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Abebe W, Lemma W, Tegegne Y, Sisay A, Misganaw T, Ayana S, Kasew D, Debash MN, Zemariam AB, Emagneneh T, Derso A. Biochemical, coagulation, and platelet count profiles among Schistosoma mansoni infected patients attending at selected Dembiya health institutions, Northwest Ethiopia. BMC Microbiol 2025; 25:119. [PMID: 40045196 PMCID: PMC11881258 DOI: 10.1186/s12866-025-03838-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/19/2025] [Indexed: 03/09/2025] Open
Abstract
BACKGROUND Schistosomiasis is a parasitic disease that causes coagulation disorders and biochemical abnormalities. This is due to liver failure, platelet destruction, disruption of blood flow, and endothelial function by the schistosomes. However, there is no adequate data on biochemical and coagulation profiles and platelet count of patients infected with Schistosoma mansoni in Dembiya Selected Health Institutions. Hence, the aim of this study was to assess the effect of Schistosoma mansoni infection on selected biochemical and coagulation profiles and platelet count. METHOD An institutional-based comparative cross-sectional study was conducted from March to August 2022 at Dembiya Primary Hospital, Chuahit Health Center, and Abrija Health Center, Northwest Ethiopia. A total of 70 individuals were enrolled in the study using convenient sampling techniques. A stool sample was collected for Schistosoma mansoni detection. Likewise, a blood sample was collected for biochemical and coagulation profiles and platelet count analysis. The data were analyzed using SPSS version 25. A p-value less than 0.05 was considered statistically significant. RESULTS Median values for alanine aminotransferase, aspartate aminotransferase, creatinine, total bilirubin, and direct bilirubin values were significantly higher, while total protein and glucose were significantly lower in Schistosoma mansoni infected than in the healthy control participants (P < 0.05). Prothrombin time, activated partial thromboplastin time, and international normalization ratio were significantly higher, while the platelet count was significantly lower in the Schistosoma mansoni infected than healthy control participants (P < 0.05). The values of alanine aminotransferase, aspartate aminotransferase, creatinine, total bilirubin, direct bilirubin, prothrombin time, activated partial thromboplastin time, and international normalization ratio were significantly higher, while total protein, glucose, and platelet count were significantly lower in those with moderate and heavy Schistosoma mansoni infection intensity compared to healthy control participants (P < 0.05). The number of Schistosoma mansoni eggs per gram of stool had a positive correlation with biochemical and coagulation profiles, except for total protein, glucose, and platelet count, which were correlated negatively in Schistosoma mansoni infected participants (P < 0.05). CONCLUSION Biochemical and coagulation profiles, including alanine aminotransferase, aspartate aminotransferase, creatinine, total bilirubin, direct bilirubin, glucose, total protein, prothrombin time, activated partial thromboplastin time, international normalization ratio, and platelet count, were significantly altered in S. mansoni infected participants compared to controls (p < 0.05). These findings underscore the need for routine biochemical and coagulation monitoring in endemic areas.
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Affiliation(s)
- Wagaw Abebe
- Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia.
| | - Wossenseged Lemma
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yalewayker Tegegne
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Assefa Sisay
- Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tadesse Misganaw
- Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Sisay Ayana
- Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Desie Kasew
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Marye Nigatie Debash
- Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Alemu Birara Zemariam
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tadele Emagneneh
- Department of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Adane Derso
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Tamarozzi F, Ursini T, Stroffolini G, Badona Monteiro G, Buonfrate D, Fittipaldo VA, Conci S, Gasparini C, Mansueto G, Guglielmi A, Gobbi F. Transjugular intrahepatic portosystemic shunt followed by splenectomy for complicated hepatosplenic schistosomiasis: a case report and review of the literature. THE LANCET. INFECTIOUS DISEASES 2024; 24:e405-e414. [PMID: 38368890 DOI: 10.1016/s1473-3099(23)00689-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/12/2023] [Accepted: 10/30/2023] [Indexed: 02/20/2024]
Abstract
Hepatosplenic schistosomiasis is a complex clinical condition caused by the complications of chronic infection with Schistosoma species that cause intestinal schistosomiasis. Hepatosplenic schistosomiasis derives from the fibrotic reaction stimulated around parasite eggs that are transported by the mesenteric circulation to the liver, causing periportal fibrosis. Portal hypertension and variceal gastrointestinal bleeding are major complications of hepatosplenic schistosomiasis. The clinical management of hepatosplenic schistosomiasis is not standardised and a parameter that could guide clinical decision making has not yet been identified. Transjugular intrahepatic portosystemic shunt (TIPS) appears promising for use in hepatosplenic schistosomiasis but is still reported in very few patients. In this Grand Round, we report one patient with hepatosplenic schistosomiasis treated with TIPS, which resulted in regression of oesophageal varices but had to be followed by splenectomy due to persisting severe splenomegaly and thrombocytopenia. We summarise the main challenges in the clinical management of this patient with hepatosplenic schistosomiasis, highlight results of a scoping review of the literature, and evaluate the use of of TIPS in patients with early hepatosplenic schistosomiasis, to improve the prognosis.
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Affiliation(s)
- Francesca Tamarozzi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.
| | - Tamara Ursini
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Giacomo Stroffolini
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Geraldo Badona Monteiro
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Dora Buonfrate
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Veronica Andrea Fittipaldo
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Simone Conci
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynaecology, and Paediatrics, University of Verona, University Hospital G B Rossi, Verona, Italy
| | - Clizia Gasparini
- Department of Radiology, University of Verona, University Hospital G B Rossi, Verona, Italy
| | - Giancarlo Mansueto
- Department of Radiology, University of Verona, University Hospital G B Rossi, Verona, Italy
| | - Alfredo Guglielmi
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynaecology, and Paediatrics, University of Verona, University Hospital G B Rossi, Verona, Italy
| | - Federico Gobbi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Abdelfattah A, Hijjawi NS, Jacoub K. An overview of qualitative and quantitative platelet abnormalities in schistosomiasis. Parasitol Res 2024; 123:225. [PMID: 38809265 DOI: 10.1007/s00436-024-08245-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/20/2024] [Indexed: 05/30/2024]
Abstract
Schistosomiasis is a neglected tropical disease referring to the infection with blood parasitic trematodes of the genus Schistosoma. It impacts millions of people worldwide, primarily in low-to-middle-income countries. Patients infected with schistosomiasis often exhibit a distinct hematological profile, including anemia, eosinophilia, thrombocytopenia, and coagulopathy. Platelets, essential components of the hemostatic system, play a crucial role in the pathogenesis of schistosomiasis. Schistosomes secrete serine proteases and express ectoenzymes, such as calpain protease, alkaline phosphatase (SmAP), phosphodiesterase (SmNPP5), ATP diphosphohydrolase (SmATPDase1), serine protease Sk1, SmSP2, and Sm22.6, which can interfere with platelet normal functioning. This report provides comprehensive, up-to-date information on platelet abnormalities observed in patients with schistosomiasis, highlighting their importance in the disease progression and complications. It delves into the interactions between platelets and schistosomes, including the impact of platelet dysfunction on hemostasis and immune responses, immune-mediated platelet destruction, and the potential mechanisms by which schistosome tegumental ectoenzymes affect platelets. Furthermore, the report clarifies the relationship between platelet abnormalities and clinical manifestations such as thrombocytopenia, coagulation disorders, and the emergence of portal hypertension and gastrointestinal bleeding. Understanding the complex interplay between platelets and schistosomes is crucial for improving patient management and outcomes in schistosomiasis, particularly for those with platelet alterations. This knowledge contributes to improved diagnostic methods, innovative treatment strategies, and global efforts to control and eliminate schistosomiasis.
