Schistosoma Haematobium-infected Children Research Articles

Evaluation of the Clinitek\xae, a point-of-care urinalysis system for the measurement of clinically significant urinary metabolites and detection of haematuria in Schistosoma haematobium infected children in southern C\xf4te d\u2019Ivoire

BackgroundUrinary schistosomiasis, caused by Schistosoma haematobium, remains a significant public health problem worldwide, despite years of efforts to control it. Haematuria is one of the notable indirect indicators of S. haematobium infection and is commonly assessed along with other routine screens using a urinary dipstick test. A portable “field friendly” electronic analyser would offer an automated and thus more objective read-out compared to visual-read dipstick methods.MethodsWithin the framework of a Phase 2 praziquantel dose finding study in preschool- and school-aged children infected with S. haematobium, in southern Côte d’Ivoire, we compared a visual-read of the urine dipstick strips (Multistix PRO, Siemens Healthcare Diagnostics) to an automated reader (CLINITEK Status+ analyser™ Siemens Healthcare Diagnostics). Urine samples were collected from 148 pre-school aged and 152 school-aged children for urinalysis. Values were compared using a linear weighted kappa statistic and Bland–Altman analysis.ResultsA very good correlation between the two methods for nitrites and haematuria was observed (κ coefficient of 0.88 and 0.82, respectively), while a good correlation was observed for leukocytes (κ coefficient of 0.63) A moderate to fair correlation was calculated (κ coefficient ≤ 0.6) for all other parameters. When the results were stratified according to infection intensity, the agreements were stronger from the high infection intensity sample measurements, for most of the parameters.ConclusionOur results demonstrate the device’s utility in detecting haematuria and nitrites but underline the need for further development of this tool in order to improve its performance in the field.

High Efficacy of Praziquantel in Schistosoma haematobium-Infected Children in Taraba State, Northeast Nigeria: A follow-up study

This study aimed to assess the efficacy of praziquantel in reducing urinary schistosomiasis prevalence, parasite burden and morbidity rates among a previously reported sample of Schistosoma haematobium-infected children. In addition, predisposing factors for reinfection one year post-treatment were also determined. This prospective follow-up study was conducted between March 2014 and February 2015 among 675 previously reported children with urinary schistosomiasis in the Murbai and Surbai communities of Ardo Kola, Taraba State, Nigeria. A single dose of 40 mg/kg of praziquantel was administered to each infected child, with a second dose administered one month later if necessary. The number of S. haematobium eggs in urine samples was calculated at baseline and post-treatment. At four weeks post-treatment, the overall cure rate was 98.1%. Among children with low and heavy parasite burdens at baseline, egg reduction rates (ERRs) were 100% and 96.5%, respectively. The vast majority of children with microhaematuria (98.7%) and proteinuria (98.6%) at baseline were cured at follow-up. Following a second dose, the ERR, overall and morbidity cure rates increased to 100%. At one year post-treatment, 272 infected children (40.3%) were re-assessed; of these, 51 children (18.8%) were reinfected. Close proximity to bodies of water (odds ratio [OR] = 1.23, 95% confidence interval [CI]: 0.998-1.530; P = 0.05) and fishing (OR = 2.23, 95% CI: 0.828-6.040; P = 0.01) were significant factors that predisposed children to reinfection. A moderate rate of reinfection was noted. Governmental and nongovernmental organisations in Nigeria should collaborate on mass treatment and health education campaigns to reduce the incidence of urinary schistosomiasis reinfections.

Evaluation of a novel micro-sampling device, Mitra™, in comparison to dried blood spots, for analysis of praziquantel in Schistosoma haematobium-infected children in rural Côte d’Ivoire

