Assessing urogenital schistosomiasis and female genital schistosomiasis (FGS) among adolescents in Anaocha, Anambra State, Nigeria: implications for ongoing control efforts

BACKGROUND

Urogenital schistosomiasis (UgS) remains a persistent health challenge among adolescents in Anambra State, Nigeria, despite ongoing control efforts. Mass praziquantel treatment programs, initiated in 2013, primarily target primary school-aged children (5-14 years old), leaving adolescents (10-19 years old) enrolled in secondary schools vulnerable to urogenital schistosomiaisis. Additionally, the extent of female genital schistosomiasis (FGS), a neglected gynaecological manifestation of UgS remains unclear.

METHODOLOGY

To address these gaps, a cross-sectional study was conducted in Anaocha Local Government Area from February to May 2023. Four hundred and seventy consenting adolescents aged 10-19 years were enrolled. Urinalysis including urine filtration was employed to confirm haematuria and detect urogenital schistosomiasis (UGS) among the participants. For females with heavy infections (≥ 50 eggs/10 ml urine), a gynaecologist performed colposcopy examinations, complemented by acetic acid and Lugol's iodine staining to assess for female genital schistosomiasis (FGS) lesions or other related reproductive health conditions. Socio-demographic data, including information on potential risk factors, were systematically collected using the Kobo ToolBox software, following gender-sensitive data collection guidelines. Data were analysed using SPSS version 25, incorporating descriptive statistics, multinomial logistic regression, odds ratios, and significance testing.

RESULTS

Among the 470 adolescents (52.8% females, 47.2% males) examined, an overall UgS prevalence of 14.5% was observed, with an average of 5.25 eggs per 10 ml of urine. Females had a slightly higher prevalence (16.1%), and 7.5% had heavy infections. Although gender differences in infection rates were not statistically significant, males had slightly higher odds of infection (OR: 1.332; 95% CI: 0.791-2.244; p-value: 0.280). Adolescents aged 10-14 had the highest prevalence, with significantly increased odds of infection (OR: 1.720; 95% CI: 1.012-2.923; p-value: 0.045). Colposcopy examinations of females with heavy infections revealed FGS lesions and co-infections with Trichomonas vaginalis. Haematuria, though prevalent (24.6%), was not the sole indicator, as those without it faced significantly higher odds of infection (OR: 2.924; 95% CI: 1.731-4.941; p-value: 0.000). Dysuria and genital itching/burning sensation were other UgS and FGS associated symptoms. Direct water contact was associated with higher infection odds (OR: 2.601; 95% CI: 1.007-6.716; p-value: 0.048). Various risk factors were associated with UgS.

CONCLUSION

The study highlights the need for a comprehensive Urogenital Schistosomiasis (UGS) control strategy that includes secondary school adolescents, emphasizes risk factor management, promotes safe water practices, and raises awareness about UGS and Female Genital Schistosomiasis (FGS) among adolescents, thus improving control efforts and mitigating this health challenge in the region.

Male genitourinary schistosomiasis-related symptoms among long-term Western African migrants in Spain: a prospective population-based screening study

BACKGROUND

Schistosomiasis is highly endemic in sub-Saharan Africa and frequently imported to Europe. Male urogenital manifestations are often neglected. We aimed to ascertain the prevalence of genitourinary clinical signs and symptoms among long-term African migrants in a non-endemic European country using a serology test.

METHODS

We carried out a prospective, community-based cross-sectional study of adult male migrants from sub-Saharan Africa living in Spain. Schistosoma serology tests and microscopic urine examinations were carried out, and clinical data were obtained from an electronic medical record search and a structured questionnaire.

RESULTS

We included 388 adult males, mean age 43.5 years [Standard Deviation (SD) = 12.0, range: 18-76]. The median time since migration to the European Union was 17 [Interquartile range (IQR): 11-21] years. The most frequent country of origin was Senegal (N = 179, 46.1%). Of the 338, 147 (37.6%) tested positive for Schistosoma. Parasite eggs were present in the urine of only 1.3%. Nine genitourinary clinical items were significantly associated with positive Schistosoma serology results: pelvic pain (45.2%; OR = 1.57, 95% CI: 1.0-2.4), pain on ejaculation (14.5%; OR = 1.85, 95% CI: 1.0-3.5), dyspareunia (12.4%; OR = 2.45, 95% CI: 1.2-5.2), erectile dysfunction (9.5%; OR = 3.10, 95% CI: 1.3-7.6), self-reported episodes of infertility (32.1%; OR = 1.69, 95% CI: 1.0-2.8), haematuria (55.2%; OR = 2.37, 95% CI: 1.5-3.6), dysuria (52.1%; OR = 2.01, 95% CI: 1.3-3.1), undiagnosed syndromic STIs (5.4%), and orchitis (20.7%; OR = 1.81, 95% CI: 1.0-3.1). Clinical signs tended to cluster.

CONCLUSIONS

Urogenital clinical signs and symptoms are prevalent among male African long-term migrants with a positive Schistosoma serology results. Genital involvement can be frequent even among those with long periods of non-residence in their sub-Saharan African countries of origin. Further research is needed to develop diagnostic tools and validate therapeutic approaches to chronic schistosomiasis.

Schistosoma haematobium urinary tract complications in African migrants attending primary care facilities in Paris, France: A retrospective cohort study (2004-2018)

OBJECTIVES

Little is known about the burden of urogenital schistosomiasis (UGS) outside endemic areas. This study was aimed at describing urinary complications of UGS detected among African migrants in French primary care facilities.

PATIENTS AND METHODS

A retrospective cohort study included patients with UGS diagnosed from 2004 to 2018 in 5 primary health centers in Paris. Cases were defined by the presence of typical Schistosoma haematobium eggs at urine microscopy. Demographic, clinical, biological and imaging data were collected. Ultrasonography (U-S) findings were classified in accordance with the WHO guidelines.

RESULTS

U-S was prescribed for all patients and performed in 100/118. Sex ratio (F/M) was 2/98, and mean age 24.4 years. Patients were from West Africa (73% from Mali) and consulted 8 months (median) after their arrival. Among the 95 patients with interpretable findings, 32 (33.7%) had abnormalities related to UGS, considered as major in 6 cases (6.3%), and mostly localized at the bladder (31/32) without detection of cancer. No sociodemographic, clinical, or biological factors were found to be associated with U-S abnormalities. All 100 patients were treated by praziquantel (PZQ). Among those with abnormalities, 20/32 received two to four doses at various time intervals. Post-cure imaging control performed in 19/32 showed persistent abnormalities in 6 patients, on average 5 months after the last PZQ uptake.

CONCLUSION

Urinary tract abnormalities associated with UGS were common and predominated at the bladder. U-S should be prescribed to any patient with positive urine microscopy. Schedules for PZQ uptake and U-S monitoring for patients with complications remain to be determined.

The long road to schistosomiasis elimination in Zanzibar: A systematic review covering 100 years of research, interventions and control milestones

Zanzibar is among the few places in sub-Saharan Africa where interruption of Schistosoma transmission seems an achievable goal. Our systematic review identifies and discusses milestones in schistosomiasis research, control and elimination efforts in Zanzibar over the past 100 years. The search in online databases, libraries, and the World Health Organization Archives revealed 153 records published between May 1928 and August 2022. The content of records was summarised to highlight the pivotal work leading towards urogenital schistosomiasis elimination and remaining research gaps. The greatest achievement following 100 years of schistosomiasis interventions and research is undoubtedly the improved health of Zanzibaris, exemplified by the reduction in Schistosoma haematobium prevalence from>50% historically down to<5% in 2020, and the absence of severe morbidities. Experiences from Zanzibar have contributed to global schistosomiasis guidelines, whilst also revealing challenges that impede progression towards elimination. Challenges include: transmission heterogeneity requiring micro-targeting of interventions, post-treatment recrudescence of infections in transmission hotspots, biological complexity of intermediate host snails, emergence of livestock Schistosoma species complicating surveillance whilst creating the risk for interspecies hybridisation, insufficient diagnostics performance for light intensity infections and female genital schistosomiasis, and a lack of acceptable sanitary alternatives to freshwater bodies. Our analysis of the past revealed that much can be achieved in the future with practical implementation of integrated interventions, alongside operational research. With continuing national and international commitments, interruption of S. haematobium transmission across both islands is within reach by 2030, signposting the future demise of urogenital schistosomiasis across other parts of sub-Saharan Africa.