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Affiliation(s)
- Ali Abdelfattah
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, 13133, Jordan.
| | - Nawal S Hijjawi
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, 13133, Jordan
| | - Khaldun Jacoub
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, 13133, Jordan
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Cheng JA, Lin YC, Lin Y, Wu RC, Lu HY, Yang LY, Chiang HJ, Juan YH, Lai YC, Lin G. Machine Learning Radiomics Signature for Differentiating Lymphoma versus Benign Splenomegaly on CT. Diagnostics (Basel) 2023; 13:3632. [PMID: 38132216 PMCID: PMC10742777 DOI: 10.3390/diagnostics13243632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND We aimed to develop and validate a preoperative CT-based radiomics signature for differentiating lymphoma versus benign splenomegaly. METHODS We retrospectively analyzed CT studies from 139 patients (age range 26-93 years, 43% female) between 2011 and 2019 with histopathological diagnosis of the spleen (19 lymphoma, 120 benign) and divided them into developing (n = 79) and testing (n = 60) datasets. The volumetric radiomic features were extracted from manual segmentation of the whole spleen on venous-phase CT imaging using PyRadiomics package. LASSO regression was applied for feature selection and development of the radiomic signature, which was interrogated with the complete blood cell count and differential count. All p values < 0.05 were considered to be significant. RESULTS Seven features were selected for constructing the radiomic signature after feature selection, including first-order statistics (10th percentile and Robust Mean Absolute Deviation), shape-based (Surface Area), and texture features (Correlation, MCC, Small Area Low Gray-level Emphasis and Low Gray-level Zone Emphasis). The radiomic signature achieved an excellent diagnostic accuracy of 97%, sensitivity of 89%, and specificity of 98%, distinguishing lymphoma versus benign splenomegaly in the testing dataset. The radiomic signature significantly correlated with the platelet and segmented neutrophil percentage. CONCLUSIONS CT-based radiomics signature can be useful in distinguishing lymphoma versus benign splenomegaly and can reflect the changes in underlying blood profiles.
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Affiliation(s)
- Jih-An Cheng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan; (J.-A.C.); (Y.-C.L.); (H.-Y.L.); (H.-J.C.); (Y.-H.J.); (Y.-C.L.)
| | - Yu-Chun Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan; (J.-A.C.); (Y.-C.L.); (H.-Y.L.); (H.-J.C.); (Y.-H.J.); (Y.-C.L.)
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan 333, Taiwan
- Clinical Metabolomics Core and Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan
| | - Yenpo Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan; (J.-A.C.); (Y.-C.L.); (H.-Y.L.); (H.-J.C.); (Y.-H.J.); (Y.-C.L.)
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan 333, Taiwan
- Clinical Metabolomics Core and Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan
| | - Ren-Chin Wu
- Department of Pathology, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan;
| | - Hsin-Ying Lu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan; (J.-A.C.); (Y.-C.L.); (H.-Y.L.); (H.-J.C.); (Y.-H.J.); (Y.-C.L.)
- Clinical Metabolomics Core and Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan
| | - Lan-Yan Yang
- Clinical Trial Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan;
| | - Hsin-Ju Chiang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan; (J.-A.C.); (Y.-C.L.); (H.-Y.L.); (H.-J.C.); (Y.-H.J.); (Y.-C.L.)
- Clinical Metabolomics Core and Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan
| | - Yu-Hsiang Juan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan; (J.-A.C.); (Y.-C.L.); (H.-Y.L.); (H.-J.C.); (Y.-H.J.); (Y.-C.L.)
| | - Ying-Chieh Lai
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan; (J.-A.C.); (Y.-C.L.); (H.-Y.L.); (H.-J.C.); (Y.-H.J.); (Y.-C.L.)
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan 333, Taiwan
- Clinical Metabolomics Core and Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan; (J.-A.C.); (Y.-C.L.); (H.-Y.L.); (H.-J.C.); (Y.-H.J.); (Y.-C.L.)
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan 333, Taiwan
- Clinical Metabolomics Core and Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan 333, Taiwan
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Schnyder JL, Gobbi F, Schunk M, Lindner A, Salvador F, Duvignaud A, Arsuaga Vicente M, Dejon Agobé JC, Cattaneo P, Bertoli G, Rothe C, Wintel M, Pou D, Malvy D, Adegnika AA, De Jong HK, Grobusch MP. Can haematological changes constitute a surrogate diagnostic parameter to detect schistosomiasis in migrants and travellers? - A retrospective analysis. New Microbes New Infect 2023; 53:101136. [PMID: 37187799 PMCID: PMC10176249 DOI: 10.1016/j.nmni.2023.101136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 05/17/2023] Open
Abstract
Background Earlier studies found characteristic haematological changes in African patients with active schistosomiasis. If consistently present, full blood counts (FBC) may be helpful to diagnose schistosomiasis also in migrants and returning travellers. Methods A retrospective patient record review was conducted on data from seven European travel clinics, comparing FBC of Schistosoma egg-positive travellers and migrants to reference values. Sub-analyses were performed for children, returned travellers, migrants and different Schistosoma species. Results Data analysis included 382 subjects (median age 21.0 years [range 2-73]). In returned travellers, decreases in means of haemoglobin particularly in females (β = -0.82 g/dL, p = 0.005), MCV (β = -1.6 fL, p = 0.009), basophils, neutrophils, lymphocytes and monocytes (β = -0.07, p < 0.001; -0.57, p = 0.012; -0.57, p < 0.001 and -0.13 103/μL, p < 0.001, respectively) were observed. As expected, eosinophils were increased (β = +0.45 103/μL, p < 0.001). In migrants, a similar FBC profile was observed, yet thrombocytes and leukocytes were significantly lower in migrants (β = -48 103/μL p < 0.001 and β = -2.35 103/μL, p < 0.001, respectively). Conclusions Active egg-producing Schistosoma infections are associated with haematological alterations in returned travellers and migrants. However, these differences are discrete and seem to vary among disease stage and Schistosoma species. Therefore, the FBC is unsuitable as a surrogate diagnostic parameter to detect schistosomiasis.
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Affiliation(s)
- Jenny L. Schnyder
- Centre for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Federico Gobbi
- Department of Infectious/Tropical Diseases and Microbiology, IRCCS Sacro Cuore-Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - Mirjam Schunk
- Division of Infectious Diseases and Tropical Medicine, LMU Hospital Centre, Munich, Germany
| | - Andreas Lindner
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Tropical Medicine and International Health, Berlin, Germany
| | - Fernando Salvador
- International Health Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Vall d’Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Alexandre Duvignaud
- Department of Infectious Diseases and Tropical Medicine, Hôpital Pellegrin - CHU de Bordeaux, Bordeaux, France
| | - Marta Arsuaga Vicente
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Imported Diseases and International Health Referral Unit, Hospital Universitario La Paz- Carlos III, Madrid, Spain
| | | | - Paolo Cattaneo
- Department of Infectious/Tropical Diseases and Microbiology, IRCCS Sacro Cuore-Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - Giulia Bertoli
- Department of Infectious/Tropical Diseases and Microbiology, IRCCS Sacro Cuore-Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - Camilla Rothe
- Division of Infectious Diseases and Tropical Medicine, LMU Hospital Centre, Munich, Germany
| | - Mia Wintel
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Tropical Medicine and International Health, Berlin, Germany
| | - Diana Pou
- International Health Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Vall d’Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Denis Malvy
- Department of Infectious Diseases and Tropical Medicine, Hôpital Pellegrin - CHU de Bordeaux, Bordeaux, France
| | - Ayola Akim Adegnika
- Centre de Recherches Médicales en Lambaréné (CERMEL), Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, German Centre for Infection Research, Tübingen, Germany
| | - Hanna K. De Jong
- Centre for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin P. Grobusch
- Centre for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, the Netherlands
- Centre de Recherches Médicales en Lambaréné (CERMEL), Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, German Centre for Infection Research, Tübingen, Germany
- Masanga Medical Research Unit (MMRU), Masanga, Sierra Leone
- Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Corresponding author. Centre for Tropical Medicine and Travel Medicine, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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Moriwaki M, Kito K, Nakagawa R, Tominaga E, Kapoor MP, Matsumiya Y, Fukuhara T, Yamagata H, Katsumata T, Minegawa K. Mutagenic, Acute, and Subchronic Toxicity Studies of the Hesperetin-7-Glucoside-β-Cyclodextrin Inclusion Complex. Int J Toxicol 2022; 42:50-62. [PMID: 36280476 PMCID: PMC9841476 DOI: 10.1177/10915818221134022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hesperetin glucosides such as hesperidin and hesperetin-7-glucoside are abundantly present in citrus fruits and have various pharmacological properties. However, the potential toxicity of hesperetin glucosides remains unclear. An initial assessment of the safety of hesperetin-7-glucoside-β-cyclodextrin inclusion complex (HPTGCD) as a functional food ingredient was undertaken to assess toxicity and mutagenic potential. A bacterial reverse mutation assay (Ames test) using Salmonella typhimurium (strains TA98, TA1535, TA100, and TA1537) and Escherichia coli (strain WP2 uvrA) with HPTGCD (up to 5000 µg/plate) in the absence and presence of metabolic activation was negative. In a single oral (gavage) toxicity study in male and female rats, HPTGCD at dose up to 2000 mg/kg did not produce mortality nor clinical signs of toxicity or change in body weight. In a subchronic oral (dietary admix) toxicity study in rats receiving 0, 1.5, 3, and 5% HPTGCD for 13 weeks, no adverse effects were noted and the no-observed-adverse-effect level (NOAEL) was 5% in the diet (equivalent to 3267.7 mg/kg/day for males and to 3652.4 mg/kg/day for females). These results provide initial evidence of the safety of HPTGCD.
