[Epidemiological and clinical features of newly reported advanced schistosomiasis cases in Sichuan Province from 2011 to 2022]

OBJECTIVE

To analyze the epidemiological characteristics of newly reported advanced schistosomiasis cases in Sichuan Province, so as to provide the evidence for analyzing the causes and formulating targeted control measures of newly reported advanced schistosomiasis cases.

METHODS

Individual case investigation forms for advanced schistosomiasis cases were collected from the Sichuan Provincial Epidemic Annual Report System from 2011 to 2022, and patients' demographics, previous medical history and liver parenchymal grading were retrieved. All advanced schistosomiasis cases' medical records were reviewed, and the subtypes of schistosomiasis-endemic villages where the cases' household registration were, floating population, survival and death and time of death were collected.

RESULTS

A total of 321 newly reported advanced schistosomiasis cases were found in Sichuan Province from 2011 to 2022, with a male to female ratio of 0.99 to 1. There were 274 cases at ages of over 50 years (85.4%), with the highest proportion seen at ages of 60 to 69 years (87 cases, 27.1%), and splenomegaly was the most common type (180 cases, 56.1%), with no dwarfism type detected. The highest number of cases was reported in 2011 (78 cases), followed by in 2022 (74 cases), and the highest number of cases were reported in Meishan City (199 cases, 62.0%), Dongpo District (131 cases, 40.8%), and hilly subtype areas (136 cases, 42.4%). As of the end of 2022, there were 111 deaths due to advanced schistosomiasis, with the highest number of deaths seen in 2018 (25 deaths), and the highest mortality was seen among patients with the ascites type (41.2%). There were 47 (37.3%), 40 (59.5%) and 4 (23.5%) cases with grade III liver parenchyma among patients with splenomegaly, ascites, and colonic proliferation types, respectively, and there was a significant difference in the grading of III liver parenchyma among three types of patients (H = 12.092, P < 0.05), with more severe liver parenchyma injuries seen among patients with the ascites type than among those with splenomegaly and colonic proliferation type (Z = 24.262 and 44.738, both Padjusted values < 0.05).

CONCLUSIONS

There have been newly reported advanced schistosomiasis cases in Sichuan Province during recent years, and patients with the ascites type should be given a high priority among advanced schistosomiasis cases in Sichuan Province. Intensified clue surveys are needed for early identification and treatment of advanced schistosomiasis cases, so as to increase the survival rate and improve the quality of life.

[Prevalence of comorbid depression and anxiety and effect of psychological interventions among schistosomiasis patients in China: a meta-analysis]

OBJECTIVE

To investigate the prevalence of comorbid depression and anxiety and to evaluate the effect of psychological interventions among schistosomiasis patients in China, so as to provide insights into improvements of psychological health among schistosomiasis patients.

METHODS

Publications pertaining to comorbid depression and anxiety and psychological interventions among Chinese schistosomiasis patients were retrieved in electronic databases, including CNKI, Wanfang Data, PubMed, Web of Science, and Embase. The prevalence of comorbidity, psychological interventions, and scores for the Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) before and after psychological interventions among Chinese schistosomiasis patients were extracted. The prevalence of comorbid depression and anxiety was investigated among Chinese schistosomiasis patients using a meta-analysis, and the effect of psychological interventions for depression and anxiety was evaluated.

RESULTS

A total of 231 publications were retrieved, and 14 publications that met the inclusion and exclusion criteria were included in the final analysis, including 2 English publications and 12 Chinese publications. Meta-analysis showed that the prevalence rates of comorbid depression and anxiety were 61% [95% confidential interval (CI): (48%, 72%)] and 64% [95% CI: (42%, 81%)] among Chinese schistosomiasis patients. Both the SDS [1.45 points, 95% CI: (1.30, 1.60) points] and SAS scores [2.21 points, 95% CI: (2.05, 2.38) points] reduced among Chinese schistosomiasis patients after psychological interventions than before psychological interventions, and the SDS [-0.47 points, 95% CI: (-6.90, -0.25) points] and SAS scores [-1.30 points, 95% CI: (-1.52, -1.09) points] reduced among Chinese schistosomiasis patients in the case group than in the control group.

CONCLUSIONS

The comorbid anxiety and depression are common among Chinese schistosomiasis patients, and conventional psychological interventions facilitate the improvements of anxiety and depression among schistosomiasis patients.

Diagnosis and clinical management of hepatosplenic schistosomiasis: A scoping review of the literature

BACKGROUND

Hepatosplenic schistosomiasis (HSS) is a disease caused by chronic infection with Schistosma spp. parasites residing in the mesenteric plexus; portal hypertension causing gastrointestinal bleeding is the most dangerous complication of this condition. HSS requires complex clinical management, but no specific guidelines exist. We aimed to provide a comprehensive picture of consolidated findings and knowledge gaps on the diagnosis and treatment of HSS.

METHODOLOGY/PRINCIPAL FINDINGS

We reviewed relevant original publications including patients with HSS with no coinfections, published in the past 40 years, identified through MEDLINE and EMBASE databases. Treatment with praziquantel and HSS-associated pulmonary hypertension were not investigated. Of the included 60 publications, 13 focused on diagnostic aspects, 45 on therapeutic aspects, and 2 on both aspects. Results were summarized using effect direction plots. The most common diagnostic approaches to stratify patients based on the risk of variceal bleeding included the use of ultrasonography and platelet counts; on the contrary, evaluation and use of noninvasive tools to guide the choice of therapeutic interventions are lacking. Publications on therapeutic aspects included treatment with beta-blockers, local management of esophageal varices, surgical procedures, and transjugular intrahepatic portosystemic shunt. Overall, treatment approaches and measured outcomes were heterogeneous, and data on interventions for primary prevention of gastrointestinal bleeding and on the long-term follow-up after interventions were lacking.

