Myeloradiculitis: a Rare Event in Schistosoma Infection

Abstract Schistosomiasis a parasitic disease caused by trematodes is widely distributed in (sub-)tropical countries. Depending on the species the infection manifests clinically as gastrointestinal (preferentially Schistosoma mansoni and S. japonicum) or urinary (preferentially S. haematobium) disorders. Here we present an uncommon case of myeloradiculitis leading to bladder palsy and sensory loss at the lower limbs.     

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.     

Downregulation of MIP-1α/CCL3 with praziquantel treatment in Schistosoma haematobium and HIV-1 co-infected individuals in a rural community in Zimbabwe

Background  

Chemokines have been reported to play an important role in granulomatous inflammation during Schistosoma mansoni infection. However there is less information on their role in Schistosoma haematobium infection, or on the effect of concurrent HIV-1 infection, as a potential modifying influence.     

Laboratory and field evaluation of rodent bait treated with fipronil for feed through and systemic control of Phlebotomus papatasi

The sand fly Phlebotomus papatasi is the main vector of Leishmania major, etiologic agent of zoonotic cutaneous leishmaniasis (ZCL), which is endemic in North Africa, the Middle East, and Asia. In North Africa, Meriones shawi is one of the two main reservoir hosts of L. major. P. papatasi populations are maintained in borrowing rodents such as M. shawi. Three fipronil-treated rodent baits were evaluated for systemic and feed through insecticidal activity against P. papatasi feeding on M. shawi. Through blood feeding bioassays, mortality rates of females P. papatasi increased with the concentration of fipronil in the rodent bait varying from 0.001% to 0.005%. In the laboratory, more than 90.0% of P. papatasi were killed within 48 h after blood feeding on the desert's jirds, M. shawi, treated up to 29 days prior with a single application of fipronil at a concentration of 0.001%, 0.0025% and 0.005%. Through larval bioassays, mortality rates of larvae that have fed on faeces of treated bait for M. shawi increase with the concentrations of fipronil. Faeces of orally-treated Meriones were significantly toxic to larvae for 5 weeks with a concentration of 0.005%. In the field, application of treated bait resulted in 80.0% reduction in the populations of P. papatasi up to 6 weeks after a single application of fipronil at a concentration of 0.005%. This is the first study to demonstrate field efficacy of fipronil-treated rodent baits for P. papatasi control and the first study to evaluate this approach in M. shawi, a principal ZCL reservoir host. These results suggest that fipronil-treated rodent baits can be used to effectively reduce the populations of P. papatasi associated with M. shawi in ZCL endemic areas.     

Clinical findings in female genital schistosomiasis in Madagascar

To assess the morbidity of S. haematobium infection in women of reproductive age (15–49 years) in the western part of Madagascar, the village of Betalatala with a prevalence of urinary schistosomiasis in women of 75.6% (95% confidence limit 69.3 to 81.9%) was compared with a neighbouring village with similar socio-economic characteristics and a prevalence of 5.0% (95% confidence limit 0 to 11.75%). The women were questioned in Malagasy about obstetrical history and urogynecological symptoms. They were examined gynaecologically, parasitologically and by ultrasonography. Important STDs were excluded by appropiate diagnostics. In Betalatala significantly more women reported a history of spontaneous abortion (P < 0.01), complaints of irregular menstruation (P < 0.001), pelvic pain (<0.05), vaginal discharge (P < 0.0001), dysuria (P < 0.05) and haematuria (P < 0.01) than in the control village. Biopsies were obtained from the cervix of 36 women with macroscopical lesions, and in 12 cases S. haematobium eggs were found by histological sectioning (33.3%). In the control village no eggs were detected in the histological sections of biopsies taken from 14 women. (P < 0.05). Infections with Candida albicans, Trichomonas vaginalis, Gardnerella vaginalis and Treponema pallidum were found in similar frequencies in both villages. In 9.8% of the women in Betalatala abnormalities of the upper reproductive tract were revealed by ultrasonography versus none in the women from the control village (P < 0.05). Echographic abnormalities of the urinary tract were present in 24% and 3% of the women in the study village and in the control village, respectively (P < 0.0001). These findings were accompanied by an elevated frequency of haematuria (55% versus 20%) and proteinuria (70.4% versus 25%) in the study population (P < 0.0001). Our study indicates that S. haematobium infection in women may not only cause symptoms in the urinary tract, but also frequently in the lower and upper reproductive tract.     

