Diagnosis and treatment of schistosomiasis in children in the era of intensified control

Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.
Expert Review of Anti-infective Therapy (Impact Factor: 3.46). 10/2013; 11(11). DOI: 10.1586/14787210.2013.844066
Source: PubMed


In the current era of intensified and integrated control against schistosomiasis and other neglected tropical diseases, there is a need to carefully rethink and take into consideration disease-specific issues pertaining to the diagnosis, prevention, control and local elimination. Here, we present a comprehensive overview about schistosomiasis including recent trends in the number of people treated with praziquantel and the latest developments in diagnosis and control. Particular emphasis is placed on children. Identified research needs are offered for consideration; namely, expanding our knowledge about schistosomiasis in preschool-aged children, assessing and quantifying the impact of schistosomiasis on infectious and noncommunicable diseases, developing new antischistosomal drugs and child-friendly formulations, designing and implementing setting-specific control packages and developing highly sensitive, but simple diagnostic tools that are able to detect very light infections in young children and in people living in areas targeted for schistosomiasis elimination.

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    • "It acts via increased cell-membrane calcium penetration, leading to paralysis and immune clearance by the host. Standard treatment is sometimes supplemented with a second dose (40 mg/kg) 6 weeks after the first treatment (Knopp et al. 2013; Poggensee and Feldmeier 2001; Zwang and Olliaro 2014 "
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    ABSTRACT: Male genital schistosomiasis (MGS) is a neglected manifestation of Schistosoma haematobium infection with ignored implications on reproductive health and a differential diagnosis to sexually transmitted infections in endemic regions. MGS may have associations with HIV transmission and acquisition, and treatment could be a neglected chance of HIV prevention. This review summarizes current knowledge on epidemiology, clinical manifestations, diagnosis and treatment of MGS as a hypothesized risk factor for HIV transmission. Future research areas of global interest are suggested. PubMed published literature was reviewed based on the MOOSE guidelines. All publications on MGS were included regardless of publication year and study design. Furthermore, all publications were searched for information on possible HIV association. The 40 identified publications related to MGS were dominated by case reports and observational studies. No randomized clinical trials have been conducted to date, and very scant information related to possible associations with HIV transmission was presented. Clinical, randomized studies and epidemiological studies covering the possible association between MGS and HIV are urgently needed. Furthermore, field diagnostic tools should be developed and future mass treatment programs should include adults to reduce morbidity and prevent HIV acquisition. CRD42015016252.
    International Journal of Public Health 08/2015; DOI:10.1007/s00038-015-0714-7 · 2.70 Impact Factor
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    • "Ultrasensitive diagnosis is a prerequisite for delineating the spatial distribution of S. mekongi and S. japonicum infections. Furthermore , sensitivity is imperative in the elimination stage, where the role of low-level infections play a critical role (Knopp et al., 2013; Rollinson et al., 2013; van Dam et al., 2014). This has convincingly been shown in Africa (Colley et al., 2013) and recently in P.R. "
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    ABSTRACT: In Asia, Schistosoma japonicum is the predominant schistosome species, while Schistosoma mekongi is confined to limited foci in Cambodia and Lao People's Democratic Republic. While the People's Republic of China has been successful in controlling schistosomiasis, the disease remains a major public health issue in other areas. In order to prioritise intervention areas, not only accurate diagnosis is important but also other factors, such as practicallity, time-efficiency and cost-effectiveness, since they strongly influence the success of control programmes. To evaluate the highly specific urine-based assays for the schistosome circulating cathodic antigen (CCA) and the circulating anodic antigen (CAA), banked urine samples from Cambodia (n=106) and the Philippines (n=43) were examined by the upconverted phosphor CAA lateral flow (UCP-LF CAA) assay and the point-of-care (POC)-CCA urine assay. Based on 250 μl urine samples, UCP-LF CAA sensitivity outcomes surpassed a single stool examination by the Kato-Katz technique. The banked urine samples in the current study did not allow the evaluation of larger volumes, which conceivably should deliver considerably higher readings. The sensitivity of a single urine POC-CCA was in the same order as that of a single Kato-Katz thick smear examination, while the sensitivity approached that of triplicate Kato-Katz when a combination of both CAA and CCA assays was used. The promising results from the current proof-of-concept call for larger studies that will determine the accuracy of the urine-based CCA and CAA assays for S. mekongi and S. japonicum diagnosis.
    Acta Tropica 09/2014; 141(Pt B). DOI:10.1016/j.actatropica.2014.09.003 · 2.27 Impact Factor
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    • "Using sets of negative control samples, and the application of a high-specificity cut-off threshold furthermore substantiated the very high specificity of the UCP-LF CAA assay (Corstjens et al., 2014; van Dam et al., 2013). A rapid and cost-effective diagnostic test capable of detecting as few as one or two schistosome worm pairs is urgently needed for the elimination stage of schistosomiasis (Knopp et al., 2013). There are significant differences between traditional diagnostic methods, such as stool microscopy and serology on the one hand, PCR, LAMP and detection of circulating antigens, on the other hand. "
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    ABSTRACT: The downward trend in prevalence and intensity of Schistosoma japonicum infection in the People's Republic of China (P.R. China) has reached a level where accurate methods' are required for monitoring the national schistosomiasis control programme and to verify whether transmission has been interrupted. We have assessed the prevalence of active S. japonicum infection by use of an up-converting phosphor lateral-flow (UCP-LF) assay for determination of circulating anodic antigens (CAA) in urine and serum, and compared the findings with those of the Kato-Katz technique for egg detection in stool and an immunohaemagglutination assay (IHA) for specific antibodies in serum. The study was carried out in three villages located in a remaining S. japonicum-endemic area in P.R. China. Overall, 423 individuals were investigated by Kato-Katz, 395 by IHA, 371 with the UCP-LF CAA assay adapted for urine and 178 with the UCP-LF CAA assay applied on serum. The IRA showed the highest number of positive results (n = 107, 27.1%). The UCP-LF CAA urine assay detected 36 CAA positives (9.7%) and the serumbased CAA assay 21 positives (11.8%). The Kato-Katz technique revealed only six positive stool samples (1.4%). Among those 166 individuals with complete data records, sensitivities of the different assays were determined versus a combined 'gold' standard, showing the highest sensitivity for the urine CAA assay (93%), followed by the serum CAA (73%) and IHA (53%), whilst triplicate Kato-Katz thick smears had a very low sensitivity (13%). Serum CAA concentrations were about 10-fold higher than in urine and were significantly correlated. Highest prevalences as determined by CAA were found in older age groups (>40 years). Half of the CAA- or egg-positive cases were negative for antibodies by IHA, thereby revealing an important obstacle for the effectiveness of the current schistosomiasis control and elimination efforts. The significantly higher prevalence of active schistosome infections as shown by the urine and serum UCP-LF CAA assays has implications for the national control and elimination programme in P.R. China, particularly in respect to case-finding and intervention strategies.
    Acta Tropica 08/2014; 141(Pt B). DOI:10.1016/j.actatropica.2014.08.004 · 2.27 Impact Factor
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