Molecular diagnosis of urogenital schistosomiasis in pre-school children, school-aged children and women of reproductive age at community level in central Senegal

BACKGROUND

Urogenital schistosomiasis is a major public health concern in sub-Saharan Africa. In Senegal, the disease is endemic in all regions of the country. Recently, WHO strongly recommended including pre-school children and women of reproductive age during a mass drug administration campaign. It is important to describe the burden of the disease in these group at risk using innovative diagnostic tools. This study aimed to assess the use of real-time PCR in the detection of schistosomiasis cases at the community level in a seasonal transmission area.

METHODS

A cross-sectional survey was carried out in Niakhar located in the centre of Senegal. Pre-schoolchildren, school-aged children and female adolescents and adults were invited to participate in the study in April 2018. Urine samples were collected and examined using Hemastix reagent strips, filtration technique and real-time PCR. Schistosoma haematobium was detected, identified by targeting the Dra1 gene. The prevalence of urogenital schistosomiasis was determined for each group and the performance of the real-time PCR was compared with the conventional techniques.

RESULTS

A total of 428 participants were enrolled in this study including 87 (20.4%) pre-school children (1-5 years), 262 (61.3%) school-aged children between (5-14 years), 17 (3.9%) adolescents (15-17 years) and 62 (14.4%) female adults. The comparison of the diagnostic techniques has shown that the prevalence of urogenital schistosomiasis is higher using molecular technique (34.6%) compared to microscopy (20.3%). The percentage rate of haematuria using Hemastix was 23.1%. School-aged children between 5 and 14 years old were the most affected with 29.0% and 43.1% under microscopy and RT-PCR, respectively. In female participants, microscopic prevalence decreases with age, from 21.4% in school-aged children to 17.6% in adolescents and 9.7% in adults. There was good correlation between the number of eggs per 10 ml and the cycle threshold range.

CONCLUSION

These results show the importance of using molecular tools in the surveillance of schistosomiasis particularly in pre-school children and women of reproductive age.

Urogenital schistosomiasis: prevalence, knowledge and practices among women of reproductive age in Northern Tanzania

Objective

To determine the prevalence, knowledge and practices regarding urogenital schistosomiasis among women of reproductive age in Kileo Ward, Mwanga District.

Methods

A cross-sectional study was conducted in the dispensary in Kileo Village, Mwanga District. A pre-tested structured questionnaire was administered to participants to collect information on sociodemographic characteristics and schistosomiasis-related knowledge and practices. Urine samples were examined for schistosoma eggs using the urine sedimentation technique. Data collected were cleaned, coded and entered into SPSS Version 20 for analysis. Chi-squared test and Fisher's exact test were used for analysis.

Results

Overall prevalence of urogenital schistosomiasis was 2.3%. The prevalence was higher among participants aged ≥18 years (3.2%), those who did domestic chores in river water (13.3%), and those who swam in river water (7.1%). Only a few participants had a low level of knowledge (4.8%) and poor practices (1.9%) regarding urogenital schistosomiasis.

Conclusion

The transmission of urogenital schistosomiasis was low among women of reproductive age in the study area. Despite a high level of knowledge and good practices for urogenital schistosomiasis, there are knowledge gaps regarding its causes and risk factors.

GPS-based fine-scale mapping surveys for schistosomiasis assessment: a practical introduction and documentation of field implementation

BACKGROUND

Fine-scale mapping of schistosomiasis to guide micro-targeting of interventions will gain importance in elimination settings, where the heterogeneity of transmission is often pronounced. Novel mobile applications offer new opportunities for disease mapping. We provide a practical introduction and documentation of the strengths and shortcomings of GPS-based household identification and participant recruitment using tablet-based applications for fine-scale schistosomiasis mapping at sub-district level in a remote area in Pemba, Tanzania.

METHODS

A community-based household survey for urogenital schistosomiasis assessment was conducted from November 2020 until February 2021 in 20 small administrative areas in Pemba. For the survey, 1400 housing structures were prospectively and randomly selected from shapefile data. To identify pre-selected structures and collect survey-related data, field enumerators searched for the houses' geolocation using the mobile applications Open Data Kit (ODK) and MAPS.ME. The number of inhabited and uninhabited structures, the median distance between the pre-selected and recorded locations, and the dropout rates due to non-participation or non-submission of urine samples of sufficient volume for schistosomiasis testing was assessed.

RESULTS

Among the 1400 randomly selected housing structures, 1396 (99.7%) were identified by the enumerators. The median distance between the pre-selected and recorded structures was 5.4 m. A total of 1098 (78.7%) were residential houses. Among them, 99 (9.0%) were dropped due to continuous absence of residents and 40 (3.6%) households refused to participate. In 797 (83.1%) among the 959 participating households, all eligible household members or all but one provided a urine sample of sufficient volume.

CONCLUSIONS

The fine-scale mapping approach using a combination of ODK and an offline navigation application installed on tablet computers allows a very precise identification of housing structures. Dropouts due to non-residential housing structures, absence, non-participation and lack of urine need to be considered in survey designs. Our findings can guide the planning and implementation of future household-based mapping or longitudinal surveys and thus support micro-targeting and follow-up of interventions for schistosomiasis control and elimination in remote areas. Trial registration ISRCTN, ISCRCTN91431493. Registered 11 February 2020, https://www.isrctn.com/ISRCTN91431493.

Assessment of urogenital schistosomiasis among basic school children in selected communities along major rivers in the central region of Ghana

Introduction

urogenital schistosomiasis affects school-aged children with impacts on health, growth, and cognitive development. Basic schools along active water bodies have a possibility of a high infection among the children.

Methods

we performed a school-based cross-sectional assessment of urogenital schistosomiasis among children in four selected rural communities along major rivers in the central region of Ghana. Three hundred and nine (309) basic school children class 1 to junior high school (JHS) 3 were recruited. Sociodemographic data and information on behavioral influences were collected with a structured written questionnaire. Laboratory examinations were conducted on fresh urine samples. Descriptive statistics and cross-tabulations with measures of association between variables, adjusted and unadjusted logistic regression analysis were performed on measured variables.

Results

we recorded a 10.4% prevalence of urogenital schistosomiasis. Schools in communities along the Kakum river recorded the highest disease burden (65.6%). The odds of infection among pupils who engage in irrigation activities were 4 folds more than those who do not engage in irrigation activities (adjusted odds ratio (aOR) (95%CI): 4.3 (1.6-12.1), P-value=0.005). Pupils of caregivers who resort to self-medication using local herbal concoctions had 14-fold more odds of infection compared to those who visit the health facility (aOR (95%CI): 14.4 (1.4-143.1), P-value=0.006).

Conclusion

poor health-seeking behaviors and lack of access to health facilities influenced the disease proportion among the children in these endemic communities.

Evidence of autochthonous transmission of urinary schistosomiasis in Almeria (southeast Spain): An outbreak analysis

BACKGROUND

Schistosomiasis is endemic in 78 countries belonging to tropical and subtropical areas. However, autochthonous transmission of urogenital schistosomiasis was reported in Corsica (France) in 2013. We present evidence of autochthonous transmission of urogenital schistosomiasis in Almería (Spain) in 2003.

METHODS

Description of the outbreak in farmers and subsequent epidemiological studies aimed at searching for Bulinus snails and their genotypic characteristics.

RESULTS

The outbreak affected 4 farmers out of a group of 5 people who repeatedly bathed that summer in an irrigation pool in the area. Two of them presented macroscopic hematuria with bilharziomas, showing the presence of Schistosoma eggs in bladder biopsies. Two others were asymptomatic but the serology for schistosomiasis was positive. In 2015, the presence of the vector Bulinus truncatus was demonstrated in Almería in water collections of appropriate characteristics. DNA sequencing proving that local B. truncatus species were base-to-base identical to B. truncatus from Senegal.

CONCLUSIONS

We present a new outbreak of autochthonous transmission of urogenital schistosomiasis in Europe. Although no new cases of autochthonous transmission have been reported, some other cases may have occurred at that time or later on and be unnoticed as many cases of schistosomiasis are asymptomatic or present mild and unspecific symptoms.

Urogenital schistosomiasis burden in school-aged children in Tiko, Cameroon: a cross-sectional study on prevalence, intensity, knowledge and risk factors

Background

This study aimed at determining urogenital schistosomiasis (UGS) prevalence, intensity, knowledge and risk factors in school-aged children (SAC) in the new endemic focus of Tiko, Cameroon.

