Schistosoma Haematobium Infection Research Articles

Urogenital schistosomiasis among school children in northwestern Tanzania: Prevalence, intensity of infection, associated factors, and pattern of urinary tract morbidities

BackgroundThe planning and implementation of intervention measures against schistosomiasis, particularly mass administration, require knowledge of the current status of the infection. This is important for monitoring the impact of the intervention on disease indicators such as a decline in infection prevalence, intensity of infection, and urogenital morbidities. Following repeated rounds of mass treatment in northwestern Tanzania, the epidemiology of urogenital schistosomiasis has changed; thus, for the effective planning and allocation of resources, it is important to understand the current status of the disease in the targeted groups. Therefore, the objective of the current study was to determine the prevalence, intensity, and associated factors of Schistosoma haematobium infection and urinary tract morbidities in school-aged children from northwestern Tanzania. Materials and methodsAn analytical cross-sectional study was conducted among schoolchildren aged 5–17 years between November and December 2022. A single urine sample was collected from each child and examined for the presence of S. haematobium eggs and microhaematuria using a urine filtration technique and a urine reagent dipstick. Each child underwent an ultrasonographic examination of the urinary tract according to the World Health Organization standards (Niamey protocol) to detect S. haematobium-related morbidities. ResultsOf the 3225 participants, 54.2 % were female, and the mean age was 10.9 (±1.89) years. The overall prevalence of S. haematobium was 17.7 % (95 % CI: 16.4–19.1, 572/3225). Of the 572 infected children, 81.8 % (95 % CI: 78.4–84.9, 468/572) had light-intensity infections, and 18.2 % (95 % CI: 14.9–21.4, 104/572) had heavy-intensity infections. The prevalence of macro- and microhaematuria was 2.4 % (95 % CI: 1.9–3) and 18.5 % (95 % CI: 17.2–19.8), respectively. Age (aOR: 1.2, 95 % CI: 1.0–1.5), district of residence (aOR: 2.1, 95 % CI: 1.7–2.7) and history of schistosomiasis (aOR: 2.5, 95 % CI: 1.9–3.2) were significantly associated with urinary schistosomiasis infection. However, swallowing praziquantel during the last mass drug administration was protective (aOR 0.6, 95 % CI: 0.4–0.8). The overall prevalence of ultrasound-detectable urinary tract abnormalities was 9.9 % (95 % CI: 8.9–11.1, 299/2994) and included urinary bladder abnormalities in 9.9 % (95 % CI: 8.8–11, 297/2994), ureter abnormalities in 0.2 % (95 % CI: 0.07–0.4, 6/2994), and kidney abnormalities in 0.2 % (95 % CI: 0.09–0.4, 7/2994). Calcification of the urinary bladder was observed in 0.9 % (95 % CI: 0.6–1.3, 29/2994) of the examined children. ConclusionsSchistosoma haematobium infection is still prevalent among schoolchildren in the study setting, and it causes substantial morbidity at an early age. Transmission is driven by the age of the child, district of residence, and history of schistosomiasis. However, swallowing praziquantel in rounds of mass drug administration reduces transmission. Urogenital schistosomiasis infection is associated with haematuria and ultrasound-detectable morbidities. In S. haematobium endemic areas, routine ultrasound screening for urinary tract morbidities could be considered in annual mass treatment programmes for early management. Special attention should be given to children with proteinuria, microhaematuria, and heavy infection intensities.

Efficacy of Praziquantel in Treating Schistosoma haematobium Infection Among Ethiopian Children

Background/Objectives: Praziquantel is a cornerstone of schistosomiasis control and elimination efforts. Continued surveillance of praziquantel efficacy is needed to monitor for the development of resistance, as well as to help public health officials gauge the effect of mass praziquantel administration on schistosomiasis control in communities, since it is the only drug used in schistosomiasis control programs. The objective of this study was to assess the praziquantel cure rate and egg reduction rate against urogenital schistosomiasis. Methods: This study enrolled 977 children from 12 villages in Afar and Gambella, Ethiopia, who provided urine samples that were checked for Schistosoma haematobium infection at baseline using urine filtration microscopy. Infected individuals were provided a single dose of praziquantel (40 mg/kg body weight) and retested six weeks post-treatment. Results:S. haematobium was recovered from baseline urine specimens in 177 of 977 (18%) participating children. One hundred six of these children completed therapy and presented for subsequent evaluation at six weeks; 91 children were egg-free. The egg reduction rate was 97%; changes in egg burden among the 15 children who did not achieve cure varied widely. Cure rates were better among children with light-intensity infections. No significant differences in egg reduction rates were found based on the demographic variables examined. Conclusions: Standard praziquantel monotherapy remains an effective treatment against urogenital schistosomiasis in Ethiopia.