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Affiliation(s)
- Masamitsu Moriwaki
- Taiyo Kagaku Co. Ltd., Nutrition
Division, Mie, Japan,Masamitsu Moriwaki, Taiyo Kagaku Co. Ltd.,
Nutrition Division, 1-3 Takaramachi, Yokkaichi, Mie 510-0844, Japan.
| | - Kento Kito
- Taiyo Kagaku Co. Ltd., Nutrition
Division, Mie, Japan
| | - Ryo Nakagawa
- Taiyo Kagaku Co. Ltd., Nutrition
Division, Mie, Japan
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Paulino ÉT, Ribeiro de Lima M, Viçosa AL, da Silva CH, Salomon CJ, Real DA, Leonardi D, Mello Silva CC, de Moraes Neto AHA. The Effect of Different Formulations of Praziquantel in Reducing Worms in the Prepatent Period of Schistosomiasis in Murine Models. Front Public Health 2022; 10:848633. [PMID: 35692307 PMCID: PMC9184718 DOI: 10.3389/fpubh.2022.848633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/09/2022] [Indexed: 11/21/2022] Open
Abstract
Schistosomiasis is a widely distributed parasitic disease and one of the most important neglected tropical diseases globally, for which Praziquantel® (PZQ) is the only available treatment. In this context, tests with new PZQ formulations become relevant for disease control. This study evaluated the effects of PZQ treatment in the prepatent phase of schistosomiasis using two formulations: nanoencapsulated (PZQ-NANO) and active pharmaceutical ingredient (PZQ-API). Five experimental groups were established, for which the following serological parameters were evaluated: ALT, AST, ALP, and TP. Animals treated with PZQ-API at 15 and 30 days post-infection showed decreased eggs per gram of feces (EPG) compared to untreated infected animals. The same animals showed reductions of 63.6 and 65.1%, respectively, at 60 days post-infection. Animals treated with PZQ-NANO experienced no significant changes in EPG at any time of observation. Animals treated with either PZQ-API or PZQ-NANO had higher ALT and AST levels in the patent period (60 and 90 days post-infection). Treatment with PZQ, either API or NANO, at 15 days post-infection reduced AST, ALT, and TP levels. It is concluded that prepatent treatment with PZQ-API can reduce the parasite load of infected animals and that treatment at 15 days post-infection can prevent increased serum levels of ALT, AST, and TP.
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Affiliation(s)
- Érica Tex Paulino
- Laboratory of Innovations in Therapies, Teaching and Bioproducts, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (LITEB/IOC/FIOCRUZ), Rio de Janeiro, Brazil
- Laboratory of Environmental Health Evaluation and Promotion, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (LAPSA/IOC/FIOCRUZ), Rio de Janeiro, Brazil
- Tropical Medicine Program, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, Brazil
| | - Monique Ribeiro de Lima
- Animal Experimentation Center, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, Brazil
| | - Alessandra Lifsitch Viçosa
- Laboratory of Experimental Pharmacotechnics, Farmanguinhos, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Cleber Hooper da Silva
- Institute of Science and Technology in Biomodels, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Claudio Javier Salomon
- Faculty of Biochemical and Pharmaceutical Sciences, University of Rosario, Rosario, Argentina
- Institute of Chemistry of Rosario—National Research Council Scientific and Techniques (IQUIR-CONICET), Rosario, Argentina
| | - Daniel Andrés Real
- Faculty of Biochemical and Pharmaceutical Sciences, University of Rosario, Rosario, Argentina
- Institute of Chemistry of Rosario—National Research Council Scientific and Techniques (IQUIR-CONICET), Rosario, Argentina
| | - Dario Leonardi
- Faculty of Biochemical and Pharmaceutical Sciences, University of Rosario, Rosario, Argentina
- Institute of Chemistry of Rosario—National Research Council Scientific and Techniques (IQUIR-CONICET), Rosario, Argentina
| | - Clélia Christina Mello Silva
- Laboratory of Environmental Health Evaluation and Promotion, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (LAPSA/IOC/FIOCRUZ), Rio de Janeiro, Brazil
- *Correspondence: Clélia Christina Mello Silva
| | - Antonio Henrique Almeida de Moraes Neto
- Laboratory of Innovations in Therapies, Teaching and Bioproducts, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (LITEB/IOC/FIOCRUZ), Rio de Janeiro, Brazil
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8
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Rakotomalala JA, Razafindrazoto CI, Randriamifidy NH, Ralaizanaka BM, Maherison S, Hasina Laingonirina DH, Rakotomaharo M, Rasolonjatovo AS, Rakotovao MA, Rakotozafindrabe ALR, Rabenjanahary TH, Fanantenantsoa R, Razafimahefa SH, Ramanampamonjy RM. Splenectomy Combined with Endoscopic Variceal Ligation (EVL) versus EVL Alone for Secondary Prophylaxis of Variceal Bleeding in Hepatosplenic Schistosomiasis: A Retrospective Case-Control Study. Hepat Med 2022; 14:79-85. [PMID: 35611387 PMCID: PMC9124470 DOI: 10.2147/hmer.s367849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background Hepatosplenic schistosomiasis (HSS) is one of the most common causes of portal hypertension in developing countries. Variceal bleeding is the most common cause of mortality during HSS. The objective of this study was to evaluate the efficacy of splenectomy associated with endoscopic variceal ligation (EVL) compared with EVL alone in preventing variceal bleeding in patients with HSS. Methods This was a single-center, retrospective, case–control study. Between January 2015 and December 2019, a total of 59 patients with HSS who had at least one variceal bleeding episode and received EVL with or without splenectomy were identified and stratified. In this case–control design, 22 patients had splenectomy + EVL (case group) and 37 patients had EVL alone (control group). The main endpoints were the rate of variceal rebleeding and the mortality rate between the two groups. Results The mean age of our patients was 39.92 ± 13.4 (19–75) years with a sex ratio of 1.8. The recurrence rate of variceal bleeding was significantly lower in the case group (splenectomy + EVL) than in the control group (EVL alone) (4.45% vs 27.2%, p = 0.041). There was no significant difference between the two groups in terms of mortality (4.54 vs 2.7%, p = 1.00). Conclusion Splenectomy combined with EVL was effective than EVL alone in preventing variceal rebleeding in patients with HSS.
