clove and Schistosomiasis-haematobia

In this paper we summarise the parasitological, clinical and epidemiological characteristics of female genital schistosomiasis (FGS), a frequent manifestation of the infection with Schistosoma haematobium. Means to diagnose and treat lesions in the lower and upper genital tract are discussed. Based on clinical findings and available pathophysiological as well as immunological data it is conceivable that FGS of the cervix and vagina not only facilitates the infection with agents of sexually transmitted diseases, but presumably also alters the natural history of such infections. Two infectious agents are of particular concern: the Human Immunodeficiency Virus and the oncogenic Human Papilloma Viruses. Possible interactions and their consequences are discussed and research areas which should be addressed are outlined.

Topics: Africa; Animals; Female; Genital Diseases, Female; Genitalia, Female; HIV; HIV Infections; Humans; Madagascar; Papillomaviridae; Papillomavirus Infections; Prevalence; Risk Factors; Schistosoma haematobium; Schistosomiasis haematobia; Tumor Virus Infections; Uterine Cervical Neoplasms

The goal to eliminate the parasitic disease of poverty schistosomiasis as a public health problem is aligned with the 2030 United Nations agenda for sustainable development goals, including universal health coverage (UHC). Current control strategies focus on school-aged children, systematically neglecting adults. We aimed at providing evidence for the need of shifting the paradigm of schistosomiasis control programs from targeted to generalized approaches as key element for both the elimination of schistosomiasis as a public health problem and the promotion of UHC.. In a cross-sectional study performed between March 2020 and January 2021 at three primary health care centers in Andina, Tsiroanomandidy and Ankazomborona in Madagascar, we determined prevalence and risk factors for schistosomiasis by a semi-quantitative PCR assay from specimens collected from 1482 adult participants. Univariable and multivariable logistic regression were performed to evaluate odd ratios.. The highest prevalence of S. mansoni, S. haematobium and co-infection of both species was 59.5%, 61.3% and 3.3%, in Andina and Ankazomborona respectively. Higher prevalence was observed among males (52.4%) and main contributors to the family income (68.1%). Not working as a farmer and higher age were found to be protective factors for infection.. Our findings provide evidence that adults are a high-risk group for schistosomiasis. Our data suggests that, for ensuring basic health as a human right, current public health strategies for schistosomiasis prevention and control need to be re-addressed towards more context specific, holistic and integrated approaches.

Topics: Adult; Agriculture; Animals; Coinfection; Cross-Sectional Studies; Humans; Madagascar; Male; Middle Aged; Prevalence; Risk Factors; Schistosoma haematobium; Schistosoma mansoni; Schistosomiasis haematobia; Schistosomiasis mansoni; Sex Factors; Young Adult

Female genital schistosomiasis (FGS) is a neglected manifestation of urogenital schistosomiasis caused by S. haematobium. The disease presents with symptoms such as pelvic pain, vaginal discharge and bleeding and menstruation disorders, and might lead to infertility and pregnancy complications. The perspectives of women with FGS have not been studied systematically. The aim of the study was to understand knowledge, experiences, and practices of women with FGS.. We performed a qualitative study with seventy-six women diagnosed of having FGS, in the Ambanja district in Northwest Madagascar. Data collection was either through focus group discussion (N = 60) or in an individual semi-structured interview (N = 16). FGS was diagnosed by colposcopy. The data was analysed using Mayring´s qualitative content analysis.. Knowledge on how the disease is acquired varied and ideas on prevention remained vague. Patients suffered from vaginal discharge and pelvic complaints. Some women expressed unbearable pain during sexual intercourse and compared their pain to an open wound being touched. FGS considerably impaired women´s daily activities and their quality of life. Infertility led to resignation and despair, conflicts with the partner and to social exclusion from the community. Women fearing to sexually transmit FGS refrained from partnership and sexual relations. Many women with FGS reported stigmatisation. A coping strategy was to share strain with other women having similar complaints. However, concealing FGS was a common behaviour which led to social isolation and delayed health care seeking.. Our study underlines that FGS has an important impact on the sexual health of women and on their social life in the community. Our results highlight the importance of providing adequate health education and structural interventions, such as the supply of water and the provision of sanitation measures. Further, correct diagnosis and treatment of FGS in adolescent girls and women should be available in all S. haematobium-endemic areas.. The qualitative study was embedded in a randomised controlled trial (RCT) in which two doses of praziquantel were compared (https://clinicaltrials.gov/ct2/show/NCT04115072).

