hospital, Mangochi, P.O. Box 42, Malawi
| | - Peter Makaula
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, Blantyre, P.O. Box 30096, Malawi
| | - James E. LaCourse
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Sekeleghe A. Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, Blantyre, P.O. Box 30096, Malawi
- Department of Pathology, School of Medicine and Oral Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, 360, Malawi
| | - Janelisa Musaya
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, Blantyre, P.O. Box 30096, Malawi
- Department of Pathology, School of Medicine and Oral Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, 360, Malawi
| | - J. Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Bonnie L. Webster
- Wolfson Wellcome Biomedical Laboratories, Department of Zoology, Natural History Museum, Cromwell Road, London, SW7 5HD, UK
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Archer J, Cunningham LJ, Juhàsz A, Jones S, Doull F, LaCourse JE, Mainga B, Makaula P, Kayuni SA, Musaya J, Stothard JR. Molecular Epidemiology and Assemblage Typing of Giardia duodenalis in School-Age Children Situated along the Southern Shoreline of Lake Malawi, Malawi. Am J Trop Med Hyg 2023; 109:626-639. [PMID: 37549892 PMCID: PMC10484258 DOI: 10.4269/ajtmh.23-0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/16/2023] [Indexed: 08/09/2023] Open
Abstract
Almost all human giardiasis infections are caused by Giardia duodenalis assemblages A and B. Differentiation between human infections with these assemblages, as well as between single-assemblage (A or B) and mixed-assemblage (A and B) infections, is therefore needed to better understand the pathological impact of infection with either, or both, assemblages. We assessed the prevalence of G. duodenalis assemblages A and B using 305 fecal samples provided by school-age children situated along the southern shoreline of Lake Malawi. Concurrently, intestinal pathology data were also collected to test for association(s) between assemblage infection status and intestinal health. Prevalence of G. duodenalis infection was 39.3% by real-time polymerase chain reaction. Of all identified infections, 32% were single G. duodenalis assemblage A and 32% were single G. duodenalis assemblage B, whereas 33% were mixed-assemblage infections. Fifteen unique G. duodenalis assemblage A and 13 unique G. duodenalis assemblage B β-giardin haplotypes were identified. There was a positive association between single infection with G. duodenalis assemblage B and both self-reporting of abdominal pain (odds ratio [OR]: 3.05, P = 0.004) and self-reporting of diarrhea (OR: 3.1, P = 0.003). No association between single infection with assemblage A and any form of intestinal pathology was found. Additionally, there was a positive association between mixed-assemblage infections and self-reporting of abdominal pain (OR: 3.1, P = 0.002). Our study highlights the importance G. duodenalis assemblage typing and reaffirms the need for improved access to water, sanitation and hygiene infrastructure in rural areas of low- and middle-income countries.
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Affiliation(s)
- John Archer
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Lucas J. Cunningham
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Alexandra Juhàsz
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary
| | - Sam Jones
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ffion Doull
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - James E. LaCourse
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Bright Mainga
- Laboratory Department, Mangochi District Hospital, Mangochi, Malawi
- Malawi Liverpool Wellcome Trust Programme of Clinical Tropical Research, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Peter Makaula
- Malawi Liverpool Wellcome Trust Programme of Clinical Tropical Research, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Sekeleghe A. Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Trust Programme of Clinical Tropical Research, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Department of Pathology, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- MASM Medi Clinics Limited, Medical Aid Society of Malawi, Area 12 Medi Clinic and Head Office, Lilongwe, Malawi
| | - Janelisa Musaya
- Malawi Liverpool Wellcome Trust Programme of Clinical Tropical Research, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Department of Pathology, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - J. Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Kayuni SA, Abdullahi A, Alharbi MH, Makaula P, Lampiao F, Juziwelo L, LaCourse EJ, Kumwenda JJ, Leutscher PDC, Geretti AM, Stothard JR. Prospective pilot study on the relationship between seminal HIV-1 shedding and genital schistosomiasis in men receiving antiretroviral therapy along Lake Malawi. Sci Rep 2023; 13:14154. [PMID: 37644069 PMCID: PMC10465494 DOI: 10.1038/s41598-023-40756-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
Male genital schistosomiasis (MGS) is hypothesized to increase seminal shedding of HIV-1. This prospective pilot study assessed seminal HIV-1 RNA shedding in men on long-term ART with and without a diagnosis of MGS. Study visits occurred at 0, 1, 3, 6 and 12 months. MGS was diagnosed by egg positivity on semen microscopy or PCR of seminal sediment. After optimization of the HIV-RNA assay, we examined 72 paired plasma and semen samples collected from 31 men (15 with and 16 without MGS) over 12 months. HIV-1 RNA was detected in 7/72 (9.7%) seminal samples and 25/72 (34.7%) plasma samples. When comparing sample pairs, 5/72 (6.9%) showed HIV-1 RNA detection only in the seminal sample. Overall, 3/31 (9.7%) participants, all with MGS, had detectable HIV-1 RNA in semen while plasma HIV-1 RNA was undetectable (< 22 copies/mL), with seminal levels ranging up to 400 copies/mL. Two participants showing HIV-1 RNA in seminal fluid from the MGS-negative group also had concomitant HIV-1 RNA detection in plasma. The findings suggest that MGS can be associated with low-level HIV-1 RNA shedding despite virologically suppressive ART. Further studies are warranted to confirm these observations and assess its implications.
