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Lamberti O, Bozzani F, Kiyoshi K, Bustinduy AL. Time to bring female genital schistosomiasis out of neglect. Br Med Bull 2024; 149:45-59. [PMID: 38220571 PMCID: PMC10938538 DOI: 10.1093/bmb/ldad034] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/08/2023] [Accepted: 12/09/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Female genital schistosomiasis (FGS) is a chronic gynaecological disease affecting girls and women in sub-Saharan Africa (SSA), caused by the parasite Schistosoma (S.) haematobium. FGS is associated with sexual dysfunction, reproductive tract morbidity and increased prevalence of HIV and cervical precancer lesions. SOURCE OF DATA Key peer-reviewed published literature. AREAS OF AGREEMENT FGS screening and diagnosis require costly equipment and specialized training, seldom available in resource-limited settings. FGS surveillance is not included in wider schistosomiasis control strategies. The interplay of FGS with other SRH infections is not fully understood. Integration of FGS within sexual and reproductive health (SRH) control programmes needs to be explored. AREAS OF CONTROVERSY There are no standardized methods for individual or population-based FGS screening and diagnosis, hindering accurate disease burden estimates and targeted resource allocation. Treatment recommendations rely on public health guidelines, without rigorous clinical evidence on efficacy. GROWING POINTS Integrating FGS screening with SRH programmes offers an opportunity to reach at-risk women with limited access to healthcare services. Home-based self-sampling coupled with handheld colposcopes operated by primary healthcare workers show promise for FGS diagnosis and surveillance at scale. AREAS TIMELY FOR DEVELOPING RESEARCH There is growing interest in decentralizing strategies for FGS screening and diagnosis. The accurate predictions on the 'cost-effectiveness' of these approaches will determine their affordability and feasibility within the overburdened health systems in SSA. Clinical trials are needed to optimize FGS treatment. Longitudinal studies can expand on the epidemiological knowledge on co-morbidities and integration within other SRH interventions.
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Affiliation(s)
- Olimpia Lamberti
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Fiammetta Bozzani
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Kita Kiyoshi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Mbwanji G, Mazigo HD, Maganga JK, Downs JA. Female genital schistosomiasis is a neglected public health problem in Tanzania: Evidence from a scoping review. PLoS Negl Trop Dis 2024; 18:e0011954. [PMID: 38466660 PMCID: PMC10927128 DOI: 10.1371/journal.pntd.0011954] [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: 07/27/2023] [Accepted: 01/31/2024] [Indexed: 03/13/2024] Open
Abstract
Schistosoma haematobium, the parasite that causes urogenital schistosomiasis, is widely prevalent in Tanzania. In addition to well-known effects on the urinary tract, S. haematobium also causes clinically- evident damage to the reproductive tract in approximately half of infected women, which is known as female genital schistosomiasis (FGS). FGS has major gynecologic and social consequences on women's reproductive health, yet little information is available regarding FGS in Tanzania. To cover that gap, we conducted the present scoping review to examine the epidemiology of FGS in Tanzania (both in the mainland and Zanzibar island) and to make recommendations for future work in this area. The available evidence from community-based and hospital-based retrospective studies indicates that FGS is a significant health problem in the country. Very few community-based studies have been reported from mainland Tanzania, and Zanzibar. Our review highlights the scarcity of efforts to address FGS in Tanzania and the need for additional community-based studies. The studies will help us understand the true burden of the disease nationwide, to assess the impact of praziquantel on FGS lesions, and to address social and mental health in relation to FGS. This review emphasizes integration of delivery of FGS related services in primary health care systems through the reproductive health clinics which covers sexually transmitted infections, HIV and cervical cancer screening. These actions are essential if this neglected gynecological disease is to be addressed in Tanzania.
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Affiliation(s)
- Gladys Mbwanji
- Department of Parasitology, School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Humphrey D. Mazigo
- Department of Parasitology, School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- School of Public Health, Dean’s Office, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Jane K. Maganga
- National Institute for Medical Research, Mwanza, Tanzania
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Jennifer A. Downs
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Bugando Medical Centre, Mwanza, Tanzania
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
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Makia CM, Fesuh NB, Amabo EN, Gamba VA, Oluwole AS, Stothard R. Urogenital schistosomiasis (UGS) and female genital schistosomiasis (FGS) in Cameroon: an observational assessment of key reproductive health determinants of girls and women in the Matta Health Area. BMJ Open 2023; 13:e063392. [PMID: 36787976 PMCID: PMC9930553 DOI: 10.1136/bmjopen-2022-063392] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVES AND SETTING Across sub-Saharan Africa, urogenital schistosomiasis (UGS), in particular female genital schistosomiasis (FGS), is a significant waterborne parasitic disease, with its direct burden on the sexual and reproductive health (SRH) of sufferers infrequently measured. UGS has an established control plan, which in most endemic regions as in Cameroon, still excludes FGS considerations. Highlighting existent associations between UGS and FGS could increase the management of FGS within UGS interventions. This study seeks to identify current associations among FGS and UGS with some reproductive health indicators, to provide formative information for better integrated control. PARTICIPANTS 304 females aged 5-69 years were all examined for UGS by urine filtration and microscopy. Among these, 193 women and girls were eligible for clinical FGS assessment based on age (>13). After selective questioning for FGS symptoms, a subgroup of 67 women and girls consented for clinical examination for FGS using portable colposcopy, with observed sequelae classified according to the WHO FGS pocket atlas. OUTCOME Overall UGS and FGS prevalence was measured, with FGS-related/UGS-related reproductive health symptoms recorded. Associations between FGS and UGS were investigated by univariate and multivariate logistic regression analyses. RESULTS Overall UGS prevalence was 63.8% (194/304), where FGS prevalence (subgroup) was 50.7% (34/67). FGS manifestation increased significantly with increasing age, while a significant decrease with ascending age was observed for UGS. Lower abdominal pain (LAP) vaginal itches (VI) and coital pain (CP) were identified as the main significant shared symptoms of both FGS and UGS, while LAP with menstrual irregularity (MI) appeared a strong symptomatic indicator for FGS. CONCLUSION LAP, MI, CP and VI are the potential SRH indicators that could be exploited in future for targeting of praziquantel provision to FGS sufferers within primary care, complementary with existing praziquantel distribution for UGS sufferers in Schistosoma haematobium endemic areas.
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Affiliation(s)
- Christine Masong Makia
- Social Sciences and Management, Catholic University of Central Africa, Yaounde, Centre, Cameroon
| | - Nono Betrand Fesuh
- Department of Mathematics and Physical Sciences, National Advanced School of Engineering, University of Yaoundé 1, Yaoundé, Centre, Cameroon
| | | | - Victoria A Gamba
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Nairobi, Kenya
| | - Akinola Stephen Oluwole
- Department of Pure and Applied Zoology, Federal University of Agriculture Abeokuta, Abeokuta, Ogun, Nigeria
| | - Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
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Mazigo HD, Samson A, Lambert VJ, Kosia AL, Ngoma DD, Murphy R, Matungwa DJ. "We know about schistosomiasis but we know nothing about FGS": A qualitative assessment of knowledge gaps about female genital schistosomiasis among communities living in Schistosoma haematobium endemic districts of Zanzibar and Northwestern Tanzania. PLoS Negl Trop Dis 2021; 15:e0009789. [PMID: 34591872 PMCID: PMC8509863 DOI: 10.1371/journal.pntd.0009789] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/12/2021] [Accepted: 09/03/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Schistosoma haematobium causes urogenital schistosomiasis and is widely distributed in Tanzania. In girls and women, the parasite can cause Female Genital Schistosomiasis (FGS), a gynecological manifestation of schistosomiasis that is highly neglected and overlooked by public health professionals and policy makers. This study explored community members' knowledge, attitudes and perceptions (KAP) on and health seeking behavior for FGS. METHODS/PRINCIPAL FINDINGS Using qualitative research methods-including 40 Focus Group Discussions (FGDs) and 37 Key Informant Interviews (KIIs)-we collected data from 414 participants (Males n = 204 [49.3%] and Females n = 210 [50.7%]). The study engaged 153 participants from Zanzibar and 261 participants from northwestern Tanzania and was conducted in twelve (12) purposively selected districts (7 districts in Zanzibar and 5 districts in northwestern Tanzania). Most participants were aware of urogenital schistosomiasis. Children were reported as the most affected group and blood in urine was noted as a common symptom especially in boys. Adults were also noted as a risk group due to their involvement in activities like paddy farming that expose them to infection. Most participants lacked knowledge of FGS and acknowledged having no knowledge that urogenital schistosomiasis can affect the female reproductive system. A number of misconceptions on the symptoms of FGS and how it is transmitted were noted. Adolescent girls and women presenting with FGS related symptoms were reported to be stigmatized, perceived as having a sexually transmitted infection (STI), and sometimes labeled as "prostitutes". Health seeking behavior for FGS included a combination of traditional medicine, self-treatment and modern medicine. CONCLUSION/SIGNIFICANCE Community members living in two very different areas of Tanzania exhibited major, similar gaps in knowledge about FGS. Our data illustrate a critical need for the national control program to integrate public health education about FGS during the implementation of school- and community-based mass drug administration (MDA) programs and the improvement of water, sanitation and hygiene (WASH) facilities.
