Epidemiology of mixed Schistosoma mansoni and Schistosoma haematobium infections in northern Senegal

Due to the large overlap of Schistosoma mansoni- and Schistosoma haematobium-endemic regions in Africa, many people are at risk of co-infection, with potential adverse effects on schistosomiasis morbidity and control. Nonetheless, studies on the distribution and determinants of mixed Schistosoma infections have to date been rare. We conducted a cross-sectional survey in two communities in northern Senegal (n=857) to obtain further insight into the epidemiology of mixed infections and ectopic egg elimination. Overall prevalences of S. mansoni and S. haematobium infection were 61% and 50%, respectively, in these communities. Among infected subjects, 53% had mixed infections and 8% demonstrated ectopic egg elimination. Risk factors for mixed infection - i.e. gender, community of residence and age - were not different from what is generally seen in Schistosoma-endemic areas. Similar to overall S. mansoni and S. haematobium infections, age-related patterns of mixed infections showed the characteristic convex-shaped curve for schistosomiasis, with a rapid increase in children, a peak in adolescents and a decline in adults. Looking at the data in more detail however, the decline in overall S. haematobium infection prevalences and intensities appeared to be steeper than for S. mansoni, resulting in a decrease in mixed infections and a relative increase in single S. mansoni infections with age. Moreover, individuals with mixed infections had higher infection intensities of both S. mansoni and S. haematobium than those with single infections, especially those with ectopic egg elimination (P<0.05). High infection intensities in mixed infections, as well as age-related differences in infection patterns between S. mansoni and S. haematobium, may influence disease epidemiology and control considerably, and merit further studies into the underlying mechanisms of Schistosoma infections in co-endemic areas.     

The Substrate-free and -bound Crystal Structures of the Duplicated Taurocyamine Kinase from the Human Parasite Schistosoma mansoni

The taurocyamine kinase from the blood fluke Schistosoma mansoni (SmTK) belongs to the phosphagen kinase (PK) family and catalyzes the reversible Mg²⁺-dependent transfer of a phosphoryl group between ATP and taurocyamine. SmTK is derived from gene duplication, as are all known trematode TKs. Our crystallographic study of SmTK reveals the first atomic structure of both a TK and a PK with a bilobal structure. The two unliganded lobes present a canonical open conformation and interact via their respective C- and N-terminal domains at a helix-mediated interface. This spatial arrangement differs from that observed in true dimeric PKs, in which both N-terminal domains make contact. Our structures of SmTK complexed with taurocyamine or l-arginine compounds explain the mechanism by which an arginine residue of the phosphagen specificity loop is crucial for substrate specificity. An SmTK crystal was soaked with the dead end transition state analog (TSA) components taurocyamine-NO₃²⁻-MgADP. One SmTK monomer was observed with two bound TSAs and an asymmetric conformation, with the first lobe semiclosed and the second closed. However, isothermal titration calorimetry and enzyme kinetics experiments showed that the two lobes function independently. A small angle x-ray scattering model of SmTK-TSA in solution with two closed active sites was generated.     

Interpreting low praziquantel cure rates of Schistosoma mansoni infections in Senegal

Praziquantel is currently the drug of choice for the treatment of schistosomiasis. Selective treatment of Schistosoma mansoni infections in various endemic countries usually present cure rates of >70% when using the standard dose of 40 mg kg(-1) body weight of praziquantel. However, unusually low cure rates (18-38%) have been reported from Senegal, raising fears for emergence of resistance (or tolerance) to praziquantel. One major problem is the precise quantitative interpretation of cure rates, which allows an unequivocal distinction between drug failure and normal drug performance. This article reviews studies on praziquantel treatment of population by standardizing the data through an innovative meta-analysis and provides empirical evidence concerning the extent to which the reported low cure rates from Senegal are atypical.     

