The effect of hookworm infection and urinary scistosomiasis on blood hemoglobiin concentration of schoolchildren living in northern Mozambique / Infecções por ancilostomídeos e Schistosoma haematobium e sua correlação com a concentração sanguínea de hemoglobina em crianças moçambicanas

This study aims to assess the association between schistosomiasis and hookworm infection with hemoglobin levels of schoolchildren in northern Mozambique. Through a cross-sectional survey, 1,015 children from five to 12 years old in the provinces of Nampula, Cabo Delgado and Niassa were studied. Hookworm infection and urinary schistosomiasis were diagnosed, through Ritchie and filtration methods, with a prevalence of 31.3% and 59.1%, respectively. Hemoglobin levels were obtained with a portable photometer (Hemocue®). The average hemoglobin concentration was 10.8 ± 1.42 g/dL, and 62.1% of the children presented levels below 11.5 g/dL, of which 11.8% of the total number of children had hemoglobin levels below 9 g/dL. A multiple linear regression analysis demonstrated negative interactions between hemoglobin levels and ancylostomiasis, this being restricted to the province of Cabo Delgado (β = -0.55; p < 0.001) where an independent interaction between hemoglobin levels and urinary schistosomiasis was also observed (β = -0.35; p = 0.016). The logistical regression model indicated that hookworm infection represents a predictor of mild (OR = 1.87; 95% CI = 1.17-3.00) and moderate/severe anemia (OR = 2.71; 95% CI = 1.50 - 4.89). We concluded that, in the province of Cabo Delgado, hookworm and Schistosoma haematobium infections negatively influence hemoglobin levels in schoolchildren. Periodical deworming should be considered in the region. Health education and improvements in sanitary infrastructure could achieve long-term and sustainable reductions in soil-transmitted helminthiases and schistosomiasis prevalence rates.

Este estudo tem como objetivo avaliar a relação entre a ancilostomíase e a esquistossomíase urinária com as concentrações sanguíneas de hemoglobina em crianças escolares no norte de Moçambique. Em estudo transversal, 1.015 crianças com idade entre cinco e 12 anos foram incluídas, nas Províncias de Nampula, Cabo Delgado e Niassa. A ancilostomíase e a esquistossomíase urinária foram diagnosticadas através das técnicas de Ritchie e de filtração da urina, respectivamente; prevalências de 31,3% e 59,1% foram observadas. As concentrações sanguíneas de hemoglobina foram obtidas com um fotômetro portátil (Hemocue). A concentração média de hemoglobina foi 10,8 ± 1.42 g/dL, 62,1% das crianças apresentaram concentração abaixo de 11,5 g/dL e 11,8% apresentaram nível abaixo de 9 g/dL. A regressão linear múltipla demonstrou interações negativas entre os níveis de hemoglobina e i) a infecção por ancilostomídeos (β = -0,55; p < 0,001) e ii) a esquistossomíase urinária (β = -0,35; p = 0,016), ambas associações restritas à Província de Cabo Delgado. Também em Cabo Delgado, o modelo de regressão logística demonstrou que a infecção por ancilostomídeos representa um preditor de anemia leve (OR = 1,87; 95% CI = 1,17-3,00) e anemia moderada/grave (OR = 2,71; 95% CI = 1,50 - 4,89). O estudo conclui que em Cabo Delgado, Moçambique, as infecções por ancilostomídeos e Schistosoma haematobium estão significativamente associadas a uma menor concentração sanguínea de hemoglobina em crianças em idade escolar. A administração periódica de anti-helmínticos deve ser feita regularmente. Melhorias na infraestrutura sanitária das regiões estudadas são as medidas mais eficazes para controle destas parasitoses.