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Affiliation(s)
- Sekeleghe A Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK.
- MASM Medi Clinics Limited, Medical Aid Society of Malawi (MASM), Lilongwe, Malawi.
- Malawi Liverpool Wellcome (MLW) Clinical Research Programme, Kamuzu University of Health Sciences (KUHeS), Queen Elizabeth Central Hospital Campus, Chipatala Avenue, Blantyre, Malawi.
- Department of Pathology, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Mahatma Gandhi Road, Blantyre, Malawi.
| | - Adam Abdullahi
- Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, MA, USA
- Cambridge Institute of Therapeutic Immunology and Infectious Diseases, University of Cambridge, Cambridge, UK
| | - Mohammad H Alharbi
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
- Ministry of Health, Buraydah, 52367, Saudi Arabia
| | - Peter Makaula
- Malawi Liverpool Wellcome (MLW) Clinical Research Programme, Kamuzu University of Health Sciences (KUHeS), Queen Elizabeth Central Hospital Campus, Chipatala Avenue, Blantyre, Malawi
- Research for Health, Environment and Development (RHED), Mangochi, Malawi
| | - Fanuel Lampiao
- Physiology Unit, Department of Biomedical Sciences, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Mahatma Gandhi Road, Blantyre, Malawi
| | - Lazarus Juziwelo
- National Schistosomiasis and Soil-Transmitted Helminths Control Programme, Community Health Sciences Unit, Ministry of Health, Lilongwe, Malawi
| | - E James LaCourse
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Johnstone J Kumwenda
- Department of Internal Medicine, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Mahatma Gandhi Road, Blantyre, Malawi
| | - Peter Derek Christian Leutscher
- Centre for Clinical Research, North Denmark Regional Hospital and Department of Clinical Medicine, Aalborg University, Aalborg, Region Nordjylland, Denmark
| | - Anna Maria Geretti
- Department of Infectious Diseases, Fondazione PTV, University of Rome Tor Vergata, Rome, Italy
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
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Reed AL, O'Ferrall AM, Kayuni SA, Baxter H, Stanton MC, Stothard JR, Jewell C. Modelling the age-prevalence relationship in schistosomiasis: A secondary data analysis of school-aged-children in Mangochi District, Lake Malawi. Parasite Epidemiol Control 2023; 22:e00303. [PMID: 37234267 PMCID: PMC10205779 DOI: 10.1016/j.parepi.2023.e00303] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023] Open
Abstract
Schistosomiasis is an aquatic snail borne parasitic disease, with intestinal schistosomiasis (IS) and urogenital schistosomiasis (UGS) caused by Schistosoma mansoni and S. haematobium infections, respectively. School-aged-children (SAC) are a known vulnerable group and can also suffer from co-infections. Along the shoreline of Lake Malawi a newly emerging outbreak of IS is occurring with increasing UGS co-infection rates. Age-prevalence (co)infection profiles are not fully understood. To shed light on these (co)infection trends by Schistosoma species and by age of child, we conducted a secondary data analysis of primary epidemiological data collected from SAC in Mangochi District, Lake Malawi, as published previously. Available diagnostic data by child, were converted into binary response infection profiles for 520 children, aged 6-15, across 12 sampled schools. Generalised additive models were then fitted to mono- and dual-infections. These were used to identify consistent population trends, finding the prevalence of IS significantly increased [p = 8.45e-4] up to 11 years of age then decreasing thereafter. A similar age-prevalence association was observed for co-infection [p = 7.81e-3]. By contrast, no clear age-infection pattern for UGS was found [p = 0.114]. Peak prevalence of Schistosoma infection typically occurs around adolescence; however, in this newly established IS outbreak with rising prevalence of UGS co-infections, the peak appears to occur earlier, around the age of 11 years. As the outbreak of IS fulminates, further temporal analysis of the age-relationship with Schistosoma infection is justified. This should refer to age-prevalence models which could better reveal newly emerging transmission trends and Schistosoma species dynamics. Dynamical modelling of infections, alongside malacological niche mapping, should be considered to guide future primary data collection and intervention programmes.