Methods

A cross-sectional study including 389 SAC of both sexes aged 5–15 years was carried out between April and June 2018. A structured questionnaire was used to collect demographic data, clinical and predisposing factors. Urine sample collected was used to detect Schistosoma haematobium eggs by filtration technique and microhaematuria by Heme dipstick COMBI 11. Logistic regression model was used to determine risk factors of UGS.

Results

The overall prevalence of UGS was 37.0% (CI 32.4–41.9) and 32.6% (CI 28.2–37.5) were positive by egg excretion while 24.4% (CI 20.4–28.9) by haematuria. S. haematobium egg excretion and haematuria were significantly higher in males (P = 0.016; P = 0.049) and children 12–15 years old (P = 0.009; P = 0.002), respectively. The mean number of eggs per 10 mL of urine was 77.6 (10.2) and ranged from 2 to 400. The proportion of light intensity of infection was higher (67.7%, CI 59.2–75.2) with no significant differences by sex, age and residence. However, the older children were more heavily infected when compared to the younger children, who had more of light infection. Overall, the mean knowledge score 1.42 (CI 1.32–1.51) on a scale of 6, was poor and the proportion of good knowledge of the disease (23.14%, CI 19.2–27.6) was low. Stream water contact (AOR = 4.94; P = 0.001) was the only significant risk factor identified.

Conclusion

Urogenital schistosomiasis is of public health concern among SAC in Tiko, Cameroon. Most participants have poor knowledge about the disease, hence education on vector-borne diseases and the avoidance of stream water contact should be implemented.

Association between cervical dysplasia and female genital schistosomiasis diagnosed by genital PCR in Zambian women

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.

Urogenital schistosomiasis in Nigeria post receipt of the largest single praziquantel donation in Africa

Schistosomiasis control efforts in Nigeria received a boost in 2016 when Merck Group made the largest single donation of praziquantel to an African country. We examined urine samples from 2,023 school age children from 15 locations in 10 states and an Internally Displaced Person's (IDP) camp in Nigeria. We recorded an overall Schistosoma haematobium prevalence of 10.4% in the 10 states that ranged between 6 - 37%, while prevalence in the IDP camp was 2.9%. The highest infection prevalence (37%) recorded was from the population in Wasai Dam area in Minjibir (Kano State), while five locations had no positive urine samples. We observed heavy intensity of infection (≥ 50 eggs/10 ml urine) in 87.9% of infected samples and co-occurrence of the eggs of S. haematobium and S. mansoni in urine for two participants. The overall prevalence we recorded is slightly above the national average (9.5%) reported in 2015. Our findings indicate that despite the ongoing administration of praziquantel in Nigeria, urogenital schistosomiasis is still prevalent with heavy intensity of infection. Large-scale epidemiological monitoring is required to monitor the efficacy of schistosomiasis control in Nigeria.

Distribution and factors associated with urogenital schistosomiasis in the Tiko Health District, a semi-urban setting, South West Region, Cameroon

Background

Increased risk of schistosomiasis in peri-urban and urban towns is not uncommon. An epidemiological survey was carried out in the Tiko Health District (THD), an unmapped transmission focus for urogenital schistosomiasis (UGS), to assess the distribution, intensity, and risk factors associated with the occurrence of UGS.

Methods

In this cross-sectional survey, 12 communities were purposively selected from four health areas (HAs) (Likomba, Holforth, Holforth-Likomba, and Mutengene) in South West Region of Cameroon between June and August 2018. Consenting individuals were enrolled using a convenient sampling technique and administered a semi-structured questionnaire to document information on socio-demographic and water contact behaviour. Urine samples were examined for Schistosomahaematobium infection using test strip, filtration, and microscopy methods. Bivariate and binary logistic regression analyses were used to identify predictors of infection.

Results

The overall prevalence of UGS in Likomba, Holforth-Likomba and Holforth was 31.5% [95% confidence interval (CI): 28.3–34.8] with geometric mean (GM) egg count of 28.7 (range: 2–450) eggs per 10 ml of urine. S.haematobium infection was not found in Mutengene HA. Infection was unevenly distributed among the HAs, Holforth-Likomba and Holforth being the most and least affected, respectively. The prevalence of infection varied (P < 0.001) among the affected communities, ranging from 12.0 to 56.9%. Infection status of the community related positively (P < 0.001) with proximity to stream (< 100 m), the degree of contact with water and number of improved water sources. Younger age group (5–14 years) [adjusted odds ratio (aOR): 3.7, 95% CI: 1.1–12.2] and intense water contact (degree II) (aOR: 5.2, 95% CI: 3.4–8.1) were associated with increased risk of infection. Similarly, significantly higher egg load was observed among younger aged groups (P = 0.02) and those who carried out intense water contact activities (P < 0.001).

Conclusions

Generally, THD is a moderate risk endemic focus for UGS but prevalence higher than 50.0% was observed in some communities. These findings warrant immediate mass chemotherapy with praziquantel to reduce morbidity. Provision of portable water and health education are proposed measures to reduce and eventually eliminate transmission in the area.

Graphic abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s40249-021-00827-2.

Evaluation of a real-time recombinase polymerase amplification assay for rapid detection of Schistosoma haematobium infection in resource-limited setting

Accurate diagnosis of urogenital schistosomiasis is vital for surveillance/control programs as well as achieving the WHO 2012-2020 road map for the total eradication of schistosomiasis. Recombinase polymerase amplification (RPA) has emerged as a rapid and simple molecular tool adaptable for fewer resources with diagnostic accuracy similar to polymerase chain reaction (PCR). This rapid molecular assay employs the use of enzymes for the amplification of nucleic acid taget at a constant temperature. The aim of this study was to validate a real-time RPA assay targeting the Dra 1 repittitive sequence of Schistosoma (S.) haematobium and evaluate its use in urogenital schistosomiasis diagnosis. S. haematobium Dra 1 molecular DNA standard was applied to determine the assay's analytical sensitivity. DNA extracts of S. haematobium, other Schistosoma species, protozoa and bacteria species were used to determine the specificity of the RPA assay. Clinical performance of the assay was validated with a panel of 135 urine samples from volunteers of schistosomiasis endemic communities. The developed assay was evaluated with urine samples extracted by just boiling and with SpeedXtract® DNA extraction kit. A specific fragment of S. haematobium Dra 1 repetitive sequence was amplified within 15 minutes at a constant 42˚C using the developed S. haematobium RPA assay. The detection limit was 15 copies of Dra1 molecular DNA standard per reaction. There was no cross-reaction with other protozoan and bacterial species except Schistosoma species, S. mansoni and S. japonicum. Using 135 urine samples, Schistosoma RPA assay had a clinical sensitivity and specificity of 98.4% (95% CI, 91.6-100) and 100% (95% CI, 94.9-99) respectively when compared to S. haematobium Dra 1 qPCR assay. The diagnostic performance of S. haematobium real-time RPA assay was not affected by the use of crude DNA extracted samples. The S. haematobium RPA assay can serve as an alternative to PCR, especially in low resource settings.

Macroscopic and microscopic imaging modalities for diagnosis and monitoring of urogenital schistosomiasis

Urogenital schistosomiasis remains a major global challenge. Optimal management of this infection depends upon imaging-based assessment of sequelae. Although established imaging modalities such as ultrasonography, plain radiography, magnetic resonance imaging (MRI), narrow band imaging, and computerized tomography (CT) have been used to determine tissue involvement by urogenital schistosomiasis, newer refinements in associated technologies may lead to improvements in patient care. Moreover, application of investigational imaging methods such as confocal laser endomicroscopy and two-photon microscopy in animal models of urogenital schistosomiasis are likely to contribute to our understanding of this infection's pathogenesis. This review discusses prior use of imaging in patients with urogenital schistosomiasis and experimentally infected animals, the advantages and limitations of these modalities, the latest radiologic developments relevant to this infection, and a proposed future diagnostic standard of care for management of afflicted patients.

Piloting an integrated approach for estimation of environmental risk of Schistosoma haematobium infections in pre-school-aged children and their mothers at Barombi Kotto, Cameroon

Within schistosomiasis control, assessing environmental risk of currently non-treated demographic groups e.g. pre-school-aged children (PSAC) and their mothers is important. We conducted a pilot micro-epidemiological assessment at the crater lake of Barombi Kotto, Cameroon with GPS tracking and infection data from 12 PSAC-mother pairs (n = 24) overlaid against environmental sampling inclusive of snail, parasite and water-use information. Several high-risk locations or 'hotspots' with elevated water contact, increased intermediate snail host densities and detectable schistosome environmental DNA (eDNA) were identified. Exposure between PSAC and mother pairs was temporally and spatially associated, suggesting interventions which can benefit both groups simultaneously might be feasible. When attempting to interrupt parasite transmission in future, overlaid maps of snail, parasite and water contact data can guide fine-scale spatial targeting of environmental interventions.