Topics: Adolescent; Animals; Female; Genitalia, Female; Humans; Infertility; Madagascar; Pain; Perception; Pregnancy; Schistosoma haematobium; Schistosomiasis haematobia; Social Change; Vaginal Discharge

Female Genital Schistosomiasis (FGS) is a neglected disease affecting millions, however challenging to diagnose. This explorative descriptive study compares Schistosoma real-time PCR analysis of cervico-vaginal lavages (CVL) with corresponding urine and stool samples of 933 women from five different previously described study populations. Sampling included 310 women from an S. mansoni endemic region in Mwanza, Tanzania and 112 women from a nearby S. haematobium endemic region. Findings were compared with samples collected from S. haematobium endemic regions in South Africa from 394 women and from 117 women from Madagascar of which 79 were urine pre-selected microscopy positive cases from highly-endemic communities and 38 were urine microscopy negatives from a low-endemic community. As anticipated, urine and stool microscopy and gynecological investigations varied substantially between study populations; however, the same Schistosoma real-time PCR was performed in one reference laboratory. Schistosoma DNA was detected in 13% (120/933) of the CVL, ranging from 3% in the S. mansoni Tanzanian endemic region to 61% in the pre-selected Malagasy urine microscopy positive cases. Detectable Schistosoma DNA in CVL was associated with Schistosoma DNA in urine but not with microscopic detection of eggs in urine or by cytological examination. This study confirmed real-time PCR for the detection of Schistosoma DNA in gynecological samples to be a valuable diagnostic tool to study the distribution of FGS within schistosomiasis endemic areas.

Topics: Adolescent; Animals; Child; Diagnostic Tests, Routine; DNA, Helminth; Female; Genitalia; Humans; Madagascar; Real-Time Polymerase Chain Reaction; Schistosoma haematobium; Schistosoma mansoni; Schistosomiasis haematobia; Schistosomiasis mansoni; South Africa; Tanzania; Urinalysis; Young Adult

Topics: Animals; Denmark; Gastrointestinal Hemorrhage; Humans; Madagascar; Male; Middle Aged; Rectum; Schistosoma haematobium; Schistosomiasis haematobia; Yemen

A 25-year-old female who had returned from a trip to Madagascar that was not reported, underwent an endoscopic bladder polyp resection. Histopathology examination revealed an intense pseudolymphomatous inflammatory polyp caused by a Schistosoma infection. Bladder polyps due to schistosomiasis represent a rare condition in developed countries and have to be ruled out in the case of any intense unexplained inflammation.

Topics: Adult; Animals; Diagnosis, Differential; Female; Humans; Inflammation; Madagascar; Polyps; Pseudolymphoma; Schistosoma haematobium; Schistosomiasis haematobia; Urinary Bladder; Urinary Bladder Diseases

The pathophysiology of female genital schistosomiasis (FGS) is only partially understood. This study aims to describe the histopathological findings, polymerase chain reaction (PCR) results, and gynecological manifestations of FGS in women with different intensities of Schistosoma haematobium infection.. Women aged 15-35 years living in an S. haematobium-endemic area in Madagascar underwent pelvic and colposcopic examinations. Small biopsy specimens were obtained from lesions and examined histopathologically. Schistosoma PCR was done on urine, biopsy, cervicovaginal lavage, and genital mucosal surface specimens.. Sandy patches and rubbery papules were found in 41 of 118 women (35%). Rubbery papules reflected an intense cellular immune reaction dominated by eosinophils, epithelial erosion, and viable ova. There was a significant decrease in the prevalence of rubbery papules with age, even after adjustment for urinary ova excretion. The sandy patches with grains showed moderate cellular immune reaction and ova (viable and/or calcified). They were most prevalent in cases with low-intensity urinary S. haematobium infection. Forty-two percent of women with Schistosoma-negative urine specimens had at least 1 genital specimen test positive for Schistosoma by PCR.. The results indicate a diversity of lesions caused by S. haematobium and a dynamic evolution of the genital lesions. Schistosoma PCR may give an indication of the diagnosis.