The impact of single versus mixed Schistosoma haematobium and S. mansoni infections on morbidity profiles amongst school-children in Taveta,Kenya

Two schistosome species—Schistosoma haematobium and S. mansoni—with two very different pathological profiles (urogenital versus intestinal), are responsible for the majority of human schistosomiasis infections across sub-Saharan Africa. The aim of this study was to determine whether coinfections have an impact on species-specific morbidity measures when compared to single species infections. Children from two neighbouring schools in Taveta, Kenya were grouped by infection status, i.e. uninfected, single species infections or coinfected. Clinical examination of the liver and spleen by palpation was performed and urinary albumin levels were recorded at baseline and at 12 months after praziquantel administration. Additional ultrasonographic profiles of the children's liver, spleen and bladder were incorporated at follow-up. It was found that S. haematobium-associated urogenital morbidity was lower in the coinfected group relative to single S. haematobium infections, even when infection intensities were taken into account. We also observed an association between S. haematobium infection and liver (intestinal-associated) morbidity regardless of coinfections. The findings reported here suggest that further research should be performed on the impact of S. haematobium infections on liver morbidity as well as to determine the impact of mixed schistosome species infections on human morbidity outcomes across different endemic settings.     

Accuracy of circulating cathodic antigen tests for rapid mapping of Schistosoma mansoni and S. haematobium infections in Southern Sudan

Objective To evaluate the diagnostic accuracy of a circulating cathodic antigen (CCA) urine dipstick test for detecting Schistosoma mansoni and S. haematobium alongside an integrated rapid mapping survey in Southern Sudan. Methods and Results A total of 373 children aged 5–16 years were included in the study. Of these 26.0% were infected with S. haematobium and 24.5% were infected with S. mansoni, as identified by urine filtration or single Kato–Katz thick smear, respectively. The CCA performed moderately in detecting S. mansoni, with sensitivity of 89.1% and specificity of 74.2%, and poorly in detecting S. haematobium infections, with a sensitivity of 36.8% and specificity of 78.9%. This may be a slight underestimate of true CCA accuracy, since only single stool and urine samples were examined by microscopy. The true ‘gold standard’ for comparison would have been the collection of multiple stool samples over consecutive days. Conclusion The poor CCA accuracy for diagnosis of urinary schistosomiasis means that this test is currently not suitable for rapid mapping of schistosomiasis in areas where both S. mansoni and S. haematobium may be endemic.     

Case–Control Study of Posttreatment Regression of Urinary Tract Morbidity among Adults in Schistosoma haematobium–Endemic Communities in Kwale County,Kenya

Previous population-based studies have examined treatment impact on Schistosoma-associated urinary tract disease among children, but much less is known about longer-term treatment benefits for affected adult populations in areas where risk of recurrent infection is high. In communities in Msambweni, along the Kenya coast, we identified, using a portable ultrasound, 77 adults (aged 17–85) with moderate-to-severe obstructive uropathy or bladder disease due to Schistosoma haematobium. Treatment response was assessed by repeat ultrasound 1–2 years after praziquantel (PZQ) therapy and compared with interval changes among age- and sex-matched infected/treated control subjects who did not have urinary tract abnormalities at the time of initial examination. Of the 77 affected adults, 62 (81%) had improvement in bladder and/or kidney scores after treatment, 14 (18%) had no change, and one (1.3%) had progression of disease. Of the 77 controls, 75 (97%) remained disease free by ultrasound, while two (3%) had apparent progression with abnormal findings on follow-up examination. We conclude that PZQ therapy for S. haematobium is effective in significantly reducing urinary tract morbidity from urogenital schistosomiasis among adult age groups, and affected adults stand to benefit from inclusion in mass treatment campaigns.     