Identification of the Schistosoma mansoni TNF-Alpha Receptor Gene and the Effect of Human TNF-Alpha on the Parasite Gene Expression Profile

Background

Schistosoma mansoni is the major causative agent of schistosomiasis. The parasite takes advantage of host signals to complete its development in the human body. Tumor necrosis factor-alpha (TNF-α) is a human cytokine involved in skin inflammatory responses, and although its effect on the adult parasite''s metabolism and egg-laying process has been previously described, a comprehensive assessment of the TNF-α pathway and its downstream molecular effects is lacking.

Methodology/Principal Findings

In the present work we describe a possible TNF-α receptor (TNFR) homolog gene in S. mansoni (SmTNFR). SmTNFR encodes a complete receptor sequence composed of 599 amino acids, and contains four cysteine-rich domains as described for TNFR members. Real-time RT-PCR experiments revealed that SmTNFR highest expression level is in cercariae, 3.5 (±0.7) times higher than in adult worms. Downstream members of the known human TNF-α pathway were identified by an in silico analysis, revealing a possible TNF-α signaling pathway in the parasite. In order to simulate parasite''s exposure to human cytokine during penetration of the skin, schistosomula were exposed to human TNF-α just 3 h after cercariae-to-schistosomula in vitro transformation, and large-scale gene expression measurements were performed with microarrays. A total of 548 genes with significantly altered expression were detected, when compared to control parasites. In addition, treatment of adult worms with TNF-α caused a significantly altered expression of 1857 genes. Interestingly, the set of genes altered in adults is different from that of schistosomula, with 58 genes in common, representing 3% of altered genes in adults and 11% in 3 h-old early schistosomula.

Conclusions/Significance

We describe the possible molecular elements and targets involved in human TNF-α effect on S. mansoni, highlighting the mechanism by which recently transformed schistosomula may sense and respond to this host mediator at the site of cercarial penetration into the skin.     

Changes in tegumental surface during development of Schistosoma mansoni

The tegumental surface of immature Schistosoma mansoni was studied with the scanning electron microscope. The surfaces of immature males and females bear no resemblance to that of adult worms and are characterized by having many tegumental folds. The tegumental surfaces of immature males and females are similar, and the dorsal and ventral surfaces of the male are similar before formation of the gynecophoral canal. Transition of the tegumental surface from the juvenile to the adult form begins after worms are in copula and have grown to several millimeters in length.     

Increase of malaria attacks among children presenting concomitant infection by Schistosoma mansoni in Senegal

Background

Parasites incur periodic mutations which must ultimately be eliminated to maintain their genetic integrity.

Methods

It is hypothesised that these mutations are eliminated not by the conventional mechanisms of competition between parasites in different hosts but primarily by competition between parasites within the same infection.

Results

This process is enhanced by the production of a large number of parasites within individual infections, and this may significantly contribute to parasitic virulence.

Conclusions

Several features of the most virulent human malaria parasite Plasmodium falciparum can usefully be re-interpreted in this light and lend support to this interpretation. More generally, it constitutes a novel explanation for the evolution of virulence in a wider range of microparasites.     

Glycomic Analysis of Life Stages of the Human Parasite Schistosoma mansoni Reveals Developmental Expression Profiles of Functional and Antigenic Glycan Motifs

