Schistosomiasis Endemic Community Research Articles

Development of a field diagnostic tool for Schistosoma mansoni Praziquantel resistant markers in selected endemic communities

Schistosomiasis is a neglected tropical disease that affects more than 200 million people and 45% of infections have been shown to occur in school-aged children. A large percentage of the disease burden lies in Africa. In 2012, the WHO outlined a roadmap for the elimination of schistosomiasis by 2020; however, this was not achieved. Treatment for schistosomiasis is by the use of Praziquantel, a drug in use for over 30 years and there is a concern for emerging drug resistance. There are several species of the genus Schistosoma causing infection in humans. For this study, Schistosoma mansoni which causes intestinal schistosomiasis will be investigated. There are reports of lowering cure rates and suboptimal response to praziquantel following several cycles of mass drug administration (MDA). Praziquantel resistance has also been reported in some countries and laboratory-bred schistosome experiments. To address the concerns of resistance, this study aims to employ a two-part approach to assess the prevalence of S. mansoni. praziquantel resistance amongst school-aged children in schistosomiasis endemic communities in Ghana and develop a diagnostic tool to aid in field assessment of infections. To achieve this, the study will attempt to answer the following research questions: 1. Is there developing S. mansoni praziquantel resistance in communities that have undergone several mass drug administrations? 2. Is there an interplay between intermediate host exposure to praziquantel and the development of praziquantel drug resistance in the definitive host?

Dynamics in Morbidity Markers and Cytological Observations Made in Urine of Schistosoma haematobium-Infected Children: Pre- and Post-Praziquantel Treatment in an Endemic Setting.

Background: Schistosomiasis is a neglected tropical disease caused by helminths of the genus Schistosoma. Morbidity markers and cytological observations such as squamous metaplastic cells, inflammatory cells, and hyperkeratotic cells in the urine of S. haematobium-infected children may suggest disease severity. They may also help predict severe forms of clinical presentation, such as bladder cancer in later years, among infected ones who miss out on early detection and treatment. Insights into possible changes in the morbidity markers and cytological observations in the urine of these S. haematobium-infected children before and after treatment would be of high clinical importance. Aim: The aim of this study was to identify changes/dynamics in morbidity markers and cytological abnormalities in the urine deposits of S. haematobium-infected children, pre- and post-praziquantel treatment. Methodology: This was a longitudinal study involving baseline and follow-up sampling among basic school children living in schistosomiasis-endemic communities. Urine samples were collected from 520 children at baseline and examined for S. haematobium ova by microscopy, while urine chemistry analyses were used for the examination of morbidity markers. The cytological analyses involved cytopathological examination of the urine deposits. Children whose urine showed positivity for S. haematobium eggs were treated with a single oral dose of praziquantel (40 mg/kg), after which urine chemistry and cytological analyses were repeated weekly for comparison with baseline, until the eighth week. Results: Morbidity markers such as hematuria, proteinuria, and leukocyturia were detected both at baseline and post-treatment among the infected children (30/520). Hematuria was the predominant parameter (90%, 27/30) detected at baseline, followed by proteinuria (53.3%, 16/30). Leukocyturia was the rarest parameter detected at baseline (13.3%, 4/30). However, almost all these parameters declined gradually post-treatment. Regarding cytological analyses, inflammatory cells were observed most (70.0%, 21/30) at baseline. For hyperkeratotic cells and squamous metaplastic cells, 46.7% and 26.7% were respectively observed at baseline, all of which gradually declined during the weekly follow-ups. Notably, squamous metaplastic cells persisted in all the participants from Week 1 through Week 3 post-treatment, but declined gradually thereafter. Conclusions: Morbidity markers and cytological observations in the children gradually decreased after treatment. Therefore, we continue to recommend routine cytological screening for urogenital schistosomiasis patients at hospitals in S. haematobium-endemic locations using both baseline and follow-up samples to detect these abnormalities early and monitor changes that may be occurring after treatment. Such changes may be useful in assessing treatment progress in infected persons.

Morphometric analysis of schistosome eggs recovered from human urines in communities along the shoreline of Oyan River Dam in Ogun State, Nigeria.