Topics: Adolescent; Adult; Animals; Cross-Sectional Studies; Female; Humans; Madagascar; Molecular Diagnostic Techniques; Polymerase Chain Reaction; Schistosoma haematobium; Schistosomiasis haematobia; Uterine Diseases; Young Adult

Genital granulomas induced by Schistosoma haematobium eggs can manifest as different lesion types visible by colposcopy; rubbery papules (RP), homogenous sandy patches (HSP) and grainy sandy patches (GSP). Pronounced tissue eosinophilia is a candidate marker for active S. haematobium pathology, as viable schistosome egg granulomas often are eosinophil rich. Here it was investigated whether eosinophil granule proteins ECP (eosinophil cationic protein) and EPX (eosinophil protein-X) in urine and genital lavage can be used as markers for active FGS lesions.. Uro-genital samples from 118 Malagasy women were analysed for ECP and EPX by standard sandwich avidin/biotin amplified ELISA.. The women with RP lesions had significantly higher levels of ECP and EPX in both lavage and urine. Furthermore, women with RP lesions were significantly younger than those with GSP. This could indicate that RP lesions might be more recently established and thus represent an earlier inflammatory lesion stage.. ECP in genital lavage might be a future tool aiding the identification of FGS pathology at a stage where reversibility remains a possibility following praziquantel treatment.

Topics: Adolescent; Adult; Animals; Biomarkers; Eosinophil Granule Proteins; Female; Female Urogenital Diseases; Humans; Life Cycle Stages; Madagascar; Schistosoma haematobium; Schistosomiasis haematobia; Young Adult

Schistosoma (S.) haematobium is a neglected tropical disease which may affect any part of the genital tract in women. Female genital schistosomiasis (FGS) may cause abnormal vaginal discharge, contact bleeding, genital tumours, ectopic pregnancies and increased susceptibility to HIV. Symptoms may mimic those typical of sexually transmitted infections (STIs) and women with genital schistosomiasis may be incorrectly diagnosed. An expert consensus meeting suggested that the following findings by visual inspection should serve as proxy indicators for the diagnosis of schistosomiasis of the lower genital tract in women from S. haematobium endemic areas: sandy patches appearing as (1) single or clustered grains or (2) sandy patches appearing as homogenous, yellow areas, or (3) rubbery papules. In this atlas we aim to provide an overview of the genital mucosal manifestations of schistosomiasis in women.. Photocolposcopic images were captured from women, between 1994 and 2012 in four different study sites endemic for S. haematobium in Malawi, Zimbabwe, South Africa and Madagascar. Images and specimens were sampled from sexually active women between 15 and 49 years of age. Colposcopic images of other diseases are included for differential diagnostic purposes.. This is the first atlas to present the clinical manifestations of schistosomiasis in the lower female genital tract. It will be freely available for online use, downloadable as a presentation and for print. It could be used for training purposes, further research, and in clinical practice.

Topics: Adolescent; Adult; Africa, Southern; Animals; Colposcopy; Diagnosis, Differential; Female; Genital Diseases, Female; Humans; Madagascar; Middle Aged; Schistosoma haematobium; Schistosomiasis haematobia; Sexually Transmitted Diseases; Vagina; Young Adult

The seminal vesicles and the prostate are frequently affected by egg-induced inflammation in Schistosoma haematobium infected men. The objective of this study was to assess the semen quality in men with male genital schistosomiasis (MGS). The examination of the semen samples was performed in men aged 15 to 49 years living an S. haematobium endemic area in Madagascar prior to anti-schistosoma treatment with praziquantel and five months later. Men from the high endemic Sirama sugarcane plantation with positive egg excretion in the urine and circulating anodic antigen (CAA) present in serum (n=85) were compared to men (without egg excretion and no CAA) from the neighbouring low-endemic Mataipako village (n=57). The proportion of men with egg excretion in semen was significantly higher in Sirama than in Mataipako (53% versus 4%), whereas the median ejaculate volume was significantly lower in Sirama (1.8 ml versus 2.4 ml). There was no statistical difference in median spermatocyte counts and in the proportions of men detected with azoospermia. The mean apoptotic rate was 7.8% in a subgroup of 30 men from Sirama. A positive correlation was found between apoptotic rate and seminal eosinophil cationic protein (ECP) level (rho=0.560; P<0.001). At follow up, egg excretion and ECP level in semen declined significantly and were paralleled by a significant reduction in the apoptotic rate. The study suggests that S. haematobium infection is associated with sperm apoptosis and a reduced production of seminal fluid. Egg induced inflammation in the seminal vesicles and the prostate could be underlying mechanism for both observations.

