Abstract
Objectives: To evaluate ultrasound and praziquantel to, respectively, assess and reduce urogenital schistosomiasis (UGS)-associated morbidity in migrants from Sub-Saharan Africa (SSA). Methods: Migrants from SSA with UGS attending three Italian centres for tropical diseases during 2011–2016 were retrospectively enrolled. Data on clinical symptoms, routine laboratory, parasitological tests, and ultrasound reported as per the WHO–Niamey protocol were collected at baseline and at available follow-up visits after treatment with praziquantel 40 mg/kg/day for 3 days. Results: One hundred and seventy patients with UGS were enrolled and treated with praziquantel. Baseline ultrasonography showed urinary tract abnormalities in 115/169 patients (68%); the mean global Schistosoma haematobium score was 2.29 (SD 2.84, IQR 0–2), the mean urinary bladder intermediate score 1.75 (SD 1.73, IQR 0–2), and the mean upper urinary tract intermediate score 0.54 (SD 2.37, IQR 1–10). Abnormalities were more common among the 111 (65%) who were symptomatic (p < 0.02; OR 2.53; 95% CI 1.19–5.35). Symptoms started in 94/111 (85%) before arriving (median 63 months, IQR 12–119). At follow-up, we observed a significant reduction in the prevalence of UGS-related symptoms, blood, urine, and ultrasound abnormalities. Conclusions: Our study results support the use of ultrasound and praziquantel for assessing and reducing UGS-associated morbidity in migrants. Health-seeking behaviour, diagnostic, and treatment delays contribute to the advanced pathology and qualified treatment success. To ensure earlier treatment, based on our findings, clinical experience, and available literature, we propose an algorithm for the diagnosis and clinical management of UGS. Multicentre studies are needed to improve the management of subjects with UGS in non-endemic countries.
| Original language | English |
|---|---|
| Pages (from-to) | 447-459 |
| Number of pages | 13 |
| Journal | Infection |
| Volume | 47 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Jun 1 2019 |
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Keywords
- Migrant
- Praziquantel
- Schistosoma
- Schistosomiasis
- Ultrasonography
- Ultrasound
ASJC Scopus subject areas
- Microbiology (medical)
- Infectious Diseases
Cite this
The diagnosis and treatment of urogenital schistosomiasis in Italy in a retrospective cohort of immigrants from Sub-Saharan Africa. / Tilli, Marta; Gobbi, Federico; Rinaldi, Francesca; Testa, Jacopo; Caligaris, Silvio; Magro, Paola; Buonfrate, Dora; Degani, Monica; Minervini, Andrea; Carini, Marco; Tuccio, Agostino; Sforza, Simone; Gulletta, Maurizio; Castelli, Francesco; Agostini, Simone; Parretti, Filippo; Richter, Joachim; Olliaro, Piero; Bisoffi, Zeno; Bartoloni, Alessandro; Zammarchi, Lorenzo.