Detection of <Emphasis Type="Italic">Toxocara canis</Emphasis> larvae by PCR in the liver of experimentally infected Mongolian gerbils (<Emphasis Type="Italic">Meriones unguiculatus</Emphasis>)

Summary  Toxocariasis is a common human zoonosis, which induces a clinically unapparent course of infection. Diagnosis is difficult and relies upon serological testing (searching of specific IgG antibodies by ELISA), laboratory abnormalities and clinical manifestations. The polymerase chain reaction (PCR) technique was adapted for the detection of Toxocara canis larvae in a host tissue. Mongolian gerbils (Meriones unguiculatus) were used as an animal model for human toxocariasis. 8 animals were inoculated with 1000 T. canis eggs, four uninfected were used as control. At 3, 5, 7, and 14 days post-infection, 2 infected and 1 control gerbil were killed and their livers were used for molecular analysis. Specific primer in the PCR reaction allowed identification of T. canis larvae, with the parasite gDNA found in the liver of all infected gerbils. The results indicate that the PCR method has a potential as a supporting technique for the diagnosis of human toxocariasis.     

Spatial distribution and risk factors of Brucellosis in Iberian wild ungulates

Background

In the developing world co-infections and polyparasitism within humans appear to be the rule rather than the exception, be it any combination of inter-specific and/or inter- and intra-Genera mixed infections. Mixed infections might generate synergistic or antagonistic interactions and thereby clinically affect individuals and/or impact parasite epidemiology.

Methods

The current study uniquely assesses both Schistosoma mansoni - and Schistosoma haematobium -related morbidity of the liver and the bladder as assessed by ultrasound as well as spleen and liver morbidity through clinical exams. The impact of praziquantel (PZQ) treatment on such potential inter-specific schistosome interactions and resulting morbidity using uniquely detailed longitudinal data (pre- and one year post-PZQ treatment) arising from the National Schistosomiasis Control Program in three areas of Mali: Ségou, Koulikoro and Bamako, is also evaluated. At baseline, data were collected from up to 2196 children (aged 7-14 years), 844 of which were infected with S. haematobium only, 124 with S. mansoni only and 477 with both. Follow-up data were collected from up to 1265 children.

Results

Results suggested lower liver morbidity in mixed compared to single S. mansoni infections and higher bladder morbidity in mixed compared to single S. haematobium infections. Single S. haematobium or S. mansoni infections were also associated with liver and spleen morbidity whilst only single S. haematobium infections were associated with bladder morbidity in these children (light S. haematobium infection OR: 4.3, p < 0.001 and heavy S. haematobium infection OR: 19, p < 0.001). PZQ treatment contributed to the regression of some of the forms of such morbidities.

Conclusions

Whilst the precise biological mechanisms for these observations remain to be ascertained, the results illustrate the importance of considering mixed species infections in any analyses of parasite-induced morbidity, including that for the proposed Disability Adjusted Life Years (DALYs) revised estimates of schistosomiasis morbidity.     

Angiogenesis, proliferation, and apoptosis in anal high-grade squamous intraepithelial lesions