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Affiliation(s)
| | | | | | | | - Sonny Maherison
- Gastroenterology Unit, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | | | - Mialitiana Rakotomaharo
- Gastroenterology Unit, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | | | - Mamisoa Anicet Rakotovao
- General Surgery Unit, University Hospital Andrainjato, Fianarantsoa, Madagascar.,Visceral Surgery Unit, University Hospital Tambohobe, Fianarantsoa, Madagascar
| | | | | | - Rija Fanantenantsoa
- General Surgery Unit, University Hospital Andrainjato, Fianarantsoa, Madagascar.,Visceral Surgery Unit, University Hospital Tambohobe, Fianarantsoa, Madagascar
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9
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Gunda DW, Mtui EF, Manyiri PM, Majinge DC, Kilonzo SB, Mazigo HD, Kidenya BR. Schistosoma mansoni-related periportal fibrosis; can we use APRI and PSDR levels in the real-time selection of patients for targeted endoscopy in a resource-limited setting? A case-control study. BMC Gastroenterol 2021; 21:219. [PMID: 33985430 PMCID: PMC8117578 DOI: 10.1186/s12876-021-01802-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/03/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Schistosoma mansoni related hepatic fibrosis is usually associated with hemodynamic alteration with increased mortality due to bleeding varices. The diagnosis of varices before bleeding imposes a big challenge in resource-limited countries using endoscopy. Published evidence on the utility of non-invasive clinical tools in predicting the presence of varices among patients with S. mansoni related periportal fibrosis is still inadequate including Aspartate to platelet ratio index (APRI) and Platelet to splenic diameter ratio (PSDR) levels. This study describes the determinants of portal varices and assesses the potential utility of the APRI and PSDR level in the discrimination of portal varices among patients with S. mansoni related periportal fibrosis (PPF). METHODS A case-control study using cross-sectional data was done among patients with Schistosoma mansoni related periportal fibrosis at Bugando Medical Centre, in Mwanza Tanzania. The derivation cohort included patients enrolled between 2015 and 2019 and the validation cohort included patients enrolled from 2019 till March 2021. Socio-demographic, laboratory, ultrasound, and upper digestive endoscopic information were analyzed using STATA 13. The prevalence and determinants of varices were determined by logistic regression. The sensitivity and specificity of independent factors were determined to assess their utility in discriminating the presence of portal varices in patients with PPF. RESULTS In total, 250 patients were included in the derivation cohort, 109 (43.6%; 95% CI 37.3-49.9) of them had varices. The odds of having varices were independently increased among patients with higher APRI levels than 1.51, (AOR: 5.8; 95% CI 3.1-11.1; p < 0.001) and PSDR levels that were lower than 5700 (AOR: 5.9; 95% CI 3.2-11.2; p < 0.001). Both APRI and PSDR levels had significantly high sensitivity and specificity in predicting the presence of esophageal varices. However, the combined values of APRI and PSDR had higher specificity than any of the two markers. Of the 200 patients in the validation cohort 94 (47.0%; 95% CI 40.0-54.2) had varices, the discriminative power of the final model and the predictive ability of both APRI, PSDR, and APRI-PSDR combined levels were highly maintained. CONCLUSIONS This study indicates that varices are a common encounter among patients with S. mansoni related periportal fibrosis and it is independently associated with higher APRI and lower PSDR levels suggesting that these tools are potential discriminators of varices in this subgroup of patients. The reproducibility of these results should further be assessed longitudinally as potential non-invasive tools in selecting patients at high risk of having esophageal varices who could benefit from the targeted endoscopic intervention in a resource-limited setting like ours.
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Affiliation(s)
- Daniel W. Gunda
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, 1464 Mwanza, Tanzania
- Department of Internal Medicine, Bugando Medical Centre, 1370 Mwanza, Tanzania
| | - Elizabeth F. Mtui
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, 1464 Mwanza, Tanzania
| | - Paulina M. Manyiri
- Department of Internal Medicine, Bugando Medical Centre, 1370 Mwanza, Tanzania
| | - David C. Majinge
- Department of Internal Medicine, Bugando Medical Centre, 1370 Mwanza, Tanzania
| | - Semvua B. Kilonzo
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, 1464 Mwanza, Tanzania
- Department of Internal Medicine, Bugando Medical Centre, 1370 Mwanza, Tanzania
| | - Humphrey D. Mazigo
- Department of Parasitology, Catholic University of Health and Allied Sciences, 1464 Mwanza, Tanzania
| | - Benson R. Kidenya
- Department of Biochemistry and Molecular Biology, Catholic University of Health and Allied Sciences, 1464 Mwanza, Tanzania
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10
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Barreto AVMS, Domingues ALC, Diniz GTN, Cavalcanti AMS, Lopes EP, Montenegro SML, Morais CNL. The Coutinho index as a simple tool for screening patients with advanced forms of Schistosomiasis mansoni: a validation study. Trans R Soc Trop Med Hyg 2021; 116:19-25. [PMID: 33728455 DOI: 10.1093/trstmh/trab040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/07/2021] [Accepted: 02/24/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Periportal fibrosis (PPF) is the major pathological consequence of Schistosoma mansoni infection. The Coutinho index-the alkaline phosphatase (ALP) to platelet ratio ([ALP/upper limit of normality {ULN}]/platelet count [106/L] x 100)-was validated. Validation consisted of modest laboratory tests to predict advanced PPF. METHODS A total of 378 individuals from an endemic area of Brazil with a previous history of the disease and/or a positive parasitological examination were evaluated. We used ultrasound examination as the gold standard for classification of the PPF pattern and measured the biological markers of the index. RESULTS Forty-one individuals (10.8%) without PPF, 291 (77%) with moderate PPF and 46 (12.2%) with advanced PPF, were identified. ALP and platelet count were used for the index. The cut-off point ≥0.228 predicted the presence of fibrosis with an area under the receiver operating characteristic curve (AUROC) of 0.56, sensitivity of 68.6% and specificity of 46.3%. There was an absence of PPF in 46.3% of individuals without fibrosis and the presence of PPF in 68.5% of cases with moderate and advanced ultrasound fibrosis. The identification of advanced fibrosis with a cut-off point ≥0.316 revealed an AUROC curve of 0.70, sensitivity of 67.4% and specificity of 68.3%, thus confirming the advanced phase in 65.2% of cases compared with ultrasound. CONCLUSION The Coutinho index was able to predict advanced PPF in most individuals. It is valid as a new tool, uses routine laboratory tests and therefore is more accessible for screening patients with a severe form of the disease in endemic areas.
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Affiliation(s)
- Ana V M S Barreto
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife-Pernambuco, 50670-420, Brasil
| | - Ana L C Domingues
- Centro de Ciências Médicas, Universidade Federal de Pernambuco, Recife-Pernambuco, 50670-901, Brasil
| | - George T N Diniz
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife-Pernambuco, 50670-420, Brasil
| | - Ana M S Cavalcanti
- Laboratório Central de Saúde Pública, Secretaria Estadual de Saúde, Recife-Pernambuco, 52171-011, Brasil
| | - Edmundo P Lopes
- Centro de Ciências Médicas, Universidade Federal de Pernambuco, Recife-Pernambuco, 50670-901, Brasil
| | - Silvia M L Montenegro
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife-Pernambuco, 50670-420, Brasil
| | - Clarice N L Morais
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife-Pernambuco, 50670-420, Brasil
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11
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Tamarozzi F, Fittipaldo VA, Orth HM, Richter J, Buonfrate D, Riccardi N, Gobbi FG. Diagnosis and clinical management of hepatosplenic schistosomiasis: A scoping review of the literature. PLoS Negl Trop Dis 2021; 15:e0009191. [PMID: 33764979 PMCID: PMC7993612 DOI: 10.1371/journal.pntd.0009191] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hepatosplenic schistosomiasis (HSS) is a disease caused by chronic infection with Schistosma spp. parasites residing in the mesenteric plexus; portal hypertension causing gastrointestinal bleeding is the most dangerous complication of this condition. HSS requires complex clinical management, but no specific guidelines exist. We aimed to provide a comprehensive picture of consolidated findings and knowledge gaps on the diagnosis and treatment of HSS. METHODOLOGY/PRINCIPAL FINDINGS We reviewed relevant original publications including patients with HSS with no coinfections, published in the past 40 years, identified through MEDLINE and EMBASE databases. Treatment with praziquantel and HSS-associated pulmonary hypertension were not investigated. Of the included 60 publications, 13 focused on diagnostic aspects, 45 on therapeutic aspects, and 2 on both aspects. Results were summarized using effect direction plots. The most common diagnostic approaches to stratify patients based on the risk of variceal bleeding included the use of ultrasonography and platelet counts; on the contrary, evaluation and use of noninvasive tools to guide the choice of therapeutic interventions are lacking. Publications on therapeutic aspects included treatment with beta-blockers, local management of esophageal varices, surgical procedures, and transjugular intrahepatic portosystemic shunt. Overall, treatment approaches and measured outcomes were heterogeneous, and data on interventions for primary prevention of gastrointestinal bleeding and on the long-term follow-up after interventions were lacking. CONCLUSIONS Most interventions have been developed on the basis of individual groups' experiences and almost never rigorously compared; furthermore, there is a lack of data regarding which parameters can guide the choice of intervention. These results highlight a dramatic need for the implementation of rigorous prospective studies with long-term follow-up in different settings to fill such fundamental gaps, still present for a disease affecting millions of patients worldwide.