Sex as a biological variable in HIV-1 and schistosome co-infection.

The sex of people living with HIV-1 infection, schistosome infection, or both, is a fundamental determinant of their clinical outcomes and of how these two infections interact in the host. Data from longitudinal and cross-sectional human studies and animal models indicate that males with HIV-1 and schistosome co-infection excrete fewer schistosome eggs and might have higher HIV-1 RNA viral loads and greater liver damage. Females with schistosome infection appear to have higher risk of HIV-1 acquisition than females without, particularly in Schistosoma haematobium infection, and a greater risk of death in HIV-1 and schistosome co-infection. Greater transmission of HIV-1 to partners has been shown in both sexes in those with schistosome infection. Biological sex is a consequential factor affecting pathophysiological and clinical responses in HIV-1 and schistosome co-infection. Designing future analyses to incorporate sex is vital to optimise research and care for people living with HIV-1, schistosomes, and HIV-1 and schistosome co-infection.

Exploring the genome-wide transcriptomic responses of Bulinus truncatus to Schistosoma haematobium infection: An important host-parasite system involved in the transmission of human urogenital schistosomiasis

Freshwater snails of the genus Bulinus are critical hosts for Schistosoma haematobium, the causative agent of urogenital schistosomiasis. Among the 37 recognized Bulinus species, B. truncatus is a key vector. Using RNA sequencing (RNAseq), we investigated the genome-wide transcriptional responses of B. truncatus to S. haematobium infection. Our findings suggest that snails employ a complex defense strategy against the parasites by up-regulating genes involved in immune response, stress reaction, structural integrity, metabolism, and detoxification. In response, schistosome parasites appear to manipulate the snail’s defense system, as evidenced by the suppression of immune-related genes such as ficolin, peptidoglycan recognition protein, and C-type lectin domain-containing protein genes. The down-regulation of biomphalysin 9, compared to its function in Biomphalaria glabrata, indicates divergent immune strategies among snail hosts. Additionally, we compared transcriptome profiles between embryos and juveniles, providing insights into developmental processes. This study offers valuable genomic data for Bulinus snails, illuminating the molecular interactions between bulinids and schistosomes, and advancing our understanding of their developmental biology.

Comparative evaluation of plasma biomarkers of Schistosoma haematobium infection in endemic populations from Burkina Faso.

Infection with Schistosoma haematobium causes urogenital disease associated with organ disfunction, bleeding, pain, and higher susceptibility to infections and cancer. Timely and accurate diagnosis is crucial for prompt and appropriate treatment as well as surveillance efforts, and the use of plasma biomarkers offers important advantages over parasitological examination of urine, including increased sensitivity and the possibility to use the same specimen for multiple investigations. The present study aims to evaluate the diagnostic performance of different plasma biomarkers in endemic populations from Burkina Faso, West Africa. Schistosoma spp. Circulating Anodic Antigen (CAA), cell free S. haematobium DNA (cfDNA), class M and G antibodies against S. haematobium Soluble Worm Antigen Preparation (SWAP) and Soluble Egg Antigen (SEA) were measured in 406 plasma samples. Results of each biomarker test were compared to those of CAA, a Composite Reference Standard (CRS) and Latent Class Analysis (LCA). An identical proportion of positive samples (29%) was observed as a result of CAA and cfDNA testing, with a substantial agreement (84%, Cohen k = 0.62) between the results of the two tests, and a comparable agreement with the results of CRS and LCA. A higher positivity was observed, as expected, as a result of specific antibody testing (47%-72%), with IgG showing a higher agreement than IgM with the three references. Also, higher IgG levels were observed in current vs past infection, and ROC analysis identified optimal cutoff values for improved testing accuracy. This study provides compelling evidence that can inform the choice of the most appropriate diagnostic plasma biomarker for urogenital schistosomiasis in endemic areas, depending on the purpose, context, and available resources for testing. Either CAA or cfDNA testing can be used for the diagnosis of patients and for epidemiological investigations, even in absence of urine filtration microscopy, whereas anti-SWAP or anti-SEA IgG can be employed for surveillance and integrated monitoring of control interventions against poverty-associated diseases.