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Affiliation(s)
- Humphrey D. Mazigo
- Department of Parasitology and Entomology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Anna Samson
- Department of Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Valencia J. Lambert
- Center for Global Health, Weill Cornell Medicine, New York City, New York, United States of America
| | - Agnes L. Kosia
- School of Nursing, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Deogratias D. Ngoma
- Accelerating the Sustainable Control and Elimination of Neglected Tropical Diseases—Crown Agents, London, United Kingdom
| | | | - Dunstan J. Matungwa
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
- Department of Anthropology, School of Arts and Sciences, Rutgers University, New Brunswick, New Jersey, United States of America
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Rafferty H, Sturt AS, Phiri CR, Webb EL, Mudenda M, Mapani J, Corstjens PLAM, van Dam GJ, Schaap A, Ayles H, Hayes RJ, van Lieshout L, Hansingo I, Bustinduy AL. Association between cervical dysplasia and female genital schistosomiasis diagnosed by genital PCR in Zambian women. BMC Infect Dis 2021; 21:691. [PMID: 34273957 PMCID: PMC8286581 DOI: 10.1186/s12879-021-06380-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 02/26/2021] [Accepted: 05/27/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Female genital schistosomiasis (FGS) is a neglected tropical gynaecological disease that affects millions of women in sub-Saharan Africa (SSA). FGS is caused by Schistosoma haematobium, a parasitic carcinogen involved in the pathogenesis of squamous cell carcinoma of the bladder. Cervical cancer incidence and mortality are highest in SSA, where pre-cancerous cervical dysplasia is often detected on screening with visual inspection with acetic acid (VIA). There are no studies evaluating the association between VIA positivity and FGS diagnosed by genital PCR. METHODS Women were recruited from the Bilharzia and HIV (BILHIV) study in Zambia a community-based study comparing genital self-sampling to provider obtained cervicovaginal-lavage for the diagnosis of FGS in women aged 18-31. FGS was defined as positive Schistosoma DNA from any genital PCR. Urogenital schistosomiasis diagnostics included urine circulating anodic antigen, urine microscopy and portable colposcopy. Participants were offered cervical cancer screening using VIA at Livingstone Central Hospital. Associations of PCR confirmed FGS and other diagnostics with VIA positivity were assessed using multivariable logistic regression. RESULTS VIA results were available from 237 BILHIV participants. A positive Schistosoma PCR in any genital specimen was detected in 14 women (5.9%), 28.6% (4/14) of these women had positive VIA compared to 9.0% without PCR evidence of schistosome infection (20/223). Schistosoma PCR positivity in any genital specimen was strongly associated with VIA positivity (OR: 6.08, 95% CI: 1.58-23.37, P = 0.02). CONCLUSIONS This is the first study to find an association between FGS and positive VIA, a relationship that may be causal. Further longitudinal studies are needed.
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Affiliation(s)
- H Rafferty
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - A S Sturt
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | - E L Webb
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - M Mudenda
- Livingstone Central Hospital, Livingstone, Zambia
| | - J Mapani
- Livingstone Central Hospital, Livingstone, Zambia
| | - P L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - G J van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - H Ayles
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Zambart, Lusaka, Zambia
| | - R J Hayes
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - L van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - I Hansingo
- Livingstone Central Hospital, Livingstone, Zambia
| | - A L Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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Sturt AS, Webb EL, Francis SC, Hayes RJ, Bustinduy AL. Beyond the barrier: Female Genital Schistosomiasis as a potential risk factor for HIV-1 acquisition. Acta Trop 2020; 209:105524. [PMID: 32416076 PMCID: PMC7429987 DOI: 10.1016/j.actatropica.2020.105524] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 12/16/2022]
Abstract
Female genital schistosomiasis (FGS) results from egg-deposition in the female reproductive tract primarily by the waterborne parasite Schistosoma (S.) haematobium, and less commonly by Schistosoma (S.) mansoni. FGS affects an estimated 20-56 million women worldwide, mostly in sub-Saharan Africa. There is cross-sectional evidence of increased HIV-1 prevalence in schistosomiasis-infected women, but a causal relationship between FGS and either HIV-1 acquisition or transmission has not been fully established. Beyond the pathognomonic breach in the cervicovaginal barrier caused by FGS, this narrative review explores potential mechanisms for a synergistic relationship between S. haematobium infection, FGS, and HIV-1 acquisition through vaginal inflammation and target cell recruitment.
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Affiliation(s)
- A S Sturt
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom.
| | - E L Webb
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - S C Francis
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - R J Hayes
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - A L Bustinduy
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
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Paciência FMD, Rushmore J, Chuma IS, Lipende IF, Caillaud D, Knauf S, Zinner D. Mating avoidance in female olive baboons ( Papio anubis) infected by Treponema pallidum. Sci Adv 2019; 5:eaaw9724. [PMID: 31840059 PMCID: PMC6892622 DOI: 10.1126/sciadv.aaw9724] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 10/18/2019] [Indexed: 06/10/2023]
Abstract
Sexually transmitted infections (STIs) are ubiquitous within wild animal populations, yet it remains largely unknown whether animals evolved behavioral avoidance mechanisms in response to STI acquisition. We investigated the mating behavior of a wild population of olive baboons (Papio anubis) infected by the bacterium Treponema pallidum. This pathogen causes highly conspicuous genital ulcerations in males and females, which signal infectious individuals. We analyzed data on 876 mating attempts and associated acceptance or rejection responses in a group of about 170 baboons. Our findings indicate that females are more likely to avoid copulation if either the mating partner or females themselves have ulcerated genitals. We suggest that this outcome is linked to the overall higher choosiness and infection-risk susceptibility typically exhibited by females. Our results show that selection pressures imposed by pathogens induce individual behavioral modifications, leading to altered mate choice and could reduce promiscuity in a wild nonhuman primate population.