Glycans present on glycoproteins and glycolipids of the major human parasite Schistosoma mansoni induce innate as well as adaptive immune responses in the host. To be able to study the molecular characteristics of schistosome infections it is therefore required to determine the expression profiles of glycans and antigenic glycan-motifs during a range of critical stages of the complex schistosome lifecycle. We performed a longitudinal profiling study covering schistosome glycosylation throughout worm- and egg-development using a mass spectrometry-based glycomics approach. Our study revealed that during worm development N-glycans with Galβ1–4(Fucα1–3)GlcNAc (LeX) and core-xylose motifs were rapidly lost after cercariae to schistosomula transformation, whereas GalNAcβ1–4GlcNAc (LDN)-motifs gradually became abundant and predominated in adult worms. LeX-motifs were present on glycolipids up to 2 weeks of schistosomula development, whereas glycolipids with mono- and multifucosylated LDN-motifs remained present up to the adult worm stage. In contrast, expression of complex O-glycans diminished to undetectable levels within days after transformation. During egg development, a rich diversity of N-glycans with fucosylated motifs was expressed, but with α3-core fucose and a high degree of multifucosylated antennae only in mature eggs and miracidia. N-glycan antennae were exclusively LDN-based in miracidia. O-glycans in the mature eggs were also diverse and contained LeX- and multifucosylated LDN, but none of these were associated with miracidia in which we detected only the Galβ1–3(Galβ1–6)GalNAc core glycan. Immature eggs also exhibited short O-glycan core structures only, suggesting that complex fucosylated O-glycans of schistosome eggs are derived primarily from glycoproteins produced by the subshell envelope in the developed egg. Lipid glycans with multifucosylated GlcNAc repeats were present throughout egg development, but with the longer highly fucosylated stretches enriched in mature eggs and miracidia. This global analysis of the developing schistosome''s glycome provides new insights into how stage-specifically expressed glycans may contribute to different aspects of schistosome-host interactions.Schistosoma blood flukes give rise to infections in over 200 million people in developing countries worldwide (1). With a Disability-Adjusted Life Years (DALY) value of more than 3 million, schistosomiasis ranks as one of the neglected tropical diseases with the highest impact on public health (2). The schistosome has a complex and intriguing lifecycle, which involves a definitive host (mammal) as well as an intermediate host (snail). Infections with Schistosoma mansoni, one of the major schistosome species infecting humans, are initiated when snail-borne cercariae penetrate intact skin. The cercariae then transform into schistosomula, which enter the vasculature of the host and mature while migrating to the portal system. Here, adult male and female worms pair, with the female worm producing hundreds of eggs each day during a life span of several years unless the infection is treated by chemotherapy. Miracidia develop inside the maturing eggs while they cross the intestinal wall over a period of several days to be excreted with the feces. Miracidia then hatch from the eggs upon contact with fresh water and infect the snail host where asexual replication takes place and eventually new cercariae are shed. Notably, many eggs get trapped in organs such as the liver, where they induce a granulomatous inflammation and organ damage, the main cause of pathology in schistosomiasis (1).Throughout their lifecycle, schistosomes express a multitude of protein- and lipid-linked glycans that play an important role in the parasite biology. The expression of many glycan elements appears to be developmentally regulated by the differential expression of glycosyltransferases during the different lifecycle stages (3). A series of papers has been published indicating that schistosome glycans play essential roles in the molecular interaction of the parasite and the host immune system, enabling survival of the parasite and allowing chronic infection to establish. For example, glycosylated soluble egg antigens (SEA) interact with the C-type lectins mannose receptor (MR), macrophage galactose-type lectin (MGL) and dendritic cell-specific ICAM-3-grabbing nonintegrin (DC-SIGN), and some of these interactions lead to immunomodulatory effects of specific components of SEA via dendritic cells (DCs)¹ (4, 5). Furthermore, fucosylated egg glycolipids trigger innate immune responses of peripheral blood mononuclear cells and egg glycans are required for periovular granuloma formation in a mouse model. In addition, cercarial secretions induce alternatively activated macrophages in a carbohydrate dependent manner (6–9). Importantly, also adaptive immune responses to schistosome glycans are mounted by the human host. A large part of the antibody responses to schistosomes is directed against antigenic glycan motifs, raising the question whether they could form a basis for antischistosome vaccine strategies (10).Rapid developments in mass spectrometry-based glycan-analysis technology in the last two decades have led to several studies focused on elucidating the glycan structures of somatic and secretory schistosome preparations (11–22). Among the typical glycan elements detected in S. mansoni were unusual and antigenic Fucα1–2Fucα1–3- (DF-) motifs attached to GalNAcβ1–4GlcNAc (LacDiNAc or LDN) (12, 14, 17–19, 21), Xylβ1–2- and Fucα1–3-modified N-glycan core structures (13, 15, 17, 20), and a unique O-glycan core (Galβ1–3(Galβ1–6)GalNAc) (14, 17) (see supplemental Table S5 for a definition of glycan motifs of S. mansoni glycoconjugates). Also more widely occurring glycan elements shared with the mammalian or snail host were detected, e.g. Galβ1–4GlcNAc (LacNAc or LN), Galβ1–4(Fucα1–3)GlcNAc (Lewis X or LeX), LDN, and GalNAcβ1–4(Fucα1–3)GlcNAc (LDN-F) (23, 24). These data were generated over a long period of time, often focusing on a single schistosome life stage and a specific class of glycans only, and using various analytical techniques and strategies that make inter-study comparisons often difficult. In addition, glycosylation of the schistosomula that develop shortly after infection and are considered to be relatively vulnerable to immune attack, has remained largely unexplored (20, 25, 26), although these could be interesting therapeutic targets (27–29). Clearly, an integrated and complete overview of schistosome glycosylation was so far not available.In this study, we therefore set out to determine the overall schistosome protein- and lipid-linked glycome by analyzing a total of 16 lifecycle stages ranging from cercariae to miracidia. We analyzed the glycoprotein-derived N- and O-glycans as well as the lipid-derived glycans of these life stages by a MALDI-TOF MS-based approach complemented with fragmentation and enzyme degradation studies. Our findings give new insights in the glycobiology of parasite development and parasite–host interaction and contribute to the identification of new potential immune intervention targets.     