Effects of Schistosoma haematobium infection and treatment on the systemic and mucosal immune phenotype, gene expression and microbiome: A systematic review.

Urogenital schistosomiasis caused by Schistosoma haematobium affects approximately 110 million people globally, with the majority of cases in low- and middle-income countries. Schistosome infections have been shown to impact the host immune system, gene expression, and microbiome composition. Studies have demonstrated variations in pathology between schistosome subspecies. In the case of S. haematobium, infection has been associated with HIV acquisition and bladder cancer. However, the underlying pathophysiology has been understudied compared to other schistosome species. This systematic review comprehensively investigates and assimilates the effects of S. haematobium infection on systemic and local host mucosal immunity, cellular gene expression and microbiome. We conducted a systematic review assessing the reported effects of S. haematobium infections and anthelmintic treatment on the immune system, gene expression and microbiome in humans and animal models. This review followed PRISMA guidelines and was registered prospectively in PROSPERO (CRD42022372607). Randomized clinical trials, cohort, cross-sectional, case-control, experimental ex vivo, and animal studies were included. Two reviewers performed screening independently. We screened 3,177 studies and included 94. S. haematobium was reported to lead to: (i) a mixed immune response with a predominant type 2 immune phenotype, increased T and B regulatory cells, and select pro-inflammatory cytokines; (ii) distinct molecular alterations that would compromise epithelial integrity, such as increased metalloproteinase expression, and promote immunological changes and cellular transformation, specifically upregulation of genes p53 and Bcl-2; and (iii) microbiome dysbiosis in the urinary, intestinal, and genital tracts. S. haematobium induces distinct alterations in the host's immune system, molecular profile, and microbiome. This leads to a diverse range of inflammatory and anti-inflammatory responses and impaired integrity of the local mucosal epithelial barrier, elevating the risks of secondary infections. Further, S. haematobium promotes cellular transformation with oncogenic potential and disrupts the microbiome, further influencing the immune system and genetic makeup. Understanding the pathophysiology of these interactions can improve outcomes for the sequelae of this devastating parasitic infection.

Survey of Schistosoma haematobium and Environmental Factors in Donga Local Government Area, Taraba State, Nigeria

Schistosoma haematobium infection is known to be endemic especially among residents along Rivers, This study was conducted to establish the preval_ence of urinary schistosomiasis in relation to some epidemiological factors among elementary pupils in Donga Local Government Area. Urine filtration technique using polycarbonate membrane filters was employed to check the presence of Schistosoma haematobium eggs in urine and questionnaires were administered. Overall preval_ence of 8.94% (21) was recorded out of the 235 urine examined. Chi square analysis showed insignificant association of the infection with the various schools (χ²= 6.192, P = 0.185). Similarly, ANOVA revealed no significant difference in the mean egg intensity (27.29 eggs/10ml of urine) among the schools (p = 0.293). Males were more infected 13.33%(16) than females 4.50%(5) with a significant difference (P=0.020). However, there was no statistical significant difference in their mean egg intensities (30.3 eggs/10ml of urine in male and 17.6 eggs/10ml of urine in female) (p = 0.27). The age-related preval_ence was higher 11.82% (13) in 10-15 years children while children aged 16-20 had the least preval_ence 0.01% (1). Chi square showed statistical significant association between infection and age (χ²=12.964, P=0.002). But there was a statistical insignificant difference between their mean egg intensities; 10-15, 4-9 and 16-20 (31.08, 23.4, 5 eggs/10ml of urine respectively) with p=0.462. Children who fish had the highest preval_ence 16.67% and children that do not partake in any of these activities had no case of infection 0%(64). Chi square revealed a statistical significant association between participant's water contact activities and infection (χ² =11.21; p = 0.024). However, ANOVA showed statistical insignificant difference in the mean egg intensity among these activities (p = 0.486). This findings indicates that urinary schistosomiasis has low endemicity in this area which could be due to the fact that It was concluded that the overall low preval_ence could be attributed to improved environmental hygiene among others.