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Affiliation(s)
- Amber L. Reed
- Lancaster Medical School, Lancaster University, Bailrigg House, Bailrigg, Lancaster LA1 4YE, UK
- Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke PI, Liverpool L3 5QA, UK
| | - Angus M. O'Ferrall
- Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke PI, Liverpool L3 5QA, UK
| | - Sekeleghe A. Kayuni
- Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke PI, Liverpool L3 5QA, UK
- MASM Medi Clinics Limited, Medical Aid Society of Malawi (MASM), P.O. Box 31659, Lilongwe 3. Malawi
| | - Hamish Baxter
- Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke PI, Liverpool L3 5QA, UK
| | - Michelle C. Stanton
- Vector Biology, Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool L3 5QA, UK
| | - J. Russell Stothard
- Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke PI, Liverpool L3 5QA, UK
| | - Christopher Jewell
- Mathematics and Statistics, Lancaster University, Bailrigg House, Bailrigg, Lancaster LA1 4YE, UK
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Kayuni SA, Alharbi MH, Shaw A, Fawcett J, Makaula P, Lampiao F, Juziwelo L, LaCourse EJ, Verweij JJ, Stothard JR. Detection of male genital schistosomiasis (MGS) by real-time TaqMan® PCR analysis of semen from fishermen along the southern shoreline of Lake Malawi. Heliyon 2023; 9:e17338. [PMID: 37539175 PMCID: PMC10394912 DOI: 10.1016/j.heliyon.2023.e17338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 08/05/2023] Open
Abstract
Background Male genital schistosomiasis (MGS) is an underappreciated complication of schistosomiasis, first described in 1911. However, its epidemiology, diagnostic testing and case management are not well understood in sub-Saharan Africa. To shed new light on MGS prevalence in Malawi, a longitudinal cohort study was conducted among adult fishermen along the southern shoreline of Lake Malawi using detection of schistosome DNA in participants' semen by real-time TaqMan® PCR analyses. Methods Upon recruitment of 376 participants, 210 submitted urine samples and 114 semen samples for parasitological tests. Thereafter, the available semen samples were subsequently analysed by real-time TaqMan® PCR. Praziquantel (PZQ) treatment was provided to all participants with follow-ups attempted at 1, 3, 6 and 12-months' intervals. Results At baseline, real-time PCR detected a higher MGS cohort prevalence of 26.6% (n = 64, Ct-value range: 18.9-37.4), compared to 10.4% by semen microscopy. In total, 21.9% of participants (n = 114) were detected with MGS either by semen microscopy and/or by real-time PCR. Subsequent analyses at 1-, 3-, 6- and 12-month follow-ups indicated variable detection dynamics. Conclusions This first application of a molecular method, to detect MGS in sub-Saharan Africa, highlights the need for development of such molecular diagnostic tests which should be affordable and locally accessible. Our investigation also notes the persistence of MGS over a calendar year despite praziquantel treatment.