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Affiliation(s)
- F. M. D. Paciência
- Cognitive Ethology Laboratory, Leibniz Institute for Primate Research, German Primate Center, Kellnerweg 4, 37077 Göttingen, Germany
- Work Group Neglected Tropical Diseases, Infection Biology Unit, Leibniz Institute for Primate Research, German Primate Center, Kellnerweg 4, 37077 Göttingen, Germany
| | - J. Rushmore
- EpiCenter for Disease Dynamics, One Health Institute, School of Veterinary Medicine, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA
| | - I. S. Chuma
- Sokoine University of Agriculture, P.O. Box 3000, Chuo Kikuu, Morogoro, Tanzania
| | - I. F. Lipende
- Sokoine University of Agriculture, P.O. Box 3000, Chuo Kikuu, Morogoro, Tanzania
| | - D. Caillaud
- Department of Anthropology, University of California, One Shields Avenue, Davis, CA 95616, USA
| | - S. Knauf
- Work Group Neglected Tropical Diseases, Infection Biology Unit, Leibniz Institute for Primate Research, German Primate Center, Kellnerweg 4, 37077 Göttingen, Germany
- Division of Microbiology and Animal Hygiene, Georg-August-University, Göttingen, Germany
| | - D. Zinner
- Cognitive Ethology Laboratory, Leibniz Institute for Primate Research, German Primate Center, Kellnerweg 4, 37077 Göttingen, Germany
- Leibniz ScienceCampus Primate Cognition, Göttingen, Germany
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Kukula VA, MacPherson EE, Tsey IH, Stothard JR, Theobald S, Gyapong M. A major hurdle in the elimination of urogenital schistosomiasis revealed: Identifying key gaps in knowledge and understanding of female genital schistosomiasis within communities and local health workers. PLoS Negl Trop Dis 2019; 13:e0007207. [PMID: 30897093 PMCID: PMC6428244 DOI: 10.1371/journal.pntd.0007207] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/31/2019] [Indexed: 12/24/2022] Open
Abstract
Background Urogenital schistosomiasis is endemic throughout Ghana with elevated infection levels in certain areas e.g. Lake Volta Region. While the primary focus of the national control program is on mass drug administration of praziquantel to school-aged children, Female Genital Schistosomiasis (FGS), a disease-specific affliction of girls and women, has been largely overlooked. To better focus future actions, our study investigated the perceptions, knowledge and understanding of FGS amongst community members and health providers. Method/Principal findings We used qualitative methods including 12 focus group discussions and 34 in-depth interviews. We purposively selected 16 communities along the Lake Volta in the Shai-Osudoku District. Participant selection was based on gender, age and occupation; providing an opportunity to explore community understanding of FGS through participants own words and perceptions. Awareness of schistosomiasis was reported and is commonly experienced among children (12–17 years) and younger adults (18–25 years) in the study communities but is typically considered a boy’s disease. Knowledge of FGS was lacking in women, girls and front-line health workers. There was a general misconception that FGS may be the result of sexual promiscuity. Adolescent girls reporting vaginal discharge and itching were often stigmatized by health workers and treated for sexually transmitted infections. Limited alternatives to the river as key source of water meant that all members of the community faced the regular risk of schistosomiasis. Conclusion/Significance There is a clear imperative for the national control program to better engage on FGS and implement interventions to meet girls and women’s needs. The key consideration is to integrate more adequately preventive services with sexual and reproductive primary health care with future training of health workers for improved management of FGS cases. More broadly, harmonizing the portfolio of all actions on FGS is needed, especially with a call for improved access to safe water and sanitation for all those at current or future risk. Female Genital Schistosomiasis (FGS) is a serious, chronic gynecological condition that affects up to 56 million African women and girls. To date, FGS has been mostly overlooked within national neglected tropical disease control programs and associated health systems in sub-Saharan Africa. Furthermore, knowledge and understanding of FGS within affected communities themselves are often incomplete and confused with other ailments. Using qualitative research methods, we explored the knowledge and understanding of girls and women on FGS, as well as, local health care providers’ knowledge and practice relating to FGS. While, our work found that FGS was rarely on the radar of suspicion for health workers, more importantly, adolescent girls were often stigmatized by health care workers when they sought care in public health facilities owing to misdiagnosis of the disease as sexually transmitted infections. Our work speaks to the urgent need for national control programs to expand their remit outside current focus of annual provision of praziquantel to in-school children and integrate such treatments within sexual and reproductive health services available in primary health care services. Ultimately, urogenital and intestinal schistosomiasis is a disease of poverty and there is an urgent need to extend access to improved water and sanitation facilities to all affected communities.
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Affiliation(s)
- Vida Ami Kukula
- Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana
- * E-mail: ,
| | - Eleanor E. MacPherson
- Malawi-Liverpool-Wellcome Trust, Blantyre, Malawi
- Department of International Public Health, COUNTDOWN Consortium, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Irene Honam Tsey
- Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana
| | - J. Russell Stothard
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sally Theobald
- Department of International Public Health, COUNTDOWN Consortium, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Margaret Gyapong
- COUNTDOWN Consortium, Institute for Health Research, University of Health and Allied Sciences, Ho, Ghana
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Vallely LM, Toliman P, Ryan C, Rai G, Wapling J, Gabuzzi J, Allen J, Opa C, Munnull G, Kaima P, Kombuk B, Kumbia A, Kombati Z, Law G, Kelly-Hanku A, Wand H, Siba PM, Mola GDL, Kaldor JM, Vallely AJ. Performance of syndromic management for the detection and treatment of genital Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis among women attending antenatal, well woman and sexual health clinics in Papua New Guinea: a cross-sectional study. BMJ Open 2017; 7:e018630. [PMID: 29288183 PMCID: PMC5778337 DOI: 10.1136/bmjopen-2017-018630] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Papua New Guinea (PNG) has among the highest estimated prevalences of genital Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) of any country in the Asia-Pacific region. Diagnosis and treatment of these infections have relied on the WHO-endorsed syndromic management strategy that uses clinical presentation without laboratory confirmation to make treatment decisions. We evaluated the performance of this strategy in clinical settings in PNG. DESIGN Women attending antenatal (ANC), well woman (WWC) and sexual health (SHC) clinics in four provinces were invited to participate, completed a face-to-face interview and clinical examination, and provided genital specimens for laboratory testing. We estimated the performance characteristics of syndromic diagnoses against combined laboratory diagnoses. RESULTS 1764 women were enrolled (ANC=765; WWC=614; SHC=385). The prevalences of CT, NG and TV were highest among women attending ANC and SHC. Among antenatal women, syndromic diagnosis of sexually transmitted infection had low sensitivity (9%-21%) and positive predictive value (PPV) (7%-37%), but high specificity (76%-89%) and moderate negative predictive value (NPV) (55%-86%) for the combined endpoint of laboratory-confirmed CT, NG or TV. Among women attending WWC and SHC, 'vaginal discharge syndrome' had moderate to high sensitivity (72%-78%) and NPV (62%-94%), but low specificity (26%-33%) and PPV (8%-38%). 'Lower abdominal pain syndrome' had low sensitivity (26%-41%) and PPV (8%-23%) but moderate specificity (66%-68%) and high NPV (74%-93%) among women attending WWC, and moderate-high sensitivity (67%-79%) and NPV (62%-86%) but low specificity (26%-28%) and PPV (14%-33%) among SHC attendees. CONCLUSION The performance of syndromic management for the detection and treatment of genital chlamydia, gonorrhoea and trichomonas was poor among women in different clinical settings in PNG. New diagnostic strategies are needed to control these infections and to prevent their adverse health outcomes in PNG and other high-burden countries.
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Affiliation(s)
- Lisa M Vallely
- Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Pamela Toliman
- Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Claire Ryan
- The Macfarlane Burnet Institute for Medical Research and Public Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Glennis Rai
- School of Medicine and Health Sciences, University of Papua New Guinea, Boroko, Papua New Guinea
| | - Johanna Wapling
- The Macfarlane Burnet Institute for Medical Research and Public Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Josephine Gabuzzi
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea
| | - Joyce Allen
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea
| | - Christine Opa
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea
| | - Gloria Munnull
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea
| | - Petronia Kaima
- Tininga clinic, Mt Hagen General Hospital, Mount Hagen, Papua New Guinea
| | - Benny Kombuk
- Obstetrics and Gynaecology, Mt Hagen General Hospital, Mount Hagen, Papua New Guinea
| | - Antonia Kumbia
- Obstetrics and Gynaecology, Eastern Highlands Provincial Hospital, Goroka, Papua New Guinea
| | - Zure Kombati
- Department of Pathology, Mt Hagen General Hospital, Mt Hagen, Papua New Guinea
| | - Greg Law
- Sexual Health and Disease Control Branch, National Department of Health, Poert Moresby, Papua New Guinea
| | - Angela Kelly-Hanku
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea
| | - Handan Wand
- Biostatistics and Database Program, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Peter M Siba
- Former Director, Papua New Guinea Institute of Medical Research, Port Moresby, Papua New Guinea
| | - Glen D L Mola
- School of Medicine and Health Sciences, University of Papua New Guinea, Boroko, Papua New Guinea
| | - John M Kaldor
- Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrew J Vallely
- Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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10
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Boechat VC, Mendes Junior AAV, Madeira MDF, Ferreira LC, Figueiredo FB, Rodrigues FDCDC, Oliveira VDC, de Oliveira RDVC, Menezes RC. Occurrence of Leishmania infantum and associated histological alterations in the genital tract and mammary glands of naturally infected dogs. Parasitol Res 2016; 115:2371-9. [PMID: 26979730 DOI: 10.1007/s00436-016-4987-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/04/2016] [Indexed: 12/21/2022]
Abstract
The objectives of this study were to evaluate the occurrence of Leishmania infantum in the male and female genital tract and female mammary glands of dogs and the parasite burden and to identify histological alterations associated with this protozoan. Twenty male and 20 female Leishmania-seropositive dogs with isolation of L. infantum were examined. Tissue samples of the prepuce, glans, epididymis, testes, prostate, vulva, vagina, uterus, uterine tubes, and mammary glands were analyzed by immunohistochemistry and histopathology. For parasitological culture and in situ hybridization, samples were collected from the testis, epididymis, and uterus. Additionally, seminal fluid was aspirated from the epididymis for parasitological culture. In the genital tract, 34 (85 %) dogs, including 18 males and 16 females, were positive for Leishmania. Of these, 27 (79 %) animals were symptomatic. Leishmania was detected in the mammary glands of 13 (65 %) females. L. infantum was isolated for the first time from the seminal fluid and uterus of naturally infected dogs. The parasite burden and intensity of the inflammatory reaction were greater in the prepuce and glans of males and in the vulva and mammary glands of females. In addition to inflammation, testicular degeneration, atrophy, absence of spermatogenesis, and necrosis were observed. Detection of amastigote forms in the mammary gland lumen indicates possible elimination of this parasite in milk. The frequent parasitism observed in the genital tract of infected males and females and the viability of L. infantum in seminal fluid and uterus suggest the possibility of bidirectional venereal and vertical transmission.
