Katayama syndrome disguised as eosinophilic asthma with acute systemic symptoms and pulmonary nodules.

Background: Katayama syndrome is an acute manifestation of schistosomiasis, a parasitic infection that manifests itself through a hypersensitivity reaction to migrating larvae and early egg deposition. Left undiagnosed and untreated, acute schistosomiasis can develop into chronic schistosomiasis which can lead to debilitating morbidity such as pulmonary hypertension. This case highlights that Katayama syndrome can also been seen in regions where the parasite is not endemic, as it occurs in travelers returning from endemic regions or in immigrants. Case presentation: We describe the case of a 26-year-old asthmatic male, who presented with systemic symptoms including fever, myalgia, night sweats as well as gastro-intestinal and pulmonary complaints since five days. At presentation, there was a raised blood eosinophil count and nodular lesions were seen on computed tomography. After considering diagnoses such as tuberculosis, vasculitis and hypereosinophilic syndrome, it was repeated history taking that revealed that the patient had suffered from swimmer's itch during a stay in Guinea. A stool sample showed microscopic presence of Schistosoma mansoni eggs, confirming the diagnosis of Katayama syndrome. The patient was treated with tapered corticosteroids to suppress the hypersensitivity reaction and praziquantel was added to cure the parasitic infection. This led to a complete resolution of the patients' symptoms and radiological abnormalities. Negative stool samples confirmed the eradication of the schistosomes. Conclusions: Swimmer's itch and Katayama syndrome are manifestations of acute schistosomiasis. It is important to recognize the syndrome, because early diagnosis and adequate treatment can prevent chronic disease and significant morbidity.

Unusual and Severe Complications of Acute Schistosomiasis in Travelers.

Acute schistosomiasis (ASC) is a hypersensitivity reaction seen mostly in nonimmune travelers and manifests mainly with fever, urticaria, and respiratory symptoms. We describe unusual severe presentations of ASC in 3 patients, including hip-monoarthritis, peri-myocarditis, and optic neuritis. In all 3 patients, clinical symptoms appeared or worsened after praziquantel administration.

Schistosomiasis at the Crossroad to Elimination: Review of Eclipsed Research with Emphasis on the Post-Transmission Agenda.

While chronic schistosomiasis is pathologically well defined, the acute form of the disease is less well understood. It is generally agreed that early lesions, such as lung nodules and bladder polyps, are reversible, which impedes identification of the time elapsed since exposure. The intermediate stage between the acute and the chronic forms of schistosomiasis requires further investigation, as does the clinical stage due to lesions remaining after treatment. With current schistosomiasis control efforts gradually progressing to elimination, there is a need to focus on post-transmission schistosomiasis, which not only refers to remaining lesions from previous infections, but also accounts for the potential presence of surviving worms after treatment. This issue is particularly salient for migrants from endemic to non-endemic countries and should be kept in mind for returning expatriates from schistosomiasis-endemic countries. Negative stool examination or urine filtration are generally taken as indicative of cure since rectoscopy for Schistosoma mansoni infection, or cystoscopy for S. haematobium infection, are rarely performed. However, pathology of affected organs may persist indefinitely, while potentially remaining live worms could produce additional pathology. Hence, post-transmission schistosomiasis can prevail for years after elimination of the disease, and thus, warrant further attention.

Clinical Spectrum of Schistosomiasis: An Update.

Schistosomiasis is a helminthic infection and one of the neglected tropical diseases (NTDs). It is caused by blood flukes of the genus Schistosoma. It is an important public health problem, particularly in poverty-stricken areas, especially those within the tropics and subtropics. It is estimated that at least 236 million people worldwide are infected, 90% of them in sub-Saharan Africa, and that this disease causes approximately 300,000 deaths annually. The clinical manifestations are varied and affect practically all organs. There are substantial differences in the clinical presentation, depending on the phase and clinical form of schistosomiasis in which it occurs. Schistosomiasis can remain undiagnosed for a long period of time, with secondary clinical lesion. Here, we review the clinical profile of schistosomiasis. This information may aid in the development of more efficacious treatments and improved disease prognosis.

Case Report: Diagnosis and Assessment of Cure Approaches for Acute Schistosomiasis in Pre-School Children.