CONCLUSIONS

Most interventions have been developed on the basis of individual groups' experiences and almost never rigorously compared; furthermore, there is a lack of data regarding which parameters can guide the choice of intervention. These results highlight a dramatic need for the implementation of rigorous prospective studies with long-term follow-up in different settings to fill such fundamental gaps, still present for a disease affecting millions of patients worldwide.

[Effect of rational emotive therapy on negative emotion in advanced schistosomiasis patients with repeated hospitalization]

OBJECTIVE

To examine the effect of rational emotive therapy on negative emotions among advanced schistosomiasis patients with repeated hospitalizations.

METHODS

A total of 97 advanced schistosomiasis patients with anxiety and depressive emotions that were hospitalized in Xiangyue Hospital of Hunan Institute of Schistosomiasis Control for three times or more were enrolled, and given rational emotive therapy for 4 weeks in addition to routine nursing care. The scores for anxiety, depression and quality of life were estimated in patients before and after the rational emotive therapy using the Self-Rating Anxiety Scale (SRS), the Self-Rating Depression Scale (SDS) and WHOQOL-BREF Form.

RESULTS

The SAS and SDS scores were significantly lower 4 weeks following rational emotive therapy than before the intervention (SAS score, 45.40 ± 7.77 vs. 59.25 ± 9.29, t = 14.021, P < 0.01; 51.48 ± 8.01 vs. 63.93 ± 9.59, t = 12.991, P < 0.01). The percentages of patients with moderate and severe anxiety and depression were significantly lower 4 weeks following rational emotive therapy than before the intervention (P < 0.01), and the scores for each item in the quality of life were all significantly greater 4 weeks following rational emotive therapy than before the intervention (P < 0.01).

CONCLUSIONS

Rational emotive therapy may improve the negative emotions and the quality of life of advanced schistosomiasis patients with repeated hospitalizations.

Knowledge, attitudes and practices on schistosomiasis and soil-transmitted helminths among caregivers in Ingwavuma area in uMkhanyakude district, South Africa

BACKGROUND

Schistosomiasis and soil-transmitted helminth infections are among the most chronic infections worldwide. Based on their demonstrable impact on human health, the WHO recently recommended the implementation of robust strategies aimed at controlling or eliminating schistosomiasis and soil-transmitted helminths by 2020. The implementation of this strategy, however, warrants a clear understanding of the community's knowledge, attitudes and practices in relation to these infections. This study sought to identify sociocultural gaps that should be addressed to ensure the success of cost-effective community-based schistosomiasis-soil-transmitted helminths control and elimination programs.

METHODS

This was a cross-sectional mixed methodology study. Quantitative data were collected using a structured questionnaire from 442 caregivers of preschool aged children. In-depth interviews and focus group discussions were conducted among caregivers, preschool teachers, traditional authorities and community caregivers. All interviews were captured using an audio recorder to maximize accuracy. Quantitative data were analysed using bivariate and multivariate techniques while qualitative data were analysed thematically.

RESULTS

Findings reflected inadequate knowledge, attitudes and practices in relation to schistosomiasis and soil-transmitted helminths while awareness of schistosomiasis and soil-transmitted helminths was high (87.1 and 79.2% respectively). Correct knowledge on transmission, prevention, signs and symptoms and life cycle was low (below 50%) for both infections among those who had heard of the disease. From multivariate analysis, being aged at least 35 years increased the odds of reporting good practices on schistosomiasis by 65% (COR 1.652, 95% CI: 1.073-2.543) while receiving health information through community meetings (COR 0.072, 95% CI: 0.010-0.548) significantly reduced the odds of having good knowledge on schistosomiasis.

CONCLUSIONS

These findings are valuable in designing behavioural change approaches towards enhancing health outcomes through community-based interventions to ensure effective control and elimination of schistosomiasis and soil-transmitted helminths. There is a critical need for channelling efforts towards making health education the core of schistosomiasis and soil-transmitted helminths programs aimed at achieving intensified control or elimination of these infections by 2020.

Mapping evidence of the concomitant management of schistosomiasis by traditional health practitioners and health care professionals in communities with high prevalent infections: a systematic scoping review protocol

BACKGROUND

Schistosomiasis is one of the most prevalent parasitic diseases in low- and middle-income countries (LMICs), being regarded as a neglected tropical disease in sub-Saharan Africa. Praziquantel is the conventional treatment recommended for schistosomiasis in mainstream healthcare systems. In many poor settings, while many people reportedly use both traditional medicine and public sector mainstream healthcare systems, little is known if those infected with schistosomiasis use both African traditional and prescribed antischistosomal medicines. This review aims to map evidence of the concomitant management of schistosomiasis by traditional health practitioners (THPs) and health care professionals (HCPs) in communities with a high prevalence schistosomiasis infection in LMICs.