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Affiliation(s)
- Francesca Tamarozzi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Veronica A. Fittipaldo
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Hans Martin Orth
- Department of Gastroenterology, Hepatology and Infectious Diseases, Duesseldorf University Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Joachim Richter
- Institute of Tropical Medicine and International Health, Charité Universitätsmedizin, Berlin, Germany
| | - Dora Buonfrate
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Niccolò Riccardi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Federico G. Gobbi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
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12
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Dib PRB, Quirino-Teixeira AC, Merij LB, Pinheiro MBM, Rozini SV, Andrade FB, Hottz ED. Innate immune receptors in platelets and platelet-leukocyte interactions. J Leukoc Biol 2020; 108:1157-1182. [PMID: 32779243 DOI: 10.1002/jlb.4mr0620-701r] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 06/11/2020] [Accepted: 06/28/2020] [Indexed: 12/14/2022] Open
Abstract
Platelets are chief cells in hemostasis. Apart from their hemostatic roles, platelets are major inflammatory effector cells that can influence both innate and adaptive immune responses. Activated platelets have thromboinflammatory functions linking hemostatic and immune responses in several physiological and pathological conditions. Among many ways in which platelets exert these functions, platelet expression of pattern recognition receptors (PRRs), including TLR, Nod-like receptor, and C-type lectin receptor families, plays major roles in sensing and responding to pathogen-associated or damage-associated molecular patterns (PAMPs and DAMPs, respectively). In this review, an increasing body of evidence is compiled showing the participation of platelet innate immune receptors, including PRRs, in infectious diseases, sterile inflammation, and cancer. How platelet recognition of endogenous DAMPs participates in sterile inflammatory diseases and thrombosis is discussed. In addition, platelet recognition of both PAMPs and DAMPs initiates platelet-mediated inflammation and vascular thrombosis in infectious diseases, including viral, bacterial, and parasite infections. The study also focuses on the involvement of innate immune receptors in platelet activation during cancer, and their contribution to tumor microenvironment development and metastasis. Finally, how innate immune receptors participate in platelet communication with leukocytes, modulating leukocyte-mediated inflammation and immune functions, is highlighted. These cell communication processes, including platelet-induced release of neutrophil extracellular traps, platelet Ag presentation to T-cells and platelet modulation of monocyte cytokine secretion are discussed in the context of infectious and sterile diseases of major concern in human health, including cardiovascular diseases, dengue, HIV infection, sepsis, and cancer.
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Affiliation(s)
- Paula Ribeiro Braga Dib
- Laboratory of Immunothrombosis, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil.,Laboratory of Immunology, Infectious Diseases and Obesity, Department of Parasitology, Microbiology and Immunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Anna Cecíllia Quirino-Teixeira
- Laboratory of Immunothrombosis, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Laura Botelho Merij
- Laboratory of Immunothrombosis, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Mariana Brandi Mendonça Pinheiro
- Laboratory of Immunothrombosis, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Stephane Vicente Rozini
- Laboratory of Immunothrombosis, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Fernanda Brandi Andrade
- Laboratory of Immunothrombosis, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Eugenio Damaceno Hottz
- Laboratory of Immunothrombosis, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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13
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Zambrano LD, Jentes E, Phares C, Weinberg M, Kachur SP, Basnet MS, Klosovsky A, Mwesigwa M, Naoum M, Nsobya SL, Samson O, Goers M, McDonald R, Morawski B, Njuguna H, Peak C, Laws R, Bakhsh Y, Iverson SA, Bezold C, Allkhenfr H, Horth R, Yang J, Miller S, Kacka M, Davids A, Mortimer M, Stauffer W, Marano N. Clinical Sequelae Associated with Unresolved Tropical Splenomegaly in a Cohort of Recently Resettled Congolese Refugees in the United States-Multiple States, 2015-2018. Am J Trop Med Hyg 2020; 103:485-493. [PMID: 32372751 PMCID: PMC7356405 DOI: 10.4269/ajtmh.19-0534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 03/09/2020] [Indexed: 12/20/2022] Open
Abstract
Tropical splenomegaly is often associated with malaria and schistosomiasis. In 2014 and 2015, 145 Congolese refugees in western Uganda diagnosed with splenomegaly during predeparture medical examinations underwent enhanced screening for various etiologies. After anecdotal reports of unresolved splenomegaly and complications after U.S. arrival, patients were reassessed to describe long-term clinical progression after arrival in the United States. Post-arrival medical information was obtained through medical chart abstraction in collaboration with state health partners in nine participating states. We evaluated observed splenomegaly duration and associated clinical sequelae between 130 case patients from eastern Congo and 102 controls through adjusted hierarchical Poisson models, accounting for familial clustering. Of the 130 case patients, 95 (73.1%) had detectable splenomegaly after arrival. Of the 85 patients with records beyond 6 months, 45 (52.9%) had persistent splenomegaly, with a median persistence of 14.7 months (range 6.0-27.9 months). Of the 112 patients with available results, 65 (58.0%) patients had evidence of malaria infection, and the mean splenomegaly duration did not differ by Plasmodium species. Refugees with splenomegaly on arrival were 43% more likely to have anemia (adjusted relative risk [aRR]: 1.43, 95% CI: 1.04-1.97). Those with persistent splenomegaly were 60% more likely (adjusted relative risk [aRR]: 1.60, 95% CI: 1.15-2.23) to have a hematologic abnormality, particularly thrombocytopenia (aRR: 5.53, 95% CI: 1.73-17.62), and elevated alkaline phosphatase (aRR: 1.57, 95% CI: 1.03-2.40). Many patients experienced persistent splenomegaly, contradicting literature describing resolution after treatment and removal from an endemic setting. Other possible etiologies should be investigated and effective treatment, beyond treatment for malaria and schistosomiasis, explored.