In: Infection, Vol. 47, No. 3, 01.06.2019, p. 447-459.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The diagnosis and treatment of urogenital schistosomiasis in Italy in a retrospective cohort of immigrants from Sub-Saharan Africa
AU - Tilli, Marta
AU - Gobbi, Federico
AU - Rinaldi, Francesca
AU - Testa, Jacopo
AU - Caligaris, Silvio
AU - Magro, Paola
AU - Buonfrate, Dora
AU - Degani, Monica
AU - Minervini, Andrea
AU - Carini, Marco
AU - Tuccio, Agostino
AU - Sforza, Simone
AU - Gulletta, Maurizio
AU - Castelli, Francesco
AU - Agostini, Simone
AU - Parretti, Filippo
AU - Richter, Joachim
AU - Olliaro, Piero
AU - Bisoffi, Zeno
AU - Bartoloni, Alessandro
AU - Zammarchi, Lorenzo
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Objectives: To evaluate ultrasound and praziquantel to, respectively, assess and reduce urogenital schistosomiasis (UGS)-associated morbidity in migrants from Sub-Saharan Africa (SSA). Methods: Migrants from SSA with UGS attending three Italian centres for tropical diseases during 2011–2016 were retrospectively enrolled. Data on clinical symptoms, routine laboratory, parasitological tests, and ultrasound reported as per the WHO–Niamey protocol were collected at baseline and at available follow-up visits after treatment with praziquantel 40 mg/kg/day for 3 days. Results: One hundred and seventy patients with UGS were enrolled and treated with praziquantel. Baseline ultrasonography showed urinary tract abnormalities in 115/169 patients (68%); the mean global Schistosoma haematobium score was 2.29 (SD 2.84, IQR 0–2), the mean urinary bladder intermediate score 1.75 (SD 1.73, IQR 0–2), and the mean upper urinary tract intermediate score 0.54 (SD 2.37, IQR 1–10). Abnormalities were more common among the 111 (65%) who were symptomatic (p < 0.02; OR 2.53; 95% CI 1.19–5.35). Symptoms started in 94/111 (85%) before arriving (median 63 months, IQR 12–119). At follow-up, we observed a significant reduction in the prevalence of UGS-related symptoms, blood, urine, and ultrasound abnormalities. Conclusions: Our study results support the use of ultrasound and praziquantel for assessing and reducing UGS-associated morbidity in migrants. Health-seeking behaviour, diagnostic, and treatment delays contribute to the advanced pathology and qualified treatment success. To ensure earlier treatment, based on our findings, clinical experience, and available literature, we propose an algorithm for the diagnosis and clinical management of UGS. Multicentre studies are needed to improve the management of subjects with UGS in non-endemic countries.
AB - Objectives: To evaluate ultrasound and praziquantel to, respectively, assess and reduce urogenital schistosomiasis (UGS)-associated morbidity in migrants from Sub-Saharan Africa (SSA). Methods: Migrants from SSA with UGS attending three Italian centres for tropical diseases during 2011–2016 were retrospectively enrolled. Data on clinical symptoms, routine laboratory, parasitological tests, and ultrasound reported as per the WHO–Niamey protocol were collected at baseline and at available follow-up visits after treatment with praziquantel 40 mg/kg/day for 3 days. Results: One hundred and seventy patients with UGS were enrolled and treated with praziquantel. Baseline ultrasonography showed urinary tract abnormalities in 115/169 patients (68%); the mean global Schistosoma haematobium score was 2.29 (SD 2.84, IQR 0–2), the mean urinary bladder intermediate score 1.75 (SD 1.73, IQR 0–2), and the mean upper urinary tract intermediate score 0.54 (SD 2.37, IQR 1–10). Abnormalities were more common among the 111 (65%) who were symptomatic (p < 0.02; OR 2.53; 95% CI 1.19–5.35). Symptoms started in 94/111 (85%) before arriving (median 63 months, IQR 12–119). At follow-up, we observed a significant reduction in the prevalence of UGS-related symptoms, blood, urine, and ultrasound abnormalities. Conclusions: Our study results support the use of ultrasound and praziquantel for assessing and reducing UGS-associated morbidity in migrants. Health-seeking behaviour, diagnostic, and treatment delays contribute to the advanced pathology and qualified treatment success. To ensure earlier treatment, based on our findings, clinical experience, and available literature, we propose an algorithm for the diagnosis and clinical management of UGS. Multicentre studies are needed to improve the management of subjects with UGS in non-endemic countries.
KW - Migrant
KW - Praziquantel
KW - Schistosoma
KW - Schistosomiasis
KW - Ultrasonography
KW - Ultrasound
UR - http://www.scopus.com/inward/record.url?scp=85060544215&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85060544215&partnerID=8YFLogxK
U2 - 10.1007/s15010-019-01270-0
DO - 10.1007/s15010-019-01270-0
M3 - Article
C2 - 30666616
AN - SCOPUS:85060544215
VL - 47
SP - 447
EP - 459
JO - Infection
JF - Infection
SN - 0300-8126
IS - 3
ER -