There are growing concerns that communities characterized with surface water, where both humans and livestock interact for agricultural, domestic, cultural and recreational purposes, are likely to support hybridization between schistosome species infecting humans and livestock. This study therefore investigated the morphometrics of schistosome eggs recovered from human urine samples in four schistosomiasis endemic communities (Imala-Odo, Abule-Titun, Apojula and Ibaro-Oyan) along the banks of Oyan River Dam in Ogun State, Nigeria. Recovered eggs were counted, photographed, and measured with IC Measure™ for total length, maximum width and a ratio of egg shape. A total of 1984 Schistosoma eggs were analysed. Two major egg morphotypes were identified: the first represented 67.8% of the eggs, with the typical round to oval shape and mean length and width of 166 μm, 66.8 μm, respectively; the second represented 32.2% of the eggs and are more elongated, with a mean length of 198 μm, and width of 71.3 μm. Our results revealed significant variations in sizes of the schistosome eggs recovered (length: t = -35.374, degrees of freedom (df) = 1982, P = 0.000; weight: t = -10.431, df = 1982, P = 0.000), with the atypical shaped eggs appearing more elongated than expected. These eggs might represent individuals with some degree of contribution from Schistosoma bovis or possibly other Schistosoma species known to be present in Nigeria. Hence, this observation calls for further molecular studies to establish the genetic information about the miracidia from both atypical and typical eggs. It is also important to establish the presence of bona fide S. bovis infection in cattle and vector snails in the presumptive areas of hybridization.

Associations of IL13 gene polymorphisms and immune factors with Schistosoma haematobiuminfection in schoolchildren in four schistosomiasis-endemic communities in Ghana.

BackgroundSchistosomiasis remains a major public health issue with over 90% of the prevalence rates recorded in Sub-Saharan Africa. In this study, the relationships between different interleukin gene polymorphisms (IL-13-591A/G, IL-13-1055C/T, IL-13-1258A/G) and Schistosoma haematobium infection levels were evaluated; as well as the host plasma antibodies and cytokine profiles associated with schistosomiasis infection.MethodologyA total of 469 school children aged 6 to 19 years from four schistosomiasis-endemic communities in Ghana were involved. Single urine and stool samples were obtained from each pupil, processed via sedimentation and Kato-Katz, and examined via microscopy for Schistosoma and soil-transmitted helminth (STH) eggs. Next, venous blood samples were drawn from 350 healthy pupils, and used to measure antibody and plasma cytokine levels by ELISA. Single nucleotide polymorphisms in the IL-13 gene were genotyped on 71 selected blood samples using the Mass Array technique.Principal findings and conclusionThe overall prevalence of urinary schistosomiasis was 21.11%. Community-level prevalences were 17.12%, 32.11%, 20.80%, and 15.32% for Asempaneye, Barikumah, Eyan Akotoguah, and Apewosika respectively. Generally, higher S. haematobium infection prevalence and intensity were recorded for participants with genotypes bearing the IL13-1055C allele, the IL13-591A, and the IL13-1258A alleles. Also, higher S. haematobium infection prevalence was observed among participants in the 12-14-year age group with the IL13-1055C, IL13-591A, and IL13-1258A alleles. Interestingly, higher STH prevalence was also observed among participants with the IL13-1055C, IL13-591A, and IL13-1258A alleles. Furthermore, the age-associated trends of measured antibodies and cytokines of S. haematobium-infected school-children depicted a more pro-inflammatory immune profile for pupils aged up to 1l years, and an increasingly anti-inflammatory profile for pupils aged 12 years and above. This work provides insight into the influence of IL-13 gene polymorphisms on S. haematobium, and STH infections, in school-aged children (SAC).

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.

Schistosoma Egg Antigen Induces Oncogenic Alterations in Human Prostate Cells.