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Affiliation(s)
- Laura Divens Zambrano
- Epidemic Intelligence Service, CDC, Atlanta, Georgia
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
| | - Emily Jentes
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
| | - Christina Phares
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
| | - Michelle Weinberg
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
| | - S. Patrick Kachur
- Columbia University Mailman School of Public Health, New York, New York
| | | | | | - Moses Mwesigwa
- International Organization for Migration, Geneva, Switzerland
| | - Marwan Naoum
- International Organization for Migration, Geneva, Switzerland
| | - Samuel Lubwama Nsobya
- School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Disease Research Collaboration, Kampala, Uganda
| | - Olivia Samson
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Matthew Goers
- Epidemic Intelligence Service, CDC, Atlanta, Georgia
- Division of Global Health Protection, Center for Global Health, CDC, Atlanta, Georgia
| | - Robert McDonald
- Epidemic Intelligence Service, CDC, Atlanta, Georgia
- New York State Department of Health, Albany, New York
| | | | - Henry Njuguna
- Epidemic Intelligence Service, CDC, Atlanta, Georgia
- Washington State Department of Health, Tumwater, Washington
| | - Corey Peak
- Epidemic Intelligence Service, CDC, Atlanta, Georgia
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
| | - Rebecca Laws
- Epidemic Intelligence Service, CDC, Atlanta, Georgia
- California Department of Public Health, Sacramento, California
| | - Yasser Bakhsh
- Epidemic Intelligence Service, CDC, Atlanta, Georgia
- California Department of Public Health, Sacramento, California
| | - Sally Ann Iverson
- Epidemic Intelligence Service, CDC, Atlanta, Georgia
- Arizona Department of Health Services, Phoenix, Arizona
| | - Carla Bezold
- Epidemic Intelligence Service, CDC, Atlanta, Georgia
- Arizona Department of Health Services, Phoenix, Arizona
| | | | - Roberta Horth
- Epidemic Intelligence Service, CDC, Atlanta, Georgia
- Utah Department of Health, Salt Lake City, Utah
| | - Jun Yang
- Pennsylvania Department of Human Services, Harrisburg, Pennsylvania
| | - Susan Miller
- Pennsylvania Department of Human Services, Harrisburg, Pennsylvania
| | - Michael Kacka
- South Carolina Department of Health and Environmental Control, Columbia, South Carolina
| | - Abby Davids
- Family Medicine Residency of Idaho, Boise, Idaho
| | | | - William Stauffer
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
- University of Minnesota, Minneapolis, Minnesota
| | - Nina Marano
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
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14
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Sinkala E, Vinikoor M, Zyambo K, Besa E, Nsokolo B, Kelly P. Propranolol Reduces Portal Vein Diameter in Schistosomal Liver Disease with Portal Hypertension: A Prospective Cohort Study. Am J Trop Med Hyg 2020; 102:832-837. [PMID: 32067625 PMCID: PMC7124927 DOI: 10.4269/ajtmh.19-0452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Hepatosplenic schistosomiasis (HSS) complicates portal hypertension, leading to life-threatening variceal bleeding. Variceal bleeding is associated with increased portal vein diameter (PVD). Beta-blockers prevent variceal bleeding. It is unclear whether beta-blockers such as propranolol can reduce PVD in HSS. We aimed to explore the effect of propranolol on PVD in HSS. A longitudinal study was conducted at the University Teaching Hospital, Zambia, as an extension of a clinical trial of rifaximin undertaken to test the hypothesis that rifaximin could reduce bacterial translocation in HSS. We randomized 85 adults to either rifaximin and standard care, or propranolol-based standard care only for 42 days. We then followed up all the patients on propranolol up to day 180. We used ultrasound to measure PVD at baseline and day 180. The primary outcome was reduction in PVD. Beta-blockade and splenic size reduction were secondary outcomes. Portal vein diameter reduced after 180 days of propranolol therapy from median 12 mm (interquartile range (IQR): 11–14) to median 10 mm (IQR: 9–13) (P < 0.001). The pulse rate reduced from baseline median 70 beats/minute (IQR: 66–80) to 65 beats/minute (IQR: 60–70) by day 180 (P = 0.006). Hemoglobin levels improved from baseline median 8 g/dL (IQR: 6–11) to 12 g/dL (10–14) (P < 0.001). Splenic size remained unchanged. Propranolol led to the reduction in PVD over 180 days. This suggests that ultrasound could be useful in monitoring response and compliance to beta-blockers, especially in resource-constraint areas where portal hypertension measurement facilities are unavailable.
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Affiliation(s)
- Edford Sinkala
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia.,Department of Internal Medicine, Tropical Gastroenterology and Nutritional Group, University of Zambia, Lusaka, Zambia
| | - Michael Vinikoor
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kanekwa Zyambo
- Department of Internal Medicine, Tropical Gastroenterology and Nutritional Group, University of Zambia, Lusaka, Zambia
| | - Ellen Besa
- Department of Internal Medicine, Tropical Gastroenterology and Nutritional Group, University of Zambia, Lusaka, Zambia
| | - Bright Nsokolo
- Department of Internal Medicine, Tropical Gastroenterology and Nutritional Group, University of Zambia, Lusaka, Zambia.,Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Paul Kelly
- Blizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom.,Department of Internal Medicine, Tropical Gastroenterology and Nutritional Group, University of Zambia, Lusaka, Zambia.,Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
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15
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Eyayu T, Zeleke AJ, Seyoum M, Worku L. Basic Coagulation Profiles and Platelet Count Among Schistosoma mansoni-Infected Adults Attending Sanja Primary Hospital, Northwest Ethiopia. Res Rep Trop Med 2020; 11:27-36. [PMID: 32368171 PMCID: PMC7184861 DOI: 10.2147/rrtm.s244912] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/07/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To assess basic coagulation profiles and platelet count among Schistosoma mansoni-infected and non-infected adults. PATIENTS AND METHODS A comparative cross-sectional study was conducted from February to April 2019 at Sanja Primary Hospital, northwest Ethiopia. A total of 200 adults (100 cases and 100 controls) were enrolled using convenient sampling technique. Both wet mount and Kato-Katz techniques were performed using a stool sample. The venous blood sample was collected to perform platelet count, basic coagulation and serological tests. The data were coded and entered into EpiData Manager (v4.4.2.1) and analyzed using SPSS version 20. Nonparametric tests were used during data analysis. P-value less than 0.05 was considered as statistically significant. RESULTS Prothrombin time (PT), activated partial thromboplastin time (APTT) and international normalization ratio (INR) were significantly higher while the platelet count was significantly lower in S. mansoni-infected than healthy adults (P <0.001). There were statistically significant differences in the median [IQR] value of PT, APTT, INR and platelet count between light, moderate and heavy infected groups (P <0.05). Infection intensity had a positive correlation with basic coagulation profiles and a negative correlation with platelet count (P <0.05) of S. mansoni-infected adults. CONCLUSION The prevalence of coagulation abnormality was higher in S. mansoni-infected adults than healthy controls. Coagulation test and platelet count should be used to monitor and manage schistosomiasis-related complications.
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Affiliation(s)
- Tahir Eyayu
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Ayalew Jejaw Zeleke
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Masresha Seyoum
- University of Gondar Referral Hospital Laboratory, University of Gondar, Gondar, Amhara Regional State, Ethiopia
| | - Ligabaw Worku
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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16
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Zambrano LD, Samson O, Phares C, Jentes E, Weinberg M, Goers M, Kachur SP, McDonald R, Morawski B, Njuguna H, Bakhsh Y, Laws R, Peak C, Iverson SA, Bezold C, Allkhenfr H, Horth R, Yang J, Miller S, Kacka M, Davids A, Mortimer M, Khan N, Stauffer W, Marano N. Unresolved Splenomegaly in Recently Resettled Congolese Refugees - Multiple States, 2015-2018. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2018; 67:1358-1362. [PMID: 30543602 DOI: 10.155850/mmwr.mm6749a2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In 2014, panel physicians from the International Organization for Migration (IOM), who conduct Department of State-required predeparture examinations for U.S.-bound refugees at resettlement sites in Uganda, noticed an unusually high number of Congolese refugees with enlarged spleens, or splenomegaly. Many conditions can cause splenomegaly, such as various infections, liver disease, and cancer. Splenomegaly can result in hematologic disturbances and abdominal pain and can increase the risk for splenic rupture from blunt trauma, resulting in life-threatening internal bleeding. On CDC's advice, panel physicians implemented an enhanced surveillance and treatment protocol that included screening for malaria (through thick and thin smears and rapid diagnostic testing), schistosomiasis, and several other conditions; treatment of any condition identified as potentially associated with splenomegaly; and empiric treatment for the most likely etiologies, including malaria and schistosomiasis. CDC recommended further treatment for malaria with primaquine after arrival, after glucose-6-phosphate dehydrogenase testing, to target liver-stage parasites. Despite this recommended treatment protocol, 35 of 64 patients with available follow-up records had splenomegaly that persisted beyond 6 months after resettlement. Among 85 patients who were diagnosed with splenomegaly through abdominal palpation or ultrasound at any point after resettlement, 53 had some hematologic abnormality (leukopenia, anemia, or thrombocytopenia), 16 had evidence of current or recent malaria infection, and eight had evidence of schistosomiasis. Even though primaquine was provided to a minority of patients in this cohort, it should be provided to all eligible patients with persistent splenomegaly, and repeated antischistosomal therapy should be provided to patients with evidence of current or recent schistosomiasis. Given substantial evidence of familial clustering of cases, family members of patients with known splenomegaly should be proactively screened for this condition.
