Schistosomatoza (bilharcjoza) – Rokowania, prognozy i postęp choroby

Schistosomatoza (bilharcjoza)
Rokowania, prognozy i postęp choroby

Schistosomiasis, przewlekła choroba pasożytnicza wywołana przez przywry Schistosoma, dotyka ponad 240 milionów osób globalnie. Rokowanie zależy od stadium choroby, lokalizacji zmian, ciężkości infekcji oraz dostępu do leczenia przeciwpasożytniczego. Wczesne postacie dobrze reagują na terapię, a nawet zaawansowane zmiany w wątrobie, układzie moczowym, nerkach, jelitach i mózgu mogą ulec poprawie po leczeniu. Ostre schistosomiasis cechuje się wysoką śmiertelnością do 25%. Zaawansowana choroba prowadzi do poważnych powikłań, takich jak nadciśnienie wrotne, serce płucne, nefropatia obstrukcyjna, bakteriemia i nowotwory (drogi moczowe, wątroba, pęcherzyk żółciowy), które wiążą się z wysoką śmiertelnością. Nomogram prognostyczny dla schistosomiasis japonica wykazał wysoką wartość diagnostyczną (indeks C 0,97–0,98, czułość 78–86%, swoistość 97%, PPV 78–79%, NPV 97–98%), co umożliwia identyfikację pacjentów z wysokim ryzykiem zgonu i optymalizację alokacji zasobów. W diagnostyce raka pęcherza moczowego związanego z bilharziozą (BBC) obiecujące są biomarkery sha-miR-71a i MAPK-3, wykazujące czułość 88% i 87% oraz swoistość 100% w moczu przy wartościach odcięcia 10,5 i 6,2, co może wspierać nieinwazyjną diagnostykę i prognozowanie.

Schistosomiasis (bilharzia) – Prognosis (przewidywanie wyników leczenia)

Rokowanie we wczesnym stadium choroby
Rokowanie w zaawansowanej schistosomiasis
Narzędzia predykcyjne w schistosomiasis
Biomarkery prognostyczne w schistosomiasis
Ryzyko ponownego zakażenia i czynniki wpływające na rokowanie
Wpływ masowego podawania leków (MDA) na rokowanie
Modelowanie prognostyczne i jego ograniczenia
Wpływ koinfekcji na rokowanie
Wpływ leczenia na rokowanie
Interwencje w zakresie wody, warunków sanitarnych i higieny (WASH)
Kolejne rozdziały

Schistosomiasis (bilharzia) – Prognosis (przewidywanie wyników leczenia)

Schistosomiasis (bilharzia) jako przewlekła choroba pasożytnicza wywołana przez przywry z rodzaju Schistosoma dotyka ponad 240 milionów ludzi na świecie. Rokowanie w tej chorobie jest zróżnicowane w zależności od stadium zaawansowania, lokalizacji zmian chorobowych, ciężkości infekcji oraz dostępu do leczenia przeciwpasożytniczego.¹²

Rokowanie we wczesnym stadium choroby

Wczesna postać schistosomiasis zazwyczaj dobrze odpowiada na leczenie. Co zaskakujące, pacjenci z chorobą wątroby i układu moczowego, nawet przy obecnym zwłóknieniu, mogą wykazywać znaczącą poprawę w ciągu miesięcy lub lat po terapii. Zmiany patologiczne w nerkach i jelitach również ulegają poprawie po leczeniu, podobnie jak zmiany w mózgu (w zależności od ich lokalizacji i wielkości).¹

Ostre schistosomiasis wiąże się jednak ze śmiertelnością sięgającą nawet 25% w niektórych seriach badań. Chociaż większość osób z przewlekłą schistosomiasis ma niewiele objawów lub nie ma ich wcale, może rozwinąć się znacząca chorobowość. Skargi są trudne do określenia ilościowego ze względu na geograficzne rozmieszczenie tej infekcji w krajach rozwijających się i częstość występowania chorób współistniejących, takich jak wirusowe zapalenie wątroby.²

Rokowanie w zaawansowanej schistosomiasis

Zaawansowana schistosomiasis stanowi późne stadium choroby, poważnie zagrażające jakości życia lub długości życia zakażonych osób. Choroby wątrobowo-śledzionowe z nadciśnieniem wrotnym są najczęstszym długoterminowym, poważnym powikłaniem, a następnie zajęcie sercowo-płucne, nefropatia obstrukcyjna, bakteriemia i nowotwory złośliwe.³⁴

Schistosomiasis wątrobowo-śledzionowa ma stosunkowo dobre rokowanie, ponieważ funkcja wątroby jest zachowana aż do końcowego stadium choroby (chyba że wystąpi krwawienie z żylaków). Mimo że leczenie jest wskazane u pacjentów z końcowymi powikłaniami nadciśnienia wrotnego i ciężkim nadciśnieniem płucnym, ci pacjenci mają znacznie mniejsze szanse na skorzystanie z leczenia. Serce płucne (cor pulmonale) zwykle nie ulega znaczącej poprawie po leczeniu.⁵