Evaluating the impact of biannual school-based and community-wide treatment on urogenital schistosomiasis in Niger

Background

The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) coordinated a five-year study implemented in several countries, including Niger, to provide an evidence-base for programmatic decisions regarding cost-effective approaches to preventive chemotherapy for schistosomiasis control.

Methods

This was a cluster-randomised trial investigating six possible combinations of annual or biannual community-wide treatment (CWT), school-based treatment (SBT), and holidays from mass treatment over four years. The most intense arm involved two years of annual CWT followed by 2 years of biannual CWT, while the least intensive arm involved one year of annual SBT followed by a year without treatment and two more years of annual SBT. The primary outcome of interest was prevalence and intensity of Schistosoma haematobium among 100 children aged 9–12 years sampled each year. In addition, 100 children aged 5–8 years in their first year of school and 50 adults (aged 20–55 years) were tested in the first and final fifth year of the study.

Results

In total, data were collected from 167,500 individuals across 225 villages in nine districts within the Niger River valley, Western Niger. Overall, the prevalence of S. haematobium decreased from baseline to Year 5 across all study arms. The relative reduction of prevalence was greater in biannual compared with annual treatment across all arms; however, the only significant difference was seen in areas with a high starting prevalence. Although adults were not targeted for treatment in SBT arms, a statistically significant decrease in prevalence among adults was seen in moderate prevalence areas receiving biannual (10.7% to 4.8%) SBT (P < 0.001). Adults tested in the annual SBT group also showed a decrease in prevalence between Year 1 and Year 5 (12.2% to 11.0%), but this difference was not significant.

Conclusions

These findings are an important consideration for schistosomiasis control programmes that are considering elimination and support the idea that scaling up the frequency of treatment rounds, particularly in areas of low prevalence, will not eliminate schistosomiasis. Interestingly, the finding that prevalence decreased among adults in SBT arms suggests that transmission in the community can be reduced, even where only school children are being treated, which could have logistical and cost-saving implications for the national control programmes.

Renal function in children infected with Schistosoma haematobium: a case-control study of an endemic Ghanaian community

Schistosomiasis has been associated with kidney diseases leading to serious health problems especially in advanced cases. Most studies have used renal biopsy, and ultrasonography in the diagnosis of renal damage among urogenital schistosomiasis affected individuals. This study assessed serum urea, creatinine, and eGFR as biochemical markers of renal abnormalities in children with urogenital schistosomiasis (Schistosoma haematobium) at a resource limited setting in Sorodofo-Abaasa in the Central Region of Ghana. A case-control study was conducted among 116 basic school children aged 9 to 17 years from January 2015 to May 2015 at Sorodofo-Abaasa in the Abura Asebu Kwamankese District of the Central Region of Ghana. A pre-tested questionnaire was used to obtain information on age, sex, guardian's occupation, water contact activities, history of gross haematuria and history of medication. Participants weight and height were measured using a bathroom scale (Zhongshan Camry Electronic Co. Ltd, Guangdong-China) and a wall-mounted ruler to the nearest 0.1 kg and 0.1 cm respectively. Approximately 4 ml of venous blood sample was collected from the median cubital vein of the study participants and used for the estimation of serum urea and creatinine levels. eGFR (mL/min/1.73 m²) was calculated using the Schwartz equation. The average ages of the cases and the controls recruited in this study were 12.7 ± 1.0 and 12. ± 2.6 years respectively. The median (minimum-maximum) did not differ between cases and controls with regards to eGFR [115.92(62.40-164.98) vs 112.50(51.82-170.36; p = 0.806], serum creatinine [57.20(28.91-84.67) vs 58.19(25.17-90.21); p = 0.876], and urea [9.82(5.80-13.74) vs 10.21(7.29-13.03); p = 0.586]. Hyperfiltration though statistically similar (p = 0.787), was observed among a higher proportion of the controls (20.5%) than observed among the cases (18.4%). This study documented no significant differences between children with light (less than 50 ova per 10 ml urine) and heavy (more than 50 ova per 10 ml urine) infection. This study documented no significant variation in the biochemical markers of renal function between the cases and controls. S. haematobium Infection intensity did not significantly alter the renal physiology of the school children studied.

Association of schistosomiasis and risk of prostate cancer development in residents of Murehwa rural community, Zimbabwe

Background

Prostatic male genital schistosomiasis and prostate cancer co-existence cases are uncommon however, some studies have indicated that schistosomiasis may trigger development of prostate cancer regardless of age. Schistosomiasis is a public health problem in sub-Saharan Africa and may account for some undocumented cases of schistosomiasis prostatic cancer in schistosome endemic rural communities. It is against this background that we investigated the association between schistosomiasis and risk of prostate cancer development in residents of Murehwa Community, a schistosomiasis endemic area.

Methodology

We conducted a cross sectional study involving 366 men residing in Murehwa District, Zimbabwe. Schistosoma haematobium and S. mansoni infection was diagnosed using urine filtration and Kato Katz techniques, respectively. Haematuria was detected using urinalysis reagent strip test. A structured questionnaire was used to obtain history of schistosomiasis infection among study participants. Risk of prostate cancer development was assessed by measuring prostate-specific antigen levels in serum using the ELISA.

Results

Prevalence of S. haematobium and S. mansoni infection was 12.3% and 1.4%, respectively. Individuals with schistosomiasis had higher prostate-specific antigen levels (mean 1.208 ± SD 1.557 ng/mL) compared to those without schistosomiasis (mean 0.7721 ± SD 1.173 ng/mL; p < 0.05). Older individuals > 50 years had higher prostate specific antigen levels (mean 0.7212 ± SD 1.313 ng/mL) compared to individuals < 50 years old (mean 0.4159 ± SD 0.8622 ng/mL; p < 0.05). Prostate-specific antigen levels log₁₀ (mean 0.2584 ± SD 0.2128 ng/mL) and were associated to S. haematobium infection intensity log₁₀ (mean 1.121 ± SD 0.5371 eggs/10 mL), r(s) = − 0.3225, p < 0.05. There was a correlation between prostate-specific antigen levels log₁₀ (mean 0.2246 ± SD 0.1858 ng/mL) and S. haematobium infection intensity log₁₀ (mean 1.169 ± SD 0.5568 eggs/10 mL) among participants with a history of schistosomiasis infection (r(s) = − 0.3520; p < 0.05). There was no correlation between prostate-specific antigen levels of > 4 ng/mL (mean 5.324 ± SD1.568 ng/mL) and schistosome eggs log₁₀ (mean 1.057 ± SD 0.6730 eggs/10 mL; p > 0.05).

Conclusion

Urogenital schistosome infections and history of schistosome infections were associated with prostate specific antigen levels, an indicator for risk of prostate cancer. Therefore, S. haematobium schistosome egg burden was associated with the risk of prostate cancer development in adult males residing in Murehwa District, Zimbabwe.

An immunoinformatics approach for the design of a multi-epitope subunit vaccine for urogenital schistosomiasis

Discovery of T and B memory cells capable of eliciting long-term immunity against schistosomiasisis is important for people in endemic areas. Changes in schistosomes environment due to developmental cycle, induces up-regulation of Heat Shock Proteins (HSPs) which assist the parasite in coping with the hostile conditions associated with its life cycle. This study therefore focused on exploring the role of HSPs in urogenital schistosomiasis to develop new multi-epitope subunit vaccine against the disease using immunoinformatic approaches. The designed subunit vaccine was subjected to in silico antigenicity, immunogenicity, allergenicity and physicochemical parameters analysis. A 3D structure of the vaccine construct was predicted, followed by disulphide engineering for stability, codon adaptation and in silico cloning for proper expression and molecular protein–protein docking of vaccine construct in the vector against toll-like receptor 4 receptor, respectively. Consequently, a 493 amino acid multi-epitope vaccine construct of antigenicity probability of 0.91 was designed. This was predicted to be stable, non-allergenic in nature and safe for human use.