METHODS/DESIGN

Guided by Arksey and O'Malley scoping review framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we will map the evidence from relevant studies dating from 2007 to 2019 published in LMICs. An electronic keyword search of the following databases will be conducted: PubMed, Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and MEDLINE via EBSCOhost, Google Scholar, and WILEY online Library. Peer-reviewed articles, gray literature sources, and reference lists will be included to identify eligible studies. Following title screening, two reviewers will independently screen the abstracts and full texts. Any study that focuses on managing schistosomiasis will be included. The data will be analyzed using thematic analysis with the help of NVIVO software version 12, with the Mixed Method Appraisal Tool (MMAT) being used to assess the quality of the included studies.

DISCUSSION

This review will map the evidence in the literature of the concomitant management of schistosomiasis by THPs and HCPs in communities with a high prevalent infection in LMICs. The review findings will be important for policy makers across the healthcare continuum and be used to inform stakeholders' consensus process to explore the development of a generic set of patient-centered quality indicators that are applicable to multiple care settings. It will also identify research gaps in schistosomiasis management in LMICs and provide direction for future research. The results will be disseminated through a peer-reviewed publication and presented in relevant conferences.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42017078198.

Unresolved Splenomegaly in Recently Resettled Congolese Refugees ― Multiple States, 2015–2018

In 2014, panel physicians from the International Organization for Migration (IOM), who conduct Department of State–required predeparture examinations for U.S.-bound refugees at resettlement sites in Uganda, noticed an unusually high number of Congolese refugees with enlarged spleens, or splenomegaly. Many conditions can cause splenomegaly, such as various infections, liver disease, and cancer. Splenomegaly can result in hematologic disturbances and abdominal pain and can increase the risk for splenic rupture from blunt trauma, resulting in life-threatening internal bleeding. On CDC’s advice, panel physicians implemented an enhanced surveillance and treatment protocol that included screening for malaria (through thick and thin smears and rapid diagnostic testing), schistosomiasis, and several other conditions; treatment of any condition identified as potentially associated with splenomegaly; and empiric treatment for the most likely etiologies, including malaria and schistosomiasis. CDC recommended further treatment for malaria with primaquine after arrival, after glucose-6-phosphate dehydrogenase testing, to target liver-stage parasites. Despite this recommended treatment protocol, 35 of 64 patients with available follow-up records had splenomegaly that persisted beyond 6 months after resettlement. Among 85 patients who were diagnosed with splenomegaly through abdominal palpation or ultrasound at any point after resettlement, 53 had some hematologic abnormality (leukopenia, anemia, or thrombocytopenia), 16 had evidence of current or recent malaria infection, and eight had evidence of schistosomiasis. Even though primaquine was provided to a minority of patients in this cohort, it should be provided to all eligible patients with persistent splenomegaly, and repeated antischistosomal therapy should be provided to patients with evidence of current or recent schistosomiasis. Given substantial evidence of familial clustering of cases, family members of patients with known splenomegaly should be proactively screened for this condition.

[Study on effect of clinical pathway implementation in advanced schistosomiasis with ascites]

OBJECTIVE

To evaluate the effect of clinical pathway (CP) on the implementation of advanced schistosomiasis patients with ascites.

METHODS

Totally 1 129 cases of advanced schistosomiasis patients with ascites but without other complications were selected randomly from the Performance Evaluation and Management System for Medical Treatment of Advanced Schistosomiasis Patients in Hubei Province from year 2011 to 2013. Among the patients, 754 cases were treated by CP (CP group), and 375 cases were treated with traditional methods (NCP group), and the hospitalization days, hospitalization expenses, medicine proportions, treatment outcomes and degrees of satisfaction and health knowledge rates of the two groups were compared. Meanwhile, the variation of CP was calculated.

RESULTS

The average length of hospital days of the CP group and NCP group were (13.85 ± 5.60) d and (17.92 ± 5.80) d, respectively, and the average hospitalization costs of the two groups were (4 699.14 ± 1 520.59) Yuan and (5 692.01 ± 1 616.66) Yuan, respectively, both the differences were statistically significant (both P ＜ 0.05). Also the hospitalization cost structures of the two groups were remarkably different, the composition ratios of the inspection fee and accommodation fee in the CP group were lower than those in the NCP group, but the constituent ratios of the examination fee, diagnosis and treatment fee, drug charges and other expenses were higher than those in the NCP group (all P < 0.05). The awareness rate of health knowledge in the CP group was higher than that in the NCP group (P < 0.05), but there were no statistically significant differences in the treatment outcome and the degree of satisfaction between the two groups (both P > 0.05). The variation rate of CP was 9.02% (68/754).

CONCLUSIONS

The implementation of CP can decrease the days of hospital stay and medical expenses, improve the awareness rate on health knowledge of the patients. The CP treatment with low variation rate is applicable to advanced schistosomiasis patients with ascites but without complications.

Paediatric schistosomiasis: What we know and what we need to know

Schistosomiasis affects over 200 million people worldwide, most of whom are children. Research and control strategies directed at preschool-aged children (PSAC), i.e., ≤5 years old, have lagged behind those in older children and adults. With the recent WHO revision of the schistosomiasis treatment guidelines to include PSAC, and the recognition of gaps in our current knowledge on the disease and its treatment in this age group, there is now a concerted effort to address these shortcomings. Global and national schistosome control strategies are yet to include PSAC in treatment schedules. Maximum impact of schistosome treatment programmes will be realised through effective treatment of PSAC. In this review, we (i) discuss the current knowledge on the dynamics and consequences of paediatric schistosomiasis and (ii) identify knowledge and policy gaps relevant to these areas and to the successful control of schistosome infection and disease in this age group. Herein, we highlight risk factors, immune mechanisms, pathology, and optimal timing for screening, diagnosis, and treatment of paediatric schistosomiasis. We also discuss the tools required for treating schistosomiasis in PSAC and strategies for accessing them for treatment.