PURPOSE: Management of anal high-grade squamous intraepithelial lesions is controversial. Anal and cervical high-grade squamous intraepithelial lesions are similar in that they occur in transitional squamous epithelium, are associated with human papilloma virus infection, and have increased incidence in the immunocompromised population. Ablation of cervical high-grade squamous intraepithelial lesions is preferred, but similar ablation or excision of anal high-grade squamous intraepithelial lesions may compromise bowel control; thus, there is a need to define the malignant potential of anal high-grade squamous intraepithelial lesions. METHODS: We analyzed 50 paraffin sections of normal anoderm, anal low-grade squamous intraepithelial lesions, high-grade squamous intraepithelial lesions, and anal squamous-cell carcinoma. Microvessels were detected immunohistochemically with von Willebrand factor and counted manually along the epithelial-stromal junction. Proliferation and apoptosis were determined in the epithelial cells with MIB-1 antibody immunostaining and the terminal deoxynucleotidyl transferase-mediated digoxigenin-11-dUTP nick end labeling, respectively. RESULTS: Microvascular density was significantly greater in anal high-grade squamous intraepithelial lesions (mean, 0.50 vessels/cm)vs. normal anoderm (mean, 0.21 vessels/cm;P=0.0017, Mann-WhitneyU test). The proliferative percentages were greater in low-grade squamous intraepithelial lesions, high-grade squamous intraepithelial lesions, and squamous-cell carcinoma (mean, 20.4, 21.8, and 23.6 percent)vs. normal anoderm (mean, 14.4 percent), although not significantly (P=0.06, Kruskal-Wallis statistic). Although the mean proliferative proportions were similar in low-grade squamous intraepithelial lesions and high-grade squamous intraepithelial lesions, the apoptotic proportion was lower for high-grade squamous intraepithelial lesions than low-grade squamous intraepithelial lesions (10.13vs. 19.96 percent, respectively;P=NS, Mann-WhitneyU test). CONCLUSIONS: Angiogenesis, increased proliferation, and decreased apoptosis occur in anal high-grade squamous intraepithelial lesions as they do in the cervix before the development of malignancy. These biologic markers support the importance of anal high-grade squamous intraepithelial lesions as a potential premalignant lesion warranting surgical intervention.Supported by a grant from the National Institutes of Health (DDDN, NIDDK KO8 DK 02507-03).Podium presentation at The American Society of Colon And Rectal Surgeons' 100th Anniversary and Tripartite Meeting, Washington, D.C., May 1 to 6, 1999.     

Simple questionnaire and urine reagent strips compared to microscopy for the diagnosis of Schistosoma haematobium in a community in northern Ghana

Objectives To evaluate the utility of a simple questionnaire and urine reagent strip testing for the rapid diagnosis of Schistosoma haematobium in rural northern Ghana. Methods Cross‐sectional parasitological and questionnaire survey in a community in northern Ghana. Participants provided two urine specimens that were examined under a microscope using a centrifugation method. The first urine sample was additionally subjected to reagent strip testing. A short questionnaire was administered to all participants. Results Microscopy of urine samples obtained from 208 individuals aged 1–77 years revealed an S. haematobium prevalence of 6.8%. The presence of any blood or protein on a urine reagent strip was 100% and 42% sensitive, and 93% and 80% specific for S. haematobium diagnosis. Questionnaires were completed by 198 individuals. Self‐reported haematuria showed a sensitivity of 53% and a specificity of 85%. A dichotomous two‐question panel was helpful in S. haematobium diagnosis, with working and playing near the river significantly associated with S. haematobium infection (P < 0.001). Conclusion The use of urine reagent strips, coupled with questions pertaining to water contact patterns, might be considered for point‐of‐contact diagnosis of S. haematobium where microscopy is unavailable.     

Schistosoma mansoni: a rare cause of tubal infection

S. haematobium is an important cause of urinary schistosomiasis, and symptomatic female genital infection is a common gynecological finding in areas where S. haematobium is prevalent. On the other hand, genital manifestations of intestinal schistosomas as S. mansoni are not frequent or are misdiagnosed. A case of a 40-year-old woman with abnormal uterine bleeding and asymptomatic tubal infection by S. mansoni identified in histological examination is presented.     