Estrogen receptors in urogenital schistosomiasis and bladder cancer: Estrogen receptor alpha-mediated cell proliferation

Estrogen-like metabolites have been identified in S. haematobium, the helminth parasite that causes urogenital schistosomiasis (UGS) and in patients´ blood and urine during UGS. Estrogen receptor (ER) activation is enriched in the luminal molecular subtype bladder cancer (BlaCa). To date, the significance of ER to these diseases remains elusive. We evaluated ERα and ERβ expression in UGS-related BlaCa (n = 27), UGS-related non-malignant lesions (n = 35), and noninfected BlaCa (n = 80). We investigated the potential of ERα to recognize S. haematobium-derived metabolites by docking and molecular dynamics simulations and studied ERα modulation in vitro using 3 BlaCa cell lines, T24, 5637 and HT1376. ERα was expressed in tumor and stromal cells in approximately 20% noninfected cases and in 30% of UGS-related BlaCa, predominantly in the epithelial cells. Overall, ERα expression was associated with features of tumor aggressiveness such as high proliferation and p53 positive expression. ERα expression correlated with presence of schistosome eggs. ERβ was widely expressed in both cohorts but weaker in UGS-related cases. molecular dynamics simulations of the 4 most abundant S. haematobium-derived metabolites revealed that smaller metabolites have comparable affinity for the ERα active state than 17β-estradiol, while the larger metabolites present higher affinity. Our in vitro findings suggested that ERα activation promotes proliferation in ERα expressing BlaCa cells and that this can be reverted with anti-estrogenic therapy. In summary, we report differential ER expression between UGS-related BlaCa and noninfected BlaCa and provide evidence supporting a role of active ERα during UGS and UGS-induced carcinogenesis.

Interactions between Schistosoma haematobium group species and their Bulinus spp. intermediate hosts along the Niger River Valley

Background

Urogenital schistosomiasis, caused by infection with Schistosoma haematobium, is endemic in Niger but complicated by the presence of Schistosoma bovis, Schistosoma curassoni and S. haematobium group hybrids along with various Bulinus snail intermediate host species. Establishing the schistosomes and snails involved in transmission aids disease surveillance whilst providing insights into snail-schistosome interactions/compatibilities and biology.

Methods

Infected Bulinus spp. were collected from 16 villages north and south of the Niamey region, Niger, between 2011 and 2015. From each Bulinus spp., 20–52 cercariae shed were analysed using microsatellite markers and a subset identified using the mitochondrial (mt) cox1 and nuclear ITS1 + 2 and 18S DNA regions. Infected Bulinus spp. were identified using both morphological and molecular analysis (partial mt cox1 region).

Results

A total of 87 infected Bulinus from 24 sites were found, 29 were molecularly confirmed as B. truncatus, three as B. forskalii and four as B. globosus. The remaining samples were morphologically identified as B. truncatus (n = 49) and B. forskalii (n = 2). The microsatellite analysis of 1124 cercariae revealed 186 cercarial multilocus genotypes (MLGs). Identical cercarial genotypes were frequently (60%) identified from the same snail (clonal populations from a single miracidia); however, several (40%) of the snails had cercariae of different genotypes (2–10 MLG’s) indicating multiple miracidial infections. Fifty-seven of the B. truncatus and all of the B. forskalii and B. globosus were shedding the Bovid schistosome S. bovis. The other B. truncatus were shedding the human schistosomes, S. haematobium (n = 6) and the S. haematobium group hybrids (n = 13). Two B. truncatus had co-infections with S. haematobium and S. haematobium group hybrids whilst no co-infections with S. bovis were observed.

Conclusions

This study has advanced our understanding of human and bovid schistosomiasis transmission in the Niger River Valley region. Human Schistosoma species/forms (S. haematobium and S. haematobium hybrids) were found transmitted only in five villages whereas those causing veterinary schistosomiasis (S. bovis), were found in most villages. Bulinus truncatus was most abundant, transmitting all Schistosoma species, while the less abundant B. forskalii and B. globosus, only transmitted S. bovis. Our data suggest that species-specific biological traits may exist in relation to co-infections, snail-schistosome compatibility and intramolluscan schistosome development.

Schistosomiasis-from immunopathology to vaccines

Schistosomiasis (bilharzia) is a neglected tropical disease caused by trematode worms of the genus Schistosoma. The transmission cycle involves human (or other mammalian) water contact with surface water contaminated by faeces or urine, as well as specific freshwater snails acting as intermediate hosts. The main disease-causing species are S. haematobium, S. mansoni and S. japonicum. According to the World Health Organisation, over 250 million people are infected worldwide, leading to considerable morbidity and the estimated loss of 1.9 million disability-adjusted life years (DALYs), a likely underestimated figure. Schistosomiasis is characterised by focal epidemiology and an over-dispersed population distribution, with higher infection rates in children. Complex immune mechanisms lead to the slow acquisition of immune resistance, but innate factors also play a part. Acute schistosomiasis, a feverish syndrome, is most evident in travellers following a primary infection. Chronic schistosomiasis affects mainly individuals with long-standing infections residing in poor rural areas. Immunopathological reactions against schistosome eggs trapped in host tissues lead to inflammatory and obstructive disease in the urinary system (S. haematobium) or intestinal disease, hepatosplenic inflammation and liver fibrosis (S. mansoni and S. japonicum). An effective drug—praziquantel—is available for treatment but, despite intensive efforts, no schistosomiasis vaccines have yet been accepted for public use. In this review, we briefly introduce the schistosome parasites and the immunopathogenic manifestations resulting from schistosomiasis. We then explore aspects of the immunology and host-parasite interplay in schistosome infections paying special attention to the current status of schistosomiasis vaccine development highlighting the advancement of a new controlled human challenge infection model for testing schistosomiasis vaccines.

Development of a recombinase polymerase amplification (RPA) fluorescence assay for the detection of Schistosoma haematobium

Background

Accurate diagnosis of urogenital schistosomiasis is vital for surveillance and control programmes. While a number of diagnostic techniques are available there is a need for simple, rapid and highly sensitive point-of-need (PON) tests in areas where infection prevalence and intensity are low. Recombinase Polymerase Amplification (RPA) is a sensitive isothermal molecular diagnostic technology that is rapid, portable and has been used at the PON for several pathogens.

Results

A real time fluorescence RPA assay (RT-ShDra1-RPA) targeting the Schistosoma haematobium Dra1 genomic repeat region was developed and was able to detect 1 fg of S. haematobium gDNA. Results were obtained within 10 minutes using a small portable battery powered tube scanner device that incubated reactions at 40 °C, whilst detecting DNA amplification and fluorescence over time. The assay’s performance was evaluated using 20 urine samples, with varying S. haematobium egg counts, from school children from Pemba Island, Zanzibar Archipelago, Tanzania. Prior to RPA analysis, samples were prepared using a quick crude field DNA extraction method, the Speed Extract Kit (Qiagen, Manchester, UK). Positive assay results were obtained from urine samples with egg counts of 1–926 eggs/10 ml, except for two samples, which had inconclusive results. These two samples had egg counts of two and three eggs/10 ml of urine.

Conclusions

The RT-ShDra1-RPA assay proved robust for S. haematobium gDNA detection and was able to amplify and detect S. haematobium DNA in urine samples from infected patients. The assay’s speed and portability, together with the use of crude sample preparation methods, could advance the rapid molecular diagnosis of urogenital schistosomiasis at the PON within endemic countries.

A systematic review with epidemiological update of male genital schistosomiasis (MGS): A call for integrated case management across the health system in sub-Saharan Africa

Male genital schistosomiasis (MGS) is a gender specific manifestation of urogenital schistosomiasis (UGS) first described in 1911 by Madden in Egypt. Today, while affecting millions of men and boys worldwide, MGS receives insufficient attention, especially in sub-Saharan Africa (SSA). To provide a systematic review with an epidemiological update of MGS, we inspected both online and hardcopy resources in our appraisal. A total of 147 articles were eventually identified, only 31 articles were exclusively focused on MGS with original or targeted research. From these, we discuss pertinent clinico-pathological features of MGS, highlight the possible connection and interplay with HIV, and assess current diagnostic techniques alongside consideration of their use and application in SSA. To appreciate the burden of MGS more fully, especially in endemic areas, there is a clear need for better surveillance and longitudinal population research to investigate the best point-of-care (POC) diagnostic and its performance through time. Furthermore, to optimise individual case management, exploration of alternative praziquantel dosing regimens is needed for MGS in men with or without HIV co-infection.