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Affiliation(s)
- Sekeleghe A. Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
- MASM Medi Clinics Limited, Medical Society of Malawi (MASM), P. O. Box 31659, Lilongwe 3, Malawi
- Malawi Liverpool Wellcome (MLW) Clinical Research Programme, Kamuzu University Of Health Sciences (KUHeS), Queen Elizabeth Central Hospital campus, Chipatala Avenue, Blantyre, Malawi
| | - Mohammad H. Alharbi
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
- Ministry of Health, Buraydah 52367, Saudi Arabia
| | - Alexandra Shaw
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
| | - Joanna Fawcett
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
| | - Peter Makaula
- Malawi Liverpool Wellcome (MLW) Clinical Research Programme, Kamuzu University Of Health Sciences (KUHeS), Queen Elizabeth Central Hospital campus, Chipatala Avenue, Blantyre, Malawi
- Research for Health, Environment and Development (RHED), Mangochi, Malawi
| | - Fanuel Lampiao
- Physiology Department, College of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Lazarus Juziwelo
- National Schistosomiasis and STH Control Programme, Community Health Sciences Unit, Ministry of Health, Lilongwe, Malawi
| | - E. James LaCourse
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
| | - Jaco J. Verweij
- Elisabeth TweeSteden Hospital Tilburg, Microvida Laboratory for Medical Microbiology and Immunology, Hilvarenbeekseweg 60, Tilburg, the Netherlands
| | - J. Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
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Alharbi MH, Condemine C, Hesketh J, Kayuni SA, Arme TM, Archer J, Jones S, LaCourse EJ, Makaula P, Musaya J, Stothard JR. Biomphalaria pfeifferi (Gastropoda: Planorbidae) in Lake Malawi and Upper Shire River, Mangochi District, Malawi: Distribution, Genetic Diversity and Pre-Patent Schistosome Infections. Trop Med Infect Dis 2023; 8:126. [PMID: 36828541 PMCID: PMC9963223 DOI: 10.3390/tropicalmed8020126] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/01/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
In November 2017, Biomphalaria pfeifferi, the key intermediate host for Schistosoma mansoni in Africa, was first reported in Lake Malawi, Mangochi District. Two subsequent malacological surveys in 2018 and 2019 confirmed its lacustrine presence, as well as its presence along the Upper Shire River. These surveys provided sufficient specimens for analyses of the genetic structure and a transmission assessment for intestinal schistosomiasis. A total of 76 collected snails were characterized by a DNA sequence analysis of a 650 bp fragment of the mitochondrial cytochrome oxidase subunit 1 (cox1); by size fractionation of six fluorescently labelled microsatellite loci (Bgμl16, Bgμl, Bpf8, rg6, U-7, and rg9);by denaturing PAGE; and by detection of pre-patent Schistosoma infection by real-time PCR with a TaqMan® probe. Five closely related cox1 haplotypes were identified, all present within a single location, with only one haplotype common across all the other locations sampled. No allelic size variation was detected with the microsatellites and all loci were monomorphic. Overall, the pre-patent prevalence of Schistosoma spp. was 31%, with infected snails found at several sampling locations. In this part of Lake Malawi, Bi. pfeifferi exhibits low genetic diversity and is clearly being exposed to the miracidia of S. mansoni, which is likely facilitating the autochthonous transmission of this parasite.
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Affiliation(s)
- Mohammad H. Alharbi
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
- Ministry of Health, Buraydah 52367, Saudi Arabia
| | - Charlotte Condemine
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Josie Hesketh
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Sekeleghe A. Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
- MASM Medi Clinics Limited, Medical Society of Malawi (MASM), Lilongwe P.O.Box 1254, Malawi
| | - Thomas M. Arme
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
- School of Biodiversity, One Health & Veterinary Medicine, University of Glasgow, Glasgow G12 8QQ, UK
| | - John Archer
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Sam Jones
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - E. James LaCourse
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Peter Makaula
- Research for Health, Environment and Development (RHED), Mangochi P.O. Box 345, Malawi
| | - Janelisa Musaya
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Private Bag, Blantyre P.O. Box 30096, Malawi
| | - J. Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
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Kayuni SA, Al-Harbi MH, Makaula P, Injesi B, Mainga B, Lampiao F, Juziwelo L, LaCourse EJ, Stothard JR. Pathological Abnormalities Observed on Ultrasonography among Fishermen Associated with Male Genital Schistosomiasis (MGS) along the South Lake Malawi Shoreline in Mangochi District, Malawi. Trop Med Infect Dis 2022; 7:tropicalmed7080169. [PMID: 36006261 PMCID: PMC9415567 DOI: 10.3390/tropicalmed7080169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 07/07/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022] Open
Abstract
