Imported human Schistosoma japonicum: A report on two cases in Filipino migrants present in Italy and a systematic review of literature

Iacopo Vellere, Valentina Dianora Mangano, Maria Cristina Cagno, Federico Gobbi, Andrea Ragusa, Alessandro Bartoloni, Giandomenico Biancofiore, Paolo De Simone, Daniela Campani, Fabrizio Bruschi, Lorenzo Zammarchi

Research output: Contribution to journalReview article

Abstract

Background: Schistosoma japonicum is endemic in the Philippines, China, and Indonesia, and is the third-most common schistosoma species. The infection can be asymptomatic for years but, if left untreated, can lead to irreversible complications. Method: We report the results of a systematic review of the literature on imported S. japonicum infection and describe two previously unpublished cases diagnosed in Filipino migrants in Italy. Results: Twenty-five imported cases of S. japonicum schistosomiasis were retrieved. All patients but one were migrants. Most subjects acquired the infection in Philippines (n = 18, 72%). Median age at diagnosis was 46 years. Median period of residence in non-endemic countries before diagnosis was 14.5 years. Cases of prevalent hepatosplenic involvement were 10 (40%), those with prevalent intestinal involvement were 10 (40%), whereas five (20%) had overlapping manifestations. Ten patients suffered from cirrhosis; two underwent liver transplantation. Three patients presented with acute abdomen due to intestinal complications, leading to explorative laparotomy. In all cases, but one, the diagnosis was based on a histological examination of biopsy specimen, revealing S. japonicum ova. Seventeen patients were treated with praziquantel, and in three of them, possible treatment failures occurred. Conclusions: S. japonicum infection is uncommonly reported in non-endemic areas, but is probably underestimated because of a low threshold awareness of clinicians and unavailability of specific diagnostic tools. Viable S. japonicum adults may persist for decades, indicating that migrants or travellers previously exposed in areas with high-risk areas can harbour viable worms and deserve treatment.

Original languageEnglish
Article number101496
JournalTravel Medicine and Infectious Disease
DOIs
Publication statusAccepted/In press - Jan 1 2019

Fingerprint

Schistosoma japonicum
Italy
Philippines
Infection
Schistosoma
Praziquantel
Acute Abdomen
Indonesia
Schistosomiasis
Treatment Failure
Liver Transplantation
Laparotomy
Ovum
China
Fibrosis
Biopsy

Keywords

  • Europe
  • Migrant
  • Non endemic
  • Schistosoma japonicum
  • Schistosomiasis
  • Travellers

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Imported human Schistosoma japonicum : A report on two cases in Filipino migrants present in Italy and a systematic review of literature. / Vellere, Iacopo; Mangano, Valentina Dianora; Cagno, Maria Cristina; Gobbi, Federico; Ragusa, Andrea; Bartoloni, Alessandro; Biancofiore, Giandomenico; De Simone, Paolo; Campani, Daniela; Bruschi, Fabrizio; Zammarchi, Lorenzo.

In: Travel Medicine and Infectious Disease, 01.01.2019.

Research output: Contribution to journalReview article

Vellere, Iacopo ; Mangano, Valentina Dianora ; Cagno, Maria Cristina ; Gobbi, Federico ; Ragusa, Andrea ; Bartoloni, Alessandro ; Biancofiore, Giandomenico ; De Simone, Paolo ; Campani, Daniela ; Bruschi, Fabrizio ; Zammarchi, Lorenzo. / Imported human Schistosoma japonicum : A report on two cases in Filipino migrants present in Italy and a systematic review of literature. In: Travel Medicine and Infectious Disease. 2019.
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title = "Imported human Schistosoma japonicum: A report on two cases in Filipino migrants present in Italy and a systematic review of literature",
abstract = "Background: Schistosoma japonicum is endemic in the Philippines, China, and Indonesia, and is the third-most common schistosoma species. The infection can be asymptomatic for years but, if left untreated, can lead to irreversible complications. Method: We report the results of a systematic review of the literature on imported S. japonicum infection and describe two previously unpublished cases diagnosed in Filipino migrants in Italy. Results: Twenty-five imported cases of S. japonicum schistosomiasis were retrieved. All patients but one were migrants. Most subjects acquired the infection in Philippines (n = 18, 72{\%}). Median age at diagnosis was 46 years. Median period of residence in non-endemic countries before diagnosis was 14.5 years. Cases of prevalent hepatosplenic involvement were 10 (40{\%}), those with prevalent intestinal involvement were 10 (40{\%}), whereas five (20{\%}) had overlapping manifestations. Ten patients suffered from cirrhosis; two underwent liver transplantation. Three patients presented with acute abdomen due to intestinal complications, leading to explorative laparotomy. In all cases, but one, the diagnosis was based on a histological examination of biopsy specimen, revealing S. japonicum ova. Seventeen patients were treated with praziquantel, and in three of them, possible treatment failures occurred. Conclusions: S. japonicum infection is uncommonly reported in non-endemic areas, but is probably underestimated because of a low threshold awareness of clinicians and unavailability of specific diagnostic tools. Viable S. japonicum adults may persist for decades, indicating that migrants or travellers previously exposed in areas with high-risk areas can harbour viable worms and deserve treatment.",
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author = "Iacopo Vellere and Mangano, {Valentina Dianora} and Cagno, {Maria Cristina} and Federico Gobbi and Andrea Ragusa and Alessandro Bartoloni and Giandomenico Biancofiore and {De Simone}, Paolo and Daniela Campani and Fabrizio Bruschi and Lorenzo Zammarchi",
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T2 - A report on two cases in Filipino migrants present in Italy and a systematic review of literature

