Marta Tilli1, Federico Gobbi2, Francesca Rinaldi1, Jacopo Testa2,3, Silvio Caligaris4, Paola Magro4, Dora Buonfrate2, Monica Degani2, Andrea Minervini1,5, Marco Carini1,5, Agostino Tuccio5, Simone Sforza1,5, Maurizio Gulletta4, Francesco Castelli4,6, Simone Agostini7, Filippo Parretti7, Joachim Richter8, Piero Olliaro9,10, Zeno Bisoffi2,11, Alessandro Bartoloni1,12,13, Lorenzo Zammarchi14,15,16. 1. Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy. 2. IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy. 3. Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University, Varese, Italy. 4. University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy. 5. Department of Urology, Careggi University and Hospital, Florence, Italy. 6. UNESCO Chair "Training and Empowering Human Resources for Health Development in Resource-Limited Countries, University of Brescia", Brescia, Italy. 7. Radiology Unit, Careggi University and Hospital, Florence, Italy. 8. Institut für Tropenmedizin und Internationale Gesundheit Charité, Universitätsmedizin Berlin, Berlin, Germany. 9. Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland. 10. Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK. 11. Department of Diagnostics and Public Health, University of Verona, Verona, Italy. 12. Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, Italy. 13. Referral Centre for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy. 14. Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy. lorenzo.zammarchi@unifi.it. 15. Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, Italy. lorenzo.zammarchi@unifi.it. 16. Referral Centre for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy. lorenzo.zammarchi@unifi.it.
Abstract
OBJECTIVES: To evaluate ultrasound and praziquantel to, respectively, assess and reduce urogenital schistosomiasis (UGS)-associated morbidity in migrants from Sub-Saharan Africa (SSA). METHODS: Migrants from SSA with UGS attending three Italian centres for tropical diseases during 2011-2016 were retrospectively enrolled. Data on clinical symptoms, routine laboratory, parasitological tests, and ultrasound reported as per the WHO-Niamey protocol were collected at baseline and at available follow-up visits after treatment with praziquantel 40 mg/kg/day for 3 days. RESULTS: One hundred and seventy patients with UGS were enrolled and treated with praziquantel. Baseline ultrasonography showed urinary tract abnormalities in 115/169 patients (68%); the mean global Schistosoma haematobium score was 2.29 (SD 2.84, IQR 0-2), the mean urinary bladder intermediate score 1.75 (SD 1.73, IQR 0-2), and the mean upper urinary tract intermediate score 0.54 (SD 2.37, IQR 1-10). Abnormalities were more common among the 111 (65%) who were symptomatic (p < 0.02; OR 2.53; 95% CI 1.19-5.35). Symptoms started in 94/111 (85%) before arriving (median 63 months, IQR 12-119). At follow-up, we observed a significant reduction in the prevalence of UGS-related symptoms, blood, urine, and ultrasound abnormalities. CONCLUSIONS: Our study results support the use of ultrasound and praziquantel for assessing and reducing UGS-associated morbidity in migrants. Health-seeking behaviour, diagnostic, and treatment delays contribute to the advanced pathology and qualified treatment success. To ensure earlier treatment, based on our findings, clinical experience, and available literature, we propose an algorithm for the diagnosis and clinical management of UGS. Multicentre studies are needed to improve the management of subjects with UGS in non-endemic countries.
OBJECTIVES: To evaluate ultrasound and praziquantel to, respectively, assess and reduce urogenital schistosomiasis (UGS)-associated morbidity in migrants from Sub-Saharan Africa (SSA). METHODS: Migrants from SSA with UGS attending three Italian centres for tropical diseases during 2011-2016 were retrospectively enrolled. Data on clinical symptoms, routine laboratory, parasitological tests, and ultrasound reported as per the WHO-Niamey protocol were collected at baseline and at available follow-up visits after treatment with praziquantel 40 mg/kg/day for 3 days. RESULTS: One hundred and seventy patients with UGS were enrolled and treated with praziquantel. Baseline ultrasonography showed urinary tract abnormalities in 115/169 patients (68%); the mean global Schistosoma haematobium score was 2.29 (SD 2.84, IQR 0-2), the mean urinary bladder intermediate score 1.75 (SD 1.73, IQR 0-2), and the mean upper urinary tract intermediate score 0.54 (SD 2.37, IQR 1-10). Abnormalities were more common among the 111 (65%) who were symptomatic (p < 0.02; OR 2.53; 95% CI 1.19-5.35). Symptoms started in 94/111 (85%) before arriving (median 63 months, IQR 12-119). At follow-up, we observed a significant reduction in the prevalence of UGS-related symptoms, blood, urine, and ultrasound abnormalities. CONCLUSIONS: Our study results support the use of ultrasound and praziquantel for assessing and reducing UGS-associated morbidity in migrants. Health-seeking behaviour, diagnostic, and treatment delays contribute to the advanced pathology and qualified treatment success. To ensure earlier treatment, based on our findings, clinical experience, and available literature, we propose an algorithm for the diagnosis and clinical management of UGS. Multicentre studies are needed to improve the management of subjects with UGS in non-endemic countries.
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