First reports of urogenital schistosomiasis in the Ndikiniméki health district, Center Cameroon

ObjectivesSchistosomiasis is still a public health problem in sub-Saharan Africa, particularly in Cameroon. In this context, a cross-sectional study was carried out from June 2023 to July 2023 in the Ndikiniméki subdivision, with the aim of knowing the status of this locality in relation to Schistosoma haematobium infection. MethodsA parasitologic analysis of S. haematobium eggs was carried out on urine samples using the sedimentation technique. ResultsA total of 402 urine samples were collected from households. The age range of participants was 1-96 years, with the most signified age group being 1-9 years. Women were the most represented, with a proportion of 56.47%. Of the 402 people examined, 18 (4.45%) were affected, with an average intensity of 54.43 ± 85.30 eggs/10 mL urine. Women were the most affected, with a prevalence and average parasite intensity of 3.73% and 53.10 ± 131.27 eggs/10 mL of urine. The most affected age group was 10-19 years, with a prevalence and intensity of 4.60% and 49.49 ± 67.00 eggs per 10 mL of urine, respectively. Of those infected, 72.22% were lightly infected and 27.28% were heavily infected. ConclusionsThis study indicates that this locality is a risk area for urinary schistosomiasis despite its low prevalence.

PREVALENCE OF SCHISTOSOMA HAEMATOBIUM INFECTION AMONG PRIMARY SCHOOL CHILDREN IN FASKARI AND FUNTUA LOCAL GOVERNMENT AREAS OF KATSINA STATE, NIGERIA

Schistosomiasis is a water-borne parasitic disease caused by Schistosoma; the digeic trematode found in the blood vessels of a man and livestock. This study was conducted to determine the prevalence of schistosoma haematobium infection among the Primary Schools pupils in Faskari and Funtua Local Government Areas of Katsina State. A total of 496 of urine samples were collected from children of 8 Primary Schools in the study areas; 4 from each local government. A questionnaire was used to collect socio-demographic and other exposure information to explore Schistosoma infection for urine, and urine sedimentation microscopic technique was used for sample analysis. Data were expressed in prevalence (%) and subjected to Chi-square analysis at p < 0.05. Out of the 496 children assessed, 160 (32.2%) were positive for urinary schistosomiasis. The prevalence is significantly (p<0.05) higher in Faskari Model Primary School with (48.3%). It was found from the result that, there was no significant relationship (P=6.608) between source of water and Schistosoma haematobium infection among the pupils in the study areas. There was also no statistical association (P= 1.570) between the source of water for bathing and the infection of urinary schistosomiasis among the students in the study areas. Therefore, schistosomiasis is prevalent in the study areas with Faskari local government having higher prevalence of the infection.

Detection of Urinary Analytes due to Schistosoma haematobium Infection among School Children for Possible Application in Screening for Urinary Schistosomiasis

Study’s Novelty/Excerpt This study introduces an approach for the rapid screening and diagnosis of urinary schistosomiasis using urinalysis in remote communities, where advanced diagnostic techniques are often unavailable. By analyzing 600 school children across six Local Government Areas in Kaduna State, Nigeria, the research highlights significant associations between urinary schistosomiasis and specific urinalysis indicators, such as leukocytes, proteinuria, and micro-hematuria. This method not only demonstrates the feasibility of immediate treatment initiation but also underscores the potential for preventing the chronicity and further community spread of the disease, addressing a critical gap in current public health strategies for rural settings. Full Abstract Urinary schistosomiasis is a disease that has persisted for a long time among children in Nigeria and other African countries. The persistence of schistosomiasis in people living in rural communities is attributed to the abundance of unsafe water bodies where both children and adults engage in activities such as irrigation, bathing, fishing, washing, or fetching water for domestic use. The lack of adequate community-based screening and treatment of infected cases has contributed to the continuous spread of schistosomiasis from endemic communities to new areas. Urinalysis can serve as a rapid method for screening for urinary schistosomiasis among populations in remote locations, enabling immediate treatment and the prevention of its transmission. In this study, 600 school children who gave their consent were enrolled across six Local Government Areas in Kaduna State, Nigeria. A fresh 10mL urine sample was collected from each subject, and eleven analytes were immediately determined upon submission using urine reagent test strips (SG11100-Uric 11V, Guilin Zhonghui Technology Co., Ltd, China). The urine samples underwent centrifugation at 3000 revolutions per minute for 5 minutes, and the sediment from each sample was examined microscopically for Schistosoma haematobium eggs. The data were analyzed statistically at a 95% confidence interval using IBM SPSS Version 23. The overall prevalence of urinary schistosomiasis among the children in the six LGAs of Kaduna State was 6.8%, with heavy infections at 2.2% and light infections at 4.7%. Significant associations were found between urinary schistosomiasis and the presence of leukocytes (18.5%, χ2=47.596, df=1, P=0.000, OR=8.822), proteinuria (23.1%, χ2=17.287, df=1, P=0.000, OR=4.959), and micro-hematuria (49.3%, χ2=213.184, df=1, P=0.000, OR=63.695). This study demonstrates that urinalysis can be effectively utilized for screening urinary schistosomiasis in remote communities where advanced techniques like microscopy may not be available, facilitating prompt treatment initiation. Therefore, early detection and treatment are crucial in preventing the chronicity and community spread of the disease.