Cytokine Responses to Schistosoma mansoni and Schistosoma haematobium in Relation to Infection in a Co-endemic Focus in Northern Senegal

Background

In Africa, many areas are co-endemic for the two major Schistosoma species, S. mansoni and S. haematobium. Epidemiological studies have suggested that host immunological factors may play an important role in co-endemic areas. As yet, little is known about differences in host immune responses and possible immunological interactions between S. mansoni and S. haematobium in humans. The aim of this study was to analyze host cytokine responses to antigens from either species in a population from a co-endemic focus, and relate these to S. mansoni and S. haematobium infection.

Methodology

Whole blood cytokine responses were investigated in a population in the north of Senegal (n = 200). Blood was stimulated for 72 h with schistosomal egg and adult worm antigens of either Schistosoma species. IL-10, IL-5, IFN-γ, TNF-α, and IL-2 production was determined in culture supernatants. A multivariate (i.e. multi-response) approach was used to allow a joint analysis of all cytokines in relation to Schistosoma infection.

Principal Findings

Schistosoma haematobium egg and worm antigens induced higher cytokine production, suggesting that S. haematobium may be more immunogenic than S. mansoni. However, both infections were strongly associated with similar, modified Th2 cytokine profiles.

Conclusions/Significance

This study is the first to compare S. mansoni and S. haematobium cytokine responses in one population residing in a co-endemic area. These findings are in line with previous epidemiological studies that also suggested S. haematobium egg and worm stages to be more immunogenic than those of S. mansoni.     

Rodents as reservoir hosts in the transmission of Schistosoma mansoni in Richard-Toll, Senegal, West Africa

More than 2000 animals belonging to six different rodent species and one insectivore species were examined for infection with schistosomes in the region of Richard-Toll, Senegal. Two murid rodents, Arvicanthis niloticus and Mastomys huberti, were found infected with Schistosoma mansoni. Prevalences were about 5% for both rodent species with a mean worm burden of about 20 worms per host. The sex-ratios of S. mansoni worms were always biased towards males. Prevalences and worm burdens, although similar in both male and female rodents, increased significantly with age. The highest prevalences and worm burdens were found near habitations and decreased significantly with the distance from the town of Richard-Toll. Eggs were also observed in the liver and faeces of the two naturally infected rodent species. The results suggest that rodents participate in the transmission of intestinal schistosomiasis in Richard-Toll but the human population is the main source of infection. The genetic resemblance between human and murine isolates of S. mansoni suggests that further epidemiological studies are needed in this region of Senegal.     