Schistosomiasis is a neglected tropical disease that affects 200 million people and accounts for 100,000 deaths annually. In endemic geographical areas, schistosomiasis has been implicated as an etiological agent in the pathogenesis of bladder, colorectal, and renal carcinoma largely due to Schistosoma eggs in tissues that comes with chronic infection. Several studies have also reported cases of association between Schistosoma infection and prostate cancer. The possible causal association is however poorly understood. We hypothesized in this study that infection of the prostate cells with Schistosoma spp promotes cancer. Urine samples from individuals living in Galilea, a schistosomiasis endemic community in the Ga South District of Ghana, were collected and screened for Schistosoma infection via microscopy and multiplex PCR. Soluble egg antigens (SEA) were prepared from Schistosoma egg-positive urine samples and assessed for the ability to induce cancer-like phenotypes including excessive proliferation, oxidative stress (reduced glutathione (GSH) depletion), and diminished apoptosis in cultured human prostate (PNT2) cells. Molecular analysis revealed infecting schistosome species to be S. haematobium and S. mansoni. Prostate cell proliferation was significantly induced by 12.5 μg/ml SEA (p = 0.029). Also, SEA dose-dependently depleted cellular GSH. Flow cytometric analysis and fluorescence staining revealed that SEA dose-dependently diminished apoptosis, significantly, in prostate cells. Findings of this study suggest that schistosome infection may play a role in the pathogenesis of prostate cancer. In vivo studies are however needed to confirm this association.

Quantitative label-free proteomic analysis of human urine to identify novel candidate protein biomarkers for schistosomiasis.

BackgroundSchistosomiasis is a chronic neglected tropical disease that is characterized by continued inflammatory challenges to the exposed population and it has been established as a possible risk factor in the aetiology of bladder cancer. Improved diagnosis of schistosomiasis and its associated pathology is possible through mass spectrometry to identify biomarkers among the infected population, which will influence early detection of the disease and its subtle morbidity.MethodologyA high-throughput proteomic approach was used to analyse human urine samples for 49 volunteers from Eggua, a schistosomiasis endemic community in South-West, Nigeria. The individuals were previously screened for Schistosoma haematobium and structural bladder pathologies via microscopy and ultrasonography respectively. Samples were categorised into schistosomiasis, schistosomiasis with bladder pathology, bladder pathology, and a normal healthy control group. These samples were analysed to identify potential protein biomarkers.ResultsA total of 1306 proteins and 9701 unique peptides were observed in this study (FDR = 0.01). Fifty-four human proteins were found to be potential biomarkers for schistosomiasis and bladder pathologies due to schistosomiasis by label-free quantitative comparison between groups. Thirty-six (36) parasite-derived potential biomarkers were also identified, which include some existing putative schistosomiasis biomarkers that have been previously reported. Some of these proteins include Elongation factor 1 alpha, phosphopyruvate hydratase, histone H4 and heat shock proteins (HSP 60, HSP 70).ConclusionThese findings provide an in-depth analysis of potential schistosoma and human host protein biomarkers for diagnosis of chronic schistosomiasis caused by Schistosoma haematobium and its pathogenesis.

Knowledge and awareness of genital involvement and reproductive health consequences of urogenital schistosomiasis in endemic communities in Ghana: a cross-sectional study.

BackgroundThe World Health Organization, in the year 2009, renamed Schistosomiasis haematobium disease, urinary schistosomiasis, as urogenital schistosomiasis. This study, sought to determine whether urogenital schistosomiasis endemic community members were aware of the broadened scope of the disease and associated certain reproductive health related signs and symptoms to S. haematobium infection.MethodThis is a cross-sectional study in which 2,585 respondents aged 15–49 years from 30 riparian communities along the lower arm of the Volta lake were interviewed using a structured questionnaire; 24 focus group discussions were also conducted. Descriptive statistics were used to determine the frequency of responses for each question posed and Chi squared tests used to determine the associations between demographic variables and variables of interest. Binary logistic regression was used to predict the probability of a reported symptom as an indicator of urogenital schistosomiasis. Thematic analysis was used to examine narratives.ResultNinety four percent of male respondents and 88.7 % of female respondents acknowledged schistosomiasis as a water-borne disease. Only 207 out of 1,096 subjects (18.9 %) responding to questionnaire agreed to the knowledge that urogenital schistosomiasis can have reproductive health implications. A significant difference in variation in this knowledge was found between males (14.5 %) and females (7.2 %) (p = 0.001). The study also found that, although knowledge on HIV was high, only 12.3 % of respondents knew that urogenital schistosomiasis could facilitate the acquisition of HIV. Women who reported to have ever suffered schistosomiasis were 1.3 and 1.5 times more likely to report vaginal discharge and vaginal itch. Sexual dysfunction (11.1 %) and urethral discharge (10.6 %) were the most frequently reported symptoms among males.ConclusionThe study finds very limited knowledge on the reproductive health consequences of the disease among endemic communities. It is recommended that health education on urogenital schistosomiasis should also include issues on symptoms of the disease, reproductive health consequences and HIV transmission.