Pharmacokinetic (PK) studies with paediatric populations are increasing in importance for drug development. However, conventional PK sampling methods are characterised by invasiveness and low patient adherence, unsuitable for use with sensitive population, such as children. Mitra™ is a novel volumetric absorptive micro-sampling device, which offers an alternative to the dried blood spotting (DBS) technique, a current popular sampling technique within PK studies. We tested Mitra™ for the first time in the framework of a randomised controlled trial in rural Côte d’Ivoire. Thirty-five school-aged children, infected with Schistosoma haematobium, were sampled with both DBS and Mitra™, at 10 time points after treatment with praziquantel (PZQ). An extraction method for PZQ from Mitra™ was developed, optimised and validated. Analytes, namely R- and S-praziquantel (R-/SPZQ) and the main human metabolite, R-trans-4-OH-praziquantel, were measured using liquid chromatography-tandem mass spectrometry and the results were compared with Bland-Altman analysis to determine agreement between matrices. PK parameters, such as maximal plasma concentration and area under the concentration-time curve, were estimated using non-compartmental analysis.While we observed strong positive correlation (R2 > 0.98) and agreement between both matrices within the calibration line and quality control samples, Mitra™ revealed higher concentrations of all the analytes in the majority of patients’ samples compared to DBS sampling, namely 63% samples for RPZQ, 49% for SPZQ and 78% for the metabolite were overestimated. While T1/2 and Tmax were in agreement between both matrices, area under the curve and maximal blood concentration were up to 2× higher for Mitra™ samples, with P < 0.005 for all parameters except Cmax of SPZQ, which was not significantly different between the two matrices. The reasons for the higher PZQ concentrations, more pronounced in incurred Mitra™ samples compared to spiked samples, are yet to be fully explored. Mitra™ appears superior to DBS in terms of simplicity and practicality however labelling issues and the high price of Mitra™ are difficult to overlook.

S. Haematobium Infection and Chemotherapy-Induced Changes in Interleukin-6 and Acute Phase Proteins Associated with Inflammation in School Children in a Schistosomiasis-Endemic Area

Objective: There is an increased risk of cases of direct and indirect morbidities as a result of stimulation of tissue-destructive inflammation caused by Schistosoma haematobium infection, hence the need to determine the levels of inflammatory markers in Schistosoma haematobium infected children and also determine the effect of repeated annual mass treatment on levels of interleukin-6 and acute phase proteins.Methodology: Urine specimens from 212 school children were collected and examined to determine prevalence of Schistosoma haematobium at baseline and 2 years following annual rounds of praziquantel treatment. Levels of 4 acute phase proteins were measured from serum samples from the participants using the magnetic bead-based immuno-assays at baseline and 2 years following praziquantel treatment. Sandwich enzyme-linked immunosorbent assay was used to determine levels of interleukin-6.Results: The overall pre-treatment prevalence of Schistosoma haematobium infection was 23.1% at baseline and 0.47% after 2 years of annual treatments. Schistosoma haematobium infected children had marginally higher levels of procalcitonin and tissue plasminogen activator before treatment though the difference of all three was not significant p>0.05 using Mann-Whitney non-parametric U test. Levels of ferritin and fibrinogen were lower in Schistosoma haematobium infected children before treatment, however the difference was also not significant p>0.05 using Mann-Whitney test. There was no association between infection status or interleukin-6 and the levels acute phase proteins p>0.05 for all acute phase proteins using the Mann-Whitney U test.Discussion and conclusion: Findings from this study suggest no bearing of Schistosoma haematobium infection status on level of acute phase proteins before and after annual treatment with praziquantel. The extent of inflammation cannot be determined using ferritin, tissue plasminogen activator and fibrinogen. Levels of interleukin-6 did not have any bearing on levels of acute phase proteins. There is a need to explore other acute phase proteins as inflammatory markers in Schistosoma haematobium infection.

