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Infection

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The diagnosis and treatment of urogenital schistosomiasis in Italy in a retrospective cohort of immigrants from Sub-Saharan Africa

  • Marta Tilli
  • Federico Gobbi
  • Francesca Rinaldi
  • Jacopo Testa
  • Silvio Caligaris
  • Paola Magro
  • Dora Buonfrate
  • Monica Degani
  • Andrea Minervini
  • Marco Carini
  • Agostino Tuccio
  • Simone Sforza
  • Maurizio Gulletta
  • Francesco Castelli
  • Simone Agostini
  • Parretti Filippo
  • Joachim Richter
  • Piero Olliaro
  • Zeno Bisoffi
  • Alessandro Bartoloni
  • Lorenzo ZammarchiEmail author
Original Paper

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.

Keywords

Schistosoma Schistosomiasis Migrant Praziquantel Ultrasonography Ultrasound 

Notes

Funding

This research did not receive any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

15010_2019_1270_MOESM1_ESM.docx (245 kb)
Supplementary material 1 (DOCX 244 KB)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Marta Tilli
    • 1
  • Federico Gobbi
    • 2
  • Francesca Rinaldi
    • 1
  • Jacopo Testa
    • 2
    • 3
  • Silvio Caligaris
    • 4
  • Paola Magro
    • 4
  • Dora Buonfrate
    • 2
  • Monica Degani
    • 2
  • Andrea Minervini
    • 1
    • 5
  • Marco Carini
    • 1
    • 5
  • Agostino Tuccio
    • 5
  • Simone Sforza
    • 1
    • 5
  • Maurizio Gulletta
    • 4
  • Francesco Castelli
    • 4
    • 6
  • Simone Agostini
    • 7
  • Parretti Filippo
    • 7
  • Joachim Richter
    • 8
  • Piero Olliaro
    • 9
    • 10
  • Zeno Bisoffi
    • 2
    • 11
  • Alessandro Bartoloni
    • 1
    • 12
    • 13
  • Lorenzo Zammarchi
    • 1
    • 12
    • 13
    Email author
  1. 1.Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
  2. 2.IRCCS Sacro Cuore Don Calabria HospitalVeronaItaly
  3. 3.Center for Clinical Ethics, Biotechnology and Life Sciences DepartmentInsubria UniversityVareseItaly
  4. 4.University Department of Infectious and Tropical DiseasesUniversity of Brescia and Spedali Civili General HospitalBresciaItaly
  5. 5.Department of UrologyCareggi University and HospitalFlorenceItaly
  6. 6.UNESCO Chair “Training and Empowering Human Resources for Health Development in Resource-Limited Countries, University of Brescia”BresciaItaly
  7. 7.Radiology UnitCareggi University and HospitalFlorenceItaly
  8. 8.Institut für Tropenmedizin und Internationale Gesundheit CharitéUniversitätsmedizin BerlinBerlinGermany
  9. 9.Special Programme for Research and Training in Tropical Diseases (TDR)World Health OrganizationGenevaSwitzerland
  10. 10.Centre for Tropical Medicine and Global Health, Nuffield Department of MedicineOxford UniversityOxfordUK
  11. 11.Department of Diagnostics and Public HealthUniversity of VeronaVeronaItaly
  12. 12.Infectious and Tropical Diseases UnitCareggi University and HospitalFlorenceItaly
  13. 13.Referral Centre for Tropical Diseases of Tuscany, Infectious and Tropical Diseases UnitCareggi University HospitalFlorenceItaly

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