Topics: Adolescent; Adult; Animals; Apoptosis; Black People; Host-Parasite Interactions; Humans; Madagascar; Male; Middle Aged; Schistosoma haematobium; Schistosomiasis haematobia; Semen; Semen Analysis; Young Adult

In settings in which adequate laboratory service is lacking, the coexistence of urogenital schistosomiasis and sexually transmitted infections (STIs) poses a diagnostic challenge for health care providers in the management of patients with urogenital complaints.. Symptoms were recorded with use of a semistructured questionnaire at baseline and in follow-up surveys after STI and Schistosoma haematobium infection had been assessed and systematically treated as part of a community-based study of 253 women and 236 men, aged 15-49 years, living in an area of Madagascar where S. haematobium is endemic.. Of those infected with S. haematobium, 35% of the women had concordant STI (e.g., infection with Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and/or Trichomonas vaginalis), compared with 17% of the men. Both S. haematobium infection and STI were significantly more common among younger individuals, aged 15-24 years, than among older individuals. A broad spectrum of urogenital symptoms was reported. However, one-half of the women and men who had positive test results for an STI or for S. haematobium infection were asymptomatic. Gross hematuria and dysuria were, in multivariate analysis, associated with S. haematobium infection, as were genitopelvic discomfort in women and ejaculation pain in men. The association became stronger with higher intensity of infection. In bivariate analysis but not in the multiregression model, STI was associated with vaginal discharge and genitopelvic discomfort in women and was associated with urethral discharge in men.. The rationale for empirical antischistosoma treatment of adolescents and younger adults in areas where S. haematobium is endemic, with praziquantel alone or in combination with existing anti-STI regimens, is discussed.

Topics: Adolescent; Adult; Animals; Chlamydia Infections; Chlamydia trachomatis; Female; Humans; Madagascar; Male; Middle Aged; Mycoplasma genitalium; Mycoplasma Infections; Schistosoma haematobium; Schistosomiasis haematobia; Sexually Transmitted Diseases, Bacterial; Trichomonas vaginalis; Trichomonas Vaginitis; Young Adult

Markers of male genital schistosomiasis (MGS) are needed to elucidate the consequences for reproductive health. Eosinophil cationic protein (ECP) and soluble egg antigen (SEA) in urine and semen, and circulating anodic antigen (CAA) in serum were assessed as MGS markers. Egg counts, ECP, and SEA in urine and CAA in serum, correlated positively. Seminal egg excretion exhibited marked day-to-day variations, but counts correlated positively with urinary egg counts and SEA in semen and with CAA. Positive predictive values with reference to seminal egg excretion were as follows: seminal ECP (52%), seminal SEA (83%), CAA (97%), and urinary egg excretion (82%). SEA in semen and CAA in serum constitute potential markers of MGS. However, urine egg counts as an indirect marker of MGS remains the preferred diagnostic method from a public health perspective.

Topics: Adolescent; Adult; Antigens, Helminth; Eosinophil Cationic Protein; Glycoproteins; Helminth Proteins; Humans; Madagascar; Male; Middle Aged; Ovum; Parasite Egg Count; Schistosomiasis haematobia; Semen; Sensitivity and Specificity; Urine

Ultrasonography (US) was applied in this community-based study in northern Madagascar to compare urogenital findings in Schistosoma haematobium-positive individuals (105 women and 116 men) from the high-endemic Sirama village, with urinary egg negative controls (100 women and 108 men) from the neighboring low-endemic Mataipako village. In addition to examination of the urinary tract, the female genitals were examined by transvaginal US, whereas the male genitals were examined by transrectal and transscrotal US. Pathology of the urinary tract was significantly more prevalent among women and men in Sirama. There were no differences in female genital tract between the two study populations, whereas significantly higher proportions of men in Sirama were detected with hyperechogenic and calcified lesions in the seminal vesicles and the prostate. Moreover, the mean size of the seminal vesicles was significantly larger in Sirama. There were no differences with respect to the external male genitals. Six months after anti-schistosome treatment, no changes were observed in the female genital tract in Sirama, whereas hyperechogenicity of the prostate and the seminal vesicles, in addition to size of the seminal vesicles, declined significantly. This study has provided new insight into genital pathology in S. haematobium-infected men and women. However, the clinical significance of these findings needs further exploration.