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MESH Headings
- Animals
- Cross-Sectional Studies
- Dog Diseases/diagnosis
- Dog Diseases/parasitology
- Dog Diseases/pathology
- Dogs
- Female
- Genitalia, Female/parasitology
- Genitalia, Female/pathology
- Genitalia, Male/parasitology
- Genitalia, Male/pathology
- Humans
- Immunohistochemistry/veterinary
- Infectious Disease Transmission, Vertical/veterinary
- Leishmania infantum/isolation & purification
- Leishmania infantum/physiology
- Leishmaniasis, Visceral/diagnosis
- Leishmaniasis, Visceral/parasitology
- Leishmaniasis, Visceral/pathology
- Leishmaniasis, Visceral/veterinary
- Male
- Mammary Glands, Animal/parasitology
- Mammary Glands, Animal/pathology
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Affiliation(s)
- Viviane Cardoso Boechat
- Laboratório de Pesquisa Clínica em Dermatozoonoses em Animais Domésticos, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365, Rio de Janeiro, RJ, 21040-360, Brazil
| | - Artur Augusto Velho Mendes Junior
- Laboratório de Pesquisa Clínica em Dermatozoonoses em Animais Domésticos, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365, Rio de Janeiro, RJ, 21040-360, Brazil
| | - Maria de Fátima Madeira
- Laboratório de Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365, Rio de Janeiro, RJ, 21040-360, Brazil
| | - Luiz Claudio Ferreira
- Serviço de Anatomia Patológica, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365, Rio de Janeiro, RJ, 21040-360, Brazil
| | - Fabiano Borges Figueiredo
- Laboratório de Pesquisa Clínica em Dermatozoonoses em Animais Domésticos, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365, Rio de Janeiro, RJ, 21040-360, Brazil
| | | | - Valéria da Costa Oliveira
- Laboratório de Pesquisa Clínica em Dermatozoonoses em Animais Domésticos, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365, Rio de Janeiro, RJ, 21040-360, Brazil
| | | | - Rodrigo Caldas Menezes
- Laboratório de Pesquisa Clínica em Dermatozoonoses em Animais Domésticos, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365, Rio de Janeiro, RJ, 21040-360, Brazil.
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11
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Kleppa E, Ramsuran V, Zulu S, Karlsen GH, Bere A, Passmore JAS, Ndhlovu P, Lillebø K, Holmen SD, Onsrud M, Gundersen SG, Taylor M, Kjetland EF, Ndung’u T. Effect of female genital schistosomiasis and anti-schistosomal treatment on monocytes, CD4+ T-cells and CCR5 expression in the female genital tract. PLoS One 2014; 9:e98593. [PMID: 24896815 PMCID: PMC4045760 DOI: 10.1371/journal.pone.0098593] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 05/06/2014] [Indexed: 11/19/2022] Open
Abstract
Background Schistosoma haematobium is a waterborne parasite that may cause female genital schistosomiasis (FGS), characterized by genital mucosal lesions. There is clinical and epidemiological evidence for a relationship between FGS and HIV. We investigated the impact of FGS on HIV target cell density and expression of the HIV co-receptor CCR5 in blood and cervical cytobrush samples. Furthermore we evaluated the effect of anti-schistosomal treatment on these cell populations. Design The study followed a case-control design with post treatment follow-up, nested in an on-going field study on FGS. Methods Blood and cervical cytobrush samples were collected from FGS negative and positive women for flow cytometry analyses. Urine samples were investigated for schistosome ova by microscopy and polymerase chain reaction (PCR). Results FGS was associated with a higher frequency of CD14+ cells (monocytes) in blood (11.5% in FGS+ vs. 2.2% in FGS-, p = 0.042). Frequencies of CD4+ cells expressing CCR5 were higher in blood samples from FGS+ than from FGS- women (4.7% vs. 1.5%, p = 0.018). The CD14+ cell population decreased significantly in both compartments after anti-schistosomal treatment (p = 0.043). Although the frequency of CD4+ cells did not change after treatment, frequencies of CCR5 expression by CD4+ cells decreased significantly in both compartments (from 3.4% to 0.5% in blood, p = 0.036; and from 42.4% to 5.6% in genital samples, p = 0.025). Conclusions The results support the hypothesis that FGS may increase the risk of HIV acquisition, not only through damage of the mucosal epithelial barrier, but also by affecting HIV target cell populations, and that anti-schistosomal treatment can modify this.
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Affiliation(s)
- Elisabeth Kleppa
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital (OUH), Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
- * E-mail:
| | - Veron Ramsuran
- HIV Pathogenesis Programme, Nelson R Mandela School of Medicine, University of KwaZulu-Natal (UKZN), Durban, South Africa
| | - Siphosenkosi Zulu
- School of Public Health Medicine, Nelson R Mandela School of Medicine, UKZN, Durban, South Africa
| | | | - Alfred Bere
- Emory Vaccine Center, Emory University, Atlanta, Georgia, United States of America
| | - Jo-Ann S. Passmore
- Division of Medical Virology, IDM, University of Cape Town, Cape Town, South Africa
| | | | - Kristine Lillebø
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital (OUH), Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sigve D. Holmen
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital (OUH), Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Svein Gunnar Gundersen
- Research Unit, Sorlandet Hospital, Kristiansand, Norway
- Centre for Development Studies, University of Agder, Kristiansand, Norway
| | - Myra Taylor
- School of Public Health Medicine, Nelson R Mandela School of Medicine, UKZN, Durban, South Africa
| | - Eyrun F. Kjetland
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital (OUH), Oslo, Norway
- School of Public Health Medicine, Nelson R Mandela School of Medicine, UKZN, Durban, South Africa
| | - Thumbi Ndung’u
- HIV Pathogenesis Programme, Nelson R Mandela School of Medicine, University of KwaZulu-Natal (UKZN), Durban, South Africa
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12
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Baumjohann K, Schiwy-Bochat KH, Rothschild MA. Maggots reveal a case of antemortal insect infestation. Int J Legal Med 2011; 125:487-92. [PMID: 21534007 DOI: 10.1007/s00414-011-0571-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 04/01/2011] [Indexed: 11/26/2022]
Affiliation(s)
- Kristina Baumjohann
- Institute of Legal Medicine, University Hospital of Cologne, Melatenguertel 60-62, 50823 Cologne, Germany.
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13
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Yücel S, Ciçek H, Kar S, Eser M. [Genital myiasis in a cat]. Turkiye Parazitol Derg 2008; 32:241-243. [PMID: 18985579] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Genital myiasis was diagnosed in a cat which was brought to the clinic for therapy six days after giving birth. Ten dead larvae were collected from its genital organs. During the microscopic examination, the larvae were identified as the third stage larva of Lucilia sericata.
