Schistosoma mansoni population structure and persistence after praziquantel treatment in two villages of Bahia, Brazil

Praziquantel has been used to treat schistosome infections since 1979 and currently is the only chemotherapeutic agent in production for this purpose, raising concerns about the potential for the emergence of drug resistance. In practice, 10-20% of infected patients will continue to excrete eggs after treatment. It is not understood to what degree this represents selection of a resistant population or incomplete elimination due to the presence of immature worms at the time of treatment. We used a population genetics approach to test whether or not persistent Schistosomamansoni parasites were drawn from the same population as susceptible parasites. In this study, stool samples were collected from 96% of individuals in two small Brazilian communities (populations 482 and 367) and examined for S.mansoni eggs. The combined prevalence of S.mansoni infections in the villages was 41%. Total egg DNA was extracted from each sample and was genotyped at 15 microsatellite markers. Day-to-day variation of the infrapopulation from an individual human host was low (median differentiation using Jost’s D = 0.010), so that a single stool was representative of the genotypes present in stool eggs, at least in the short term. Average pairwise analysis of D among all pre-treatment infrapopulations suggested moderate differentiation (mean D = 0.082 and 0.122 for the two villages), whereas the pre-treatment component population differentiation between the two communities was 0.047. The differentiation of the component population remaining after treatment from the fully susceptible component population was low (mean D = 0.007 and 0.020 for the two villages), suggesting that the persistent parasites were not selected by praziquantel treatment. We will continue to follow these communities for evidence of selection or changes in population structure.     

Random spatial distribution of Schistosoma mansoni and hookworm infections among school children within a single village

Schistosomes and soil-transmitted helminths currently infect a third of the world's human population. An important feature of these parasitic infections is their focal distribution, which has significant implications for control. Only a few studies have been carried out at the microepidemiological scale, comparing infection levels among individuals or households within a single village. In this study, data are presented from a cross-sectional survey, examining all children attending a primary school in rural C?te d'Ivoire over several consecutive days for Schistosoma mansoni, soil-transmitted helminths, and intestinal protozoa. All houses in the main village were mapped, and school children were linked to these households for small-area spatial analyses. Comparison between the 260 school children who live within the main village and the 89 children who reside in nearby settlements revealed significant differences in the overall prevalence and intensity of infections with S. mansoni and hookworm, confirming the focal nature of these 2 parasites. On the other hand, S. mansoni and hookworm infections exhibited random spatial patterns within the main village. The validity of these results is discussed in the context of this epidemiological setting, drawing attention to the issue of scale. Our findings have direct implications for intervention because they call for a uniform, community-wide approach to control schistosomiasis and soil-transmitted helminthiasis. Implementation can be relatively straightforward, and the proposed control approach might be cost-effective and prove sustainable.     

High levels of Schistosoma mansoni infections among schoolchildren in central Sudan one year after treatment with praziquantel

A longitudinal study was conducted to evaluate the impact of praziquantel (PZQ) for the treatment of Schistosoma mansoni infection among schoolchildren in Al Gunaid in Central Sudan. A cohort of schoolchildren (6-15 years of age) was investigated before and 1 year after treatment with a single dose of PZQ 40?mg/kg. Parasitological examinations for S. mansoni were performed before and after treatment, and prevalence and intensity of infection were analysed. Of 2741 schoolchildren recruited from six elementary schools at baseline, 2521 were successfully traced and re-examined at follow-up, with two complete sets of longitudinal parasitological data on S. mansoni. Boys showed significantly higher prevalence of S. mansoni infection than girls. A single dose of PZQ reduced the overall prevalence of S. mansoni infection by 36.7% (from 59.1 to 37.4%) and the intensity of infection by 41.1% (from 116.7 to 68.7 eggs per gram of stool) 1 year after treatment. The reduction in prevalence was significantly higher among the group of children with heavy infections (by 76.1%, from 6.7 to 1.6%) and among girls (by 54.1%, 42.3 to 19.4%) at 1 year after treatment. Thus, in spite of a significant reduction in the prevalence and intensity of S. mansoni infection 1 year after PZQ treatment, the prevalence of the disease was still high and further research is needed on this topic.     

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.     

