Schistosomiasis in immigrants, refugees and travellers in an Italian referral centre for tropical diseases

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Abstract

Background: Schistosomiasis is one of the most important neglected tropical diseases. If unrecognised and untreated, the chronic infection can lead to irreversible complications. Methods: Retrospective observational study aimed at describing clinical history, laboratory findings and imaging presentation of imported schistosomiasis diagnosed at the Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital of Negrar, Verona, Italy from 2010 to 2014. The aim of our study was to assess differences in demographic characteristics, clinical presentation, laboratory data and ultrasound findings between immigrants/visiting friends and relatives (VFR) from endemic countries (endemic group) and expatriates/travellers (non-endemic group). Results: A total of 272 patients were retrieved: 234 in the endemic and 38 in the non-endemic group. Most of the patients acquired schistosomiasis in Africa (97.4%). Symptoms were reported by 52.9% of the patients; abdominal pain (36%), macroscopic hematuria (11.3%), and genito-urinary symptoms (7.4%) being the most frequently reported. Increased IgE and blood eosinophilia were observed in 169 (63.8%) and 130 (47.8%) patients, respectively. The proportion of positive serology was 250/272 (91.9%).The Circulating Cathodic Antigen CCA for Schistosoma mansoni was positive in 14/61 individuals (23%). At microscopy, infected subjects were 103/272 (37.9%). The species of Schistosoma found were S. haematobium (47.6%), S. mansoni (46.6%) or both (5.8%). Schistosomiasis was classified as confirmed in 103 (37.9%), probable in 165 (60.6%) and suspected in 4 (1.5%) cases using clinical presentation, laboratory data and ultrasound findings. The infection was further classified based on organ involvement: intestinal (17.9%), hepatosplenic (5.1%), urogenital (48.9%), and indeterminate (43.8%). The comparative analysis of endemic and non-endemic patients highlighted differences in sex and age. Endemic patients had more frequent ova identification (41.9% vs. 13.2%, P < 0.001) and increased IgE (70% vs. 26.3%, P < 0.001) when compared with non-endemic. Multivariate analyses showed that younger age, abnormal ultrasound findings and blood eosinophilia were significantly associated with positive microscopy (OR = 0.94, OR = 2.12, OR = 1.98, respectively). Conclusions: Symptoms, eosinophilia and abnormal ultrasound findings were present in about half of patients, without differences between groups. Many patients had positive serology but negative microscopy, indicating that schistosomiasis might be misdiagnosed. A combination of diagnostic tools may facilitate the diagnosis.

Original languageEnglish
Article number55
JournalInfectious Diseases of Poverty
Volume7
Issue number1
DOIs
Publication statusPublished - Jun 16 2018

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Refugees
Schistosomiasis
Referral and Consultation
Eosinophilia
Microscopy
Schistosoma mansoni
Serology
Immunoglobulin E
Neglected Diseases
Schistosoma
Hematuria
Infection
Diagnostic Errors
Sex Characteristics
Abdominal Pain
Italy
Observational Studies
Ovum
Multivariate Analysis
Retrospective Studies

Keywords

  • Europe
  • Italy
  • Neglected tropical diseases, immigrants
  • Refugees
  • Schistosomiasis
  • Travellers