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Affiliation(s)
- Sükran Yücel
- Gaziantep Universitesi, Fen-Edebiyat Fakültesi, Zooloji Anabilim Dali, Biyoloji, Gaziantep, Turkey
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14
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Simpson P, Higgins G, Qiao M, Waddell R, Kok T. Real-time PCRs for detection of Trichomonas vaginalis beta-tubulin and 18S rRNA genes in female genital specimens. J Med Microbiol 2007; 56:772-777. [PMID: 17510262 DOI: 10.1099/jmm.0.47163-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Trichomonas vaginalis is the cause of one of the most common types of vaginitis, trichomoniasis. The incidence of trichomoniasis in developed countries has decreased substantially during the past decade, but high prevalence of this disease can still be found in rural and remote areas of Australia. Clinical manifestations of symptomatic women are generally non-specific, but include vaginal discharge, vaginitis and irritation. T. vaginalis infection has also been linked to the increased risk of human immunodeficiency virus transmission. Current diagnosis of T. vaginalis relies on the visualization of motile organisms in a wet-mount preparation. Culture is used mainly in reference laboratories. The latter two methods require viable organisms and would not be suitable for use where transportation of specimens can be delayed. Two real-time fluorescence resonance energy transfer (FRET) hybridization probe PCR assays were used in this study to test for T. vaginalis DNA, targeting the beta-tubulin and 18S rRNA genes. We tested 500 randomly selected female patients, in an STD setting, for T. vaginalis DNA. The FRET PCRs targeting the beta-tubulin gene and the 18S rRNA gene detected 96 % (85/89) and 100 % (89/89) , respectively, of the positive specimens (first-void urine sample or genital swabs). Wet-mount microscopy was performed on 76 of these PCR-positive specimens and showed a sensitivity of 38 % (29/76). The prevalence, by PCR, of trichomoniasis was 18 % in this study. The two real-time PCRs developed in this study, targeting different genetic regions of the organism, provide a rapid, sensitive and specific diagnosis of T. vaginalis infection.
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Affiliation(s)
- Paul Simpson
- Infectious Diseases Laboratories, Institute of Medical and Veterinary Science, Adelaide, South Australia 5000, Australia
| | - Geoff Higgins
- Infectious Diseases Laboratories, Institute of Medical and Veterinary Science, Adelaide, South Australia 5000, Australia
| | - Ming Qiao
- Infectious Diseases Laboratories, Institute of Medical and Veterinary Science, Adelaide, South Australia 5000, Australia
| | - Russell Waddell
- Infectious Diseases Laboratories, Institute of Medical and Veterinary Science, Adelaide, South Australia 5000, Australia
| | - Tuckweng Kok
- Infectious Diseases Laboratories, Institute of Medical and Veterinary Science, Adelaide, South Australia 5000, Australia
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15
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Friedman JF, Mital P, Kanzaria HK, Olds GR, Kurtis JD. Schistosomiasis and pregnancy. Trends Parasitol 2007; 23:159-64. [PMID: 17336160 DOI: 10.1016/j.pt.2007.02.006] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [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: 09/28/2006] [Revised: 01/11/2007] [Accepted: 02/14/2007] [Indexed: 10/23/2022]
Abstract
Currently, schistosomes infect approximately 40 million women of child-bearing age, yet little is known about schistosome-associated morbidity in pregnant women and their offspring. Animal models indicate a deleterious effect of schistosome infection on maternal, fetal and neonatal outcomes. Case reports have documented maternal infection in association with poor birth outcomes, and two observational studies indicate that maternal schistosome infection might be associated with decreased birth weight. Rigorously identifying and quantifying the impact of schistosome infection on pregnancy outcomes with well-designed observational and treatment studies are crucial for improving birth outcomes in schistosome-endemic areas. In addition, studies that address the safety of praziquantel during pregnancy could lead to further adoption of the recent informal recommendation by the World Health Organization to treat schistosome-infected pregnant and lactating women.
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Affiliation(s)
- Jennifer F Friedman
- Center for International Health Research, Rhode Island Hospital, 55 Claverick Street, Providence, RI 02903, USA.
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16
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Rutkowski MR, Harmsen AG. Tritrichomonas foetus: Pathogenesis of acute infection in normal, estradiol-treated, and stressed mice. Exp Parasitol 2007; 115:143-59. [PMID: 17014850 DOI: 10.1016/j.exppara.2006.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2006] [Revised: 07/19/2006] [Accepted: 07/23/2006] [Indexed: 11/24/2022]
Abstract
Environmental stress and endocrine control can affect pathogenesis of sexually transmitted diseases such as trichomoniasis. Acute Tritrichomonas foetus infection was compared in female BALB/c mice to infections in mice treated with high doses of estradiol or housed in constant bright illumination (stressed). In untreated mice, T. foetus readily colonized the reproductive tract, causing minimal epithelial damage and inflammation. Several fold increases of IFN-gamma, TNF-alpha, MCP-1, and IL-6 cytokines were detected after estradiol-treatment of mice, resulting in greatly enhanced inflammation and tissue damage throughout the reproductive tract. Interestingly, estradiol-treatment of mice resulted in reduced T. foetus colonization compared to untreated mice. Infection in stressed mice resulted in increased tissue damage, inflammation, and inflammatory cytokine expression, although parasite colonization within the reproductive tract was similar to that in untreated mice. These results indicate that either estradiol-treatment or stress result in pathogenesis often observed during severe disease. Alternatively, infection in non-treated mice results in chronic colonization, with little inflammation or pathology.
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Affiliation(s)
- Melanie R Rutkowski
- Department of Veterinary Molecular Biology, Montana State University, Molecular Biosciences Building, 960 Technology Blvd., Bozeman, MT 59718, USA.
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17
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Boucher S, Gracia E, Villa A, Fernández A, Nouaille L, Briffaud MA, Albizu I, Baselga R. Pathogens in the reproductive tract of farm rabbits. Vet Rec 2001; 149:677-8. [PMID: 11765326 DOI: 10.1136/vr.149.22.677] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Deriabin DG, Minakov AA, Borisov SD. [Spectrum of microflora isolated from various areas of the female reproductive tract]. Zh Mikrobiol Epidemiol Immunobiol 2001:84-6. [PMID: 11569275] [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] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The composition of microflora in different sections of the reproductive tract of women with disturbances of reproductive function was studied. The study revealed that the spectrum of microorganisms isolated from a bioptic specimen taken from the cavity of the small pelvis was narrower in comparison with such spectrum in material aspirated from the uterine cavity. The latter was narrower in comparison with that in the microflora of the lower sections of the reproductive tract. The possibility for one and the same patient to have both similarities and essential differences in the spectra of microflora in different sections of the reproductive tract was shown.
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Affiliation(s)
- D G Deriabin
- Research Institute of Cellular and Intracellular Symbiosis, Regional Center of Family Planning and Reproduction, Regional Center of State Sanitary and Epidemiological Inspection, Orenburg, Russia
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19
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Abstract
Trypanosoma cruzi is usually transmitted by contact with the excreta of infected Triatominae; among non-vectorial infections, direct transmission through coitus has been proposed. We investigated this possibility by instilling, through the external meatus of the vagina and the penis of previously anesthetized NMRI albino mice, blood of mice infected with strains isolated from Didelphis marsupialis (opossum, strain CO57), Rattus rattus (rat, strain CO22) and human (strain EP). Some animals were allowed to copulate the same day of the instillation. In other experiments, the strains were inoculated in the scrotum. To determine the effect of immunosuppression, some mice were treated with cyclophosphamide 30 days post-instillation. Controls were instilled orally and ocularly. Vaginal instillation with strain CO22 produced systemic infection with tropism to the heart, skeletal muscle, skin, duodenum, pancreas, ovary and sternum. Scrotal inoculation with strain EP likewise invaded liver, spleen, lung, lymph nodes and urogenital organs; while strain CO57 invaded skeletal and cardiac muscle, pancreas, testis, and vas deferens. Penile infection with strain CO22 was detected by xenodiagnosis. Immunosuppression did not increase parasitemia of vaginally infected mice or controls. Mating did not produce infection. Our results show that contact of blood trypomastigotes of T. cruzi with genital mucosa can produce blood and tissue infections. These results are discussed in relation to reports of frequent experimental tropism of T. cruzi toward urogenital organs.