Topics: Adolescent; Adult; Animals; Female; Female Urogenital Diseases; Genitalia, Female; Humans; Madagascar; Male; Male Urogenital Diseases; Middle Aged; Parasite Egg Count; Rural Health; Schistosoma haematobium; Schistosomiasis haematobia; Seminal Vesicles; Treatment Outcome; Ultrasonography; Urinary Bladder

Schistosomiasis is a major public health problem in Madagascar. The aim of the national control program is to reduce the morbidity in hyperendemic areas. A prospective study has been conducted in Morombe and Ampanihy to elaborate a simple method to identify Shistosoma haematobium hyperendemic communities. The study included 1,373 children from 5 to 15 years old in 17 primary schools. Moderate sensitivity and Negative Predictive Value, with high specificity and Positive Predictive Value of "blood in urine" and "Schistosomiasis" have been found. Those diagnosis values increase with age. The first symptom should be used in older children.

Topics: Adolescent; Age Distribution; Child; Cross-Sectional Studies; Endemic Diseases; Hematuria; Humans; Madagascar; Morbidity; National Health Programs; Population Surveillance; Prevalence; Schistosomiasis haematobia; Sensitivity and Specificity; Sex Distribution; Students; Surveys and Questionnaires

Reduction of morbidity is the main component in the National Schistosomiasis Control Program in Madagascar. The lot quality assurance sampling (LQAS) method has previously been shown as a useful tool in assessment of immunization coverage. A study was carried in the western part of Madagascar aiming to evaluate the applicability of the method in measuring the level of Schistosoma haematobium endemic level in different communities. Parasitological examination of urine samples from 1,124 children aged 5 to 19 years from 12 different schools by use of filtration technique constituted the reference in determining the prevalence. Three schools were found hyper-endemic (prevalence more than 60%), 5 schools were intermediate-endemic (prevalence between 30 to 59%), and 4 were hypo-endemic (prevalence less than 30%). Those figures indicate a heterogeneous distribution of S. haematobium in the study area. A sampling plan (16.6) was then tested in the same area while other sampling plans were simulated in the laboratory. School teachers randomized under supervision the children to participate in this study and collected urine samples. All sampling plans (16.6), (14.5), (12.4), (10.3), (8.2), (6.1) et (4.0) allowed correct identification of hyper-endemic and hypo-endemic areas. Misclassifications occurred frequently for intermediate-endemic areas. The study confirms that the LQAS method by use of a (16.6) sampling plan constitute a valuable tool for large scale screening of hyper-endemic areas for therapeutic intervention as part of the control program. The study has also shown that school teachers may offer a potential source of manpower locally in such screening operations.

Topics: Adolescent; Child; Child, Preschool; Endemic Diseases; Female; Humans; Madagascar; Male; Mass Screening; Population Surveillance; Prevalence; Quality Assurance, Health Care; Sampling Studies; Schistosomiasis haematobia; School Health Services; Schools; Sensitivity and Specificity

Of the four species of Bulinus found on Madagascar, three species: B. obtusispira, B. liratus and B. bavayi are endemic while the fourth, B. forskalii, is probably a recent introduction from the African mainland. The evolutionary relationships of these species with Bulinus species from Africa were studied by phylogenetic analysis of DNA sequence variation at two mitochondrial loci: cytochrome oxidase subunit I (COI) and large ribosomal subunit (LSU) or 16S. The observed levels of nucleotide divergence within Bulinus were substantial but may underestimate the true levels as there was evidence of 'saturation' of transitional substitutions at both loci. A putative secondary structure model for the sequenced segment of the 16S was developed. Subsequent phylogenetic analysis using transversional changes only for both loci, showed that there were contrasting levels of divergence within the four species groups. B. obtusispira was consistently placed within the B. africanus group, appearing ancestral to this group and was closest to the basal node within Bulinus. Together with B. bavayi, the two species appear to have been isolated on Madagascar for a long time, contrasting with both B. liratus and B. forskalii that appear more recent colonisers; however, estimate of exact times of divergence is problematic. A PCR-RFLP assay was developed to enable identification and discrimination of B. obtusispira and B. liratus using discriminatory variation within the COI. To enable population genetic analysis within B. obtusispira, microsatellite markers were developed using an enrichment method and 8 primer pairs are reported. Laboratory infection experiments using Madasgacan S. haematobium from the Mahabo area showed that certain populations of B. obtusispira, B. liratus and B. bavayi were compatible.