[Clinical characteristics of 96 patients with advanced schistosomiasis in Yingcheng City]

OBJECTIVE

To understand the clinical characteristics of patients with advanced schistosomiasis in Yingcheng City, so as to provide evidences for the assistance work of advanced schistosomiasis.

METHODS

The clinical data of all the advanced schistosomiasis patients in Yingcheng City were collected and analyzed.

RESULTS

Up to December 30, 2014, there were 96 advanced schistosomiasis patients in Yingcheng City, among which, 68 cases (70.8%) were male, 28 cases (29.2%) were female, and their average age was 64.2 years. Most of the patients (90.6%) were ascitic type, followed by splenomegaly type (5.2%), colon proliferation type (2.1%), and dwarf type (2.1%). Totally 48 cases (50.0%) were positive in immunological detections, among which 8 cases (8.3%) were positive in ELISA and 12 cases (12.5%) were positive in IHA. For all the 4 indexes of hepatic fibrosis (HA, LN, CIV and PCⅢ), only 15 cases (15.6%) were normal.

CONCLUSIONS

Though Yingcheng City has reached the criteria of transmission control, the hepatic fibrosis of some patients continues to progress. Therefore, the intensity of the treatment and assistance could not be weakened, especially for those of the ascitic type patients.

[Diagnosis and treatment of imported African schistosomiasis]

This paper summarizes the clinical diagnosis and treatment of imported African schistosomiasis, in order to make the therapeutic standards. Imported African schistosomiasis includes mainly schistosomiasis haematobia and schistosomiasis mansoni in China. In order to set up the operational standards, enhance diagnostic and cure rates, and reduce the complications, we review the related literature combined with our experience over years, and summarize, in this paper, the pathogenic mechanism, and key points of clinical diagnosis and treatment of schistosomiasis haematobia and schistosomiasis mansoni, so as to provide the reference for clinical doctors.

[Effect of clinical pathway on advanced schistosomiasis patients with acites: a report of 220 cases]

OBJECTIVE

To evaluate the effect of the clinical pathway on advanced schistosomiasis patients with acites.

METHODS

According to the Handbook of Schistosomiasis Control, and the Clinical Pathway on Advanced Schistosomiasis in Hubei Province, the therapeutic effects, disease awareness, and the satisfaction of patients of 220 advanced schistosomiasis patients (ascitic type) who were treated by the traditional pathway in 2013 and 220 patients who treated by the clinical pathway in 2014, respectively, were evaluated and compared with the statistical method.

RESULTS

As the outcomes of the patients had no significant difference between the traditional pathway therapy and the clinical pathway therapy, the average hospitalization days and medical expense were reduced when the patients were treated by the clinical pathway. The average hospitalization days were reduced to 12 days from 14 days. The average medical expense was reduced to RMB 5,800 form RMB 6,400. The average rate of awareness about the disease and the satisfaction rate of the patients were raised to 95% in the patients treated by the clinical pathway. The results of t test for the three indicators above mentioned showed significant differences between the two therapies (all P < 0.05).

CONCLUSION

The clinical pathway can standardize the medical behavior and avoid the waste of medical resources, so as to improve the treatment of advanced schistosomiasis.

[Evaluation on effect of treatment and assistance to advanced schistosomiasis patients in Qianjiang City]

OBJECTIVE

To evaluate the implementation and effect of the program of treatment and assistance to advanced schistosomiasis patients in Qianjiang City.

METHODS

The data about the program from 2004 to 2012 were collected and analyzed, and the analysis of cost-effectiveness was performed. Meanwhile, 160 patients were sampled and surveyed about the recovery of their health.

RESULTS

From 2004 to 2012, totally 2 363 person-times' patients received the treatment, and 339 patients were cured clinically. On average, each patient received 3.11 times of treatment and 22.28 d of hospitalization, the treatment cost was 5,382.87 yuan per year for each patient, and the cost-effectiveness was 12.7 thousand yuan per life-year-saved.

CONCLUSION

The program of treatment and assistance to advanced schistosomiasis patients cures a part of patients and improves the working capacity and life quality of the patients.

[Design and application of psychological intervention paths for ascites type of advanced schistosomiasis patients]

OBJECTIVE

To explore the design and application of psychological intervention paths for ascites type of advanced schistosomiasis patients.

METHODS

A total of 156 ascites type of advanced schistosomiasis patients were divided into an intervention group and a control group with 78 cases each. A psychological intervention path table was designed in accordance with the psychological characteristics and demands of the advanced schistosomiasis patients. Five steps were used to guide the nurses involved to carry out the psychological intervention.

RESULTS

Before the intervention, there were no statistically significant differences (all P > 0.05) between two groups in SAS, SDS, WHOQOL-BRER scores, but after the intervention, all the evaluation indexes improved in the intervention group and there were statistically significant differences between the intervention group and control group in SAS, SDS, WHOQOL-BRER scores (all P < 0.05).

CONCLUSION

The application of psychological intervention paths for ascites type of advanced schistosomiasis patients can improve their negative emotions and qualities of life.

[Evaluation on effect of treatment and assistance to advanced schistosomiasis patients in Hunan Province from 2004 to 2013]

OBJECTIVE

To comprehensively evaluate the effect of the program of treatment and assistance to advanced schistosomiasis patients in Hunan Province from 2004 to 2013.