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Affiliation(s)
- L Herrera
- Laboratorio de Biología de Trypanosoma de Mamíferos, Instituto de Zoología Tropical, Facultad de Ciencias, Universidad Central de Venezuela, Caracas 104l-A, Venezuela
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20
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Abstract
In this paper we summarise the parasitological, clinical and epidemiological characteristics of female genital schistosomiasis (FGS), a frequent manifestation of the infection with Schistosoma haematobium. Means to diagnose and treat lesions in the lower and upper genital tract are discussed. Based on clinical findings and available pathophysiological as well as immunological data it is conceivable that FGS of the cervix and vagina not only facilitates the infection with agents of sexually transmitted diseases, but presumably also alters the natural history of such infections. Two infectious agents are of particular concern: the Human Immunodeficiency Virus and the oncogenic Human Papilloma Viruses. Possible interactions and their consequences are discussed and research areas which should be addressed are outlined.
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Affiliation(s)
- G Poggensee
- Institute of Tropical Medicine and Medical Faculty Charité, Humboldt-University, Berlin, Germany.
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21
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Abstract
In this paper Gabriele Poggensee, Hermann Feldmeier and Ingela Krantz discuss the public health relevance of female genital schistosomiasis (FGS). Some of the stated hypotheses are supported only by clinical observations and/or circumstantial evidence as valid epidemiological and immunological data of this disease entity are still very scanty. Morbidity caused by the presence of schistosome eggs in the lower and upper genital tract have been almost completely neglected during the past two decades. This has been acknowledged by the WHO and, in 1997, the Gender Task Force of the WHO's Tropical Disease Research Programme (TDR) included FGS in a list of scientific areas that deserve high research priority.
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Affiliation(s)
- G Poggensee
- Institut für Tropenmedizin, Spandauer Damm 130, 14050 Berlin, Germany.
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22
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Abstract
This paper reports reduction on the reproductive capacity of female mice infected with Schistosoma mansoni, either in the acute phase or in the chronic one of the disease. This decrease in the reproductive capacity was highly significant (93.3% and 86.7%, for the acute and chronic phases, respectively).
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Affiliation(s)
- R T Mello
- Departamento de Análises Clínicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte
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23
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Nouhou H, Sève B, Idi N, Moussa F. [Schistosomiasis of the female genital tract: anatomoclinical and histopathological aspects. Apropos of 26 cases]. Bull Soc Pathol Exot 1998; 91:221-3. [PMID: 9773194] [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] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The authors report 26 cases of female genital schistosomiasis. This parasitosis is observed in women of ages ranging between 17 and 70 years (mean age = 30 years) and associated with sterility (6 cases), uterine tract cancer (1 case), tubular pregnancy (1 case), benign teratoma (1 case) and serous cystadenoma (1 case). The diagnosis is based on an histological analysis which shows several lesions with schistosomiasis (Schistosoma haematobium) eggs, confirmed by ZIEHL coloration. When coupled with infections these anatomical lesions lead to dysfunctions such as sterility and extra-uterine pregnancy through tubular dysfunction.
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Affiliation(s)
- H Nouhou
- Laboratoire d'anatomie et cytologie pathologiques, Faculté des sciences de la santé, Niamey, Niger
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24
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Abstract
Infection of isolated organs of the reproductive system by Trypanosoma cruzi has been described since Chagas' disease was first studied. A detailed histopathological analysis of mice acutely infected with T. cruzi CL strain showed colonization of male (preputial glands and skin, penis, testicular albuginea, epididymis, vas deferens, seminal vesicles, prostate, coagulative, bulbo urethral and urethral glands) and female (vagina, uterus, oviduct, ovary, mesovary, clitoris and mammary glands) structures of the reproductive system. The results presented herein demonstrated invasion of epithelial cells, pronounced colonization of the epididymis and male genital adnexa, but absence of parasitism in penile corpora cavernosa.
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Affiliation(s)
- H L Lenzi
- Department of Pathology, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil.
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25
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Abstract
Genital infestations caused by Wohlfahrtia magnifica (Schiner, 1862) has been reported as being a common problem encountered in female camels in the Gobi desert. Thus, a field investigation to establish the prevalence of wohlfarthiosis in camel herds in the eastern Gobi district was carried out between May and July 1994. The objectives of the study were to establish the relevance of genital myiasis, and to describe the disease patterns, clinical course and pathomorphological changes associated with it. The field study was designed to suit the specific ecological, infrastructural and logistic conditions. Two cross-sectional samples were taken from 45 selected herds in six different areas of the Chatanbulag Sumon to obtain data on herd structure, age distribution, and the breeding history of infested female animals. Post partum events and previous occurrence of genital myiasis were recorded by use of a standardised questionnaire. Clinically infested animals were first detected visually. All camels to be investigated further were subsequently immobilised using ropes and the genitals were examined for tissue lesions and the presence of larvae. Examination of 1676 Bactrian camels from 45 selected herds in six different areas of the Chatanbulag Sumon in the Eastern Gobi district, Mongolia, led to an estimate of Wohlfahrtia magnifica infestation rates between 8-10%. Most myiasis cases were found in older females (> 4 yr), younger animals were infested at a lower rate. Highest prevalence rates were discovered during June and July, highest levels of infestation occurred in the Aman Us Chudak region with infestation rates up to 15%.
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Affiliation(s)
- A Valentin
- Institute for Zoo Biology and Wildlife Research Berlin, Germany.
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26
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Alemu T, Luckins AG, Phipps LP, Reid SW, Holmes PH. The use of enzyme linked immunosorbent assays to investigate the prevalence of Trypanosoma equiperdum in Ethiopian horses. Vet Parasitol 1997; 71:239-50. [PMID: 9299693 DOI: 10.1016/s0304-4017(96)01139-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A field study involving 309 horses was undertaken in the provinces of Arsi and Bale in the Ethiopian highlands to investigate the prevalence of Trypanosoma equiperdum infections using enzyme linked immunosorbent assays (ELISAs) for the detection of both trypanosomal antigen and antibody. Adult horses of both sexes were examined for clinical signs of T. equiperdum infection and serum samples were collected for the assays. One hundred and one horses showed the presence of trypanosomal antibodies in their serum and 70 animals showed typical clinical signs of dourine. Nineteen horses showed the presence of trypanosomal antigen. Eight horses were positive for both T. equiperdum antibody and antigen. Blood and genital washes from seven antigenaemic horses were inoculated into mice and rabbits in an attempt to isolate trypanosomes but none became infected. Statistical analysis of the results of antibody assays indicated that there were significant differences in the distribution of serologically positive horses in the different clinical groupings, with seropositivity increasing with the severity of the observed clinical signs (P < 0.001). There was also a positive correlation between the presence of circulating trypanosomal antigen and clinical evidence of infection. Although it was not possible to obtain direct parasitological evidence of infection, the results of the serological assays, together with the clinical signs of disease observed in many of the horses, provide strong circumstantial evidence that T. equiperdum occurs in Arsi and Bale provinces of Ethiopia. Furthermore, in view of the large number of horses in Ethiopia and the unrestricted movement of animals throughout the country it is likely that dourine may be more widespread in Ethiopia than is currently realised. The assays used show potential for diagnosis of dourine, but to be widely applied in field situations for the diagnosis and control of dourine in Africa they require validation of their specificity and sensitivity.
