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Schistosomiasis in immigrants, refugees and travellers in an Italian referral centre for tropical diseases.
Infect Dis Poverty. 2018 Jun 16; 7(1):55.ID

Abstract

BACKGROUND

Schistosomiasis is one of the most important neglected tropical diseases. If unrecognised and untreated, the chronic infection can lead to irreversible complications.

METHODS

Retrospective observational study aimed at describing clinical history, laboratory findings and imaging presentation of imported schistosomiasis diagnosed at the Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital of Negrar, Verona, Italy from 2010 to 2014. The aim of our study was to assess differences in demographic characteristics, clinical presentation, laboratory data and ultrasound findings between immigrants/visiting friends and relatives (VFR) from endemic countries (endemic group) and expatriates/travellers (non-endemic group).

RESULTS

A total of 272 patients were retrieved: 234 in the endemic and 38 in the non-endemic group. Most of the patients acquired schistosomiasis in Africa (97.4%). Symptoms were reported by 52.9% of the patients; abdominal pain (36%), macroscopic hematuria (11.3%), and genito-urinary symptoms (7.4%) being the most frequently reported. Increased IgE and blood eosinophilia were observed in 169 (63.8%) and 130 (47.8%) patients, respectively. The proportion of positive serology was 250/272 (91.9%).The Circulating Cathodic Antigen CCA for Schistosoma mansoni was positive in 14/61 individuals (23%). At microscopy, infected subjects were 103/272 (37.9%). The species of Schistosoma found were S. haematobium (47.6%), S. mansoni (46.6%) or both (5.8%). Schistosomiasis was classified as confirmed in 103 (37.9%), probable in 165 (60.6%) and suspected in 4 (1.5%) cases using clinical presentation, laboratory data and ultrasound findings. The infection was further classified based on organ involvement: intestinal (17.9%), hepatosplenic (5.1%), urogenital (48.9%), and indeterminate (43.8%). The comparative analysis of endemic and non-endemic patients highlighted differences in sex and age. Endemic patients had more frequent ova identification (41.9% vs. 13.2%, P < 0.001) and increased IgE (70% vs. 26.3%, P < 0.001) when compared with non-endemic. Multivariate analyses showed that younger age, abnormal ultrasound findings and blood eosinophilia were significantly associated with positive microscopy (OR = 0.94, OR = 2.12, OR = 1.98, respectively).

CONCLUSIONS

Symptoms, eosinophilia and abnormal ultrasound findings were present in about half of patients, without differences between groups. Many patients had positive serology but negative microscopy, indicating that schistosomiasis might be misdiagnosed. A combination of diagnostic tools may facilitate the diagnosis.

Authors+Show Affiliations

Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024, Negrar, Italy. University Department of Infectious and Tropical Diseases & WHO Collaborating Centre for TB/HIV and TB elimination, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024, Negrar, Italy. anna.beltrame@sacrocuore.it.Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024, Negrar, Italy.Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024, Negrar, Italy.Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024, Negrar, Italy.Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024, Negrar, Italy.Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024, Negrar, Italy.Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024, Negrar, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29907162