Assessment of Heavy Metals Contamination in Agricultural Soil of Southwestern Nile Delta,Egypt

The spatial and vertical distributions of heavy metals were quantitatively determined for organic-rich agricultural soils in the Southwestern Nile Delta. This study aims to undertake an assessment of heavy metals contamination in the soils of Quessna district using the inductively coupled plasma-optical emission spectroscopy, remote sensing, and geographic information system techniques. In this study, 24 soil samples were collected at 12 sites representing the main suburbs in the Quessna district. The concentrations of the studied metals decreased in the order of Zn > Cr > Pb > Cu > Ni > Co. The contamination degree and ecological risk assessment for metals in soil samples were evaluated using the enrichment factor, geoaccumulation index, improved Nemerow's pollution index, Pollution load index, and potential ecological risk index. The spatial and vertical distribution of heavy metals concentrations were affected by soil properties such as clay and organic matter content and scavenger metals (Fe and Mn). The intensive urbanization, industrial activity, and agricultural practices are thought to be the main anthropogenic sources of heavy metals contamination. Further studies especially human health risk assessment are recommended to investigate possible risks for humans from heavy metals in this area.     

Consequences of multiple infection with Plasmodium falciparum in an area of high endemicity

Most Plasmodium falciparum infections occur in partially immune hosts in highly endemic areas. In such situations, many hosts are simultaneously infected with multiple parasite genotypes, which must lead to intense competition between different parasite populations. We here summarise a series of studies of multiple infection, mostly using polymerase chain reaction-restriction fragment polymorphism (PCR-RFLP) genotyping of the highly polymorphic msp-2 gene. These indicate that chronic infections, characteristic of the partially immune host, appear to protect against super-infecting parasites. This protection is not seen in infants. A consequence is that selection for fast-growing (virulent) parasites, occurs mainly in the youngest, immunologically na?ve, hosts. The normal situation for P. falciparum is one in which the host is partially immune, and competition between parasite genotypes in this situation is not expected to result in selection for virulence.     

Status of intestinal parasites infection among primary school children in Kampongcham,Cambodia

A survey was made to find the extent of intestinal parasite infection in Kampongcham, Cambodia in February 2002. A total of 251 fecal specimens were collected from Tonlebat primary school children and examined by formalin-ether sedimentation technique. The overall infection rate of intestinal parasite was 54.2% (males, 57.3%; females, 50.8%). The infection rate of intestinal helminths by the species were as follows: Ascaris lumbricoides 26.3%, Echinostoma sp. 15.6%, hookworm 6.4%, Opisthorchis sp. 4.0%, Rhabditis sp. 2.4%, and Trichuris trichiura 0.4%. The infection rate of intestinal protozoa were as follows: E. coli 7.6%, G. lamblia 3.2%, I. butschlii 3.2%, and E. histolytica 0.8%. More than two different kinds of parasites were found in 16.7% of the stool samples. All the children infected were treated with albendazole, praziquantel and metronidazole according to parasite species. The results showed that intestinal parasites are highly endemic in this area.     

Environmental relationships of aquatic vegetation in the fresh water ecosystem of the Nile Delta,Egypt

In generalized four sectors, 350 stands (water channels) in 50 selected and geo‐referenced sites with eighteen environmental factors were surveyed. The total number of recorded species varied from a sector to another: 21 in the northern, nineteen in the middle, seventeen in the western and sixteen in the eastern. New populations of Cyperus papyrus were explored. Vallisneria spiralis, Elodea canadensis and Najas armata were among seven extinct species that were not recorded few decades ago. The floristic composition alteration may be because of the addition of organic matter of plant and animal origin and the discharge of industrial and sewage effluents. Classification and ordination analyses (DCA) resulted in the segregation of seventeen vegetation groups (communities), three of them were repeatedly recorded; namely Phragmites australis‐Eichhornia crassipes, Phragmites australis‐Myriophyllum spicatum and Potamogeton pectinatus‐Myriophyllum spicatum. Phragmites australis‐Cyperus papyrus group was a new community spreading in the eastern sector of the Delta. Electric conductivity, Fe, Hg and chemical oxygen demand (COD) showed high significant variation (P < 0.001) among the vegetation groups. Other significant variables were Cl, Ca, NO₃, pH and SO₄ (P < 0.047). Redundancy analysis (RDA) was chosen as the appropriate ordination method to perform direct gradient analysis. Trace elements Cu, Fe, Hg and Pb participated in the floristic and chemical composition of each sector.     