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Affiliation(s)
- T Alemu
- National Tsetse and Trypanosomiasis Investigation and Control Centre, Addis Ababa, Ethiopia
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27
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Leutscher P, Raharisolo C, Pecarrere JL, Ravaoalimalala VE, Serieye J, Rasendramino M, Vennervald B, Feldmeier H, Esterre P. Schistosoma haematobium induced lesions in the female genital tract in a village in Madagascar. Acta Trop 1997; 66:27-33. [PMID: 9177093 DOI: 10.1016/s0001-706x(97)00673-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Female genital schistosomiasis, FGS, was investigated in a gynaecological study as part of an overall community based morbidity survey, including parasitological and ultrasonographical examination, of a Schistosoma haematobium endemic area in Madagascar. Women (103), of childbearing age (15-49 years), were included for a gynaecological examination and visible lesions of vagina and cervix were biopsied in order to determine the origin of the lesion. Furthermore all women were screened for the presence of schistosome ova using PAP smears from the vagina and the endo/exo cervix. In total 15 women showed schistosome ova in the vagina and/or cervix (median age 24 years and range 15-36 years). Of 36 women with cervical abnormalities, 12 eggs were detected by cervical biopsy (33%). In addition, two of the 12 presented vaginal induration, which contained eggs. Six women had eggs in their PAP smears of which three were egg negative by cervical biopsy. The prevalence of positive S. haematobium egg excretion in the urine among the 103 women was 69% and the geometric mean egg count of positive individuals was 51 eggs/10 ml of urine. Five of the 15 women with confirmed FGS had < or = 1 egg/10 ml of urine. Bladder lesions and congestive changes in the kidneys were demonstrated by ultrasonographic examination in 33 and 9% of the 103 women, respectively. None of the 15 women with confirmed FGS had renal congestion. Our study demonstrates that FGS is a common manifestation of the infection with S. haematobium, even in lightly infected individuals.
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Affiliation(s)
- P Leutscher
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
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28
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Nakamura K, Mitarai Y, Tanimura N, Hara H, Ikeda A, Shimada J, Isobe T. Pathogenesis of reduced egg production and soft-shelled eggs in laying hens associated with Leucocytozoon caulleryi infection. J Parasitol 1997; 83:325-7. [PMID: 9105322] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The pathogenesis of reduced egg production with soft-shelled eggs in laying hens naturally infected with Leucocytozoon caulleryi was investigated. Many large schizonts of L. caulleryi schizonts were seen in the ovary and oviducts of chickens. Granulomatous and lymphocytic inflammation, edema, and pressure atrophy were associated with these schizonts. The uterine region that secretes the egg shell exhibited the most severe damage. These lesions in the reproductive organs may explain the mechanism for causing the reduced egg production and soft-shelled eggs in laying hens infected with L. caulleryi.
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Affiliation(s)
- K Nakamura
- National Institute of Animal Health, Ibaraki, Japan
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29
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Helling-Giese G, Kjetland EF, Gundersen SG, Poggensee G, Richter J, Krantz I, Feldmeier H. Schistosomiasis in women: manifestations in the upper reproductive tract. Acta Trop 1996; 62:225-38. [PMID: 9028408 DOI: 10.1016/s0001-706x(96)00025-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Female genital schistosomiasis (FGS) is a neglected disease entity which may give rise to considerable suffering among women of child-bearing age in areas where schistosomiasis (especially due to Schistosoma haematobium) is prevalent. The close relation between the vessels in genital organs and the urinary bladder enables the parasite to easily change location to virtually any organs in the female pelvic area. Symptoms concur with the anatomical location of worm pairs and their ova. Lesions of the lower female genital tract can easily be investigated by cytology, histology or direct demonstration of eggs in scrapings or biopsies whereas schistosomiasis of the upper genital tract is clinically indecipherable and less accessible for examination. In the literature there are references to FGS as a cause of infertility, complications of pregnancy, menstrual disorders, problems related to sexual intercourse, diagnostic similarities to STDs and cancer, unspecified complaints related to blood loss, chronic abdominal pain, social segregation and related psychological problems. The diagnosis of female upper genital schistosomiasis is difficult and the authors point out possible diagnostic procedures which might be helpful for further understanding of this complex entity.
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Affiliation(s)
- G Helling-Giese
- Department of Gynecology and Obstetrics, Frauenklink Finkenau, Hamburg, Germany
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30
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Gundersen SG, Kjetland EF, Poggensee G, Helling-Giese G, Richter J, Chitsulo L, Koumwenda N, Krantz I, Feldmeier H. Urine reagent strips for diagnosis of schistosomiasis haematobium in women of fertile age. Acta Trop 1996; 62:281-7. [PMID: 9028412 DOI: 10.1016/s0001-706x(96)00029-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hematuria, proteinuria and leukocyturia were semiquantitatively assessed by reagent strips in single morning urine of women of fertile age visiting the outpatient department of the Mangochi district hospital, Malawi. This was part of a diagnostic approach to female genital schistosomiasis (FGS). In 51 women ova of Schistosoma haematobium were detected in urine by a filtration technique. In 33 of these women ova were also present in genital tissue as demonstrated by microscopic examination of biopsies. In 209 women no ova were found in the single urine filtered. There were significantly higher scores for hematuria, proteinuria and leukocyturia as well as of the combined reagent strip index (RSI) in egg-excreting than in egg-negative women. The sensitivity of a single hematuria, proteinuria and leukocyturia reading was 98, 84 and 73%, respectively. However, the respective specificity was only 24, 22 and 23%. The best prediction of urinary schistosomiasis was achieved by a +2 score for hematuria, of which the sensitivity was 94% and the specificity was 61%. The high false-positive rates can probably be explained by contamination of urine by vaginal secretion. Moreover, cases of schistosomiasis have probably been overlooked because only a single morning urine sample was examined. The total absence of hematuria, proteinuria and leukocyturia, however, may be used to rule out heavy infections in community surveys. There was no difference in reagent strip scores between women with genital and urinary schistosomiasis as compared with those with urinary tract lesions alone. Thus urine analysis reagent strip readings do not help to discriminate between S. haematobium infected women with and without FGS.
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Affiliation(s)
- S G Gundersen
- Ullevaal Centre for International Medicine, Oslo, Norway
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Helling-Giese G, Sjaastad A, Poggensee G, Kjetland EF, Richter J, Chitsulo L, Kumwenda N, Racz P, Roald B, Gundersen SG, Krantz I, Feldmeier H. Female genital schistosomiasis (FGS): relationship between gynecological and histopathological findings. Acta Trop 1996; 62:257-67. [PMID: 9028410 DOI: 10.1016/s0001-706x(96)00027-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Schistosomiasis of the lower female reproductive tract manifests itself in a broad spectrum of clinical features. However, clinical and histopathological findings have never been studied in a synoptic manner. Based on the assumption that any type of pathology present in the female reproductive tract is the expression of a complex pathophysiological reaction towards eggs sequestered in the genital tissues, we decided to analyze colposcopic and histopathological findings in a comprehensive manner. Thirty-three women in Malawi with urinary and genital schistosomiasis were examined parasitologically and gynecologically. A thorough colposcopic examination with photodocumentation was performed and biopsies were taken from the cervix, the vagina and/or the vulva for histological sectioning and immunohistochemistry. The predominant colposcopic findings were sandy patches on the cervical surface similar to those seen in the bladder and polypous/papillomatous tumors with irregular surface on the vaginal wall and in the vulvar area. The histopathological sections of sandy-patch-like lesions demonstrated only a small cellular reaction around S. haematobium eggs in various stages of disintegration. In contrast, in the case of polyps the histology revealed a more pronounced immunological reaction characterized by a heavy cellular infiltrate. One case of invasive squamous cell carcinoma of the cervix was diagnosed. We conclude that colposcopy is a useful tool in the detection of FGS related pathology in the lower female reproductive tract and that the synoptic assessment of surface and of corresponding histological sections helped to understand the pathophysiology of S. haematobium associated disease in genital tissue.
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Affiliation(s)
- G Helling-Giese
- Department of Gynecology and Obstetrics, Frauenklinik Finkenau, Hamburg, Germany
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32
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Kjetland EF, Poggensee G, Helling-Giese G, Richter J, Sjaastad A, Chitsulo L, Kumwenda N, Gundersen SG, Krantz I, Feldmeier H. Female genital schistosomiasis due to Schistosoma haematobium. Clinical and parasitological findings in women in rural Malawi. Acta Trop 1996; 62:239-55. [PMID: 9028409 DOI: 10.1016/s0001-706x(96)00026-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A total of 51 women with urinary schistosomiasis haematobium were examined in order to identify diagnostic indicators for female genital schistosomiasis (FGS). Patients were selected at random from the outpatient department of the Mangochi District Hospital, Malawi. The medical histories were recorded according to a pre-designed questionnaire and the women were subjected to a thorough gynaecological examination including colposcopy and photographic documentation of lesions. Microscopy of genital biopsies revealed that 33 of the 51 women had S. haematobium ova in cervix, vagina and/or vulva in addition to the presence of ova in urine. The most sensitive diagnostic procedure was beside microscopic examination of a wet cervix biopsy crushed between two glass slides, which revealed 25 of the 33 genital infections. There was a significant correlation between the size of genital lesions and the number of ova counted per mm2 of crushed tissue. Women with FGS had significantly more tumours in the vulva than women with schistosomiasis limited to the urinary tract. Most of the observed genital pathology could easily be identified by the naked eye, but colposcopic examination yielded valuable additional information like the demonstration of neovascularisation around cervical sandy patches. Few of the symptoms previously regarded as indicators for FGS could be linked to the presence of schistosome ova in genital tissue. Husbands of infertile women with FGS had children with other women significantly more often than husbands of women who only had urinary schistosomiasis. This, together with the finding that the majority of the divorced women had FGS, indicates that the manifestation of this disease may have implications for the marital and sexual life of the affected women.