MyD88 Signaling Accompanied by Microbiota Changes Supports Urinary Bladder Carcinogenesis.

Urinary bladder cancer (BC) inflicts a significant impairment of life quality and poses a high mortality risk. Schistosoma haematobium infection can cause BC, and the urinary microbiota of BC patients differs from healthy controls. Importantly, intravesical instillation of the bacterium Bacillus Calmette-Guerin stands as the foremost therapy for non-muscle invasive BC. Hence, studying the receptors and signaling molecules orchestrating bacterial recognition and the cellular response in the context of BC is of paramount importance. Thus, we challenged Toll-like receptor 4 (Tlr4) and myeloid differentiation factor 88 (Myd88) knock-out (KO) mice with N-butyl-N-(4-hydroxylbutyl)-nitrosamine (BBN), a well-known urinary bladder carcinogen. Gut microbiota, gene expression, and urinary bladder pathology were followed. Acute exposure to BBN did not reveal a difference in bladder pathology despite differences in the animal's ability to recognize and react to bacteria. However, chronic treatment resulted in reduced cancer invasiveness among Myd88KO mice while the absence of functional Tlr4 did not influence BC development or progression. These differences correlate with a heightened abundance of the Faecalibaculum genus and the lowest microbial diversity observed among Myd88KO mice. The presented data underscore the important role of microbiota composition and MyD88-mediated signaling during bladder carcinogenesis.

Evaluating the Performance of FlukeCatcher at Detecting Urogenital Schistosomiasis.

Urine filtration microscopy (UFM) lacks sensitivity in detecting low-intensity Schistosoma haematobium infections. In pursuit of a superior alternative, this study evaluated the performance of FlukeCatcher microscopy (FCM) at detecting S. haematobium eggs in human urine samples. Urine samples were collected from 572 school-age children in Afar, Ethiopia in July 2023 and examined using UFM and FCM approaches. Using the combined UFM and FCM results as a reference, the sensitivity, negative predictive value, and agreement levels for the two testing methods in detecting S. haematobium eggs in urine samples were calculated. The sensitivity and negative predictive value of detecting S. haematobium eggs in urine samples for FCM was 84% and 97%, respectively, compared to 65% and 93% for UFM. The FCM test results had an agreement of 61% with the UFM results, compared to 90% with the combined results of FCM and UFM. However, the average egg count estimates were lower when using FCM (6.6 eggs per 10 mL) compared to UFM (14.7 eggs per 10 mL) (p < 0.0001). Incorporating FCM into specimen processing could improve the diagnosis of S. haematobium infection but may underperform in characterizing the intensity of infection.