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

@article{f5e4e2288c4d4c0db8cfe7457be7bb0b,
title = "Schistosomiasis in immigrants, refugees and travellers in an Italian referral centre for tropical diseases",
abstract = "Background: Schistosomiasis is one of the most important neglected tropical diseases. If unrecognised and untreated, the chronic infection can lead to irreversible complications. Methods: Retrospective observational study aimed at describing clinical history, laboratory findings and imaging presentation of imported schistosomiasis diagnosed at the Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital of Negrar, Verona, Italy from 2010 to 2014. The aim of our study was to assess differences in demographic characteristics, clinical presentation, laboratory data and ultrasound findings between immigrants/visiting friends and relatives (VFR) from endemic countries (endemic group) and expatriates/travellers (non-endemic group). Results: A total of 272 patients were retrieved: 234 in the endemic and 38 in the non-endemic group. Most of the patients acquired schistosomiasis in Africa (97.4{\%}). Symptoms were reported by 52.9{\%} of the patients; abdominal pain (36{\%}), macroscopic hematuria (11.3{\%}), and genito-urinary symptoms (7.4{\%}) being the most frequently reported. Increased IgE and blood eosinophilia were observed in 169 (63.8{\%}) and 130 (47.8{\%}) patients, respectively. The proportion of positive serology was 250/272 (91.9{\%}).The Circulating Cathodic Antigen CCA for Schistosoma mansoni was positive in 14/61 individuals (23{\%}). At microscopy, infected subjects were 103/272 (37.9{\%}). The species of Schistosoma found were S. haematobium (47.6{\%}), S. mansoni (46.6{\%}) or both (5.8{\%}). Schistosomiasis was classified as confirmed in 103 (37.9{\%}), probable in 165 (60.6{\%}) and suspected in 4 (1.5{\%}) cases using clinical presentation, laboratory data and ultrasound findings. The infection was further classified based on organ involvement: intestinal (17.9{\%}), hepatosplenic (5.1{\%}), urogenital (48.9{\%}), and indeterminate (43.8{\%}). The comparative analysis of endemic and non-endemic patients highlighted differences in sex and age. Endemic patients had more frequent ova identification (41.9{\%} vs. 13.2{\%}, P < 0.001) and increased IgE (70{\%} vs. 26.3{\%}, P < 0.001) when compared with non-endemic. Multivariate analyses showed that younger age, abnormal ultrasound findings and blood eosinophilia were significantly associated with positive microscopy (OR = 0.94, OR = 2.12, OR = 1.98, respectively). Conclusions: Symptoms, eosinophilia and abnormal ultrasound findings were present in about half of patients, without differences between groups. Many patients had positive serology but negative microscopy, indicating that schistosomiasis might be misdiagnosed. A combination of diagnostic tools may facilitate the diagnosis.",
keywords = "Europe, Italy, Neglected tropical diseases, immigrants, Refugees, Schistosomiasis, Travellers",
author = "Valentina Marchese and Anna Beltrame and Andrea Angheben and Monteiro, {Geraldo Badona} and Giovanni Giorli and Francesca Perandin and Dora Buonfrate and Zeno Bisoffi",
year = "2018",
month = "6",
day = "16",
doi = "10.1186/s40249-018-0440-5",
language = "English",
volume = "7",
journal = "Infectious Diseases of Poverty",
issn = "2095-5162",
publisher = "Springer Science + Business Media",
number = "1",

}

TY - JOUR

T1 - Schistosomiasis in immigrants, refugees and travellers in an Italian referral centre for tropical diseases