Końcowa choroba wątrobowo-śledzionowa z krwawieniem z żylaków, nadciśnienie płucne z sercem płucnym oraz choroba ośrodkowego układu nerwowego są związane z wysoką śmiertelnością. Rak dróg moczowych, wątroby i pęcherzyka żółciowego może powodować śmierć. Chociaż istnieje skuteczne leczenie przeciwpasożytnicze, może ono nie odwrócić zwłóknienia i może nie być łatwo dostępne w obszarach endemicznych.⁶

Narzędzia predykcyjne w schistosomiasis

Opracowano nomogram do przewidywania rokowania u pacjentów z zaawansowaną schistosomiasis japonica. Może on służyć jako wskazówka dla personelu klinicznego lub decydentów w formułowaniu strategii interwencyjnych lub efektywnej alokacji zasobów w walce z zaawansowaną schistosomiasis. Nomogram wykazał wysokie wartości wskaźników diagnostycznych: indeks C, czułość, swoistość, PPV i NPV wynosiły odpowiednio 0,97, 0,78, 0,97, 0,78 i 0,97 w zestawie treningowym oraz 0,98, 0,86, 0,97, 0,79 i 0,98 w zestawie walidacyjnym.⁷

Krzywe kalibracyjne wykazały, że model dobrze pasował między prognozą a rzeczywistą obserwacją zarówno w zestawie treningowym, jak i walidacyjnym. Krzywe decyzyjne i wpływu klinicznego pokazały, że nomogram ma dobre zastosowanie kliniczne do identyfikacji pacjentów z wysokim ryzykiem zgonu.⁸

Biomarkery prognostyczne w schistosomiasis

W przypadku raka pęcherza moczowego związanego z bilharziozą (BBC) zidentyfikowano specyficzne biomarkery, które mogą służyć jako narzędzia diagnostyczne i prognostyczne. Szczególnie obiecujące są Sha-miR-71a i MAPK-3, które wykazały zwiększoną ekspresję w BBC w porównaniu z przypadkami raka pęcherza moczowego niezwiązanego z bilharziozą (NBBC).⁹

Analiza krzywej ROC wykazała, że sha-miR-71a i MAPK-3 w moczu są diagnostyczne dla BBC przy wartości odcięcia 10,5 i 6,2, z czułością 88% i 87% oraz swoistością 100% i 100%. Oba biomarkery wykazały dodatnią korelację i mogą stanowić potencjalne nieinwazyjne, łatwe i specyficzne narzędzie o wartości diagnostycznej i prognostycznej.¹⁰

Ryzyko ponownego zakażenia i czynniki wpływające na rokowanie

Ponowne zakażenie jest niezwykle częste u osób, które mieszkają lub wracają na obszary endemiczne. Powtarzające się leczenie jest konieczne, aby zapobiec progresji choroby w tej sytuacji. Pacjenci z większym obciążeniem pasożytami mają mniejsze szanse na poprawę i częściej wymagają ponownego leczenia.¹¹¹²

Czynniki środowiskowe, takie jak dostęp do wody, również wpływają na ryzyko schistosomiasis. Niezadowalająca jakość wody w odwiertach perpetuuje zależność od powierzchniowych zbiorników wodnych, pośrednio zwiększając ryzyko schistosomiasis i prowadząc do szybkiej reinfekcji (do 40% prewalencji sześć miesięcy po chemioterapii zapobiegawczej).¹³

Wysokie stężenie żelaza w wodach gruntowych było związane ze zwiększonym ryzykiem schistosomiasis. Ostateczne wyniki modelu potwierdziły tę hipotezę, przy czym zawartość żelaza w wodach gruntowych była dominującym czynnikiem ryzyka schistosomiasis o znacznie wyższej wartości IncNodePurity w porównaniu z jakąkolwiek zmienną środowiskową.¹⁴¹⁵

Wpływ masowego podawania leków (MDA) na rokowanie

Światowa Organizacja Zdrowia (WHO) ustanowiła dwa główne cele w kontroli schistosomiasis:

Kontrola zachorowalności, definiowana jako osiągnięcie mniej niż 5% częstości występowania infekcji o dużej intensywności u dzieci w wieku szkolnym (SAC).
Eliminacja jako problem zdrowia publicznego (EPHP), osiągnięta, gdy częstość występowania infekcji o dużej intensywności u SAC zmniejsza się do mniej niż 1%.

¹⁶

Badania wykazały, że ukierunkowanie wyłącznie na SAC może osiągnąć cel związany z zachorowalnością we wszystkich warunkach transmisji, niezależnie od obciążenia infekcją u dorosłych. Cel EPHP można osiągnąć w warunkach niskiej transmisji, ale w niektórych warunkach umiarkowanych do wysokich potrzebne jest leczenie całej społeczności.¹⁷

W warunkach niskiej transmisji leczenie 75% SAC co 3 lata może osiągnąć oba cele z wysokim prawdopodobieństwem (0,95 dla kontroli zachorowalności i 0,75 dla eliminacji jako problemu zdrowia publicznego), niezależnie od profilu wiekowego infekcji. W warunkach umiarkowanej transmisji prognozy zależą od obciążenia infekcją u dorosłych.¹⁸