Topics: Animals; Base Sequence; Bulinus; DNA, Mitochondrial; DNA, Ribosomal; Electron Transport Complex IV; Evolution, Molecular; Genetic Markers; Humans; Madagascar; Molecular Sequence Data; Phylogeny; Polymerase Chain Reaction; Polymorphism, Restriction Fragment Length; RNA, Ribosomal, 16S; Schistosoma haematobium; Schistosomiasis haematobia; Sequence Homology, Nucleic Acid

Detection of Schistosoma haematoblum eggs in 43% of semen samples with Increased levels of eosinophil cationic protein suggests that the genital organs of men are frequently affected with schistosomiasis.. This community-based cross-sectional study was undertaken to assess the frequency of genital schistosomiasis among men in Androvakely, Madagascar, where Schistosoma haematobium is prevalent. Egg excretion and levels of eosinophil cationic protein (ECP) were measured in paired urine and semen samples obtained from 44 males eligible for the study. Findings revealed that the eggs of S. haematobium were detected in 25 urine samples (57%) and in 19 semen samples (43%). The median egg output (range) in urine was 10 eggs/ml (1-950); in semen, 3 eggs/ejaculate (1-19). Median ECP concentration in urine was 2.2 mcg/l; in semen, 109.0 mcg/l. Moreover, the concentration of ECP in urine was positively correlated with the number of eggs excreted in urine, and increased levels of seminal ECP were significantly associated with the presence of eggs in semen. The presence of eggs in 43% of the semen samples indicated that genitals were common sites for oviposition in men with S. haematobium infection. Based on the findings, a similar effect of genital schistosomiasis on HIV shedding in men, with egg deposition in the genital organs, can lead to an inflammatory response, which may then increase the viral load in semen from HIV-positive people.

Topics: Adolescent; Adult; Animals; Blood Proteins; Cross-Sectional Studies; Eosinophil Granule Proteins; Eosinophils; Genital Diseases, Male; Humans; Madagascar; Male; Middle Aged; Ribonucleases; Schistosoma haematobium; Schistosomiasis haematobia; Semen

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 appropriate 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.

Topics: Abortion, Spontaneous; Adolescent; Adult; Female; Genital Diseases, Female; Humans; Madagascar; Menstruation Disturbances; Middle Aged; Pregnancy; Prevalence; Rural Population; Schistosomiasis haematobia; Social Class; Surveys and Questionnaires; Ultrasonography

This prospective study was designed to look for and describe urologic and nephrologic consequences of urinary bilharziosis due to schistosoma haematobium in a hyperendemic hotbed in the middle west of Madagascar. Methodology included clinical examination, kidney and bladder ultrasonography, urine dipsticks and creatininemia. Amongst a population of 574 persons aged 5 years ore more, 436 (76%) had bilharziosis ova in the urine (filtration method). From the clinical point of view, 257 patients (58.9%) had microscopic hematuria, 178 (40.8%) had presently an hematuria; 111 patients (25.5%) suffered from dysuria; 18 patients (4.1%) had limb oedema when 3 patients had present oedema (0.7%). Among 436 checked people, 267 (61.2%) had an ultrasonography abnormality. In 252, it was bladder wall abnormalities (57.8%). They were wall irregularities in 182 cases (41.7%); vesico-ureteral reflux in 22 cases (5.3%); ureteral dilatations in 22 cases (5.3%) and pyelocalyceal dilatations in 61 cases (13.9%). Prevalence of proteinuria 75.2% (316 amongst 420 checked people) of whom 5.7% (24 cases) had 5 g/l or more. Hematuria was found in 352 patients (83.8%) of whom 238 (56.7%) had more than 250 erythrocytes per microliter. Prevalence of leucocyturia was 56.7% (238 cases). Creatininemia was measured in 140 people with positive filtration; it was normal in all except two patients. This study highlights the parallel evolution between parasitic infection and uronephrological manifestations of the disease.