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

BackgroundSurface 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.MethodsOur mixed-methods study assessed the context of water use in a rural community endemic for schistosomiasis.ResultsEighty-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.ConclusionsCollectively, our study illustrates how complex attitudes towards water resources can affect which methods will be appropriate to address schistosomiasis.

Relationship between eosinophil cationic protein and infection intensity in a schistosomiasis endemic community in Ghana

Relationship between eosinophil cationic protein and infection intensity in a schistosomiasis endemic community in Ghana

Cytological Findings in Urine of Adult Residents of Urinary Schistosomiasis Endemic Community in Cross River State, Nigeria

Aims: To investigate urinary cytological abnormalities among adult residents of a urinary schistosomiasis endemic community. Study Design: Ethical approval, consent from the village Head/villagers, parasitological survey and cytological analysis of urine. Place and Duration of Study: Adim Community in Cross River State, Nigeria between May and November 2014 Methodology: Urine samples from 160 sex matched adults aged 18–85 years were examined using standard parasitological techniques for the presence of ova of Schistosoma haematobium. The urine smears were stained with Papanicolaou and Alcian Blue (PH 2.5) staining techniques and examined for cytological abnormalities and the presence of Hyaluronic acid respectively. Results: 18 (11.3%) subjects were infected. Subjects in the age groups >35 – 45 years had the Original Research Article Inyang-Etoh et al.; BJMMR, 8(11): 948-955, 2015; Article no.BJMMR.2015.525 949 highest prevalence rate 9(20.5%) while those in the age group >75 – 85 years had the lowest prevalence rate 0(0%) and the difference was statistically significant (P = 0.359). The infection rate was higher among females 11(12.5%) than the males 7(9.7%) but the difference was not statistically significant (P = 0.580). Males had a higher mean egg count (18±25.7 egg/10 ml of urine) than the females (17±15.5 egg/10 ml of urine). Subjects in the age group >35–45 years had the highest level of abnormal epithelial cells 1(11.1%). Males had a higher prevalence of abnormal cells 3(42.9%) than the females 1(9.1%). There was a positive correlation between the occurrence of infection and abnormal epithelial cells (r = 0.5). 3(1.9%) of the subjects were positive for hyaluronic acid. Male subjects had a higher level of epithelial cells positive for hyaluronic acid 2(2.8%) than the female subjects 1(1.14%) but this was not statistically significant (p<0.05). Conclusion: This study has reconfirmed the endemicity of urinary schistosomiasis and has also revealed the presence of abnormal epithelial cells as an indicator for bladder cancer in the urine of residents in Adim community.

Can Mass Drug Administration Lead to the Sustainable Control of Schistosomiasis?

In the Philippines, the current national control strategy for schistosomiasis is annual mass drug administration (MDA) with 40 mg/kg of praziquantel in all schistosomiasis-endemic villages with a prevalence ≥10%. A cross-sectional survey of schistosomiasis was conducted in 2012 on 18 221 individuals residing in 22 schistosomiasis-endemic villages in the province of Northern Samar. The prevalence of schistosomiasis, intensity of Schistosoma infection, and morbidity of disease were assessed. Despite an active schistosomiasis-control program in Northern Samar for >30 years, which included a MDA campaign in the last 5 years, the mean prevalence of schistosomiasis among 10 435 evaluated subjects was 27.1% (95% confidence interval [CI], 26.3%-28.0%), and the geometric mean intensity of infection among 2832 evaluated subjects was 17.2 eggs per gram of feces (95% CI, 16.4-18.1). Ultrasonography revealed high levels of schistosomiasis-induced morbidity in the schistosomiasis-endemic communities. Left lobe liver enlargement (≥70 mm) was evident in 89.3% of subjects. Twenty-five percent of the study population had grade II/III liver parenchyma fibrosis, and 13.3% had splenomegaly (≥100 mm). MDA on its own was insufficient to control the prevalence of schistosomiasis, intensity of Schistosoma infection, or morbidity of the disease. Alternative control measures will be needed to complement the existing national MDA program.