Clinical usefulness of urinary symptoms and urinalysis in diagnosis of Schistosoma haematobium infection in an endemic area in Southern Nigeria: descriptive study

Background: Schistosoma haematobium infection occurs worldwide with the largest number of cases seen in sub-Saharan Africa. Most of the infections are acquired during childhood and are linked to urogenital diseases which contributes significantly to morbidity and mortality. A study on the use of urinary symptoms, signs and urinalysis in the diagnosis of S. haematobium infection might aid in providing early, prompt and rapid intervention that will limit associated complications. Methods: The study was a descriptive cross-sectional of 421 children aged 6-12 years in Ohaukwu LGA, Ebonyi State, recruited from four public primary schools using multistage sampling method. Urinary symptoms and signs were obtained using a questionnaire; urine samples were collected for urinalysis and urine microscopy. Simple proportions and odds ratio (CI) were used to analyze the data. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for various symptoms and signs. The data was analyzed with IBM-SPSS 20. Significance was set at p&lt;0.05. Results: The prevalence of S. haematobium infection among school children in Ohaukwu LGA was 30.17%. Visible blood in urine 71.77% and dysuria 70.16% were the predominant symptoms while liver tenderness 8.87% was the most common sign. The sensitivity vs specificity of visible blood in urine and microscopic haematuria were 71.77% vs 94.43% and 100.00% vs 97.21% respectively. Conclusions: Microscopic haematuria alone was highly sensitive and specific and can be a reliable alternative to the gold standard in making diagnosis of S. haematobium infection in children living in this endemic region.

Antibody response to malaria vaccine candidates in pregnant women with Plasmodium falciparum and Schistosoma haematobium infections.

Malaria in pregnancy has severe consequences for the mother and foetus. Antibody response to specific malaria vaccine candidates (MVC) has been associated with a decreased risk of clinical malaria and its outcomes. We studied Plasmodium falciparum (Pf) and Schistosoma haematobium (Sh) infections and factors that could influence antibody responses to MVC in pregnant women. A total of 337 pregnant women receiving antenatal care (ANC) and 139 for delivery participated in this study. Pf infection was detected by qPCR and Sh infection using urine filtration method. Antibody levels against CSP, AMA-1, GLURP-R0, VAR2CSA and Pfs48/45 MVC were quantified by ELISA. Multivariable linear regression models identified factors associated with the modulation of antibody responses. The prevalence of Pf and Sh infections was 27% and 4% at ANC and 7% and 4% at delivery. Pf infection, residing in Adidome and multigravidae were positively associated with specific IgG response to CSP, AMA-1, GLURP-R0 and VAR2CSA. ITN use and IPTp were negatively associated with specific IgG response to GLURP-R0 and Pfs48/45. There was no association between Sh infection and antibody response to MVC at ANC or delivery. Pf infections in pregnant women were positively associated with antibody response to CSP, GLURP-R0 and AMA-1. Antibody response to GLURP-R0 and Pfs48/45 was low for IPTp and ITN users. This could indicate a lower exposure to Pf infection and low malaria prevalence observed at delivery.

Clinical and Demographic Factors Associated With Kaposi Sarcoma-Associated Herpesvirus Shedding in Saliva or Cervical Secretions in a Cohort of Tanzanian Women.

Reasons for the high prevalence of Kaposi sarcoma-associated herpesvirus (KSHV) in sub-Saharan Africa, and risk factors leading to viral reactivation and shedding, remain largely undefined. Preliminary studies have suggested that schistosome infection, which has been associated with impaired viral control, is associated with KSHV. In this study we sought to determine the relationship between active Schistosoma mansoni or Schistosoma haematobium infection and KSHV shedding. We quantified KSHV DNA in saliva and cervical swabs from 2 cohorts of women living in northwestern Tanzanian communities endemic for S mansoni or S haematobium by real-time polymerase chain reaction. χ2 and Fisher exact tests were used to determine differences in clinical and demographic factors between those who were and were not shedding KSHV. Among 139 total women, 44.6% were KSHV seropositive. Six percent of those with S mansoni and 17.1% of those with S haematobium were actively shedding KSHV in saliva and none in cervical samples. Women from the S mansoni cohort who were shedding virus reported infertility more frequently (80% vs 19.5%, P = .009). There was no difference in frequency of KSHV salivary shedding between schistosome-infected and -uninfected women. In an area with high KSHV seroprevalence and endemic schistosome infections, we provide the first report with data demonstrating no association between schistosome infection and salivary or cervical herpesvirus shedding. KSHV salivary shedding was associated with infertility, a known effect of another herpesvirus, human herpesvirus 6.