Expression of β‐Adrenoceptor Subtypes in Urothelium,Interstitial Cells and Detrusor of the Human Urinary Bladder

Objective: We examined whether interstitial cells (ICs) of the human urinary bladder expressed β‐adrenoceptor (AR) subtypes, and semiquantitatively compared the staining intensity among urothelium, ICs and detrusor muscles. Methods: Paraffin sections of the human urinary bladder were obtained from histologically normal areas of formalin‐fixed specimens removed for bladder carcinoma. Double‐labeling immunohistochemical methods using antibodies against each β‐AR subtype and vimentin were performed to identify ICs of the human urinary bladder. The staining intensity of β‐ARs was semiquantitatively compared among urothelium, ICs and detrusor muscles. Further, gender‐related difference or age‐related correlation in the staining intensity of β‐ARs was compared in the same cell types. Results: The expression of β₁‐, β₂‐, and β₃‐AR was observed in vimentin‐positive ICs localized in suburothelium, between detrusor muscle bundles, and within these bundles of the human urinary bladder. The rank order of the staining intensity was urothelium > ICs = detrusor muscles in β₁‐AR, urothelium > ICs > detrusor muscles in β₂‐AR, whereas its order was ICs = detrusor muscles > urothelium in β₃‐AR. Except for urothelial β₁‐AR, there was no gender‐related difference in the signal intensity of β‐ARs in the urothelium, ICs or detrusor muscles. Age negatively correlated with the signal intensity of all β‐AR subtypes. Conclusion: β‐ARs were expressed in vimentin‐positive ICs of the human urinary bladder. As for β₂‐ and β₃‐AR, there was no gender‐related difference or age‐related correlation in urothelium, ICs and detrusor muscles. In the human urinary bladder, β‐ARs expressed in ICs may play a role in bladder physiology.     

Preneoplastic Lesions and Conditions of the Urinary Bladder

Background and Methods: Early clinical observations regarding the biology of the “at risk” field suggested that sites of urothelial preneoplastic changes could follow several distinct clinical courses. It is possible that areas of dysplasia remain simply dysplastic. Alternatively, the urinary epithelium can progress either to superficial bladder neoplasms, characterized by recurrence but rare life threatening progression, or along the path towards invasion with its well recognised risk of mortality. Evidence in support of these disparate pathways comes from the low progression rate of the majority of superficial bladder tumours, coupled with that fact that many invasive neoplasms present as such initially.Results and Discussion: From the morphological point of view, two basic pathways are identified on the basis of the pattern of growth of the intraepithelial lesions (flat and papillary), the behaviour of these lesions being related to the degree of architectural and cytological alteration of the urothelium. Several classification and grading schemes (including revisions and refinements) of the urothelial non-invasive or intraepithelial lesions have been reported in the literature. However, some controversies on the precise criteria and terminology, especially when the papillary lesions are concerned, are still present.     

Detectable urogenital schistosome DNA and cervical abnormalities 6 months after single‐dose praziquantel in women with Schistosoma haematobium infection

We explored response to single‐dose praziquantel therapy in a cohort of 33 women with Schistosoma haematobium infection in rural Mwanza, Tanzania. Women with S. haematobium infection confirmed both by eggs in urine and by polymerase chain reaction (PCR) received single‐dose praziquantel and treatment of concomitant sexually transmitted infections. Macroscopic cervical abnormalities were also quantified. After 6 months, microscopically detectable egg excretion was eliminated, but 8 of 33 women (24%) were persistently positive for S. haematobium by PCR, and 11 (33%) had cervical abnormalities potentially attributable to schistosomiasis. This suggests that praziquantel treatment more frequently than every 6 months may be necessary for complete elimination of the parasite and prevention of genital tissue pathology. This aggressive therapy may in turn play a key role decreasing HIV susceptibility in millions of people living in regions in which S. haematobium is endemic.     

Cross-protection between species of the Schistosoma haematobium group induced by vaccination with irradiated parasites

Mice vaccinated with irradiated cercariae of Schistosoma haematobium, S. bovis and S. margrebowiei showed good levels of resistance (38–62%) against an homologous challenge, and varying degrees of resistance (19–46%), against challenges with closely related species. No protection against S. mansoni was induced by vaccination with any of these species. This restricted cross-protection reflects the close phylogenetic relationship between species of the S. haematobium group and indicates that immunologically important epitopes are conserved within this species complex.     