Urogenital schistosomiasis elimination in Zanzibar: accuracy of urine filtration and haematuria reagent strips for diagnosing light intensity Schistosoma haematobium infections

Background

Urine filtration and microhaematuria reagent strips are basic standard diagnostic methods to detect urogenital schistosomiasis. We assessed their accuracy for the diagnosis of light intensity infections with Schistosoma haematobium as they occur in individuals living in Zanzibar, an area targeted for interruption of transmission.

Methods

Urine samples were collected from children and adults in surveys conducted annually in Zanzibar from 2013 through 2016 and examined with the urine filtration method to count S. haematobium eggs and with the reagent strip test (Hemastix) to detect microhaematuria as a proxy for infection. Ten percent of the urine filtration slides were read twice. Sensitivity was calculated for reagent strips, stratified by egg counts reflecting light intensity sub-groups, and kappa statistics for the agreement of urine filtration readings.

Results

Among the 39,207 and 18,155 urine samples examined from children and adults, respectively, 5.4% and 2.7% were S. haematobium egg-positive. A third (34.7%) and almost half (46.7%) of the egg-positive samples from children and adults, respectively, had ultra-low counts defined as 1–5 eggs per 10 ml urine. Sensitivity of the reagent strips increased significantly for each unit log10 egg count per 10 ml urine in children (odds ratio, OR: 4.7; 95% confidence interval, CI: 4.0–5.7; P < 0.0001) and adults (OR: 2.6; 95% CI: 1.9–3.7, P < 0.0001). Sensitivity for diagnosing ultra-light intensity infections was very low in children (50.1%; 95% CI: 46.5–53.8%) and adults (58.7%; 95% CI: 51.9–65.2%). Among the 4477 and 1566 urine filtration slides read twice from children and adults, most were correctly identified as negative or positive (kappa = 0.84 for children and kappa = 0.81 for adults). However, 294 and 75 slides had discrepant results and were positive in only one of the two readings. The majority of these discrepant slides (76.9% of children and 84.0% of adults) had counts of 1–5 eggs per 10 ml urine.

Conclusions

We found that many individuals infected with S. haematobium in Zanzibar excrete > 5 eggs per 10 ml urine. These ultra-light infections impose a major challenge for accurate diagnosis. Next-generation diagnostic tools to be used in settings where interruption of transmission is the goal should reliably detect infections with ≤ 5 eggs per 10 ml urine.

Trial Registration

ISRCTN, ISRCTN48837681. Registered 05 September 2012 - Retrospectively registered.

Electronic supplementary material

The online version of this article (10.1186/s13071-018-3136-6) contains supplementary material, which is available to authorized users.

Geographical and behavioral risks associated with Schistosoma haematobium infection in an area of complex transmission

BACKGROUND

Schistosoma haematobium infection in endemic areas varies depending on the nature and complexity of the transmission networks present. Studies of micro-geographical transmission of S. haematobium infection indicate that discrepancy in prevalence between households is associated with diverse water contact behaviors and transmission that is restricted to particular sites harboring snail intermediate hosts. Detection of variations in the transmission sources with complex transmission networks of water bodies is required for optimization of malacological control. Longitudinal parasitological and malacological surveys were conducted to investigate geographical variations in transmission of urogenital schistosomiasis in Ikingwamanoti village, Shinyanga District, Tanzania.

METHODS

Urine samples were collected at baseline and follow-up time points from 282 school-aged children and examined microscopically for the presence of S. haematobium eggs. Malacological surveys involved collection of Bulinus nasutus every month from 30 sites. Snails were examined for patent infections. Global positioning system was used to map household distances from S. haematobium transmission sites, while water contact behavior was assessed using a questionnaire.

RESULTS

Schistosoma haematobium infection was observed to be prevalent among older children (12-14 years) compared to younger groups prior to treatment, but no significant difference in infection prevalence was observed at one-year. Boys were highly infected than girls at both time points. No spatial influence was observed between children's infection and the distance from child's residence to the nearby snail habitats nor was any significant association observed between children's reported water contact behavior with S. haematobium infection. However, malacological surveys with cercarial shedding combined with GPS data detected significant variation among different water sources in the transmission of S. haematobium with children living in households near to ponds with high B. nasutus populations having the highest prevalence of infection.

CONCLUSIONS

Interaction between malacological surveys with cercarial shedding combined with GPS mapping in endemic settings can help detection of transmission sources even in areas with complex transmission networks. Subsequent studies are needed to determine whether the combination of GPS mapping and parasitology screens can aid the detection of transmission hotspots across varied transmission settings to enhance schistosomiasis control programmes.

Defining the Pathways of Urogenital Schistosomiasis-Associated Urothelial Carcinogenesis through Transgenic and Bladder Wall Egg Injection Models

Urogenital schistosomiasis (infection with Schistosoma haematobium) is a major cause of bladder carcinogenesis. However, the exact mechanisms of the sequelae leading up to the development of bladder cancer are poorly understood, mainly because of a dearth of tractable mouse models. We developed a mouse model of urogenital schistosomiasis through intramural injection of parasite eggs into the bladder wall to mimic the trapping of parasite eggs in the bladder. This approach recapitulates many of the sequelae observed in infected humans. Here, we describe procedures for utilizing this surgical technique in combination with well-established transgenic mouse strains to dissect the role of cancer-related genes in the initiation and establishment of bladder carcinogenesis. The described method utilizes CRE-mediated flox activity to render mice p53 haploinsufficient before challenging them with bladder wall egg injection. These techniques are potentially amenable to studying the role of other pro-carcinogenic and cancer suppressor gene(s) in urogenital schistosomiasis-associated urothelial carcinogenesis.

Prevalence and factors associated with urogenital schistosomiasis among primary school children in barrage, Magba sub-division of Cameroon

BACKGROUND

The purpose of this study was to determine the prevalence and intensity as well as the factors associated with urogenital schistosomiasis (US) in Barrage, a rural community around the Mape΄ dam, in the West region of Cameroon not previously documented for transmission.

METHODS

In this cross sectional parasitological survey, 382 children were enrolled from three primary schools in the study area between March and May 2016. A semi-structured questionnaire was used to collect information on demographics, clinical and predisposing factors. The syringe filtration technique was used to analyse urine samples. Samples with visible or gross haematuria were recorded prior to filtration. The Pearson chi-square, the student T-test and logistic regression were all performed as part of the statistical analyses.

RESULTS

The overall prevalence of US was 41.1% (95% CI: 36.1-46.2). Infection was more common in children below 10 years (p = 0.009), in males (p = 0.029), and in children who frequently come into contact with water from the dam (p < 0.001). Furthermore, US was more common in children attending Ecole Public (EP) Manbonko Bord (81.1%, p < 0.001) which is very close to the dam and in children from a fishing background (80.9%, p < 0.001). On the contrary, knowledge about schistosomiasis was not observed to be associated with prevalence. In this study, the intensity of infection was observed to be higher in children below 10 years (p < 0.001), in males (p = 0.001), and in children attending EP Manbonko Bord (p < 0.001). The intensity of infection was also highest in children presenting with haematuria (p < 0.001). Frequent contact with water from the dam and having parents whose occupation was fishing were identified as the associated factors for US.

CONCLUSION

A high prevalence of US was observed in school-aged children in the study area especially in those attending EP Manbonko Bord. Limiting contact with water from the dam, control of the snail intermediate host, provision of portable water and mass treatment of the entire population are proposed as some of the measures to reduce and eventually eliminate transmission in the area.

Large outbreak of urogenital schistosomiasis acquired in Southern Corsica, France: monitoring early signs of endemicization?

OBJECTIVES

Clustered cases of urogenital schistosomiasis were reported in April 2014 among French and German tourists linked to exposure in the Cavu River, Southern Corsica, France, between 2011 and 2013. We set up national surveillance for autochthonous urogenital schistosomiasis to document the largest possible number of cases in order to identify potential sites of transmission and to determine the extent of the outbreak in France and Corsica.

METHODS

The early response consisted mostly of prohibiting swimming in the river, performing a nationwide serologic screening of all persons exposed to the river between 2011 and 2013 and treating confirmed cases. Physicians were asked to report all patients with one or more positive antischistosome serologic test. Cases were defined as occurring in a resident of France with serologic evidence of schistosomiasis or schistosome eggs in urine and no history of contact with freshwater in known endemic areas. We documented symptoms as well as place and time of exposure to freshwater for all subjects. To estimate the outbreak size, we modelled the effect of the 2014 nationwide screening on the 2011-2015 time series of serodiagnosed schistosomiasis cases using log-linear autoregression.