METHODS

The fund investment of the program, the profits of hospitals and the improvement of the patients' health were investigated by data collection and questionnaire survey. The evaluation index system of treatment and assistance to advanced schistosomiasis in Hunan Province was constructed by the Delphi method and analytic hierarchy process, and the program was assessed comprehensively.

RESULTS

The evaluation index system including 6 primary indices and 33 secondary indices was established. Among all the primary indices, the score of the treatment and assistance (22.25) was the highest, and that of the satisfaction assessment (8.15) was the lowest, and the score of the comprehensive assessment was 87.06. The average cure rate of the patients was 13.08% from 2004 to 2013. More than 60% of the patients' disease condition got better, and nearly 70% of the patients' psychological condition improved, and more than 70% of patients' self-help ability and social contact improved, as well as family happiness increased. In addition, the annual average cost for caretakers decreased by 2000 Yuan, and the profits of all the fixed-point hospitals for treatment and assistance increased.

CONCLUSION

The effectiveness and efficiency of the treatment and assistance to advanced schistosomiasis patients in Hunan Province is obvious, and the government should continuously invest in the program.

[Analysis on depression of patients with advanced schistosomiasis and its influencing factors]

OBJECTIVE

To explore the status of depression in patients with advanced schistosomiasis and its influencing factors, so as to provide the evidence for improving psychological interventions.

METHODS

A total of 206 patients with advanced schistosomiasis were investigated with the self-designed general information questionnaire, the Self-Rating Depression Scale, and WHOQOL-BREF Form.

RESULTS

Among the 206 cases, the incidence of depression was 69.4%, and depression was negatively related to the quality of life (P = 0.000). The multiple logistic regression analysis showed that the times of hospitalization (β = 0.442, P = 0.007) was a risk factor for depression, while the high education levels (β = -0.583, P = 0.011) and the history of portal hypertension operation (β = -0.917, P = 0.000) were the protective factors.

CONCLUSION

The incidence of depression in advanced schistosomiasis patients is high, and it is influenced by various factors. Therefore, we should take corresponding interventions to reduce its occurrence.

Dynamics of people's socio-economic status in the face of schistosomiasis control interventions in Ukerewe district, Tanzania

There is a paucity of research on micro-level assessment of the dynamics of socio-economic status following health interventions. The use of household asset data to determine wealth indices is a common procedure for estimating socio-economic position in low-income countries. Indeed, in such settings information about income is usually lacking and the collection of individual consumption or expenditure data would require in-depth interviews, posing a considerable risk of bias. In this study, we determined the socio-economic status of 159 households in a village in north-western Tanzania before and 1 year after participatory hygiene and sanitation transformation (PHAST) intervention to control schistosomiasis. We constructed a household 'wealth index' based on durable assets ownership (e.g. bicycle and radio) and household characteristics dealing with ownership of land and house construction features (e.g. type of walls and roof). We employed principal components analysis and classified households into wealth quintiles. The study revealed that asset variables with positive factor scores were associated with higher socio-economic status, whereas asset variables with negative factor scores were associated with lower socio-economic status. Overall, households which were rated as the poorest and very poor were on the decrease, whereas those rated as poor, less poor and the least poor were on the increase after PHAST intervention. This decrease/increase was significant. The median shifted from -0.761 to -0.448, and the mean from -0.204 (standard deviation (SD) 1.924) to 0.193 (SD 2.079) between pre- and post-intervention phases. The difference in socio-economic status of the people comparing the pre- and post-intervention phases was highly statistically significant (p<0.001). This observation was confirmed by a multinomial model with a random effect on the households. We argue that significant changes in the socio-economic status observed in our study are attributable to the PHAST intervention, despite other sporadic interventions against schistosomiasis.

[Qualitative research of self-management behavior in patients with advanced schistosomiasis]

OBJECTIVE

To explore the self-management behavior of patients with advanced schistosomiasis, so as to provide the evidence for improving clinical nursing.

METHODS

A total of 18 patients with advanced schistosomiasis were interviewed in depth by using a semi structured interview method. The results were analyzed with Miles and Huberman content analysis method.

RESULTS

Most of the patients with advanced schistosomiasis had self-management control behavior and were cooperated with medical assistance because of their seriously illness. Based on data analysis, the symptom management, follow-up management, a healthy lifestyle, medication awareness, and emotional management were obtained.

CONCLUSION

The patients with advanced schistosomiasis have self management control behavior. Health care workers should promote the patients, their families and social people to participate in the self-management behavior of advanced schistosomiasis patients.

[Performance of detection and treatment in schistosomiasis in Hubei Province, 2011]

OBJECTIVE

To evaluate the performance of schistosomiasis detection and treatment program in Hubei Province in 2011, so as to enhance the benefit and management of the program.

METHODS

In 63 schistosomiasis epidemic counties of Hubei Province, there were 3 types of endemic situation, that was endemic controlled, transmission controlled, and transmission interrupted. Six counties (districts) in each type were selected by the stratified random sampling method. The data including schistosomiasis detection and treatment, fund utilization and others were collected and analyzed statistically in 2011.

RESULTS

The completion rate of schistosomiasis detection task was 103.9% and the completion rate of chemotherapy task 106.9%. The total fund was 73.815 million Yuan. The detection cost accounted for 12.0% while the chemotherapy cost accounted for 4.9%. The detection cost per capita was 9.03 Yuan and the treatment cost per capita was 10.35 Yuan. The cost effectiveness ratio was 1:6.1 and the net cost effectiveness ratio was 1:5.1.