Skin reactivity to mycobacterial antigens in children living in an area of Mycobacterium xenopi endemicity

Intradermal skin tests with a 2TU dose of PPD-RT 23 prepared from M. tuberculosis and 0.1 ug/0.1 ml of PPD-RS 631 from M. xenopi were simultaneously carried out in 378 7-year-old children from two localities in North-Bohemian region's capital Ustí n. Lab., a focus of M. xenopi endemicity repeatedly confirmed since its disclosure in 1980 by positive M. xenopi isolations from humans and public water supply network. A further group 157 children serving as controls was from Prague district 4 where no presence of M. xenopi strains was ever recorded. All of these children had received routine immunization at birth with Czech BCG vaccine. The children from the two endemic localities were found to give a positive 6 mm or greater reaction to M. xenopi mycobacterin in 43.3% and 22.3%, to human tuberculin in 12.8% and 12.6%, respectively. The frequency histogram clearly separated a group of reactors with 8-18 mm indurations from a group of nonreactors showing a skin induration of 4-8 mm. The higher reactivity of this exposed child population was also reflected in a larger proportion of reactions greater to M. xenopi PPD than to human tuberculin antigen: the reactions greater by 1-5 mm accounted, respectively, for 25.1% and 20.6%, reactions greater by 6 mm or more for 23.7% and 15.9%. Among a group of children from Prague district 4, 6.4% had medium-sized and 3.8% large-sized reactions to M. xenopi antigen; the proportion of reactions greater to M. xenopi antigen than to human tuberculin accounted for only 5.1%, reactions greater to tuberculin than to sensitin were here in slight predominance. The evidenced skin sensitization to M. xenopi mycobacterin is suggested to result from the different degrees of exposure to infection by environmental mycobacteria.     

Microevolution of Dengue viruses circulating among primary school children in Kamphaeng Phet, Thailand

To determine the extent and structure of genetic variation in dengue viruses (DENV) on a restricted spatial and temporal scale, we sequenced the E (envelope) genes of DENV-1, -2, and -3 isolates collected in 2001 from children enrolled in a prospective school-based study in Kamphaeng Phet, Thailand, and diagnosed with dengue disease. Our analysis revealed substantial viral genetic variation in both time and space, with multiple viral lineages circulating within individual schools, suggesting the frequent gene flow of DENV into this microenvironment. More-detailed analyses of DENV-2 samples revealed strong clustering of viral isolates within individual schools and evidence of more-frequent viral gene flow among schools closely related in space. Conversely, we observed little evolutionary change in those viral isolates sampled over multiple time points within individual schools, indicating a low rate of mutation fixation. These results suggest that frequent viral migration into Kamphaeng Phet, coupled with population (school) subdivision, shapes the genetic diversity of DENV on a local scale, more so than in situ evolution within school catchment areas.     

Species richness and phenology of vegetation along irrigation canals and drains in the Nile Delta,Egypt

This study evaluates the species richness, phenology and effect of environmental factors on the composition of canal and drain vegetation in the Nile Delta, Egypt. Altogether, 365 stands were sampled along the terraces, slopes, littoral zones and water zones of 28 canals and 10 drains. Smooth species compositional changes were found in the first three zones. The slope plant community has the highest total number of species and species richness and a medium value of species turnover. The water zone has the lowest values of these variables.The number of species with seedlings and vegetative plants had two peaks: one in winter and the second in summer, which was related to the contrasted behaviour of the winter and summer weeds. The number of species with vegetative and fruiting plants was relatively higher, while the number with dormant plants was relatively lower in the canal vegetation when compared to that of the drains. The number of species with vegetative, flowering and fruiting plants increased with the decrease of canal-drain width.     

Population dynamics of Eichhornia crassipes (C. Mart.) Solms in the Nile Delta,Egypt

The present study aims to evaluate the growth and seasonal allocation of the biomass of water hyacinth (Eichhornia crassipes) under natural conditions in the south Mediterranean region (the Nile Delta, Egypt). In this study, the population characteristics (density, morphology and primary production) over a one‐growing‐season cycle were described. In the Nile Delta, the biomass of the shoot and root systems of E.crassipes was sampled monthly along three water courses from April 2014 to November 2014 using five quadrats (each of 0.5 m × 0.5 m) at each water course. The shoot system started to grow in April (121 g/DM/m²), reached a maximum biomass of 887 g/DM/m² in July, and then decreased until reaching a minimum of 299 g/DM/m² in November. The biomass of the root system increased from 75 g/DM/m² in April to a maximum of 235 g/DM/m² in August and decreased to a minimum of 100 g/DM/m² in November. Water hyacinth allocated ca. 2% of its total biomass to stolons, 22% to laminae, 24% to roots and 52% to petioles. Peak density as high as 144 individual/m² occurred in May, but it reduced to 33–50 individual/m² during July to November. The average rate of change of biomass was maximum (17.3 g/DM/m²/day) during April and May and minimum (?8.9 g/DM/m²/day) during October and November. Relative growth rates were found to be lowest during the cooler months, October and November (?0.017 g/DM/g /day), whereas highest yields were recorded during the spring months, April and May (up to 0.044 g/DM/g/day). The correlation coefficients between the water characteristics and the first two canonical correspondence analysis axes indicated that the separation of the population parameters of water hyacinth along the first axis was negatively influenced by Zn. On the other hand, the second axis was positively correlated with electric conductivity, total N, total P, Mg, Na, K and Mn and negatively with pH.     