Acute schistosomiasis (AS) manifests with a broad spectrum of clinical features in pediatric populations. Diagnosis may be difficult in the absence of detectable numbers of eggs. As a result, new approaches may be required to achieve an accurate diagnosis. Optimal praziquantel (PZQ) treatment regimen for young children is debatable. Also, the post-treatment response is still poorly evaluated due to the lack of reliable markers. A group of 6 children (a toddler and 5 pre-school children) and one pre-adolescent were investigated for AS clinical manifestations and followed-up for two years after treatment. Ova detection was performed by Kato-Katz (KK) and presence of Schistosoma mansoni DNA was assessed by real-time PCR (rt-PCR) in stool samples. IgG and IgE anti-Schistosoma levels and urinary antigen were detected by ELISA and point-of-care circulating cathodic antigen (POC-CCA) testing in serum and urine, respectively. AS clinical symptoms were present in 5/7 (71.4%) of the infected children, and hypereosinophilia was detected in all of them. Ova detection and serology were positive in only 3/7 (44.9%) and 4/7 (57.1%), respectively. However, real-time PCR (rt-PCR) showed the presence of Schistosoma DNA in 6/7 (85.7%) of the cases, and urinary antigen was detected in all infected children. The long-term follow-up after treatment with three doses of PZQ (80mg/kg/dose), showed high cure rates (CR) as demonstrated by the DNA-based assay as well as reduced levels of side effects. CR based on urinary antigen detection ranged from 28.6 to 100%, being the highest CR due to double testing the 2-year post-treatment samples. The results suggest that high dose and repeated treatment with PZQ might be effective for AS in young children. Also, new laboratory markers should be considered to diagnosis and monitor the drug response.

Acute schistosomiasis in paediatric travellers and comparison with their companion adults.

BACKGROUND: Schistosomiasis in non-immune travellers can cause acute schistosomiasis, a multi-systemic hypersensitivity reaction. Little is known regarding acute schistosomiasis in children. We describe acute schistosomiasis in paediatric travellers and compare them with adult travellers. METHODS: A retrospective study of paediatric travellers (0-18 years old) diagnosed with schistosomiasis at Sheba Medical Center. Patients' findings are compared with those of adult travellers from the same travel groups. RESULTS: in total, 18 children and 24 adults from five different trips to Tanzania, Uganda, Nigeria and Laos were infected (90% of the exposed travellers). The median bathing time of the infected children was 30 min (interquartile range (IQR) 15-30 min). The most common presentations were respiratory symptoms in 13 (72%), eosinophilia in 13 (72%) and fever in 11 (61%). Acute illness included a median of 2.5 symptoms. Three children required hospitalization and three were asymptomatic. Fatigue was significantly less common in children compared with similarly exposed adults (33% vs 71%, P = 0.03). Rates of hospitalization and steroid treatment were similar. The median eosinophil count in children was 1045 cells/µl (IQR 625-2575), lower than adults [2900 cells/µl (IQR 1170-4584)], P = 0.02. CONCLUSIONS: Children may develop acute schistosomiasis following short exposure to contaminated freshwater, demonstrating a high infection rate. Severity seems to be similar to adults, although children report fatigue less commonly and show lower eosinophil counts. The disease should be suspected in children with multi-systemic illness and in asymptomatic children with relevant travel history.

The acute schistosomiasis mansoni ameliorates metabolic syndrome in the C57BL/6 mouse model.

Human and experimental studies have shown that chronic schistosomiasis mansoni protects against metabolic disorders through direct and indirect pathways. This study aims to investigate the co-morbidity between the acute schistosomiasis and nonalcoholic fatty liver. To address this, male C57BL/6 mice fed a high-fat chow (60% fat) or standard chow (10% fat) for 13 weeks and later infected with 80 Schistosoma mansoni cercariae. Mice were assigned into four groups: uninfected fed standard (USC), uninfected fed high-fat chow (UHFC), infected fed standard (ISC), and infected fed high-fat chow (IHFC). Blood sample and tissues were obtained at nine weeks post-infection (acute schistosomiasis) by necropsy. UHFC mice showed higher body mass, visceral adiposity, impaired glucose tolerance, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), triglyceride (TG), and liver steatosis compared to USC mice. IHFC mice showed lower blood lipid levels, blood glucose, improved glucose tolerance, body mass, and liver steatosis (macro and microvesicular) compared to UHFC mice. IHFC showed more massive histopathological changes (sinusoidal fibrosis, hepatocellular ballooning, and inflammatory infiltrates) compared to ISC. In conclusion, the co-morbidity results in both beneficial (friend) and detrimental (foe) for the host. While the acute schistosomiasis improves some metabolic features of metabolic syndrome, comorbidity worsens the liver injury.

[Role of acute schistosomiasis control in facilitating the progress towards schistosomiasis elimination].