CONCLUSION

The social-economic benefits in schistosomiasis control and treatment are obvious. However, the resource allocation still needs to be optimized.

Combined TLR7/8 and TLR9 ligands potentiate the activity of a Schistosoma japonicum DNA vaccine

Background

Toll-like receptor (TLR) ligands have been explored as vaccine adjuvants for tumor and virus immunotherapy, but few TLR ligands affecting schistosoma vaccines have been characterized. Previously, we developed a partially protective DNA vaccine encoding the 26-kDa glutathione S-transferase of Schistosoma japonicum (pVAX1-Sj26GST).

Methodology/Principal Findings

In this study, we evaluated a TLR7/8 ligand (R848) and a TLR9 ligand (CpG oligodeoxynucleotides, or CpG) as adjuvants for pVAX1-Sj26GST and assessed their effects on the immune system and protection against S. japonicum. We show that combining CpG and R848 with pVAX1-Sj26GST immunization significantly increases splenocyte proliferation and IgG and IgG2a levels, decreases CD4⁺CD25⁺Foxp3⁺ regulatory T cells (Treg) frequency in vivo, and enhances protection against S. japonicum. CpG and R848 inhibited Treg-mediated immunosuppression, upregulated the production of interferon (IFN)-γ, tumor necrosis factor (TNF)-α, interleukin (IL)-4, IL-10, IL-2, and IL-6, and decreased Foxp3 expression in vitro, which may contribute to prevent Treg suppression and conversion during vaccination and allow expansion of antigen-specific T cells against pathogens.

Conclusions

Our data shows that selective TLR ligands can increase the protective efficacy of DNA vaccines against schistosomiasis, potentially through combined antagonism of Treg-mediated immunosuppression and conversion.

There is evidence that TLR activation can block Treg cell responses and thereby break tolerance to self-antigens. It is expected that the use of TLR ligands as vaccine adjuvants will induce potent anti-pathogen immune responses and simultaneously overcome immune inhibition mediated by Tregs. However, the impact of TLR ligands on schistosomiasis vaccines is unclear. Here, we demonstrate that the use of a TLR7/8 ligand (R848) and a TLR9 ligand (CpG) as adjuvants in combination with the S. japonicum vaccine pVAX1-Sj26GST improves disease protection. The combination of CpG and R848 administered after vaccination causes an immune response marked by an upregulation of splenocyte proliferation and IgG and IgG2a levels that also coincides with a decreased proportion of CD4⁺CD25⁺ Tregs in mice. We also show that combined adjuvant use of CpG and R848 may impair Treg development and function by promoting the secretion of proinflammatory cytokines and reducing Foxp3 expression. Our findings suggest that in combination with the vaccine, TLR ligands may protect the effector response from Treg-mediated suppression, thereby eliciting the appropriate immune response to improve vaccine efficacy. Immunization combined with the TLR ligands CpG and R848 thus represents a promising new approach for the design of schistosoma vaccines.

[Application of clinical nursing path in standard management of advanced schistosomiasis patients with splenomegaly]

OBJECTIVE

To study the feasibility and effect of clinical nursing path in the standard management of advanced schistosomiasis patients with splenomegaly.

METHODS

A total of 64 advanced schistosomiasis patients with splenomegaly were randomly divided into a routine nursing group (control group) and a clinical nursing pathway group (CNP group), and the postoperative situation, average hospitalization days, cost of hospitalization and the satisfaction of the patients of the 2 groups were compared.

RESULTS

The complications, average hospitalization days, costs of hospitalization in the CNP group were significantly decreased compared with those in the control group, and satisfaction rate of the patients in the CNP group increased from 81.25% to 100%.

CONCLUSION

The implementation of CNP effectively reduces the length of hospitalization, costs and complications, and improves the satisfaction of the patients.

[Multi-disciplinary treatment for advanced schistosomiasis]

OBJECTIVE

To assess the efficiency of multi-disciplinary treatment (MDT) for advanced schistosomiasis.

METHODS

A total of 173 advanced schistosomiasis patients who received MDT were selected from January 2010 to December 2011. These patients included 75 splenomegaly cases and 98 ascites cases. Other 193 advanced schistosomiasis patients who received single-discipline treatment (SDT) from January 2007 to December 2009 were also selected, and of them 84 cases were splenomegaly and 109 were ascites. The clinical efficiencies of the two different treatments were analyzed and assessed.

RESULTS

Compared to the SDT group, the splenomegaly cases treated by MDT showed a shorter pre-operative preparation time and less days in hospitalization (both P < 0.01), less operation duration, decreased post-operative complications, lower hospitalization costs (all P < 0.05), and less patient complaints (P > 0.05). The ascites cases treated by MDT, compared to the SDT group, had less pre-treatment time, shorter ascites-disappearing time (both P <0.01), and less hospitalization duration, decreased post-treatment complications, lower hospitalization costs and less patient complaints (all P < 0.05). Conclusion MDT has a better efficiency in the treatment of advanced schistosomiasis, and it reduces the operation complications and improves the life quality of the patients.

[Investigation on advanced schistosomiasis cases in Mianyang]

OBJECTIVE

To understand the current status and disease history of advanced cases of schistosomiasis in Mianyang Prefecture.