AU - Vellere, Iacopo

AU - Mangano, Valentina Dianora

AU - Cagno, Maria Cristina

AU - Gobbi, Federico

AU - Ragusa, Andrea

AU - Bartoloni, Alessandro

AU - Biancofiore, Giandomenico

AU - De Simone, Paolo

AU - Campani, Daniela

AU - Bruschi, Fabrizio

AU - Zammarchi, Lorenzo

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Schistosoma japonicum is endemic in the Philippines, China, and Indonesia, and is the third-most common schistosoma species. The infection can be asymptomatic for years but, if left untreated, can lead to irreversible complications. Method: We report the results of a systematic review of the literature on imported S. japonicum infection and describe two previously unpublished cases diagnosed in Filipino migrants in Italy. Results: Twenty-five imported cases of S. japonicum schistosomiasis were retrieved. All patients but one were migrants. Most subjects acquired the infection in Philippines (n = 18, 72%). Median age at diagnosis was 46 years. Median period of residence in non-endemic countries before diagnosis was 14.5 years. Cases of prevalent hepatosplenic involvement were 10 (40%), those with prevalent intestinal involvement were 10 (40%), whereas five (20%) had overlapping manifestations. Ten patients suffered from cirrhosis; two underwent liver transplantation. Three patients presented with acute abdomen due to intestinal complications, leading to explorative laparotomy. In all cases, but one, the diagnosis was based on a histological examination of biopsy specimen, revealing S. japonicum ova. Seventeen patients were treated with praziquantel, and in three of them, possible treatment failures occurred. Conclusions: S. japonicum infection is uncommonly reported in non-endemic areas, but is probably underestimated because of a low threshold awareness of clinicians and unavailability of specific diagnostic tools. Viable S. japonicum adults may persist for decades, indicating that migrants or travellers previously exposed in areas with high-risk areas can harbour viable worms and deserve treatment.

AB - Background: Schistosoma japonicum is endemic in the Philippines, China, and Indonesia, and is the third-most common schistosoma species. The infection can be asymptomatic for years but, if left untreated, can lead to irreversible complications. Method: We report the results of a systematic review of the literature on imported S. japonicum infection and describe two previously unpublished cases diagnosed in Filipino migrants in Italy. Results: Twenty-five imported cases of S. japonicum schistosomiasis were retrieved. All patients but one were migrants. Most subjects acquired the infection in Philippines (n = 18, 72%). Median age at diagnosis was 46 years. Median period of residence in non-endemic countries before diagnosis was 14.5 years. Cases of prevalent hepatosplenic involvement were 10 (40%), those with prevalent intestinal involvement were 10 (40%), whereas five (20%) had overlapping manifestations. Ten patients suffered from cirrhosis; two underwent liver transplantation. Three patients presented with acute abdomen due to intestinal complications, leading to explorative laparotomy. In all cases, but one, the diagnosis was based on a histological examination of biopsy specimen, revealing S. japonicum ova. Seventeen patients were treated with praziquantel, and in three of them, possible treatment failures occurred. Conclusions: S. japonicum infection is uncommonly reported in non-endemic areas, but is probably underestimated because of a low threshold awareness of clinicians and unavailability of specific diagnostic tools. Viable S. japonicum adults may persist for decades, indicating that migrants or travellers previously exposed in areas with high-risk areas can harbour viable worms and deserve treatment.

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KW - Schistosoma japonicum

KW - Schistosomiasis

KW - Travellers

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U2 - 10.1016/j.tmaid.2019.101496

DO - 10.1016/j.tmaid.2019.101496

M3 - Review article

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SN - 1477-8939

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