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17
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Zambrano LD, Samson O, Phares C, Jentes E, Weinberg M, Goers M, Kachur SP, McDonald R, Morawski B, Njuguna H, Bakhsh Y, Laws R, Peak C, Iverson SA, Bezold C, Allkhenfr H, Horth R, Yang J, Miller S, Kacka M, Davids A, Mortimer M, Khan N, Stauffer W, Marano N. Unresolved Splenomegaly in Recently Resettled Congolese Refugees ― Multiple States, 2015–2018. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2018. [PMID: 30543602 PMCID: PMC6300079 DOI: 10.15585/mmwr.mm6749a2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
In 2014, panel physicians from the International Organization for Migration (IOM), who conduct Department of State–required predeparture examinations for U.S.-bound refugees at resettlement sites in Uganda, noticed an unusually high number of Congolese refugees with enlarged spleens, or splenomegaly. Many conditions can cause splenomegaly, such as various infections, liver disease, and cancer. Splenomegaly can result in hematologic disturbances and abdominal pain and can increase the risk for splenic rupture from blunt trauma, resulting in life-threatening internal bleeding. On CDC’s advice, panel physicians implemented an enhanced surveillance and treatment protocol that included screening for malaria (through thick and thin smears and rapid diagnostic testing), schistosomiasis, and several other conditions; treatment of any condition identified as potentially associated with splenomegaly; and empiric treatment for the most likely etiologies, including malaria and schistosomiasis. CDC recommended further treatment for malaria with primaquine after arrival, after glucose-6-phosphate dehydrogenase testing, to target liver-stage parasites. Despite this recommended treatment protocol, 35 of 64 patients with available follow-up records had splenomegaly that persisted beyond 6 months after resettlement. Among 85 patients who were diagnosed with splenomegaly through abdominal palpation or ultrasound at any point after resettlement, 53 had some hematologic abnormality (leukopenia, anemia, or thrombocytopenia), 16 had evidence of current or recent malaria infection, and eight had evidence of schistosomiasis. Even though primaquine was provided to a minority of patients in this cohort, it should be provided to all eligible patients with persistent splenomegaly, and repeated antischistosomal therapy should be provided to patients with evidence of current or recent schistosomiasis. Given substantial evidence of familial clustering of cases, family members of patients with known splenomegaly should be proactively screened for this condition.
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18
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Sinkala E, Zyambo K, Besa E, Kaonga P, Nsokolo B, Kayamba V, Vinikoor M, Zulu R, Bwalya M, Foster GR, Kelly P. Rifaximin Reduces Markers of Inflammation and Bacterial 16S rRNA in Zambian Adults with Hepatosplenic Schistosomiasis: A Randomized Control Trial. Am J Trop Med Hyg 2018; 98:1152-1158. [PMID: 29436337 PMCID: PMC5928821 DOI: 10.4269/ajtmh.17-0637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cirrhosis is the dominant cause of portal hypertension globally but may be overshadowed by hepatosplenic schistosomiasis (HSS) in the tropics. In Zambia, schistosomiasis seroprevalence can reach 88% in endemic areas. Bacterial translocation (BT) drives portal hypertension in cirrhosis contributing to mortality but remains unexplored in HSS. Rifaximin, a non-absorbable antibiotic may reduce BT. We aimed to explore the influence of rifaximin on BT, inflammation, and fibrosis in HSS. In this phase II open-label trial (ISRCTN67590499), 186 patients with HSS in Zambia were evaluated and 85 were randomized to standard care with or without rifaximin for 42 days. Changes in markers of inflammation, BT, and fibrosis were the primary outcomes. BT was measured using plasma 16S rRNA, lipopolysaccharide-binding protein, and lipopolysaccharide, whereas hyaluronan was used to measure fibrosis. Tumor necrosis factor receptor 1 (TNFR1) and soluble cluster of differentiation 14 (sCD14) assessed inflammation. 16S rRNA reduced from baseline (median 146 copies/µL, interquartile range [IQR] 9, 537) to day 42 in the rifaximin group (median 63 copies/µL, IQR 12, 196), P < 0.01. The rise in sCD14 was lower (P < 0.01) in the rifaximin group (median rise 122 ng/mL, IQR-184, 783) than in the non-rifaximin group (median rise 832 ng/mL, IQR 530, 967). TNFR1 decreased (P < 0.01) in the rifaximin group (median -39 ng/mL IQR-306, 563) but increased in the non-rifaximin group (median 166 ng/mL, IQR 3, 337). Other markers remained unaffected. Rifaximin led to a reduction of inflammatory markers and bacterial 16S rRNA which may implicate BT in the inflammation in HSS.
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Affiliation(s)
- Edford Sinkala
- Department of Internal Medicine, Tropical Gastroenterology & Nutritional Group, University of Zambia, Lusaka, Zambia.,Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Kanekwa Zyambo
- Department of Internal Medicine, Tropical Gastroenterology & Nutritional Group, University of Zambia, Lusaka, Zambia
| | - Ellen Besa
- Department of Internal Medicine, Tropical Gastroenterology & Nutritional Group, University of Zambia, Lusaka, Zambia
| | - Patrick Kaonga
- Department of Internal Medicine, Tropical Gastroenterology & Nutritional Group, University of Zambia, Lusaka, Zambia.,Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Bright Nsokolo
- Department of Internal Medicine, Tropical Gastroenterology & Nutritional Group, University of Zambia, Lusaka, Zambia.,Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Violet Kayamba
- Department of Internal Medicine, Tropical Gastroenterology & Nutritional Group, University of Zambia, Lusaka, Zambia.,Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Michael Vinikoor
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rabison Zulu
- Paediatric Centre of Excellence Laboratory, University Teaching Hospital, Lusaka, Zambia
| | - Martin Bwalya
- Paediatric Centre of Excellence Laboratory, University Teaching Hospital, Lusaka, Zambia
| | - Graham R Foster
- Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Paul Kelly
- Paediatric Centre of Excellence Laboratory, University Teaching Hospital, Lusaka, Zambia.,Department of Internal Medicine, Tropical Gastroenterology & Nutritional Group, University of Zambia, Lusaka, Zambia.,Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
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19
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Use of Ultrasound in the Diagnosis and Treatment of Tropical Diseases in Uganda. Ultrasound Q 2015; 31:290-7. [PMID: 26656992 DOI: 10.1097/ruq.0000000000000201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This manuscript will present a review of the use of ultrasound to diagnose and treat tropical diseases seen most commonly in Uganda.
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20
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Splenectomy Improves Hemostatic and Liver Functions in Hepatosplenic Schistosomiasis Mansoni. PLoS One 2015; 10:e0135370. [PMID: 26267788 PMCID: PMC4534302 DOI: 10.1371/journal.pone.0135370] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 07/08/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Schistosomiasis mansoni is a chronic liver disease, in which some patients (5-10%) progress to the most severe form, hepatosplenic schistosomiasis. This form is associated with portal hypertension and splenomegaly, and often episodes of gastrointestinal bleeding, even with liver function preserved. Splenectomy is a validated procedure to reduce portal hypertension following digestive bleeding. Here, we evaluate beneficial effects of splenectomy on blood coagulation factors and liver function tests in hepatosplenic schistosomiasis mansoni compared to non-operated patients. METHODOLOGY/PRINCIPAL FINDINGS Forty-five patients who had undergone splenectomy surgery were assessed by laboratory analyses and ultrasound examination and compared to a non-operated group (n = 55). Blood samples were obtained for liver function tests, platelet count and prothrombin time. Coagulation factors (II, VII, VIII, IX and X), protein C and antithrombin IIa, plasminogen activator inhibitor-1 were measured by routine photometric, chromogenic or enzyme-linked immunosorbent assays, while hyperfibrinolysis was defined by plasminogen activator inhibitor-1 levels. Both groups had similar age, gender and pattern of periportal fibrosis. Splenectomized patients showed significant reductions in portal vein diameter, alkaline phosphatase and bilirubin levels compared to non-operated patients, while for coagulation factors there were significant improvement in prothrombin, partial thromboplastin times and higher levels of factor VII, VIII, IX, X, protein C and plasminogen activator inhibitor-1. CONCLUSION/SIGNIFICANCE This study shows that the decrease of flow pressure in portal circulation after splenectomy restores the capacity of hepatocyte synthesis, especially on the factor VII and protein C levels, and these findings suggest that portal hypertension in patients with hepatosplenic schistosomiasis influences liver functioning and the blood coagulation status.