Anti-malaria humoral responses in children exposed to Plasmodium falciparum and Schistosoma haematobium

Antibody responses directed against the Plasmodium falciparum antigens, total extract, anti-merozoite surface protein-3 (MSP3b) and glutamate-rich protein (Glurp-R0) were studied in 42 children exposed to both Schistosoma haematobium and P. falciparum infections. The association between levels of the anti-malaria IgG subclasses and IgM with host age, sex, schistosome infection intensity and schistosome specific antibodies was studied before chemotherapeutic treatment of schistosome infections. This showed a significant negative association between schistosome infection intensity and levels of IgG1, IgG3, and IgG4 directed against malaria total extract antigen, and a positive association between levels of anti-schistosome soluble egg antigen IgG2, IgG3, and IgG4 and levels of the same subclasses directed against malaria total extract antigens. The effect of treating schistosome infections with praziquantel on malaria specific responses was also studied. This treatment resulted in increases in significant IgG4 levels against MSP3b and IgM against Glurp R0. Treatment also resulted in a significant decrease in IgG4 levels against Glurp R0. Host age, sex or pre-treatment infection intensity was not associated with the magnitude of change in the two IgG4 responses while males showed a significantly higher increase in levels of IgM. The results suggest cross reactivity between schistosome and malaria antigens in this population.

Urinary tract pathology in Schistosoma haematobium infected rural Nigerians.

Parasitological investigation assessing the ova of Schistosoma haematobium in the urine of 138 volunteers in Ihieve-Ogben, Edo State, Nigeria revealed 43 positive results (31.2%). Children had a higher prevalence of urinary schistosomiasis 30 (41.1%) than their adult counterparts 13 (20.0%) and this difference was statistically significant (t = 8.89, p > 0.01). More volunteers had light intensity of infection 27 (19.6%) than heavy infection 16 (11.6%) and this difference was statistically significant (chi2 = 22.90, p>0.05). Ultrasonographic investigations carried out on these 43 S. haematobium infected volunteers revealed ten pathological conditions, including abnormal wall thickness 24 (55.8%), abnormal shape 30 (69.8%), irregular bladder wall 12 (27.9%), masses 10 (23.3%), pseudopolyps 2 (4.7%), echogenic particles 30 (69.8%), residual volume 12 (27.9%), calcifications 24 (55.8%), hydroureter 10 (23.3%) and hydronephrosis 8 (18.6%) when compared to control subjects which lacked bladder and kidney abnormalities. These pathological conditions were slightly more common in the volunteers with heavy infection than those with light infection, but this difference was not statistically significant (t = -2.19, p < 0.02). More pathological conditions were found in children than in adults; this finding was statistically significant (t = 3.23, p > 0.03). Hydronephrosis and hydroureter were not found in the volunteers with light intensity of infection.

Association of parasitic infections and cancers.

Recent advances in the fields of molecular biology, epidemiology and infectious diseases have led to significant revelations to clarify the relationship between cancer and infective agents. This article reviews the relationship between parasitic infections and carcinogenesis and the possible mechanisms involved. Few parasites, e.g., Schistosoma haematobium and Opisthorchis viverrini have been found to be strongly associated with bladder cancer and cholangiocarcinoma respectively. The evidence for the association of several other parasites and cancers has also been postulated.

Diabetic nephropathy as a cause of end-stage renal disease in Egypt: a six-year study

The prevalence of diabetic nephropathy as a cause of end-stage renal disease [ESRD] in Egypt has been examined in small cross-sectional studies, with conflicting results. The need for a large-scale study prompted us to perform this 6-year multiple cross-sectional study. A sample of ESRD patients enrolled in the Egyptian renal data system was evaluated during the period 1996-2001 for the prevalence of diabetic nephropathy. Prevalence gradually increased from 8.9% in 1996, to 14.5% in 2001. The mean age of patients with diabetic nephropathy was significantly higher than that of patients with ESRD from other causes. Mortality was also significantly higher in diabetic patients with ESRD

Schistosoma induced squamous cell carcinoma of the bladder.

Schistosomiasis or Bilharziasis caused by S. hematobium is endemic in Africa, Egypt, southern tips of Europe and Japan. Though not unknown in India, it is a much less common occurrence. Schistosomiasis of the bladder is known to be a causative factor for bladder carcinoma; which is usually of the squamous type. These cancers are usually of a higher grade and the average initial stage is higher than those for transitional cell carcinomas. We present a case of schistosoma induced squamous carcinoma of the bladder as this is not a common association in India.