RESULTS

In 2014, a total of 106 autochthonous cases were reported, including 35 symptomatic infections. All patients had swum in the Cavu during summer 2013. Over 30 000 persons were likely screened for autochthonous schistosomiasis. The model-estimated outbreak size was 338 cases, including 36 serodiagnosed in 2015.

CONCLUSIONS

Besides the 2013 outbreak, there is evidence of small-scale transmission in 2015 in Corsica. Early detection and control of recurrences requires raising community and medical awareness.

Assessing the prevalence of urogenital schistosomaisis and transmission risk factors amongst school-aged children around Mapé dam ecological suburbs in Malantouen district, Cameroon

Background

Urogenital schistosomiasis is a parasitic infection of public health importance that affects over 112 million people worldwide. The study aimed at assessing the urogenital schistosomiasis prevalence and risk factors of transmission around Mape dam suburds in Malantouen district, West, Cameroon.

Methods

The study was conducted using semi-structured pretested questionnaires to collect socio-demographic and ecological data. Urine samples were also collected and used to confirm the prevalence of schistosomiasis in consented school-aged children in four primary schools between March – July 2014. Snails’ samples around the dam surburbs were also collected for taxonomy characterization and species identification. Data were compiled and quality control assessed and analysed using SPSS version 17 and Epiinfo data 3.1. P < 0.05 was considered statistical significance.

Results

Questionnaires were administered to 229 pupils, with gender ratio of 1.04 (m/f). The prevalence of schistosomiasis haematobium was 16.6%. Mambonko school site, which is the closest to the dam suburbs, registered the greatest prevalence rate of 40%. The age group beween 10–13 years was the most infected (18.3%) and boys were more infested than girls (21.0% vs. 15.5%). Haematuria, urination pain, school absentiesm and poor performance were the major recorded complications in 39.5 and 26.3% males to female respectively. Infection rate gender disparity documented is still poorly understood and Bulinus truncatus collected from Mambonko suburb as potential snail intermediate host requires further studies.

Conclusions

Authors advocated that schools and dam suburds sustained and innovative community-based surveillance and response targeted interventions implementation are needed to inform and support decision-making policy, but also in improving effective contextual behavioural communication changes and MDA improved uptake measures on national schistosomiasis control and elimination in Cameroon.

Electronic supplementary material

The online version of this article (doi:10.1186/s40249-017-0257-7) contains supplementary material, which is available to authorized users.

Urogenital schistosomiasis transmission on Unguja Island, Zanzibar: characterisation of persistent hot-spots

BACKGROUND

Elimination of urogenital schistosomiasis transmission is a priority for the Zanzibar Ministry of Health. Preventative chemotherapy together with additional control interventions have successfully alleviated much of the disease burden. However, a persistently high Schistosoma haematobium prevalence is found in certain areas. Our aim was to characterise and evaluate these persistent "hot-spots" of transmission and reinfection in comparison with low-prevalence areas, to support the intervention planning for schistosomiasis elimination in Zanzibar.

METHODS

Prevalences of S. haematobium were annually determined by a single urine filtration in schoolchildren from 45 administrative areas (shehias) in Unguja in 2012, 2013 and 2014. Coverage data for biannual treatment with praziquantel were available from ministerial databases and internal surveys. Among the 45 shehias, five hot-spot (≥ 15 % prevalence) and two low-prevalence (≤ 5 %) shehias were identified and surveyed in mid-2014. Human-water contact sites (HWCSs) and the presence of S. haematobium-infected and uninfected Bulinus globosus, as well as safe water sources (SWSs) and their reliability in terms of water availability were determined and mapped.

RESULTS

We found no major difference in the treatment coverage between persistent hot-spot and low-prevalence shehias. On average, there were considerably more HWCSs containing B. globosus in hot-spot than in low-prevalence shehias (n = 8 vs n = 2) and also more HWCSs containing infected B. globosus (n = 2 vs n = 0). There was no striking difference in the average abundance of SWSs in hot-spot and low-prevalence shehias (n = 45 vs n = 38) and also no difference when considering SWSs with a constant water supply (average: 62 % vs 62 %). The average number of taps with a constant water supply, however, was lower in hot-spot shehias (n = 7 vs n = 14). Average distances from schools to the nearest HWCS were considerably shorter in hot-spot shehias (n = 229 m vs n = 722 m).

CONCLUSION

The number of HWCSs, their infestation with B. globosus and their distance to schools seem to play a major role for a persistently high S. haematobium prevalence in children. In addition to treatment, increasing access to reliably working taps, targeted snail control at HWCSs near schools and enhanced behaviour change measures are needed to reduce prevalences in hot-spot areas and to finally reach elimination.

TRIAL REGISTRATION

ISRCTN48837681 .

Epidemiological and clinical aspects of urogenital schistosomiasis in women, in Burkina Faso, West Africa

BACKGROUND

Because infections with Schistosoma Haematobium usually peak in childhood, the majority of studies on schistosomiasis have focused on school-aged children. This study aimed to assess the epidemiological and clinical aspects of urogenital schistosomiasis in women in Burkina Faso, West Africa.

METHODS

A cross-sectional study was conducted in a mesoendemic region (Kombissiri) and a hyperendemic region (Dori) for schistosomiasis in Burkina Faso. A total of 287 females aged 5 to 50 years were included in the study. S. haematobium infection was assessed using the urine filtration method and dipsticks were used for the detection of hematuria. Interviews were conducted to identify clinical aspects and risk factors related to urogenital schistosomiasis.

RESULTS

The overall prevalence of S. haematobium infection in Dori was 21.3 %, where as Kombissiri was less affected with a prevalence of 4.6 %. The most affected age group was the 10- to 14-year-olds (41.2 %), followed by the 15- to 19-year-olds (26.3 %). Risk factors significantly associated with schistosomiasis (P <0.05) were place of residence, age, contact with open water in the past year, and distance of home to open water. The percentage of participants who had contact with open water was significantly higher among the women living in Dori compared to Kombissiri. Females over 15 years of age showed a significant higher rate of water contact compared to the 5- to 15-year-olds. A significant correlation between schistosomiasis and hematuria was established. Microhematuria showed a sensitivity of 80.6 %, a specificity of 92.7 %, and a positive predictive value of 61.7 %, whereas macrohematuria had a sensitivity of 47.2 %, a specificity of 99.2 %, and a positive predictive value of 89.5 %. The mass distribution of praziquantel in Burkina Faso is well established. However, over half of the participants with schistosomiasis in this study said they took praziquantel in the past 6 months, which indicates a high reinfection rate. This may be associated with a lack of knowledge about the transmission of schistosomiasis. Only 6 % of the participants in Kombissiri and 1.5 % in Dori knew about the correct mode of transmission.

CONCLUSIONS

The results of our study indicate that distribution campaigns should be extended from school-aged children to young women. Our data also demonstrate the necessity of combining already established mass distribution campaigns with information campaigns, so that long-term elimination, or at least reduction, of schistosomiasis can be achieved.

Urogenital schistosomiasis and associated determinant factors among senior high school students in the Dutsin-Ma and Safana Local Government Areas of Katsina State, Nigeria

Background

Human schistosomiasis is a chronic parasitic disease of poverty caused by the cercariae of digenetic trematodes of the genus Schistosoma. The disease is a major source of morbidity and mortality in 77 low- and middle-income countries in the tropics where 700 million people are at risk. In a bid to provide relevant epidemiological information to boost control of urogenital schistosomiasis at the state level in Nigeria, we conducted this study with the aim of investigating the disease’s prevalence and intensity, and the determinant factors responsible for its endemicity.

Methods

Data on risk factors were obtained from a total of 645 students aged 12─25 years using well- designed questionnaires. Samples were collected between 09:45 and 14:00 in universal bottles. Each10μl centrifuged sample was examined for the eggs of S. haematobium using Motic® (Binocular) Light Microscope (model S-10-P) with a x10 objective. Average infection intensity was recorded as number of eggs per 10 ml of urine sample. Survey data were entered into Microsoft Excel 2010 and analyzed using Epi Info™ 7. Associations among variables were determined using the chi square test and bivariate and multivariate logistic regressions.