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Affiliation(s)
- E F Kjetland
- Ullevaal Centre for International Medicine, Research Forum, Oslo, Norway
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Feldmeier H, Krantz I. A synoptic inventory of needs for research on women and tropical parasitic diseases. I. Application to urinary and intestinal schistosomiasis. Acta Trop 1993; 55:117-38. [PMID: 7903837 DOI: 10.1016/0001-706x(93)90073-k] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The determinants of major parasitic infections in women have never been studied systematically. Much work remains to be done before vital gaps in our knowledge will be filled. The protocol presented here categorizes the determinants of parasitic diseases, and functions as an inventory for research needs and priorities. In this paper, the synoptic inventory is tested by matching it against the scientific knowledge of schistosomiasis that is at hand. Available data and existing lacunae are discussed. We conclude that the environmental, economic, socio-cultural, nutritional, genetic, biological and immunological factors which determine schistosomiasis in women are largely unknown. There is an urgent need for systematic and interdisciplinary investigations before appropriate and sustainable interventions can be initiated.
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Affiliation(s)
- H Feldmeier
- Fachbereich Grundlagenmedizin, Freie Universität Berlin, Germany
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Feldmeier H, Poggensee G, Krantz I. A synoptic inventory of needs for research on women and tropical parasitic diseases. II. Gender-related biases in the diagnosis and morbidity assessment of schistosomiasis in women. Acta Trop 1993; 55:139-69. [PMID: 7903838 DOI: 10.1016/0001-706x(93)90074-l] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A synoptic inventory developed by us (Feldmeier and Krantz, 1993) was used for systematically reviewing existing data as to how and to what degree gender- and sex-related factors influence the validity of the diagnosis of schistosomiasis in women. Diagnostic sectors comprising survey methodology, parasitological methods, immunodiagnosis, detection of pathology and diagnosis of schistosomiasis in the female genital tract have thus been scrutinized. In this way we have identified important gaps in the scientific knowledge of diagnosis of an important parasitic infection. Socio-cultural and gender-related determinants have never been studied systematically, and it is mostly by circumstantial evidence that we can point out potential biases, sometimes for sex but more often for gender, in much of the published material concerning diagnostic categories suitable for schistosomiasis. These errors in diagnostic procedures and the ensuing lack of validity deserve attention from the fields of biomedicine and social science, preferably in a collaborative effort.
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Affiliation(s)
- H Feldmeier
- Fachbereich Grundlagenmedizin, Freie Universität Berlin, Germany
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35
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Abstract
Enterobius worms or their eggs, or both, are present in preserved tissue sections or tissue specimens of 259 patients whose medical records are on file at the Armed Forces Institute of Pathology, Washington D.C., U.S.A. The most common site of infection (86.5%) was found to be the lumen of the appendix, where the worms provoke no reaction. Of the 259 patients 11 (4.2%) had worms and/or eggs in granulomas of the abdominal and pelvic peritoneum, and an equal number had granulomas on the peritoneum of the salphinx or on the surface of the ovary. There were also ectopic worms and/or eggs in granulomas on the peritoneum of the small and large intestines (2.7%). These Enterobius granulomas form around degenerating adult worms, around discrete eggs, around clusters of eggs, and, we believe, also around the tracks of migrating worms. Three patients (1.2%) had worms in perianal abscesses. A necrotic granuloma, removed from the lung of one patient, surrounded a degenerating adult worm. This suggests that the worm, carried to the lung as an embolus, impacted in a pulmonary arteriole. A stool specimen of one patient contains eggs of Enterobius, and that of another patient contains an adult Enterobius. This is the largest recorded histopathological study of enterobiasis in man.
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Affiliation(s)
- B Sinniah
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur
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36
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Ellis WA, Thiermann AB. Isolation of leptospires from the genital tracts of Iowa cows. Am J Vet Res 1986; 47:1694-6. [PMID: 3752677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Leptospira interrogans serovar hardjo was recovered from 5 of 11 nonpregnant cows chosen at random from an Iowa slaughterhouse. Isolations were made from the kidney in each instance, the genital tract of 3 cows: uterus from 1 cow, oviduct of another, and oviduct and uterus of a 3rd cow.
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37
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Abstract
The pathologic changes in experimental animals infected with Schistosoma haematobium are reviewed and compared to the pathology in infected humans. The clinically important lesions in persons infected with S. haematobium are generally confined to the urogenital system. In experimental animals, functionally important lesions of the urogenital system are the exception but do occur in a significant proportion of infected primates. The acute lesions of the urinary tract in primates are similar to those in infected persons. Chronic lesions characterized by the extensive submucosal accumulation of calcified eggs are common in infected humans but uncommon in S. haematobium-infected animals.
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MESH Headings
- Animals
- Calcinosis
- Female
- Genitalia, Female/parasitology
- Genitalia, Female/pathology
- Genitalia, Male/parasitology
- Genitalia, Male/pathology
- Granuloma
- Humans
- Inflammation
- Intestinal Diseases, Parasitic/parasitology
- Intestinal Diseases, Parasitic/pathology
- Intestines/parasitology
- Liver/parasitology
- Liver/pathology
- Liver Diseases, Parasitic/parasitology
- Liver Diseases, Parasitic/pathology
- Lung Diseases, Parasitic/parasitology
- Lung Diseases, Parasitic/pathology
- Male
- Oviposition
- Ovum
- Schistosoma haematobium/physiology
- Schistosomiasis/parasitology
- Schistosomiasis/pathology
- Ureter/pathology
- Urinary Bladder/pathology
- Urinary Tract Infections/pathology
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38
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Wright ED, Chiphangwi J, Hutt MS. Schistosomiasis of the female genital tract. A histopathological study of 176 cases from Malawi. Trans R Soc Trop Med Hyg 1982; 76:822-9. [PMID: 7164149 DOI: 10.1016/0035-9203(82)90118-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The histopathology of 176 cases of gynaecological schistosomiasis reported from Malawi during the period 1976-80 was reviewed. Schistosomal infection was found throughout the genital tract, with 60% of cases involving the cervix. The dominant tissue reactions to ova were categorized into five histopathological groups A-E and for each site the relationship between histopathological and clinical features was explored. No evidence was found linking schistosomiasis with cancer of the genital tract. Schistosomiasis was a significant cause of gynaecological morbidity, particularly when infection involved the lower genital tract; however in a proportion of cases ova were found coincidentally in other lesions or normal tissues, and were not apparently causally linked with symptoms. The findings are discussed in relation to previous studies of gynaecological schistosomiasis.
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Abstract
In a prospective study, 138 African patients with infertility and 42 patients with incomplete abortion were examined for evidence of bilharziasis. There appeared to be a significant association between primary infertility and bilharziasis due to Schistosoma haematobium.
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41
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BARDIAUX M. [Hydatid cysts with genital localization]. Rev Fr Gynecol Obstet 1959; 54:737-43. [PMID: 13796693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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42
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HSU CT, MA YM, WANG TT. Paragonimiasis involving female genital organs. Report of two cases. Obstet Gynecol 1959; 14:461-6. [PMID: 14403597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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43
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CAMARA A. [Female genital schistosomiasis]. Rev Ginecol Obstet (Sao Paulo) 1959; 105:271-80. [PMID: 13807079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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44
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DUDKEVICH GA, MEDVEDKOVA MM. [Primary and secondary localization of echinococcosis in the female genitalia]. Akush Ginekol (Mosk) 1959; 35:104. [PMID: 13818438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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