Citation

Marchese, Valentina, et al. "Schistosomiasis in Immigrants, Refugees and Travellers in an Italian Referral Centre for Tropical Diseases." Infectious Diseases of Poverty, vol. 7, no. 1, 2018, p. 55.
Marchese V, Beltrame A, Angheben A, et al. Schistosomiasis in immigrants, refugees and travellers in an Italian referral centre for tropical diseases. Infect Dis Poverty. 2018;7(1):55.
Marchese, V., Beltrame, A., Angheben, A., Monteiro, G. B., Giorli, G., Perandin, F., Buonfrate, D., & Bisoffi, Z. (2018). Schistosomiasis in immigrants, refugees and travellers in an Italian referral centre for tropical diseases. Infectious Diseases of Poverty, 7(1), 55. https://doi.org/10.1186/s40249-018-0440-5
Marchese V, et al. Schistosomiasis in Immigrants, Refugees and Travellers in an Italian Referral Centre for Tropical Diseases. Infect Dis Poverty. 2018 Jun 16;7(1):55. PubMed PMID: 29907162.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Schistosomiasis in immigrants, refugees and travellers in an Italian referral centre for tropical diseases. AU - Marchese,Valentina, AU - Beltrame,Anna, AU - Angheben,Andrea, AU - Monteiro,Geraldo Badona, AU - Giorli,Giovanni, AU - Perandin,Francesca, AU - Buonfrate,Dora, AU - Bisoffi,Zeno, Y1 - 2018/06/16/ PY - 2017/10/05/received PY - 2018/05/16/accepted PY - 2018/6/17/entrez PY - 2018/6/17/pubmed PY - 2018/10/3/medline KW - Europe KW - Italy KW - Neglected tropical diseases, immigrants KW - Refugees KW - Schistosomiasis KW - Travellers SP - 55 EP - 55 JF - Infectious diseases of poverty JO - Infect Dis Poverty VL - 7 IS - 1 N2 - BACKGROUND: Schistosomiasis is one of the most important neglected tropical diseases. If unrecognised and untreated, the chronic infection can lead to irreversible complications. METHODS: Retrospective observational study aimed at describing clinical history, laboratory findings and imaging presentation of imported schistosomiasis diagnosed at the Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital of Negrar, Verona, Italy from 2010 to 2014. The aim of our study was to assess differences in demographic characteristics, clinical presentation, laboratory data and ultrasound findings between immigrants/visiting friends and relatives (VFR) from endemic countries (endemic group) and expatriates/travellers (non-endemic group). RESULTS: A total of 272 patients were retrieved: 234 in the endemic and 38 in the non-endemic group. Most of the patients acquired schistosomiasis in Africa (97.4%). Symptoms were reported by 52.9% of the patients; abdominal pain (36%), macroscopic hematuria (11.3%), and genito-urinary symptoms (7.4%) being the most frequently reported. Increased IgE and blood eosinophilia were observed in 169 (63.8%) and 130 (47.8%) patients, respectively. The proportion of positive serology was 250/272 (91.9%).The Circulating Cathodic Antigen CCA for Schistosoma mansoni was positive in 14/61 individuals (23%). At microscopy, infected subjects were 103/272 (37.9%). The species of Schistosoma found were S. haematobium (47.6%), S. mansoni (46.6%) or both (5.8%). Schistosomiasis was classified as confirmed in 103 (37.9%), probable in 165 (60.6%) and suspected in 4 (1.5%) cases using clinical presentation, laboratory data and ultrasound findings. The infection was further classified based on organ involvement: intestinal (17.9%), hepatosplenic (5.1%), urogenital (48.9%), and indeterminate (43.8%). The comparative analysis of endemic and non-endemic patients highlighted differences in sex and age. Endemic patients had more frequent ova identification (41.9% vs. 13.2%, P < 0.001) and increased IgE (70% vs. 26.3%, P < 0.001) when compared with non-endemic. Multivariate analyses showed that younger age, abnormal ultrasound findings and blood eosinophilia were significantly associated with positive microscopy (OR = 0.94, OR = 2.12, OR = 1.98, respectively). CONCLUSIONS: Symptoms, eosinophilia and abnormal ultrasound findings were present in about half of patients, without differences between groups. Many patients had positive serology but negative microscopy, indicating that schistosomiasis might be misdiagnosed. A combination of diagnostic tools may facilitate the diagnosis. SN - 2049-9957 UR - https://www.unboundmedicine.com/medline/citation/29907162/Schistosomiasis_in_immigrants_refugees_and_travellers_in_an_Italian_referral_centre_for_tropical_diseases_ DB - PRIME DP - Unbound Medicine ER -