Micro-Geographical Heterogeneity in Schistosoma mansoni and S. haematobium Infection and Morbidity in a Co-Endemic Community in Northern Senegal

Background

Schistosoma mansoni and S. haematobium are co-endemic in many areas in Africa. Yet, little is known about the micro-geographical distribution of these two infections or associated disease within such foci. Such knowledge could give important insights into the drivers of infection and disease and as such better tailor schistosomiasis control and elimination efforts.

Methodology

In a co-endemic farming community in northern Senegal (346 children (0–19 y) and 253 adults (20–85 y); n = 599 in total), we studied the spatial distribution of S. mansoni and S. haematobium single and mixed infections (by microscopy), S. mansoni-specific hepatic fibrosis, S. haematobium-specific urinary tract morbidity (by ultrasound) and water contact behavior (by questionnaire). The Kulldorff''s scan statistic was used to detect spatial clusters of infection and morbidity, adjusted for the spatial distribution of gender and age.

Principal Findings

Schistosoma mansoni and S. haematobium infection densities clustered in different sections of the community (p = 0.002 and p = 0.023, respectively), possibly related to heterogeneities in the use of different water contact sites. While the distribution of urinary tract morbidity was homogeneous, a strong geospatial cluster was found for severe hepatic fibrosis (p = 0.001). Particularly those people living adjacent to the most frequently used water contact site were more at risk for more advanced morbidity (RR = 6.3; p = 0.043).

Conclusions/Significance

Schistosoma infection and associated disease showed important micro-geographical heterogeneities with divergent patterns for S. mansoni and S. haematobium in this Senegalese community. Further in depth investigations are needed to confirm and explain our observations. The present study indicates that local geospatial patterns should be taken into account in both research and control of schistosomiasis. The observed extreme focality of schistosomiasis even at community level, suggests that current strategies may not suffice to move from morbidity control to elimination of schistosomiasis, and calls for less uniform measures at a finer scale.     

The infectivity of Schistosoma mansoni in mice, following dipping with an acaricide

The effect of prior treatment of mice with an acaricide (Alugan) on the infectivity of Schistosoma mansoni cercariae via the percutaneous route was assessed. No effects were observed, even in animals dipped only 1 day before exposure to cercariae.     

Dynamics of the cytokine messenger RNA expression pattern in the liver of baboons infected with Schistosoma mansoni

Periovular granulomas are the major lesions in baboons infected with Schistosoma mansoni. Temporal Northern blot analysis of cytokine messenger RNA (mRNA) expression in granulomatous baboon livers demonstrated tissue-specific expression. Interleukin 1 beta (IL-1beta, IL-6, tumor necrosis factor alpha, and migration inhibitory factor (MIF) mRNAs were expressed strongly at week 6 of infection and decayed thereafter, whereas interferon gamma (IFN-gamma), IL-2, IL-10, and IL-12 mRNAs were first expressed at week 12, with IFN-gamma and IL-12 mRNA expression persisting until week 17. IL-4 and IL-5 mRNAs first appeared at week 12, with IL-4 persisting unchanged and IL-5 increasing by week 17. Thus, egg deposition induced strong hepatic expression of proinflammatory and downregulatory cytokines. The cooccurrence of IL-2, IFN-gamma, IL-4, and IL-5 mRNAs at week 12 confirms that baboons, like humans, show a mixed type 1-type 2 cytokine response. When granulomas had become smaller at 17 wk, IFN-gamma, IL-4, and IL-5 were the only cytokine mRNAs that were expressed strongly, implicating them in granuloma modulation. The early expression of MIF mRNA and MIF's role as the main counterregulator of glucocorticoid immunosuppression ties in with our earlier demonstrations of circulating adrenal steroids changing with the progression of schistosomiasis in baboons and of proinflammatory cytokine mRNA expression in the hypothalamic-pituitary-adrenal axis tissues of infected baboons. Together, these data imply neuroendocrinological influences on disease progression in schistosomiasis.