Acute schistosomiasis is a clinical type of schistosomiasis with severe symptoms. The number of acute schistosomiasis cases is not only a sensitive indicator to assess the endemic situation and control effects, but also an important indicator to define schistosomiasis outbreaks and evaluate the achievements of infection control or transmission control. Acute schistosomiasis control is therefore of great significance to achieve the goal of schistosomiasis elimination in China. This paper analyzes the features and causes of acute schistosomiasis, and proposes some suggestions for future acute schistosomiasis control in China.

Role of acute schistosomiasis control in facilitating the progress towards schistosomiasis elimination / 中国血吸虫病防治杂志

Acute schistosomiasis is a clinical type of schistosomiasis with severe symptoms. The number of acute schistosomiasis cases is not only a sensitive indicator to assess the endemic situation and control effects, but also an important indicator to define schistosomiasis outbreaks and evaluate the achievements of infection control or transmission control. Acute schistosomiasis control is therefore of great significance to achieve the goal of schistosomiasis elimination in China. This paper analyzes the features and causes of acute schistosomiasis, and proposes some suggestions for future acute schistosomiasis control in China.

Role of acute schistosomiasis control in facilitating the progress towards schistosomiasis elimination / 中国血吸虫病防治杂志

Acute schistosomiasis is a clinical type of schistosomiasis with severe symptoms. The number of acute schistosomiasis cases is not only a sensitive indicator to assess the endemic situation and control effects, but also an important indicator to define schistosomiasis outbreaks and evaluate the achievements of infection control or transmission control. Acute schistosomiasis control is therefore of great significance to achieve the goal of schistosomiasis elimination in China. This paper analyzes the features and causes of acute schistosomiasis, and proposes some suggestions for future acute schistosomiasis control in China.

[Pulmonary ectopic lesion of acute schistosomiasis: a report of two cases].

This paper reports the diagnosis and treatment of 2 cases of acute schistosomiasis with ectopic lesion in the lung. It suggests that in schistosomiasis endemic areas, if the patients with the contact history of infested water have the symptom of fever, while the effects of anti-infection and the corresponding treatments are not good, the clinician should consider acute schistosomiasis.

[Analysis of antibody titer value of IHA in 135 acute schistosomiasis patients].

OBJECTIVE: To analyze the antibody titer value of indirect haemagglutination test (IHA) in 135 confirmed acute schistosomiasis patients, so as to provide the evidence for improving the diagnosis and treatment of acute schistosomiasis. METHODS: A total of 135 acute schistosomiasis inpatients were selected from 2001 to 2006. They all received the IHA antibody titer detection, and the correlation among the age, incubation period, and hospitalization days was calculated. RESULTS: The antibody titers of IHA were higher than 1:320 in all the cases. The percentages of 1:640, 1:1 280, 1:2 560, 1:5 120 and 1:10 240 were 1.48%, 28.15%, 35.56%, 20.00%, and 14.81% respectively. The mean age was (47.70 ± 14.58) years, average incubation period was (38.03 ± 4.59) days and mean hospital stay time was (15.08 ± 3.79) days. The antibody titer value had no correlation with the age distribution (r = 0.109, P > 0.05). There was a negatively correlation between the antibody titer value and incubation period, (r = -0.558, P <0.01), there was a positive correlation between the antibody titer value and hospitalization time (r = 0.791, P < 0.01), and there were significant differences among different groups (F = 17.07, 64.53, both P < 0.01). CONCLUSIONS: The antibody titer of acute schistosomiasis cases detected by IHA is 1:640 and above. There is no correlation between the antibody titer value and age, but the antibody titer value is higher, the incubation period is shorter and hospitalization time is longer.

Analysis of antibody titer value of IHA in 135 acute schistosomiasis patients / 中国血吸虫病防治杂志

Objective To analyze the antibody titer value of indirect haemagglutination test(IHA)in 135 confirmed acute schistosomiasis patients,so as to provide the evidence for improving the diagnosis and treatment of acute schistosomiasis. Meth-ods A total of 135 acute schistosomiasis inpatients were selected from 2001 to 2006. They all received the IHA antibody titer de-tection,and the correlation among the age,incubation period,and hospitalization days was calculated. Results The antibody titers of IHA were higher than 1:320 in all the cases. The percentages of 1:640,1:1280,1:2560,1:5120 and 1:10240 were 1.48%,28.15%,35.56%,20.00%,and 14.81%respectively. The mean age was(47.70 ± 14.58)years,average incuba-tion period was(38.03 ± 4.59)days and mean hospital stay time was(15.08 ± 3.79)days. The antibody titer value had no corre-lation with the age distribution(r=0.109,P>0.05). There was a negatively correlation between the antibody titer value and in-cubation period,(r=-0.558,P<0.01),there was a positive correlation between the antibody titer value and hospitalization time(r=0.791,P<0.01),and there were significant differences among different groups(F=17.07,64.53,both P<0.01). Conclusions The antibody titer of acute schistosomiasis cases detected by IHA is 1:640 and above. There is no correlation be-tween the antibody titer value and age,but the antibody titer value is higher,the incubation period is shorter and hospitalization time is longer.