Chlamydia Trachomatis and Neisseria Gonorrhoeae prevalence among women of reproductive age living in urogenital schistosomiasis endemic area in Ghana.

BackgroundMany studies have shown an overlap in the epidemiology of sexually transmitted infections (STIs) and urogenital schistosomiasis among young women living in schistosomiasis endemic areas. Yet we found no study assessing the prevalence of STI infections in urogenital schistosomiasis endemic areas in Ghana. As part of an epidemiological study on urogenital schistosomiasis and HIV, we sought to assess the prevalence of both Chlamydia trachomatis (CT) and Neisseria gonorhoeae (NG) infections among women living in schistosomiasis endemic communities and explore the relationship between the sexually transmitted infections (STIs) and demographic characteristics, sexual behaviour and self-reported symptoms.MethodsThis was a cross-sectional study in which endocervical samples were collected from 191 women aged 15–49 years from October 2005 to March 2006. Samples were examined for CT and NG using Polymerase Chain Reaction (PCR). A structured questionnaire was also used to elicit information on study participant’s gynaecological and obstetric history and symptoms for genital infection. Chi-square test and binary logistic regression were used to assess association between CT and NG and other variables such as age, sexual behaviour and self-reported symptoms.ResultsThe overall prevalence of CT and NG were 6.3% and 2.6% respectively.The highest prevalence rates of CT were in the 15 to 19 year group while only individuals between 15 and 39 years were positive for NG. There was no association between CT and age, contraceptive use and the other variables assessed. NG on the other hand was found to be associated with age, number of births and number of sexual partners only by chi-square test.ConclusionsOur research revealed higher prevalence of CT and NG infections when compared to previous studies conducted among higher risk groups in non-urogenital schistosomiasis areas in Ghana. We therefore recommend further studies of these STIs in urogenital schistosomiasis endemic areas in the country.

IgG Enzyme-Linked Immunosorbent Assay (ELISA) for immunodiagnosis of Schistosoma haematobium infected subjects living in an endemic Nigerian village

Schistosoma haematobium infects school children in areas where the disease is endemic. This study was carried out to determine the reliability of IgG Enzyme-Linked Immunosorbent Assay (ELISA) as an immunodiagnostic tool, using whole antigen derived from Schistosoma eggs. Children of school going age living in Ipogun village, in south western Nigeria; a schistosomiasis endemic community; were used in this study. The sensitivity of the IgG ELISA in detecting positive cases was 68.0% and there was a significant correlation (P < 0.05) between IgG titres and the intensity of infection. However, the specificity was 59.3%, slightly lower than the sensitivity. Results from this study shows that IgG ELISA can be used as a diagnostic tool for determining S. haematobium infection, as it provides an evidence for the intensity of the infection in the infected individuals.   Key words: Urinary schistosomiasis, enzyme-linked immunosorbent assay, IgG, intensity, immunodiagnosis.

Health care seeking-behaviour of people in Schistosomiasis endemic communities of Ogun and Niger States, Nigeria

A study of the dynamics of health-care seeking-behaviour of people living in communities endemic for schistosomiasis was carried out in Borgu and Shagamu Local Government areas of Niger State and Ewekoro, Odeda and Abeokuta North Local Government Areas of Ogun State, Nigeria. Questionnaires were administered, which was complimented with Focus Group Discussion (FGDs) and in-depth interviews. The study investigated the knowledge, perceptions, beliefs and practices of the people with regards to the signs/symptoms, sources of the infection, actions taken in treating the infection and their preferred health care options. While 64.4% of the 236 respondents identified the river as the source of infection, 67% also mentioned blood in urine, 36.4% mentioned itching and 22.9% mentioned drowsiness as some of the symptoms of the infection: About 59% preferred the orthodox method of treatment and 31.7% preferred both orthodox and traditional methods. It was discovered that the cost of treatment and health education had a significant impact on the respondents' health care seeking-behaviour. Keywords: health, seeking, schistosomiasis, endemic, communities Nigerian Journal of Parasitology Vol. 25, 2005: 121-126