Diagnostic tests for human Schistosoma mansoni and Schistosoma haematobium infection: a systematic review and meta-analysis

Accurate diagnosis is pivotal for implementing strategies for surveillance, control, and elimination of schistosomiasis. Despite their low sensitivity in low-endemicity areas, microscopy-based urine filtration and the Kato-Katz technique are considered as reference diagnostic tests for Schistosoma haematobium and Schistosoma mansoni infections, respectively. We aimed to collate all available evidence on the accuracy of other proposed diagnostic techniques. In this systematic review and meta-analysis, we searched PubMed, Embase, the Cochrane Library, and LILACS for studies published from database inception to Dec 31, 2022, investigating the sensitivity and specificity of diagnostic tests for S haematobium and S mansoni infections against Kato-Katz thick smears or urine microscopy (reference tests) involving adults (aged ≥18 years), school-aged children (aged 7 to 18 years), or preschool-aged children (aged 1 month to 7 years). We extracted raw data on true positives, true negatives, false positives, and false negatives for the diagnostic tests and data on the number of participants, study authors, publication year, journal, study design, participants' age and sex, prevalence of Schistosoma infection, and treatment status. To account for imperfect reference tests, we used a hierarchical Bayesian latent class meta-analysis to model test accuracy. Overall, we included 121 studies, assessing 28 different diagnostic techniques. Most studies (103 [85%] of 121) were done in Africa, 14 (12%) in South America, one (1%) in Asia, and one (1%) in an unknown country. Compared with the reference test, Kato-Katz thick smears, circulating cathodic antigen urine cassette assay version 1 (CCA1, 36 test comparisons) had excellent sensitivity (95% [95% credible interval 88-99]) and reasonable specificity (74% [63-83]) for S mansoni. ELISA-based tests had a performance comparable to circulating cathodic antigen, but there were few available test comparisons. For S haematobium, proteinuria (42 test comparisons, sensitivity 73% [62-82]; specificity 94% [89-98]) and haematuria (75 test comparisons, sensitivity 85% [80-90]; specificity 96% [92-99]) reagent strips showed high specificity, with haematuria reagent strips having better sensitivity. Despite limited data, nucleic acid amplification tests (NAATs; eg, PCR or loop-mediated isothermal amplification [LAMP]) showed promising results with sensitivity estimates above 90%. We found an unclear risk of bias of about 70% in the use of the reference or index tests and of 50% in patient selection. All analyses showed substantial heterogeneity (I2>80%). Although NAATs and immunological diagnostics show promise, the limited information available precludes drawing definitive conclusions. Additional research on diagnostic accuracy and cost-effectiveness is needed before the replacement of conventional tests can be considered. WHO and Luxembourg Institute of Health.

Minimum service package for the integration of female genital schistosomiasis in sexual and reproductive health services in Kenya

Female genital schistosomiasis (FGS) is caused by chronic Schistosoma hematobium infection. Over 56 million women and girls in sub-Saharan Africa are estimated to be infected with FGS. However, gaps in knowledge of the symptomatology of FGS often lead to misdiagnosis and undertreatment. FGS presents with nonspecific genital symptoms and is likely to be misdiagnosed as a sexually transmitted infection (STI). Recurrent treatment for STIs may result in marital discord, intimate partner violence, and social stigma. Other FGS complications include ectopic pregnancy, infertility, urine incontinence, 3-4-fold increased susceptibility to HIV infection, and persistence of human papillomavirus infection (HPV). A minimum service package (MSP) that is acceptable and feasible for the integration of FGS and sexual and reproductive health (SRH) services is needed. A foundational literature review was conducted to identify service points for FGS and sexual and reproductive health (SRH) service integration. The final MSP was developed through collaborative efforts with stakeholders in various fields associated with FGS and SRH services. The MSP identified four key areas for successful integration of FGS into SRH services including: health literacy, screening and diagnosis, treatment and care, and social inclusion and equity at the community and healthcare facility level. A context-specific integration MSP may be the most efficient, effective, and ethical way to comprehensively address the burden of FGS faced by women and girls in Africa.

A Tale of Mummified Eggs in Urine of a US Veteran

Abstract Schistosomiasis is a neglected tropical disease that remains a major threat to global health. Schistosoma is known to cause chronic urogenital infections with an increased risk of bladder carcinomas. We present a case of chronic latent Schistosoma haematobium infection in a US veteran identified several years after his active military duty in Iraq and Kuwait. This case highlights the need for proactive screening of returning veterans from endemic areas. It also leads us to wonder how many infected veterans remain undiagnosed, and how many of those who develop urothelial carcinomas had prior exposure to schistosomiasis during their service.