Schistosome eggs cause granulomata and pathological abnormalities, detectable with non-invasive radiological techniques such as ultrasonography which could be useful in male genital schistosomiasis (MGS). As part of our novel MGS study among fishermen along Lake Malawi, we describe pathologies observed on ultrasonography and praziquantel (PZQ) treatment over time. Fishermen aged 18+ years were recruited, submitted urine and semen for parasitological and molecular testing, and thereafter, transabdominal pelvic and scrotal ultrasonography, assessing pathologies in the prostate, seminal vesicles, epididymis and testes. Standard PZQ treatment and follow-up invitation at 1-, 3-, 6- and 12-months’ time-points were offered. A total of 130 recruited fishermen underwent ultrasonography at baseline (median age: 32.0 years); 27 (20.9%, n = 129) had S. haematobium eggs in urine (median: 1.0 egg/10 mL), 10 (12.3%, n = 81) in semen (defined as MGS, median: 2.9 eggs/mL ejaculate) and 16 (28.1%, n = 57) had a positive seminal Schistosoma real-time PCR. At baseline, 9 fishermen (6.9%, n = 130) had abnormalities, with 2 positive MGS having prostatic and testicular nodules. Fewer abnormalities were observed on follow-up. In conclusion, pathologies detected in male genitalia by ultrasonography can describe MGS morbidity in those with positive parasitological and molecular findings. Ultrasonography advances and accessibility in endemic areas can support monitoring of pathologies’ resolution after treatment.
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Affiliation(s)
- Sekeleghe A. Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
- MASM Medi Clinics Limited, Medical Society of Malawi (MASM), Lilongwe P.O. Box 1254, Malawi
- Correspondence: ; Tel.: +265-888-367367
| | - Mohammad H. Al-Harbi
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Peter Makaula
- Research for Health, Environment and Development (RHED), Mangochi P.O. Box 345, Malawi
| | - Boniface Injesi
- MASM Medi Clinics Limited, Medical Society of Malawi (MASM), Lilongwe P.O. Box 1254, Malawi
| | - Bright Mainga
- Laboratory Department, Mangochi District Hospital, Mangochi District Assembly, Mangochi P.O. Box 1854, Malawi
| | - Fanuel Lampiao
- Physiology Department, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Mahatma Gandhi Road, Blantyre 312225, Malawi
| | - Lazarus Juziwelo
- National Schistosomiasis and Soil-Transmitted Helminths Control Programme, Community Health Sciences Unit, Ministry of Health, Lilongwe P.O. Box 30377, Malawi
| | - E. James LaCourse
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - J. Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
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9
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Kayuni SA, Alharbi MH, Makaula P, Lampiao F, Juziwelo L, LaCourse EJ, Stothard JR. Male Genital Schistosomiasis Along the Shoreline of Lake Malawi: Baseline Prevalence and Associated Knowledge, Attitudes and Practices Among Local Fishermen in Mangochi District, Malawi. Front Public Health 2021; 9:590695. [PMID: 34095041 PMCID: PMC8175656 DOI: 10.3389/fpubh.2021.590695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [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: 08/02/2020] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Male genital schistosomiasis (MGS) is an often-overlooked chronic consequence of urogenital schistosomiasis (UGS) associated with Schistosoma haematobium eggs and associated pathologies in the genital system of afflicted men. Despite the first formal description of MGS in 1911 by Madden, its epidemiology, diagnostic testing and case management of today are not well-described. However, since several interactions between MGS and the Human Immunodeficiency Virus (HIV) are known, there is renewed public health interest in MGS across sub-Saharan Africa (SSA). To shed new light upon MGS in Malawi, a longitudinal cohort study was set up among fishermen along the southern shoreline of Lake Malawi in Mangochi District, Malawi, to document its prevalence and assess mens' knowledge, attitudes and practices (KAP). After providing informed written consent, fishermen (n = 376) aged 18+ years (median age: 30 years, range: 18-70 years) were recruited and submitted urine and semen for point-of-care (POC) field and laboratory diagnostic parasitological tests. Individual questionnaires were administered to assess their KAP, with praziquantel (PZQ) treatment provided to all participants. Baseline prevalence of MGS (S. haematobium eggs in semen) was 10.4% (n = 114, median: 5.0 eggs per ml, range: 0.1-30.0) while for UGS (S. haematobium eggs in urine) was 17.1% (n = 210, median: 2.3 eggs per 10 ml, range: 0.1-186.0) and 3.8% were positive by POC circulating cathodic antigen (POC-CCA), indicative of a Schistosoma mansoni infection. Just under 10% of participants reported having experienced symptoms associated with MGS, namely genital or coital pain, or haemospermia. A total of 61.7% reported previous difficulties in accessing PZQ therapy, with 34.8% having received PZQ therapy before. There was a significant correlation between MGS infection and the frequency of fishing in a week (rho = -0.25, n = 100, p = 0.01). In conclusion, MGS is prevalent among local fishermen yet knowledge of the disease is poor. We therefore call for improved availability and accessibility to MGS diagnostics, PZQ treatment within ongoing control interventions. This will improve the lives and reproductive health of men, their partners and communities in this shoreline environment of Lake Malawi.