Schistosomiasis as a possible cause of female infertility

This study was conducted on 1625 infertile women selected for laparoscopy over a two-year period. All the patients were subjected to urinalysis, hysterosalpingography, endometrial biopsy in addition to semen analysis of their husbands. Laparoscopic guided biopsy of suspicious lesions of genital organs was taken. Histopathological evidence of schistosomiasis was proved in 27 cases. Twenty cases of them had only tubal affection, ten cases had hydrosalpinx and ten had granulomata on the outer surface of the tube. Three had peritubal small cysts formation. Two had tubo-ovarian masses and two cases showed peritoneal nodules. The histopathology of all lesions showed the characteristic of bilharzial ova

Quantitative assessment of the risk of urinary schistosomiasis and other potential risk factor for bladder cancer in Egypt

A case-control study was conducted to assess magnitude of the risk of urinary schistosomiasis and other possible risk factors for squamous and transitional cell types of bladder cancer [BC] in Egypt. Cases included 301 patients who were recruited from National Institute of Cancer at Cairo presenting with an early stage of BC; 148 with squamous cell carcinoma [SCC] and 153 patients with transitional cell carcinoma [TCC]. A definitive diagnosis of BC and its cell type was based on histopathological examination of biopsy. Controls included 154 subjects admitted for surgery other than cancer. Urinalysis and ultrasound examinations were used to exclude controls with evidence of lesions suspicious of BC. Both cases and controls were interviewed using a structured risk-assessment questionnaire. The collected data included age, gender, diagnosis of urinary schistosomiasis, and urinary stones, smoking status, exposure to pesticides, and petrochemical products. Resuits of the bivariate analysis, showed increased significant risks for both types of BC with age >/= 50 years, male sex, urinary schistosomiasis, urinary stones and exposure to pesticides. To measure the adjusted OR and 95% confidence limits [CL] of each risk factor, stepwise logistic regression [LR] was computed to control for effects of the confounding variables. The main results of LR analysis were: 1- Elevated significant risk for SCC with urinary schistosomiasis [OR: 2.5, CL: 1.5-4.1], and urinary stones [OR: 2.2, CL: 1.1-4.2]. 2- Elevated risk for TCC with age of snore man 50 years [OR: 5.3, CL: 3.1-9.0], and urinary schistosomiasis [OR: 2.5, CL: 1.4-4.2]. 3- Increased risks for SCC and TCC, albeit non-significant on exposure to pesticides [OR: 2.0, CL: 0.9-4.8 for SCC], and [OR: 1.5 CL: 0.6-3.8 for TCC]. 4- Non-significant increased risk for SCC and TCC with cigarette smoking. Urinary schistosomiasis is a significant risk factor for SCC and TCC and its risk is almost unaffected by other confounding variables. Albeit statisticallt non-significant, the environmental and occupational factors are associated with high risk for BC

Ultrasonographic evidence of urinary tract abnormalities in children infected with schistosoma haematobium in upper Egypt and its reversibility after chemotherpy

Urinary tract morbidity of S. haematobium and its reversibility following praziquantel therapy was studied on 557 rural school children and 142 age matched healthy urban controls using ultrasonography. The frequency of mild dilatation of the left pelvicalyceal system, was significantly more in infected than non infected rural and urban controls. The frequency of thickened bladder wall alone, irregularities in the Wall, localized hypertrophy and bladder polyps were significantly higher in infected rural and urban children. Regarding calcified bladder wall, no significant difference was found between infected and non infected rural children. The mean of urinary bladder wall thickness was significantly higher in infected rural children [5.5 +/- 3.1 mm] than non infected rural [4.5 +/- 2.3 mm], p < 0.05 and urban control children [2.1 +/- 0.3 mm] p < 0.01. A significant correlation was found between the bladder wall thickness and the intensity of infections r = 0.3, p 0.001. Treatment with praziquantel caused significant reduction of the dilatation of pelvicalyceal system from 5.6 to 1.6% and this reduction was significant p < 0.05. There was also significant reduction of thickened wall [from 49.6% to 18.4%, p < 0.01] and irregular wall [from 8% to 2.4%. p < 0.05]