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21
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Martins GLP, Bernardes JPG, Rovella MS, Andrade RG, Viana PCC, Herman P, Cerri GG, Menezes MR. Radiofrequency ablation for treatment of hypersplenism: A feasible therapeutic option. World J Gastroenterol 2015; 21:6391-6397. [PMID: 26034376 PMCID: PMC4445118 DOI: 10.3748/wjg.v21.i20.6391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/06/2014] [Accepted: 02/05/2015] [Indexed: 02/06/2023] Open
Abstract
We present a case of a patient with hypersplenism secondary to portal hypertension due to hepato-splenic schistosomiasis, which was accompanied by severe and refractory thrombocytopenia. We performed spleen ablation and measured the total spleen and ablated volumes with contrast-enhanced computed tomography and volumetry. No major complications occurred, thrombocytopenia was resolved, and platelet levels remained stable, which allowed for early treatment of the patient’s underlying disease. Previous work has shown that splenic radiofrequency ablation is an attractive alternative treatment for hypersplenism induced by liver cirrhosis. We aimed to contribute to the currently sparse literature evaluating the role of radiofrequency ablation (RFA) in the management of hypersplenism. We conclude that splenic RFA appears to be a viable and promising option for the treatment of hypersplenism.
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22
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Davis SM, Wiegand RE, Mulama F, Kareko EI, Harris R, Ochola E, Samuels AM, Rawago F, Mwinzi PM, Fox LM, Odiere MR, Won KY. Morbidity associated with schistosomiasis before and after treatment in young children in Rusinga Island, western Kenya. Am J Trop Med Hyg 2015; 92:952-8. [PMID: 25758651 DOI: 10.4269/ajtmh.14-0346] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 01/19/2015] [Indexed: 11/07/2022] Open
Abstract
Schistosoma mansoni infection is a major cause of organomegaly and ultimately liver fibrosis in adults. Morbidity in pre-school-aged children is less defined, and they are currently not included in mass drug administration (MDA) programs for schistosomiasis control. We report results of a study of the association of schistosomiasis with organomegaly in a convenience sample of 201 children under 7 years old in Rusinga, Kenya on two cross-sectional visits, before and after praziquantel treatment. Data included stool examination and serology for schistosomiasis, the Niamey ultrasound protocol to stage hepatosplenic morbidity including organomegaly, and potential confounders including malaria. Unadjusted and adjusted Poisson regressions were performed. The baseline prevalence of schistosomiasis by antibody and/or stool was 80.3%. Schistomiasis was associated with hepatomegaly (adjusted prevalence ratio [aPR] = 1.4; 95% confidence interval [CI]: 1.0-2.1) and splenomegaly (aPR = 2.1; 95% CI: 1.2-3.7). The association with hepatomegaly persisted posttreatment (aPR = 1.4; 95% CI: 1.1-1.6). Schistosomiasis was associated with morbidity in this cohort. Efforts to include young children in mass treatment campaigns should intensify.
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Affiliation(s)
- Stephanie M Davis
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - Ryan E Wiegand
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - Fridah Mulama
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - Edmund Ireri Kareko
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - Robert Harris
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - Elizabeth Ochola
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - Aaron M Samuels
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - Fredrick Rawago
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - Pauline M Mwinzi
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - LeAnne M Fox
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - Maurice R Odiere
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - Kimberly Y Won
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
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23
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Da'dara AA, Skelly PJ. Schistosomes versus platelets. Thromb Res 2014; 134:1176-81. [PMID: 25294585 DOI: 10.1016/j.thromres.2014.09.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/15/2014] [Accepted: 09/23/2014] [Indexed: 01/24/2023]
Abstract
Schistosomes are parasitic platyhelminths that currently infect >200million people and cause the chronic debilitating disease schistosomiasis. While these large intravascular parasites can disturb blood flow, they do not appear to activate platelets and provoke thrombus formation. Host-interactive tegumental molecules have been proposed to be important in this regard. For example, tegumental apyrase, SmATPDase1 can degrade the platelet-activating molecule ADP in the extracellular environment. The parasites themselves can produce prostaglandins (or may induce prostaglandin production by host cells) which could inhibit platelet aggregation. Additional tegumental proteins have been proposed to impede the coagulation cascade and to promote fibrinolysis. Platelets have been shown to be directly toxic to schistosomes. Platelets recovered from infected rats are able to kill larval parasites in culture and platelets obtained at later times post-infection are generally better at killing. Even platelets from uninfected rats can rapidly kill larval schistosomes if first exposed to a variety of activators (such as: serum from infected rats, the IgE fraction of that serum, C-reactive protein, cytokines (TNFα or TNFβ)). Passive transfer of stimulated platelets can protect rats against a challenge schistosome infection. Cytokines (TNFα, TNFβ, IFNγ or IL-6) have been shown to similarly promote normal human platelet killing of schistosomes in vitro. Platelet antimicrobial effector molecules (e.g. platelet microbicidal proteins) may mediate such killing. While platelets can be protective against schistosomes following infection of humans and mice, platelet numbers decline (but not so in the non-permissive rat host) and coagulopathy becomes more apparent as schistosome-induced pathology increases.
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Affiliation(s)
- Akram A Da'dara
- Molecular Helminthology Laboratory, Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, USA
| | - Patrick J Skelly
- Molecular Helminthology Laboratory, Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, USA.
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24
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Olveda DU, Olveda RM, McManus DP, Cai P, Chau TNP, Lam AK, Li Y, Harn DA, Vinluan ML, Ross AGP. The chronic enteropathogenic disease schistosomiasis. Int J Infect Dis 2014; 28:193-203. [PMID: 25250908 DOI: 10.1016/j.ijid.2014.07.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/26/2014] [Accepted: 07/16/2014] [Indexed: 02/08/2023] Open
Abstract
Schistosomiasis is a chronic enteropathogenic disease caused by blood flukes of the genus Schistosoma. The disease afflicts approximately 240 million individuals globally, causing approximately 70 million disability-adjusted life years lost. Chronic infections with morbidity and mortality occur as a result of granuloma formation in the intestine, liver, or in the case of Schistosoma haematobium, the bladder. Various methods are utilized to diagnose and evaluate liver fibrosis due to schistosomiasis. Liver biopsy is still considered the gold standard, but it is invasive. Diagnostic imaging has proven to be an invaluable method in assessing hepatic morbidity in the hospital setting, but has practical limitations in the field. The potential of non-invasive biological markers, serum antibodies, cytokines, and circulating host microRNAs to diagnose hepatic fibrosis is presently undergoing evaluation. This review provides an update on the recent advances made with respect to gastrointestinal disease associated with chronic schistosomiasis.
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Affiliation(s)
- David U Olveda
- Department of Medical Sciences, Griffith Health Institute, Gold Coast, Australia
| | - Remigio M Olveda
- Department of Health, Research Institute for Tropical Medicine, Manila, The Philippines
| | - Donald P McManus
- Department of Molecular Parasitology, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Pengfei Cai
- Department of Molecular Parasitology, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Thao N P Chau
- Department of Public Health, Flinders University, Adelaide, Australia
| | - Alfred K Lam
- Department of Medical Sciences, Griffith Health Institute, Gold Coast, Australia
| | - Yuesheng Li
- Department of Molecular Parasitology, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Donald A Harn
- Department of Infectious Diseases, University of Georgia, Georgia, USA
| | - Marilyn L Vinluan
- Department of Health, Research Institute for Tropical Medicine, Manila, The Philippines
| | - Allen G P Ross
- Department of Medical Sciences, Griffith Health Institute, Gold Coast, Australia.
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