Results

Prevalence of urogenital schistosomiasis was 30.54 % among the study population, with a mean infection intensity of 30.27 eggs/10 ml of urine. Prevalence and average intensity were higher in males (28.37 % and 32.21 eggs/10 ml of urine respectively) than in females (2.17 % and 5 eggs/10 ml of urine respectively). Water contact activities (X²  = 29.031, P = 0.0000), sex (male) [X²  = 109.82; P<0.0001], location (Dutsin─Ma) [X²  = 7.19; P = 0.0073], age group 18-20 (X²  = 4.819, P = 0.0281), altitude (531─560 m) [X²  = 6.84, p = 0.0089], fathers doing other brown─collar jobs (X²  = 8.449, P = 0.0037) and mothers’ occupation (X²  = 9.470, P = 0.0021) were found to be significantly associated with urogenital schistosomiasis. Boys were six times more likely to be infected with the cercariae of S. haematobium compared to girls [AOR (95 % CI): 6.34 (4.89─8.22)].

Conclusions

Dutsin-Ma and Safana were classified as moderate-risk Local Government Areas for urogenital schistosomiasis. The strong association between the disease and mother’s occupation is of utmost importance and suggests a promising control measure: that is, directing health education as well as grassroots mass chemotherapeutic intervention with praziquantel at mothers. A good network including treated pipe-borne water, drainage system, and sewage disposal facilities available should be improved upon. Molluscicides should be provided at highly subsidized rate to help control the disease.

Electronic supplementary material

The online version of this article (doi:10.1186/s40249-016-0158-1) contains supplementary material, which is available to authorized users.

Global Health: Urogenital Schistosomiasis in the Adolescent Girl

Urogenital schistosomiasis affects millions of women in sub-Saharan Africa. Infection by the causative organism, Schistosoma hematobium, commonly occurs during childhood and adolescence and can lead to anemia from hematuria, inflammation on the cervix which can increase risk of HIV transmission, and pelvic infection leading to infertility. Fortunately treatment is not costly, but early diagnosis is important to reduce long-term morbidity. Our objective is to review the epidemiology, pathophysiology, and diagnosis of urogenital schistosomiasis as well as treatment to improve the reproductive health of girls where this infection is endemic.

Factors influencing community participation in control and related operational research for urogenital schistosomiasis and soil-transmitted helminths in rural villages of Kwale County, coastal Kenya

Introduction

helminthic infections caused by soil-transmitted helminths (STH) and schistosomes are among the most prevalent afflictions of humans who live in areas of poverty. An operational research was undertaken in 5 villages of Kwale County during a pilot control programme which included both the adults and school going children. Willingness of community members to participate in the treatment as well as in the research is critical. A cross sectional study sought to determine factors influencing community participation in control and related operational research and assess the treatment coverage for urogenital schistosomiasis and hookworms in rural villages of Kwale County.

Methods

cross-sectional survey utilized quantitative and qualitative methods of data collection. A total of 220 households were recruited and household heads interviewed. Bivariate analysis was used to test association between different independent and dependent factors. Multivariate analysis was done using binary logistic regression to control for confounders and effect modification. Qualitative data was transcribed, coded and analyzed thematically.

Results

religion and levels of income were significantly (P =0.04 and P = 0.026 respectively) associated with participation in the research and control programme, history of ever suffering from schistosomiasis and intestinal worms was found to be significantly (P = 0.008) associated with participation in the research. The study established that 82% (178) of the respondents received treatment for urogenital schistosomiasis and hookworms and 67% (146) of the respondents had participated in the research.

Conclusion

this information will be useful in promoting health, enhancing learning and behaviour changes which will lead to increased community participation in similar disease control.

A mixed-methods approach to understanding water use and water infrastructure in a schistosomiasis-endemic community: case study of Asamama, Ghana

Background

Surface water contaminated with human waste may transmit urogenital schistosomiasis (UGS). Water-related activities that allow skin exposure place people at risk, but public health practitioners know little about why some communities with access to improved water infrastructure have substantial surface water contact with infectious water bodies. Community-based mixed-methods research can provide critical information about water use and water infrastructure improvements.

Methods

Our mixed-methods study assessed the context of water use in a rural community endemic for schistosomiasis.

Results

Eighty-seven (35.2 %) households reported using river water but not borehole water; 26 (10.5 %) reported using borehole water but not river water; and 133 (53.8 %) households reported using both water sources. All households are within 1 km of borehole wells, but tested water quality was poor in most wells. Schistosomiasis is perceived by study households (89.3 %) to be a widespread problem in the community, but perceived schistosomiasis risk fails to deter households from river water usage. Hematuria prevalence among schoolchildren does not differ by household water use preference. Focus group data provides context for water preferences. Demand for improvements to water infrastructure was a persistent theme; however, roles and responsibilities with respect to addressing community water and health concerns are ill-defined.

Conclusions

Collectively, our study illustrates how complex attitudes towards water resources can affect which methods will be appropriate to address schistosomiasis.

Female genital schistosomiasis (FGS): from case reports to a call for concerted action against this neglected gynaecological disease

In recent years, control of neglected tropical diseases has been increasingly gaining momentum and interventions against schistosomiasis are being progressively scaled-up through expansion of donated praziquantel and preventive chemotherapy campaigns. However, the public health importance of female genital schistosomiasis is not fully recognised nor its control is adequately addressed. Taking a clinical and anatomopathological perspective, we evaluated the available literature to highlight the importance of female genital schistosomiasis and its connections with two sexually transmitted infections of global importance, Human Immunodeficiency Virus (HIV) and Human Papilloma Virus. Outside the long list of clinical descriptive reports beginning in 1899, there is presently a shocking gap in epidemiological assessment and a significant underestimation of the burden of FGS remains. The scarcity of integrated approaches to address female genital schistosomiasis calls for more concerted action in its detection, treatment and prevention alongside other concomitant women's health issues, otherwise female genital schistosomiasis will remain a neglected gynaecological disease.

Insight into the molecular basis of Schistosoma haematobium-induced bladder cancer through urine proteomics

Infection due to Schistosoma haematobium is carcinogenic. However, the cellular and molecular mechanisms underlying urogenital schistosomiasis (UGS)-induced carcinogenesis have not been well defined. Conceptually, early molecular detection of this phenomenon, through non-invasive procedures, seems feasible and is desirable. Previous analysis of urine collected during UGS suggests that estrogen metabolites, including depurinating adducts, may be useful for this purpose. Here, a new direction was pursued: the identification of molecular pathways and potential biomarkers in S. haematobium-induced bladder cancer by analyzing the proteome profiling of urine samples from UGS patients. GeLC-MS/MS followed by protein-protein interaction analysis indicated oxidative stress and immune defense systems responsible for microbicide activity are the most representative clusters in UGS patients. Proteins involved in immunity, negative regulation of endopeptidase activity, and inflammation were more prevalent in UGS patients with bladder cancer, whereas proteins with roles in renal system process, sensory perception, and gas and oxygen transport were more abundant in subjects with urothelial carcinoma not associated with UGS. These findings highlighted a Th2-type immune response induced by S. haematobium, which seems to be further modulated by tumorigenesis, resulting in high-grade bladder cancer characterized by an inflammatory response and complement activation alternative pathway. These findings established a starting point for the development of multimarker strategies for the early detection of UGS-induced bladder cancer.

Schistosoma haematobium infection and asymptomatic bacteriuria in young South African females

Schistosoma haematobium eggs can induce lesions in the urinary and genital tract epithelia, as eggs pass through or get trapped in the tissue. Local inflammatory reactions induced by S. haematobium eggs might affect the ability of bacteria to establish mucosal super-infection foci. S. haematobium infection and asymptomatic bacteriuria can both portray haematuria, proteinuria and leukocyturia. This shared set of proxy diagnostic markers could fuel routine misdiagnosis in S. haematobium endemic areas. Furthermore, S. haematobium infected individuals might be at a higher risk of contracting bacterial urinary tract infections, which could manifest either as symptomatic or asymptomatic bacteriuria. The aim of the current study was to explore whether schistosomal lesions are susceptible to super-infection by bacteria measured as asymptomatic bacteriuria. S. haematobium infection was determined by microscopy of urine samples. Furthermore, urine samples were tested with dipslides for asymptomatic bacteriuria and with dipsticks for haematuria, proteinuria and leukocytes. We found no association between asymptomatic bacteriuria and S. haematobium infection in a sample of 1040 female primary and high school students from a schistosomiasis endemic area in KwaZulu-Natal, South Africa. Furthermore, it was demonstrated that asymptomatic bacteriuria is not a bias for use of micro-haematuria as a proxy diagnostic measure for S. haematobium infection in this population.