Pulmonary ectopic lesion of acute schistosomiasis:a report of two cases / 中国血吸虫病防治杂志

This paper reports the diagnosis and treatment of 2 cases of acute schistosomiasis with ectopic lesion in the lung. It suggests that in schistosomiasis endemic areas,if the patients with the contact history of infested water have the symptom of fe-ver,while the effects of anti-infection and the corresponding treatments are not good,the clinician should consider acute schisto-somiasis.

T follicular helper cells in patients with acute schistosomiasis.

BACKGROUND: The role of T follicular helper (Tfh) cells in schistosome infection is not fully defined. In a previous study, a higher frequency of circulating PD-1(+)CXCR5(+)CD4(+) Tfh cells was observed in patients with chronic schistosomiasis relative to healthy controls (HCs) and it correlated positively with the level of soluble egg antigen (SEA) specific antibodies in serum. However, the function of Tfh cells in patients with acute schistosomiasis remains elusive; this was investigated in the present study. METHODS: The frequency of circulating Tfh cells and the expression of inducible T cell co-stimulator (ICOS), programmed cell death 1 (PD-1) and B cell subsets were analyzed in 12 patients with acute schistosomiasis and 10 HCs by flow cytometry. The expression of Bcl6, c-Maf and IL-21 mRNA were detected by quantitative real-time reverse transcriptase PCR (qRT-PCR). The concentration of serum IL-21 and IgG specific to Schistosoma japonicum antigen were then determined by enzyme linked immunosorbent assay (ELISA). Correlations between PD-1(+)CXCR5(+)CD4(+) Tfh cells, memory B cells and IgG specific to S. japonicum were analyzed by Spearman's rank correlation. RESULTS: The frequency of PD-1(+)CXCR5(+)CD4(+) Tfh and memory B cells was increased in acute schistosomiasis patients relative to HCs. Moreover, the levels of IL-21 in serum and the expression of IL-21 mRNA were higher in acute schistosomiasis patients. However, there was no significant correlation between PD-1(+)CXCR5(+)CD4(+) Tfh cells, memory B cells and IgG specific to S. japonicum antigen in patients with acute schistosomiasis. CONCLUSIONS: PD-1(+)CXCR5(+)CD4(+) Tfh cells in peripheral blood are involved in the immune response of patients with acute schistosomiasis. Understanding the immunological mechanism is helpful for the development of vaccination strategies to control schistosomiasis.

Gamma delta T cells in non-immune patients during primary schistosomal infection.

The mevalonate pathway is critical for the survival of Schistosoma. γδ T cells, a small subset of peripheral blood (PB) T cells, recognize low molecular weight phosphorylated antigens in the mevalonate pathway, which drive their expansion to exert protective and immunoregulatory effects. To evaluate their role in schistosomiasis, we measured γδ T cells in the PB of non-immune travelers who contracted Schistosoma hematobium or Schistosoma mansoni in Africa. The maximal level of γδ T-cells following infection was 5.78 ± 2.19% of the total T cells, versus 3.72 ± 3.15% in 16 healthy controls [P = 0.09] with no difference between S. hematobium and S. mansoni in this regard. However, among the nine patients in the cohort who presented with acute schistosomiasis syndrome (AS), the level (3.5 ± 1.9%) was significantly lower than in those who did not (8.6 ± 6.4%, P < 0.05), both before and after therapy. Furthermore, γδ T cells increased significantly in response to praziquantel therapy. In a patient with marked expansion of γδ T cells, most expressed the Vδ2 gene segment, a hallmark of cells responding to cognate antigens in the mevalonate pathways of the parasite or the human host. These results suggest an immunoregulatory role of antigen responsive γδ T cells in the clinical manifestations of early schistosomal infection.