Topics: Adolescent; Adult; Age Distribution; Aged; Child; Female; Humans; Kidney Diseases; Madagascar; Male; Middle Aged; Prevalence; Prospective Studies; Schistosomiasis haematobia; Urinary Bladder Diseases

Female genital schistosomiasis, FGS, was investigated in a gynaecological study as part of an overall community based morbidity survey, including parasitological and ultrasonographical examination, of a Schistosoma haematobium endemic area in Madagascar. Women (103), of childbearing age (15-49 years), were included for a gynaecological examination and visible lesions of vagina and cervix were biopsied in order to determine the origin of the lesion. Furthermore all women were screened for the presence of schistosome ova using PAP smears from the vagina and the endo/exo cervix. In total 15 women showed schistosome ova in the vagina and/or cervix (median age 24 years and range 15-36 years). Of 36 women with cervical abnormalities, 12 eggs were detected by cervical biopsy (33%). In addition, two of the 12 presented vaginal induration, which contained eggs. Six women had eggs in their PAP smears of which three were egg negative by cervical biopsy. The prevalence of positive S. haematobium egg excretion in the urine among the 103 women was 69% and the geometric mean egg count of positive individuals was 51 eggs/10 ml of urine. Five of the 15 women with confirmed FGS had < or = 1 egg/10 ml of urine. Bladder lesions and congestive changes in the kidneys were demonstrated by ultrasonographic examination in 33 and 9% of the 103 women, respectively. None of the 15 women with confirmed FGS had renal congestion. Our study demonstrates that FGS is a common manifestation of the infection with S. haematobium, even in lightly infected individuals.

Topics: Adolescent; Adult; Animals; Cervix Uteri; Female; Genitalia, Female; Humans; Madagascar; Middle Aged; Schistosoma haematobium; Schistosomiasis haematobia; Vagina; Vulva

Experimental investigation on a malagasy strain of S. haematobium: compatibility with different Bulinus snails, potential intermediate hosts. A comparative experimental study of the infectivity of different Bulinus snails by a reference S. haematobium strain was made under laboratory conditions. The results support the role of Bulinus obtusispira as an intermediate host in Madagascar but some other Bulinus species could exist and play a role in the fields far away from the experimental criteria here described.

Topics: Adolescent; Animals; Bulinus; Disease Vectors; Female; Humans; Madagascar; Schistosomiasis haematobia

This study of schistosomiasis and intestinal parasites was carried out on 496 children in the Firaisana (District) of Ankilivalo in Western Madagascar. The prevalence of these parasites was determined and data collected on nutrition, agriculture and the use of water in order to gain an understanding of the transmission and effects of these parasites. Recommendations for their control are suggested. In two schools within the area of a major irrigation scheme the prevalence of urinary schistosomiasis was 69%, and 50% suffer from at least one intestinal worm. In a school outside the main irrigation area, the prevalence of schistosomiasis was much lower (7%). Ultimately the control of schistosomiasis will depend on improvements to the irrigation and drainage infrastructure, and in standards of sanitation. However, chemotherapy is the only method of bringing the disease under control in the short term.

Topics: Adolescent; Animals; Bulinus; Child; Child Nutritional Physiological Phenomena; Female; Fresh Water; Helminthiasis; Humans; Madagascar; Male; Schistosomiasis haematobia; Swimming; Water; Water Supply

This study of bilharzia and other intestinal parasites was carried out on 496 children in the Firaisana of Ankilivalo. As well as determine the prevalence of these parasites, data was collected on nutrition, agriculture and the use of water in order to gain an understanding of the transmission and effects of these parasites, and hence make recommendations for their control. In two schools within the area of a major irrigation scheme the prevalence of bilharzia was 69%, and 50% of children suffer from at least one other intestinal worm. In a school outside the main irrigation area, the prevalence was much lower (7%), but nutritional standards were also lower. Ultimately, control of bilharzia will depend on improvements to the irrigation and drainage infrastructure, and in standards of sanitation. However, chemotherapy is the only method of bringing the disease under control in the short term.

Topics: Adolescent; Ancylostomiasis; Ascariasis; Child; Child, Preschool; Female; Humans; Intestinal Diseases, Parasitic; Madagascar; Male; Schistosomiasis haematobia; Trichuriasis

In field studies in Schistosoma haematobium endemic areas, dried filters must be transported in bulk to central laboratories, either for primary screening and counting, or for quality control of field workers. We examined filters before and after bulk transport, from three populations, of high, medium and low prevalence rate. A total of 312 filters were examined before and after transport; 28.6% of all eggs on filters were lost during transport. Negative filters became positive during transport, and hence false prevalence rates resulted from after transport studies. Egg loss did not seem to be related to initial egg density. The operational results of these findings could be serious, in terms of distribution of treatment and evaluation of results and costs.

Topics: Animals; False Positive Reactions; Humans; Madagascar; Parasite Egg Count; Schistosoma haematobium; Schistosomiasis haematobia; Specimen Handling; Urine