Epidemiology and Molecular Study of Schistosoma haematobium Infection Among People in Riverine Communities of Sokoto State, Nigeria

Microscopic examination of urine samples from individuals has long been regarded as the gold standard for diagnosing Schistosoma haematobium infection in Nigeria. However, the reliability of this method has been questioned. In light of this, the present study was designed to conduct an Epidemiology and Molecular Study of S. haematobium Infection Among People in Riverine Communities of Sokoto State. A total of 900 urine samples were collected. These samples underwent microscopic examination after filtration. Positive samples underwent DNA extraction, followed by PCR analysis to detect the presence of Schistosoma haematobium at 121 base pairs. Microscopically, 315 out of 900 samples (35.0%) tested positive for Schistosoma haematobium, with a mean egg intensity of 45.3 eggs per 10 mL of urine. The prevalence was notably high among fishermen (57.1%), individuals using any available water source (100.0%), visitors to freshwater bodies (37.7%), those residing very close to freshwater bodies (41.5%), and individuals who urinated indiscriminately (70.0%). The intensity of infection was significantly elevated among housewives (56.5%), visitors to freshwater bodies (58.7%), and individuals who urinated directly into freshwater bodies (57.2%). PCR analysis further confirmed the presence of Schistosoma haematobium in 87.6% of the samples previously analyzed microscopically. Infection rates were particularly significant among fishermen (98.2%), individuals using rivers as their water source (99.1%), visitors to freshwater bodies (89.8%), swimmers (97.8%), those residing very close to freshwater bodies (98.6%), and individuals who urinated directly into freshwater bodies (98.9%). The study revealed that microscopic examination alone may not be entirely effective in the study area. Therefore, the adoption of binary diagnosis methods is strongly recommended for more efficient detection of Schistosoma haematobium in the State.

Baseline soil-transmitted helminth and schistosome infection in the Geshiyaro project, Ethiopia: A unique transmission interruption project using biometric fingerprinting for longitudinal individual analysis.

The Geshiyaro project aims to assess the feasibility of interrupting transmission of soil-transmitted helminths (STH) and schistosome (SCH) infection in the Wolaita zone of southern Ethiopia through high coverage community-wide mass drug administration (MDA), in combination with improved water, sanitation, and hygiene services and behaviour change communication delivered through the existing health care infrastructure. To accurately measure treatment coverage a population census was conducted enrolling individuals with biometric fingerprinting and barcoded ID cards. This paper details the baseline census and parasitology surveys conducted before the start of any interventions. The census was conducted in five of the 15 Wolaita districts between October 2018 and December 2019, enrolling all consenting participants from every household. Simultaneously, a cross-sectional parasitology survey was conducted in 130 out of 361 randomly selected communities from all 15 districts, with 100 individuals across all age groups (infant to adult) per community providing stool and urine for analysis by duplicate Kato-Katz and a point-of-care circulating cathodic antigen (POC-CCA) to test for Schistosoma mansoni and STH, and microhaematuria and urine filtration for Schistosoma haematobium. Of the 130 communities, 30 were randomly selected for annual, longitudinal parasitological monitoring, with 150 randomly selected individuals from infant to adult providing two days of stool and urine samples for analysis by the same diagnostic tests per community. In total 97,919 households participated in the baseline census enrolling 466,071 individuals, with parasitological data obtained from 10,785 people. At baseline, 15.5% were infected with at least one STH species, with Ascaris lumbricoides (9.5%), followed by hookworm (7.2%) and Trichuris trichiura (1.8%). Substantial heterogeneity in STH prevalence was observed between communities ranging from 0% to 61% where most infections were low intensity. Schistosoma mansoni infection was the dominant schistosome infection (0.85% by Kato-Katz and 13.3% by POC-CCA trace negative and 21.5% trace positive), with few Schistosoma haematobium infections identified (2.77% haematuria positive and 0.13% positive by urine filtration). While the national control program in Ethiopia has made good progress in reducing prevalence of STH and SCH in Wolaita since it was launched in 2015, there remain areas of persistent infection suggesting the existence of environmental or behavioural risk factors that contribute to ongoing transmission. This project aims to identify the most efficient intervention strategies to reduce community burden and reach interruption of transmission.