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.     

Conserved classes of homeodomains in Schistosoma mansoni, an early bilateral metazoan.

Genes containing a homeobox can be divided into classes based on the distinctive peptide sequences of their diverged homeodomains. Many of these classes, including Antennapedia, engrailed and paired, are strongly conserved in higher multicellular animals, but have not previously been found in platyhelminths, the flatworms which represent the most primitive bilateral metazoans. We have screened cDNA libraries of the platyhelminth Schistosoma mansoni using a degenerate oligonucleotide derived from the third helix of the homeodomain, and have identified numerous schistosome homeobox-containing sequences, including members of the Antennapedia, engrailed and paired classes. The schistosome homeodomain sequences are more similar to the higher animals sequences in their respective classes than they are to each other, indicating that the establishment of these three distinctive classes is at least as ancient as the flatworms. Our data suggest that the ancestral functions of the Antennapedia, engrailed and paired classes involve fundamental features of all bilateral metazoan development. The putative full-length coding sequence of the S. mansoni en homologue is presented.     

Efficacy and Safety of Praziquantel in Preschool-Aged Children in an Area Co-Endemic for Schistosoma mansoni and S. haematobium

Background

In sub-Saharan Africa the recommended strategy to control schistosomiasis is preventive chemotherapy. Emphasis is placed on school-aged children, but in high endemicity areas, preschool-aged children are also at risk, and hence might need treatment with praziquantel. Since a pediatric formulation (e.g., syrup) is not available outside of Egypt, crushed praziquantel tablets are used, but the efficacy and safety of this treatment regimen is insufficiently studied.

Methodology

We assessed the efficacy and safety of crushed praziquantel tablets among preschool-aged children (<6 years) in the Azaguié district, south Côte d''Ivoire, where Schistosoma mansoni and S. haematobium coexist. Using a cross-sectional design, children provided two stool and two urine samples before and 3 weeks after treatment. Crushed praziquantel tablets, mixed with water, were administered at a dose of 40 mg/kg. Adverse events were assessed and graded 4 and 24 hours posttreatment by interviewing mothers/guardians.

Principal Findings

Overall, 160 preschool-aged children had at least one stool and one urine sample examined with duplicate Kato-Katz thick smears and a point-of-care circulating cathodic antigen (POC-CCA) cassette for S. mansoni, and urine filtration for S. haematobium diagnosis before and 3 weeks after praziquantel administration. According to the Kato-Katz and urine filtration results, we found high efficacy against S. mansoni (cure rate (CR), 88.6%; egg reduction rate (ERR), 96.7%) and S. haematobium (CR, 88.9%; ERR, 98.0%). POC-CCA revealed considerably lower efficacy against S. mansoni (CR, 53.8%). Treatment was generally well tolerated, but moderately severe adverse events (i.e., body and face inflammation), were observed in four Schistosoma egg-negative children.

Conclusions/Significance

Crushed praziquantel administered to preschool-aged children at a dose of 40 mg/kg is efficacious against S. mansoni and S. haematobium in a co-endemic setting of Côte d''Ivoire. Further research is required with highly sensitive diagnostic tools and safety must be investigated in more depth.

Trial Registration

Controlled-Trials.com ISRCTN53172722     

Efficacy of two artemisinin combination therapies for uncomplicated falciparum malaria in children under 5 years, Malakal, Upper Nile, Sudan

Background

The treatment for Plasmodium falciparum malaria in Sudan has been in process of change since 2003. Preceding the change, this study aimed to determine which artemisinin-based combination therapies is more effective to treat uncomplicated malaria in Malakal, Upper Nile, Sudan.

Methods

Clinical trial to assess the efficacy of 2 antimalarial therapies to treat P. falciparum infections in children aged 6–59 months, in a period of 42 days after treatment.

Results

A total of 269 children were followed up to 42 days. Artesunate plus Sulfadoxine/Pyrimethamine (AS+SP) and Artesunate plus Amodiaquine (AS+AQ) were both found to be efficacious in curing malaria infections by rapid elimination of parasites and clearance of fever, in preventing recrudescence and suppressing gametocytaemia. The combination of AS+SP appeared slightly more efficacious than AS+AQ, with 4.4% (4/116) versus 15% (17/113) of patients returning with malaria during the 6-week period after treatment (RR = 0.9, 95% CI 0.81–0.96). PCR analysis identified only one recrudescence which, together with one other early treatment failure, gave efficacy rates of 99.0% for AS+AQ (96/97) and 99.1% for AS+SP (112/113). However, PCR results were incomplete and assuming part of the indeterminate samples were recrudescent infections leads to an estimated efficacy ranging 97–98% for AS+SP and 88–95% for AS+AQ.