Urinary schistosomiasis and iron deficiency anemia among Malian school children

Anemia continues to be a major public health problem in many countries. The prevalence and intensity of urinary schistosomiasis, which contributes to anemia, often peak at school age adding to that age group’s nutrition and disease burdens. However, unlike malaria and hookworm infections, little is known on the role of urinary schistosomiasis in iron deficiency anemia. The objective of this study was to assess the prevalence of iron deficiency anemia and the effect of iron supplementation on hemoglobin (Hb) and serum ferritin (SF) levels among school children infected with Schistosoma haematobium in Bamako, the capital city of Mali. A total of 150 anemic school children between 7 and 12 years were randomly assigned to receive either 40mg/kg of praziquantel or 40mg/kg of praziquantel (P) + daily 66 mg of iron (Fe), five days a week for three months. Hb and SF were measured at baseline and at 6 and 12 weeks of the intervention. Only children who had complete Hb and SF data at each stage of the trial were included in the statistical analyses (n = 74 in the P+Fe group; n = 66 in the P group). At baseline, mean Hb (g/dl) was 10.53±0.93 in the P group and 10.47±1.17 in the Fe+P group; mean SF (µg/l) was 34.39±37.58 in the P group and 29.82±23.34 in the Fe+P group, and the prevalence of iron deficiency was 17.2%. At 6 and 12 weeks of the intervention, there was an important reduction in anemia and in iron deficiency in both treatment groups. Mean Hb (g/dl) was higher in the Fe+P group (11.63±0.88 and 11.55±0.94) than in the P group (11.14±0.98 and 10.84±0.86) at 6 and 12 weeks, respectively. Mean SF (µg/l) was also higher in the P+Fe group (74.26±40 and 100.29±53.92) than in the P group(40.65±35.63 and 40.70±29.57) at 6 and 12 weeks, respectively. In these Schistosoma haematobium infected children, iron deficiency was prevalent and treatments with P alone or in combination with Fe supplementation were able to increase hemoglobin and iron stores. Neither P nor P+Fe by alone completely reversed anemia in this sample population.

Urinary Schistosomiasis And Iron Deficiency Anemia Among Malian School Children

Anemia continues to be a major public health problem in many countries. The prevalence and intensity of urinary schistosomiasis, which contributes to anemia, often peak at school age adding to that age group’s nutrition and disease burdens. However, unlike malaria and hookworm infections, little is known on the role of urinary schistosomiasis in iron deficiency anemia. The objective of this study was to assess the prevalence of iron deficiency anemia and the effect of iron supplementation on hemoglobin (Hb) and serum ferritin (SF) levels among school children infected with Schistosoma haematobium in Bamako, the capital city of Mali. A total of 150 anemic school children between 7 and 12 years were randomly assigned to receive either 40mg/kg of praziquantel or 40mg/kg of praziquantel (P) + daily 66 mg of iron (Fe), five days a week for three months. Hb and SF were measured at baseline and at 6 and 12 weeks of the intervention. Only children who had complete Hb and SF data at each stage of the trial were included in the statistical analyses (n = 74 in the P+Fe group; n = 66 in the P group). At baseline, mean Hb (g/dl) was 10.53±0.93 in the P group and 10.47±1.17 in the Fe+P group; mean SF (μg/l) was 34.39±37.58 in the P group and 29.82±23.34 in the Fe+P group, and the prevalence of iron deficiency was 17.2%. At 6 and 12 weeks of the intervention, there was an important reduction in anemia and in iron deficiency in both treatment groups. Mean Hb (g/dl) was higher in the Fe+P group (11.63±0.88 and 11.55±0.94) than in the P group (11.14±0.98 and 10.84±0.86) at 6 and 12 weeks, respectively. Mean SF (μg/l) was also higher in the P+Fe group (74.26±40 and 100.29±53.92) than in the P group (40.65±35.63 and 40.70±29.57) at 6 and 12 weeks, respectively. In these Schistosoma haematobium infected children, iron deficiency was prevalent and treatments with P alone or in combination with Fe supplementation were able to increase hemoglobin and iron stores. Neither P nor P+Fe by alone completely reversed anemia in this sample population. Key words: Urinary schistosomiasis, anemia, children, Mali

Chemotherapy accelerates the development of acquired immune responses to Schistosoma haematobium infection.

Treatment of 41 Schistosoma haematobium-infected children, 5-16 years old, with the drug praziquantel induced a switch from a predominantly IgA-specific antibody response to a predominantly IgG1 response within 12 weeks. A cross-sectional survey suggests that the same switch occurs naturally, but over several years, as children age (n = 251). The switch may be driven by alterations in cytokine levels in response to the release of antigens by dead or damaged parasites. Adults are more resistant to schistosome infection than children, and the switch to an "adult" response suggests that praziquantel treatment may have an immunizing effect, with benefits extending beyond a transient reduction in levels of infection.