METHODS

The advanced patients in Fucheng, Beichuan and Anxian were investigated in 2010. Demographical information, disease history, current status, awareness and accessibility to the national medical aid to advanced schistosomiasis patients were investigated by inquiry, physical examination and information searching from the history archives.

RESULTS

There were 78 advanced schistosomiasis patients in the Prefecture, distributing at Beichuan (7 cases, 9.0%), Fucheng (19 cases, 24.4%) and Anxian (52 cases, 66.7%). The male to female ratio was 2.3:1. The age ranged from 35 to 79 years old, with 74.4% (58/78) above 50 years old. About 73.1% of the patients were illiterate or with primary school education among 67 cases participating in the investigation. 94.0% of them were farmers. There were 43 cases with splenomegaly (64.2%), 23 cases with ascites (34.3%). 52.2% (35/67) of the patients still had gastrointestinal symptoms. Abdominal ultrasonography showed that 19 cases were with grade II or above hepatic fibrosis. Among the 67 cases, 3 were clinically cured, 35 clinically stable and 29 in need of further treatment. All cases had different degrees of loss in labour capacity. 23 cases were aware of the national medical aid policy with a rate of 34.3%. 19 cases (28.4%) received the aid.

CONCLUSION

Health education should be strengthened in the rural population above 50 years old, especially those with low education level, and further advocacy on the medical aid policy to advanced schistosomiasis patients needs to be made.

[Analysis of advanced schistosomiasis situation in Hubei Province, 2004-2011]

There were 39 996 cases of advanced schistosomiasis in Hubei Province, 2004-2011, and most of them were of ascites type. During the period of 8 years, the assistance rate was 97.14%, the cure rate was 14.54%, the mortality rate was 5.59%, and the newly increased rates and the mortality rates declined year by year.

[Discussion on clinical pathways of schistosomiasis]

According to the long-term clinical experience on schistosomiasis control of Hunan Institute of Schistosomiasis and the latest clinical guidelines, this paper makes a discussion on the clinical pathways of 3 types of schistosomiasis, and establishes the pathway management including diagnosis, therapy, hospital stays, and treatment after discharge, nursing, recovery, follow-up and so on, aiming to formulate a standardized flow or a pathway for schistosomiasis treating.

[Investigation on current status of advanced schistosomiasis in Sichuan Province, 2010]

OBJECTIVE

To understand the current distribution and characteristics of patients with advanced schistosomiasis in Sichuan Province, so as to provide the scientific evidence for improving the management and treatment of advanced schistosomiasis.

METHODS

The patients who had been diagnosed as advanced schistosomiasis or were supposed with advanced schistosomiasis were the objects of the investigation. The epidemiological survey and medical examination were used to investigate these persons one by one according to the national standard.

RESULTS

There were 1 684 patients with confirmed diagnosis in 7 cities of Sichuan Province. There were 1 066 cases of splenomegaly including post-surgery (63.30%), 545 cases of ascites (32.36%), 44 cases of multiple granulomas in the colon (2.61%), and 29 cases of dwarf (1.72%). Most of the patients were old and 51.72% of them were more than 60 years old. A total of 1 331 patients (79.04%) needed treatment and assistance at present, and 36.44% of them who had ascites needed internal medicine treatment.

CONCLUSION

There are also many patients with advanced schistosomiasis in Sichuan Province, and ascites and splenomegaly (post-surgery) were the main types. The patients with ascites should be the important objects of the treatment and assistance in the future.

[Development of performance evaluation and management system on advanced schistosomiasis medical treatment]

OBJECTIVE

To construct a performance evaluation and management system on advanced schistosomiasis medical treatment, and analyze and evaluate the work of the advanced schistosomiasis medical treatment over the years.

METHODS

By applying the database management technique and C++ programming technique, we inputted the information of the advanced schistosomiasis cases into the system, and comprehensively evaluated the work of the advanced schistosomiasis medical treatment through the cost-effect analysis, cost-effectiveness analysis, and cost-benefit analysis.

RESULTS

We made a set of software formula about cost-effect analysis, cost-effectiveness analysis, and cost-benefit analysis. This system had many features such as clear building, easy to operate, friendly surface, convenient information input and information search. It could benefit the performance evaluation of the province's advanced schistosomiasis medical treatment work.

CONCLUSION

This system can satisfy the current needs of advanced schistosomiasis medical treatment work and can be easy to be widely used.

Thioredoxin glutathione reductase as a novel drug target: evidence from Schistosoma japonicum

Background

Schistosomiasis remains a major public health concern affecting billions of people around the world. Currently, praziquantel is the only drug of choice for treatment of human schistosomiasis. The emergence of drug resistance to praziquantel in schistosomes makes the development of novel drugs an urgent task. Thioredoxin glutathione reductase (TGR) enzymes in Schistosoma mansoni and some other platyhelminths have been identified as alternative targets. The present study was designed to confirm the existense and the potential value of TGR as a target for development of novel antischistosomal agents in Schistosoma japonicum, a platyhelminth endemic in Asia.

Methods and Findings

After cloning the S. japonicum TGR (SjTGR) gene, the recombinant SjTGR selenoprotein was purified and characterized in enzymatic assays as a multifunctional enzyme with thioredoxin reductase (TrxR), glutathione reductase (GR) and glutaredoxin (Grx) activities. Immunological and bioinformatic analyses confirmed that instead of having separate TrxR and GR proteins in mammalian, S. japonicum only encodes TGR, which performs the functions of both enzymes and plays a critical role in maintaining the redox balance in this parasite. These results were in good agreement with previous findings in Schistosoma mansoni and some other platyhelminths. Auranofin, a known inhibitor against TGR, caused fatal toxicity in S. japonicum adult worms in vitro and reduced worm and egg burdens in S. japonicum infected mice.