Malakoplakia after kidney transplantation: Case report and literature review

Malakoplakia is a granulomatous disease associated with an infectious etiology, usually involving the urinary tract. It reveals itself as a recurrent urinary tract infection (r‐UTI), and in some cases, it is associated with impairment of renal function. Immunosuppression is one of its main associated factors, and it has been increasingly described in patients with solid organ transplantation (SOT), mainly kidney transplantation. Macroscopically, it can form masses and sometimes it may be confused with neoplasia, which is why histological findings are fundamental for the diagnosis. Here, we present a case of bladder malakoplakia, manifested by r‐UTI from Escherichia coli in a patient with renal transplantation, refractory to long‐term antibiotic treatment and reduction in immunosuppression, which resolved after surgical management. We also summarize the clinical characteristics of malakoplakia and compare them with previous reports in the literature on SOT.     

Hepatic granulomas: histological and molecular pathological approach to differential diagnosis–a study of 442 cases

Background/Aims: The incidence of hepatic granulomas is reported in 2–15% of liver biopsies. This study was carried out to evaluate the incidence and aetiology of hepatic granulomas in a German Institute of Pathology with specialization in liver diseases. Methods: A retrospective case review was performed on 12 161 liver biopsies of the Institute of Pathology (University of Cologne) between 1996 and 2004. Aetiology was determined according to histomorphological changes, clinicopathological data and liver tissue polymerase chain reaction (PCR) for detection of diverse putative pathogens in the liver tissue. Results: Four hundred and forty‐two liver biopsies revealed granulomatous lesions (3.63%). Two hundred and fifteen cases (1.77% of all biopsies and 48.64% of granulomatous lesions) were diagnosed as primary biliary cirrhosis. In 37 cases (0.3% of all biopsies and 8.37% of granulomatous lesions), the diagnosis of sarcoidosis was established. A positive PCR result for an infectious pathogen was obtained in 15 samples (3.39%) [Bartonella henselae (n=2), Listeria (n=3), Mycobacterium tuberculosis (n=3), Yersinia pseudotuberculosis (n=1), cytomegalovirus (n=2), Epstein–Barr virus (n=4)]. In six cases, a putative diagnosis was established according to the report of clinical conditions. In 11 cases (2.48%), drugs were the putative causative agent. In 158 cases (36%) a definite diagnosis could not be established. Conclusions: Hepatic granulomas have a broad range of underlying aetiologies. With a combined histological, clinical, serological, and molecular approach, we were able to clarify the cause in 64% of the cases. Owing to the diverse prognosis and therapeutic implications, a detailed interdisciplinary workup of all liver biopsies with granulomatous lesions is mandatory.     

Function of Hollow Viscera in Children with Constipation and Voiding Difficulties

We wished to investigate the urodynamic characteristics and colonic motility in a group of children with severe chronic constipation and lower urinary tract symptoms. We performed colonic manometry using an endoscopically placed catheter. The urodynamic studies consisted of cystometry, electromyography of the external urethral sphincter, measurement of urinary flow rate, and urethral pressure profile. We found abnormal colonic motility in all patients. Findings included: absent gastrocolonic response (N = 8), absent high-amplitude propagated contractions (HAPCs) (N = 4), and abnormal propagation of HAPCs (N = 7). Urodynamic features were abnormal in 10 children. Findings included: uninhibited bladder contractions (N = 6), hypertonic bladder (N = 2), sphincter dyssynergy (N = 2), small capacity bladder (N = 1). In all children constipation improved, in three after a partial colectomy. Urinary symptoms persisted. We conclude that some children with severe constipation may have a neuropathy affecting both the colonic and lower urinary tracts systems. In this group of patients treatment of constipation does not result in resolution of urinary symptoms.