Evalution of morbidity changes of the liver and spleen in children infected with schistosoma haematobium and the effect of praziquantel on these changes

We studied 557 rural school children, 125 out of them had active S. haematobium infection and 142 age matched healthy urban control school children in order to evaluate the morbidity of S. haematobium on the liver and spleen and the effect of Praziquantel on such changes, using abdominal ultrasound [US]. US evidence of hepatomegaly was significantly higher in children infected with S. haematobium 44 [35.2% 7 P than non-infected urban children 24 [16.9% 7 P < 0.01. Also US evidence of Splenomegaly was significantly higher in infected children 28 [22.4%] than non-infected 17 [13.2%] and controls 7 [4.9%] P < 0.05 and P < 0.01 respectively. On the other hand there was no relation between the frequency of enlarged livers and spleens and intensity of infections. The frequency of grade I periportal fibrosis was significantly more in infected rural children than in non-infected rural and urban ones. None of our cases had either grade II or III periportal fibrosis. Follow up after one year following treatment with praziquantel showed that there was a significant reduction of frequency of hepatomegaly from 15.7% to 7.9% P < 0.05, splenomegaly from 19.4% to 7.3% P < 0.05 and grade I periportal fibrosis from 22.4% to 8% following treatment. In conclusion S. haemalobium can lead to morbidity changes in the liver and spleen, but to much less extent than that produced by S. mansoni. Praziquantel seems to be effective in reduction of such morbidity changes

first report of the association of bilharziasis and ectopic pregnancy in Iraq

To the best of our knowledge this is the first report In which ectopic pregnancy was associated with bilharzias is in a female patient. The role played by the ova of Shistosoma haematobium in the aetiology of this unique cases is not well understood and needs to be investigated more thoroughly in the future work. The clinical and operative findings have been supported by the histopathological identification of numerous Bilharzial ova in the biopsy specimen taken from the fallopion tube

HLA pattern in Squamous Cell Carcinoma [SCC] of the schistosomal urinary bladder

Histocompatibility antigens [HLA-A and B] were studied in 38 patients with squamous cell carcinoma [SCC] of the sch. urinary bladder and 300 control healthy individuals. No significant increase in HLA antigens frequencies were detected. The relative risk in the studied patients with SCC was not significantly different from the control. However, the genetic role in bladder carcinoma should be pursued by studying the HLA D and Dr loci antigens

Etiopathogenesis and ultrastructure of bilharzia bladder cancer

4742 cases of bladder cancer out of 48080 cancer cases, which were registered at Iraqi Cancer Registry Centre in Baghdad during 1976-1987, were studied histopathologically and analysed epidemiologically, concerning sex, age, occupation and association with bilharziasis. Surgical and biopsy materials as well as urine sediments of some patients with bilharzia bladder cancer were prepared for scanning electron microscopy. Male to female ratio was 3:1 with high incidence at age of 60-69, being most common among farmers[88%]. Squamous cell carcinoma[SCC] was dominant [46.5%] during the years 1976-1985 when compared with transitional cell carcinoma[TCC][37.7%]. SCC with bilharziasis to TCC with bilharziasis ratio was 4:1. But the number of TCC surpassed SCC cases [8:7] during 1986 and 1987, indicating possible environmental factors other than schistosomiasis, after successful antibilharziasis campaigns for the past 30 years. Ultrastructural study revealed pleomorphic microvilli and cilia on the surface of malignant urothelium, while normal one showed reticular microridges only. A quick dipping method was developed in order to utilize scanning electron microscopy for early detection of bladder cancer in high risk people. Annual urine analysis with combined light and scanning electron microscopy are suggested. Preventive measures were recommended including continuous anti-bilharziasis campaign and avoidance of nitrate contamination in rural areas, where chemical fertilizers and insecticides are widely used nowadays