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Affiliation(s)
- Sekeleghe A Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom.,MASM Medi Clinics Limited, Medical Aid Society of Malawi (MASM), Blantyre, Malawi
| | - Mohammad H Alharbi
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Peter Makaula
- Research for Health, Environment and Development (RHED), Mangochi, Malawi
| | - Fanuel Lampiao
- Physiology Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Lazarus Juziwelo
- National Schistosomiasis and STH Control Programme, Community Health Sciences Unit, Ministry of Health, Lilongwe, Malawi
| | - E James LaCourse
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Kayuni SA, O'Ferrall AM, Baxter H, Hesketh J, Mainga B, Lally D, Al-Harbi MH, LaCourse EJ, Juziwelo L, Musaya J, Makaula P, Stothard JR. An outbreak of intestinal schistosomiasis, alongside increasing urogenital schistosomiasis prevalence, in primary school children on the shoreline of Lake Malawi, Mangochi District, Malawi. Infect Dis Poverty 2020; 9:121. [PMID: 32867849 PMCID: PMC7456765 DOI: 10.1186/s40249-020-00736-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [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: 05/04/2020] [Accepted: 08/07/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Intestinal schistosomiasis was not considered endemic in Lake Malawi until November 2017 when populations of Biomphalaria pfeifferi were first reported; in May 2018, emergence of intestinal schistosomiasis was confirmed. This emergence was in spite of ongoing control of urogenital schistosomiasis by preventive chemotherapy. Our current study sought to ascertain whether intestinal schistosomiasis is transitioning from emergence to outbreak, to judge if stepped-up control interventions are needed. METHODS During late-May 2019, three cross-sectional surveys of primary school children for schistosomiasis were conducted using a combination of rapid diagnostic tests, parasitological examinations and applied morbidity-markers; 1) schistosomiasis dynamics were assessed at Samama (n = 80) and Mchoka (n = 80) schools, where Schistosoma mansoni was first reported, 2) occurrence of S. mansoni was investigated at two non-sampled schools, Mangochi Orphan Education and Training (MOET) (n = 60) and Koche (n = 60) schools, where B. pfeifferi was nearby, and 3) rapid mapping of schistosomiasis, and B. pfeifferi, conducted across a further 8 shoreline schools (n = 240). After data collection, univariate analyses and Chi-square testing were performed, followed by binary logistic regression using generalized linear models, to investigate epidemiological associations. RESULTS In total, 520 children from 12 lakeshore primary schools were examined, mean prevalence of S. mansoni by 'positive' urine circulating cathodic antigen (CCA)-dipsticks was 31.5% (95% confidence interval [CI]: 27.5-35.5). Upon comparisons of infection prevalence in May 2018, significant increases at Samama (relative risk [RR] = 1.7, 95% CI: 1.4-2.2) and Mchoka (RR = 2.7, 95% CI: 1.7-4.3) schools were observed. Intestinal schistosomiasis was confirmed at MOET (18.3%) and Koche (35.0%) schools, and in all rapid mapping schools, ranging from 10.0 to 56.7%. Several populations of B. pfeifferi were confirmed, with two new eastern shoreline locations noted. Mean prevalence of urogenital schistosomiasis was 24.0% (95% CI: 20.3-27.7). CONCLUSIONS We notify that intestinal schistosomiasis, once considered non-endemic in Lake Malawi, is now transitioning from emergence to outbreak. Once control interventions can resume after coronavirus disease 2019 (COVID-19) suspensions, we recommend stepped-up preventive chemotherapy, with increased community-access to treatments, alongside renewed efforts in appropriate environmental control.