Conclusion

These results lead to the recommendation of ACT, and specifically AS+SP, for the treatment of uncomplicated falciparum malaria in this area of Sudan. When implemented, ACT efficacy should be monitored in sentinel sites representing different areas of the country.     

Genotyping natural infections of Schistosoma mansoni in Biomphalaria alexandrina from Damietta, Egypt, with comparisons to natural snail infections from Kenya

The distribution of Schistosoma genotypes among individuals in snail populations provides insights regarding the dynamics of transmission and compatibility between schistosome and snail hosts. A survey of Biomphalaria alexandrina from Damietta (Nile Delta, Egypt), an area subjected to persistent schistosomiasis control efforts, provided only 17 snails infected with Schistosoma mansoni (6.1% overall prevalence), each shown by microsatellite analysis to have a single genotype infection. By contrast, recent studies of uncontrolled S. mansoni transmission foci in Kenya revealed that 4.3% Biomphalaria pfeifferi and 20-25% Biomphalaria sudanica snails had multiple genotype infections. Compared with the 3 Kenyan populations, the Egyptian population of S. mansoni also showed a lesser degree of genetic variability and was genetically differentiated from them. We suggest that tracking of genotype diversity in infected snails could be further developed to serve as an additional and valuable independent indicator of efficacy of schistosomiasis control in Egypt and elsewhere.     

Ruminant brucellosis in the Kafr El Sheikh Governorate of the Nile Delta, Egypt: prevalence of a neglected zoonosis

BACKGROUND: Brucellosis is a neglected tropical zoonosis allegedly reemerging in Middle Eastern countries. Infected ruminants are the primary source of human infection; consequently, estimates of the frequency of ruminant brucellosis are useful elements for building effective control strategies. Unfortunately, these estimates are lacking in most Middle East countries including Egypt. Our objectives are to estimate the frequency of ruminant brucellosis and to describe its spatial distribution in Kafr El Sheikh Governorate, Nile Delta, Egypt. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a cross-sectional study in which 791 sheep, 383 goats, 188 cattle milk tanks and 173 buffalo milk tanks were randomly selected in 40 villages and tested for the presence of antibodies against Brucella spp. The seroprevalence among different species was estimated and visualized using choropleth maps. A spatial scanning method was used to identify areas with significantly higher proportions of seropositive flocks and milk tanks. We estimated that 12.2% of sheep and 11.3% of goats in the study area were seropositive against Brucella spp. and that 12.2% and 12% of cattle and buffalo milk tanks had antibodies against Brucella spp. The southern part of the governorate had the highest seroprevalence with significant spatial clustering of seropositive flocks in the proximity of its capital and around the main animal markets. CONCLUSIONS/ SIGNIFICANCE: Our study revealed that brucellosis is endemic at high levels in all ruminant species in the study area and questions the efficacy of the control measures in place. The high intensity of infection transmission among ruminants combined with high livestock and human density and widespread marketing of unpasteurized milk and dairy products may explain why Egypt has one of the highest rates of human brucellosis worldwide. An effective integrated human-animal brucellosis control strategy is urgently needed. If resources are not sufficient for nationwide implementation, high-risk areas could be prioritized.     

Food consumption, activity, and overweight among elementary school children in an Appalachian Kentucky community

In the U.S., child overweight is on the rise and is implicated in later adult chronic illness. Given that overweight is hardly tractable, prevention as compared to treatment is seen as a better alternative for lowering the risk of long-term health consequences. To increase the success of prevention efforts, many argue that programs must be "culturally sensitive and targeted toward specific populations at greater risk. However, there exists a limited understanding of how overweight is distributed across the landscape, among and within populations and groups. This paper reports the prevalence of overweight among 54 school children in a rural, Appalachian community with a high rate of poverty, and it compares boys to girls. Thirty-seven percent of boys and 10.3% of girls are overweight, based on the 90th percentile body mass index (BMI). Analysis of food intake indicates a pattern of food consumption that is high in fatty and sugary foods and low in fruit and vegetable consumption. Analysis of activity indicates that children report more low-intensity activity than high; that overweight children report more episodes of video/computer play compared to nonoverweight children; and that boys spend more time than girls in front of the computer/television screen.