Acute schistosomiasis mansoni: the pathophysiological cycle of the schistosoma mansoni and the granulomas as egg of columbus / Esquistossomose mansônica aguda: o ciclo fisiopatológico do Schistosoma mansoni e o granuloma como ovo de colombo*

Background and objectives: Schistosomiasis has a wide geographical distribution, and is found in many countries including Brazil, where it is endemic in some states. This study aimed to describe the main pathogenic aspects of the Homo sapiens sapiens / Shistosoma mansoni interaction, focusing on the acute phase of illness. Accordingly, we reviewed the literature using a with a defined search strategy, using PubMed. The selected papers were read and the information organized into two sections, focusing on (1) the pathophysiological human-helminth interaction "cycle" and (2) the role of granuloma in the disease. Content: The pathologic process begins with the penetration of the cercariae into the skin, from which point the response mechanisms to infection are triggered - linked to the biological cycle of the helminth in the human body - and justifying the development of acute and chronic forms of the disease. The acute phase is characterized by the formation of necrotic-exudative granulomas around the eggs. Continuous oviposition allows for modulation of the immune response, the histopathological significance of which is the disappearance of the necrotic areas and size reduction of the granulomas surrounding the eggs. Conclusion: An understanding of the Homo sapiens sapiens/Schistosoma mansoni interaction is essential in order to think of ways to intervene with the natural history of the disease, avoiding the emergence of severe forms - especially in the context of evolution to chronic disease -, and, perhaps, corroborating for a better coexistence between man and helminth, in the best spirit of cohabitology...

Space-time clustering analysis of acute schistosome infections in marshland and lake areas in five provinces / 中国血吸虫病防治杂志

Objective To analyze the time and space aggregation of acute schistosome infections in marshland and lake areas in five provinces(Jiangsu,Anhui,Jiangxi,Hubei and Hunan province)from 2005 to 2012,so as to provide the evidence for es-tablishing control strategies and taking effective control measures. Methods The data of patients with acute schistosome infection in marshland and lake areas in five provinces from 2005 to 2012 were collected and analyzed with the concentration ratio and circu-lar distribution methods for the epidemic season features and time aggregation of the infection,and with the spatial autocorrelation analysis for the space aggregation of the infected cases. Results According to the concentration ratio,the occurrence of acute schistosome infection had strong seasonality,and the concentration ratio was 0.758;according to the circular distribution method, the peak day of acute schistosome infections was 10th,August. The spatial analysis suggested that the infected cases highly gath-ered around Poyang Lake,Dongting Lake and Yangtze River Basin in 23 counties of the five provinces,and the result of spatial au-tocorrelation analysis showed that the spatial autocorrelation index I was 0.16(P=0.01). Conclusion The occurrence of acute schistosome infections in lake regions of the 5 provinces shows strong seasonality and space aggregation,therefore we can bring the control mark forward,and take targeted prevention and control measures in high aggregation areas of acute schistosomiasis.

The schistosomuaa tegument antigen as a potentil candidate for the early serollogical diagnosis of schistosomiasis annsoni / Antígenos de tegumento de esquistossômulos são candidatos em potencial para o diagnóstico de fase aguda da esquistossomose mansoni

If Schistosoma mansoni infection could be detected in its early stages, especially before the egg deposition in the host tissues, the development of severe pathologic lesions could be efficiently prevented. We therefore developed an indirect enzyme-linked immunosorbent assay based on the detection of specific IgG against schistosomula antigens (ELISA-SmTeg). The assay was applied in sera samples from non-infected and infected mice collected seven and 15 days post-infection. The results were compared to the number of adult worms obtained by perfusion of the murine hepatic system 50 days post-infection. The sensitivity and specificity of the ELISA-SmTeg were 100% (p = 0.0032 and 0.0048 respectively for seven and 15 days of infection) with a cutoff value of 0.15 (p = 0.0002). Our findings show a novel low-cost serological assay using antigens which are easy to obtain, which was able to detect all the infected mice as early as seven days post-infection.

A detecção da infecção pelo helminto Schistosoma mansoni quando realizada nas fases iniciais, especialmente antes da oviposição nos tecidos do hospedeiro, pode impedir de forma eficiente o desenvolvimento de graves lesões patológicas. Baseado nisto, foi desenvolvido um ensaio imunoenzimático indireto para detecção de anticorpos IgG específicos contra antígenos de esquistossômulos (ELISA-SmTeg). Este ensaio foi aplicado em amostras sorológicas de camundongos não infectados, da mesma forma que de camundongos recentemente infectados, após sete e 15 dias de infecção. Os resultados foram comparados com o número de vermes adultos obtidos por perfusão do sistema hepático murino 50 dias pós-infecção. A sensibilidade e a especificidade do novo método, denominado ELISA-SmTeg, foram de 100% (p = 0,0032, 0,0048, respectivamente, durante sete e 15 dias de infecção) com um valor de corte de 0,15 (p = 0,0002). Nossos resultados mostraram que um ensaio de baixo custo, que utiliza antígenos de fácil obtenção, é capaz de discriminar a esquistossomose mansoni em modelo experimental de forma precoce, incluindo sete dias pós-infecção.