Conclusions

Collectively, our study confirms that a multifunctional enzyme SjTGR selenoprotein, instead of separate TrxR and GR enzymes, exists in S. japonicum. Furthermore, TGR may be a potential target for development of novel agents against schistosomes. This assumption is strengthened by our demonstration that the SjTGR is an essential enzyme for maintaining the thiol-disulfide redox homeostasis of S. japonicum.

[Road map for transmission interruption of schistosomiasis in China]

Based on the transmission status of schistosomiasis in People's Republic of China, the challenges and road map for achieving the transmission interruption of schistosomiasis by 2020 in the country was discussed, particularly focused on elimination strategy, surveillance and response approaches, and key technique needs in the three stages, e.g. pre-elimination, elimination and post-elimination stages. Recommendation of strengthening studies on transmission threshold and technological innovation at the low transmission level of schistosomiasis japonica were put forward.

Schistosoma comparative genomics: integrating genome structure, parasite biology and anthelmintic discovery

Schistosoma genomes provide a comprehensive resource for identifying the molecular processes that shape parasite evolution and for discovering novel chemotherapeutic or immunoprophylactic targets. Here, we demonstrate how intragenus and intergenus comparative genomics can be used to drive these investigations forward, illustrate the advantages and limitations of these approaches and review how post-genomic technologies offer complementary strategies for genome characterisation. Although sequencing and functional characterisation of other schistosome/platyhelminth genomes continues to expedite anthelmintic discovery, we contend that future priorities should equally focus on improving assembly quality, and chromosomal assignment, of existing schistosome/platyhelminth genomes.

Advances in tropical diseases

There are six diseases that WHO considers as the major threat in developing countries, leprosy, filariasis, malaria, schistosomiasis, Chagas disease and leishmaniasis; and of these only malaria does not present skin lesions. These diseases are among the so called tropical diseases found in countries of tropical climate, usually infections and infestations considered exotic and rare in European and North American countries. It is extremely important for doctors of all countries to be able to provide correct pre travel counseling and to make early diagnosis and treatment, thus avoiding dissemination of these dieases to non endemic areas. The authors review some important tropical diseases seen in Brazil, as paracoccidiodomycosis, lobomycosis, myiasis, tungiasis, and cutaneous schistosomiasis and discuss new information about them.

[Recent investigation and treatment of 1 060 advanced schistosomiasis cases in Zhejiang Province]

OBJECTIVE

To understand the current status of advanced schistosomiasis patients, deliver medical treatment, and improve the case management in Zhejiang Province.

METHODS

The cases previously diagnosed or suspected as advanced schistosomiasis in the province were the subjects of the investigation. Questionnairing (demographical information, disease history, etc.), clinical examination (ascites syndrome, abdominal palpation), laboratory examination (blood biochemistry, anti-Schistosoma japonicum antibody, eggs), and ultrasonography of the abdomen were used confirming the diagnosis. Treatment was given to the patients.

RESULTS

There were 1 060 advanced schistosomiasis patients in 32 counties of 7 prefectures in the province. Majority of them distributed in water network regions, and lived with poor economic conditions. The average age of the patients was (66.3 +/- 9.3), with 89.3% ranged from 50 to 80 years old. Clinically 71.3% of the cases were with splenomegaly, 27.6% with ascites, 0.9% cases of multiple granuloma in the colon and 0.2% cases with dwarfism. 1 023 patients (96.5%) had received medical treatments. 69.4% of the cases had serious complications with advanced schistosomiasis and 52.5% had concurrently disorders in other systems. 71.1% of the patients had subjective symptoms and 65.2% had hepatosplenomegaly with hepatic fibrosis and dysfunction. The serum positive rate of anti-S. japonicum antibody was 15.7%. Stool hatching test and microscopy revealed no eggs in fecal samples, but 24 out of 38 cases were found metamorphic eggs by rectal biopsy. Three years' medical treatment improved the clinical conditions in 74.3% of the cases.

CONCLUSION

Situation of the advanced schistosomiasis patients is quite critical. Treatment and care are urgently needed especially for those aged 50 to 80 years old. [

[Schistosomiasis of the female genital tract]

OBJECTIVE

Female genital tract disorders as a possible complication of schistosomiasis.

DESIGN

Literature review focused on pathogenesis and clinical symptoms of female genital schistosomiasis (FGS) including diagnosis and therapy of the disease.

SETTING

National Reference Laboratory for Tissue Helminthoses, Prague.

METHODS

An analysis of literature data dealing with the health hazards due to bathing in natural freshwater bodies in tropics and subtropics.

RESULTS

Intestinal and urinary schistosomiasis are occasionally detected in the Czech Republic, therefore, genital form of the disease in females cannot be excluded in gynecological practice.

CONCLUSION

Until the present time the disease represents an uncommon finding in the routine gynecological practice in Europe and, due to a variety of symptoms which accompany FGS, the diagnosis of the disease can be delayed. As the number of immigrants from endemic countries as well as the number of travellers to these regions arises in the Czech Republic at present, the paper, therefore, summarises recent parasitological, clinical and epidemiological characteristics of female genital schistosomiasis.