AU - Marchese, Valentina

AU - Beltrame, Anna

AU - Angheben, Andrea

AU - Monteiro, Geraldo Badona

AU - Giorli, Giovanni

AU - Perandin, Francesca

AU - Buonfrate, Dora

AU - Bisoffi, Zeno

PY - 2018/6/16

Y1 - 2018/6/16

N2 - Background: Schistosomiasis is one of the most important neglected tropical diseases. If unrecognised and untreated, the chronic infection can lead to irreversible complications. Methods: Retrospective observational study aimed at describing clinical history, laboratory findings and imaging presentation of imported schistosomiasis diagnosed at the Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital of Negrar, Verona, Italy from 2010 to 2014. The aim of our study was to assess differences in demographic characteristics, clinical presentation, laboratory data and ultrasound findings between immigrants/visiting friends and relatives (VFR) from endemic countries (endemic group) and expatriates/travellers (non-endemic group). Results: A total of 272 patients were retrieved: 234 in the endemic and 38 in the non-endemic group. Most of the patients acquired schistosomiasis in Africa (97.4%). Symptoms were reported by 52.9% of the patients; abdominal pain (36%), macroscopic hematuria (11.3%), and genito-urinary symptoms (7.4%) being the most frequently reported. Increased IgE and blood eosinophilia were observed in 169 (63.8%) and 130 (47.8%) patients, respectively. The proportion of positive serology was 250/272 (91.9%).The Circulating Cathodic Antigen CCA for Schistosoma mansoni was positive in 14/61 individuals (23%). At microscopy, infected subjects were 103/272 (37.9%). The species of Schistosoma found were S. haematobium (47.6%), S. mansoni (46.6%) or both (5.8%). Schistosomiasis was classified as confirmed in 103 (37.9%), probable in 165 (60.6%) and suspected in 4 (1.5%) cases using clinical presentation, laboratory data and ultrasound findings. The infection was further classified based on organ involvement: intestinal (17.9%), hepatosplenic (5.1%), urogenital (48.9%), and indeterminate (43.8%). The comparative analysis of endemic and non-endemic patients highlighted differences in sex and age. Endemic patients had more frequent ova identification (41.9% vs. 13.2%, P < 0.001) and increased IgE (70% vs. 26.3%, P < 0.001) when compared with non-endemic. Multivariate analyses showed that younger age, abnormal ultrasound findings and blood eosinophilia were significantly associated with positive microscopy (OR = 0.94, OR = 2.12, OR = 1.98, respectively). Conclusions: Symptoms, eosinophilia and abnormal ultrasound findings were present in about half of patients, without differences between groups. Many patients had positive serology but negative microscopy, indicating that schistosomiasis might be misdiagnosed. A combination of diagnostic tools may facilitate the diagnosis.

AB - Background: Schistosomiasis is one of the most important neglected tropical diseases. If unrecognised and untreated, the chronic infection can lead to irreversible complications. Methods: Retrospective observational study aimed at describing clinical history, laboratory findings and imaging presentation of imported schistosomiasis diagnosed at the Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital of Negrar, Verona, Italy from 2010 to 2014. The aim of our study was to assess differences in demographic characteristics, clinical presentation, laboratory data and ultrasound findings between immigrants/visiting friends and relatives (VFR) from endemic countries (endemic group) and expatriates/travellers (non-endemic group). Results: A total of 272 patients were retrieved: 234 in the endemic and 38 in the non-endemic group. Most of the patients acquired schistosomiasis in Africa (97.4%). Symptoms were reported by 52.9% of the patients; abdominal pain (36%), macroscopic hematuria (11.3%), and genito-urinary symptoms (7.4%) being the most frequently reported. Increased IgE and blood eosinophilia were observed in 169 (63.8%) and 130 (47.8%) patients, respectively. The proportion of positive serology was 250/272 (91.9%).The Circulating Cathodic Antigen CCA for Schistosoma mansoni was positive in 14/61 individuals (23%). At microscopy, infected subjects were 103/272 (37.9%). The species of Schistosoma found were S. haematobium (47.6%), S. mansoni (46.6%) or both (5.8%). Schistosomiasis was classified as confirmed in 103 (37.9%), probable in 165 (60.6%) and suspected in 4 (1.5%) cases using clinical presentation, laboratory data and ultrasound findings. The infection was further classified based on organ involvement: intestinal (17.9%), hepatosplenic (5.1%), urogenital (48.9%), and indeterminate (43.8%). The comparative analysis of endemic and non-endemic patients highlighted differences in sex and age. Endemic patients had more frequent ova identification (41.9% vs. 13.2%, P < 0.001) and increased IgE (70% vs. 26.3%, P < 0.001) when compared with non-endemic. Multivariate analyses showed that younger age, abnormal ultrasound findings and blood eosinophilia were significantly associated with positive microscopy (OR = 0.94, OR = 2.12, OR = 1.98, respectively). Conclusions: Symptoms, eosinophilia and abnormal ultrasound findings were present in about half of patients, without differences between groups. Many patients had positive serology but negative microscopy, indicating that schistosomiasis might be misdiagnosed. A combination of diagnostic tools may facilitate the diagnosis.

KW - Europe

KW - Italy

KW - Neglected tropical diseases, immigrants

KW - Refugees

KW - Schistosomiasis

KW - Travellers

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U2 - 10.1186/s40249-018-0440-5

DO - 10.1186/s40249-018-0440-5

M3 - Article

C2 - 29907162

AN - SCOPUS:85048618024

VL - 7

JO - Infectious Diseases of Poverty

JF - Infectious Diseases of Poverty

SN - 2095-5162

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