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Affiliation(s)
- Sekeleghe A Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK.,Medi Clinic Limited, Medical Aid Society of Malawi (MASM), 22 Lower Sclatter Road, P.O. Box 1254, Blantyre, Malawi
| | - Angus M O'Ferrall
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
| | - Hamish Baxter
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
| | - Josie Hesketh
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
| | - Bright Mainga
- Laboratory Department, Mangochi District Hospital, P.O. Box 42, Mangochi, Malawi
| | - David Lally
- Malawi Liverpool Wellcome Trust Programme of Clinical Tropical Research, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Blantyre, Malawi
| | | | - E James LaCourse
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
| | - Lazarus Juziwelo
- National Schistosomiasis and STH Control Programme, Ministry of Health, Lilongwe, Malawi
| | - Janelisa Musaya
- Malawi Liverpool Wellcome Trust Programme of Clinical Tropical Research, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Blantyre, Malawi.,Department of Basic Medical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Peter Makaula
- Research for Health Environment and Development, P.O. Box 345, Mangochi, Malawi
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK.
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Stothard JR, Kayuni SA, Al-Harbi MH, Musaya J, Webster BL. Future schistosome hybridizations: Will all Schistosoma haematobium hybrids please stand-up! PLoS Negl Trop Dis 2020; 14:e0008201. [PMID: 32614820 PMCID: PMC7332241 DOI: 10.1371/journal.pntd.0008201] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- J. Russell Stothard
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
| | - Sekeleghe A. Kayuni
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- MASM Medi Clinics Limited, Medical Society of Malawi (MASM), Blantyre, Malawi
| | - Mohammad H. Al-Harbi
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Ministry of Health, Qassim, Kingdom of Saudi Arabia
| | - Janelisa Musaya
- Department of Pathology, College of Medicine, University of Malawi, Blantyre, Malawi
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital College of Medicine, Blantyre, Malawi
| | - Bonnie L. Webster
- Parasites and Vectors Division, Life Sciences Department, Natural History Museum, London, United Kingdom
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12
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Kayuni SA, LaCourse EJ, Makaula P, Lampiao F, Juziwelo L, Fawcett J, Shaw A, Alharbi MH, Verweij JJ, Stothard JR. Case Report: Highlighting Male Genital Schistosomiasis (MGS) in Fishermen from the Southwestern Shoreline of Lake Malawi, Mangochi District. Am J Trop Med Hyg 2020; 101:1331-1335. [PMID: 31701858 DOI: 10.4269/ajtmh.19-0562] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Urogenital schistosomiasis causes morbidity within the genitalia but is underreported and infrequently examined in men. To draw attention to male genital schistosomiasis (MGS), a longitudinal cohort study was conducted among fishermen along the southwestern shoreline of Lake Malawi. A case series of five participants is presented inclusive of questionnaire interviews, parasitological examinations, ultrasonography, and provision of a standard dose (40 mg/kg) of praziquantel (PZQ) treatment at baseline, 1-, 3-, 6-, and 12-month follow-up time points. Eggs of Schistosoma haematobium were observed in urine or semen across all time points; parasitological diagnostics were bolstered by real-time PCR for Schistosoma DNA in semen and by portable ultrasonography to document putative MGS-associated morbidity. We highlight the importance of developing standard diagnostic tests for MGS and increasing the accessibility of PZQ treatment to men, especially those in at-risk endemic areas.
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Affiliation(s)
- Sekeleghe A Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,MASM Medi Clinics Limited, Medical Society of Malawi (MASM), Blantyre, Malawi
| | - E James LaCourse
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Peter Makaula
- Research for Health Environment and Development (RHED), Mangochi, Malawi
| | - Fanuel Lampiao
- Physiology Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Lazarus Juziwelo
- National Schistosomiasis and STH Control Program, Community Health Sciences Unit (CHSU), Ministry of Health, Lilongwe, Malawi
| | - Joanna Fawcett
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Alexandra Shaw
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mohammad H Alharbi
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jaco J Verweij
- Elisabeth-TweeSteden Hospital Tilburg, Laboratory for Medical Microbiology and Immunology, Tilburg, The Netherlands
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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