Dla umiarkowanego obciążenia intensywnością infekcji u dorosłych model stochastyczny przewiduje, że cel kontroli zachorowalności można osiągnąć w ciągu 15 lat od rozpoczęcia leczenia. Cel EPHP można osiągnąć z prawdopodobieństwem prawie 0,65, gdy wyjściowa częstość występowania SAC wynosi od 50% do 68% (umiarkowana wartość R0) i zmniejsza się do 0,5, gdy wyjściowa częstość występowania SAC wzrasta do 70% (wysoka wartość R0).¹⁹

Przy niskim obciążeniu intensywnością infekcji u dorosłych model stochastyczny przewiduje, że oba cele WHO można osiągnąć w ciągu 15 lat od rozpoczęcia leczenia dla wyjściowej częstości występowania SAC między 50% a 70%.²⁰

Modelowanie prognostyczne i jego ograniczenia

Efektywność transmisji człowiek-ślimak jest prawdopodobnie znacznie wyższa niż przewidują to standardowe modele, co w praktyce sprawi, że lokalna eliminacja poprzez wdrożenie samego MDA będzie wysoce nieprawdopodobna, nawet w okresie wieloletnim.²¹

Zaobserwowany wpływ różnych specyficznych dla lokalizacji wkładów ślimaków rzuca światło na różnorodne wzorce odpowiedzi MDA zauważone w badaniach operacyjnych nad kontrolą schistosomiasis, takich jak niedawny projekt SCORE. W praktyce jednak ostatnie projekcje standardowych modeli nie zdołały uchwycić zmienności wpływu programów MDA na poziom infekcji w społeczności, zwłaszcza w strefach wysokiego ryzyka.²²

Włączenie zmienionej, nieliniowej formy do funkcji infekcji ślimaka modeli miało głęboki wpływ na długoterminowe prognozy wpływu programów MDA na kontrolę Schistosoma. W większości przypadków zmodyfikowany model przewidywał bardziej intensywne odbicie po MDA, z szybszym nawrotem do wyjściowych poziomów infekcji. Efekt był wyraźny w społecznościach o wyższym ryzyku.²³²⁴

Wpływ koinfekcji na rokowanie

Współistniejące zakażenie schistosomiasis wraz z zapaleniem wątroby, HIV i malarią może zwiększyć ryzyko raka wątrobowokomórkowego i zwiększyć ryzyko śmiertelności. Infekcja narządów płciowych u kobiet może przyczynić się do powikłań ciąży, w tym zgłaszanych przypadków ciąży ektopowej. Schistosomiasis układu moczowo-płciowego jest uważana za czynnik ryzyka zakażenia HIV, szczególnie u kobiet.²⁵²⁶

Wpływ leczenia na rokowanie

Praziquantel należy podawać jak najszybciej, zwłaszcza w przypadku schistosomiasis rdzenia kręgowego, która ma niepewne rokowanie. Praziquantel można bezpiecznie podawać kobietom w ciąży i karmiącym piersią; zmniejsza on obciążenie chorobą i poprawia wyniki ciąży i płodu. Programy skierowane do kobiet w wieku rozrodczym poprawią ich życie reprodukcyjne i dobrostan.²⁷

Chociaż istnieje skuteczne leczenie przeciwrobaczywe, może ono nie odwrócić zwłóknienia i może nie być łatwo dostępne w obszarach endemicznych. Ponowne zakażenie jest niezwykle częste u osób, które mieszkają lub wracają na obszary endemiczne, co wymaga powtarzalnego leczenia, aby zapobiec progresji choroby.²⁸

Interwencje w zakresie wody, warunków sanitarnych i higieny (WASH)

Uwzględnienie czynników ryzyka związanych z WASH w przewidywaniu schistosomiasis może pomóc w przeniesieniu ciężaru strategii kontroli z leczenia objawów na zmniejszenie narażenia. W jednym z badań zmienne dotyczące ulepszonego i nieulepszonego dostępu do wody nie były predyktorem ryzyka schistosomiasis, co jest zgodne z ustaleniami Lai i wsp. Jednak wysokie stężenie żelaza w wodach gruntowych było związane ze zwiększonym ryzykiem schistosomiasis.²⁹

Pomimo wyzwań i ograniczeń, badania nad modelowaniem prognozowania schistosomiasis wnoszą ważny wkład w podejścia do modelowania transmisji schistosomiasis w małych zakresach przestrzennych.³⁰

Kolejne rozdziały

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Materiały źródłowe

#1 Schistosomiasis (Bilharzia): Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/228392-overview
Early disease usually improves with treatment. Surprisingly, patients with hepatic and urinary disease, even with fibrosis, may improve significantly over months or years following therapy. Renal and intestinal pathology also improves with treatment, as, usually, do brain lesions (depending on their location and size). Hepatosplenic schistosomiasis carries a relatively good prognosis because hepatic function is preserved until the end of the disease (unless variceal bleeding occurs). Although treatment is indicated for patients with end-stage complications of portal hypertension and severe pulmonary hypertension, these patients are much less likely to benefit from it. Indeed, cor pulmonale usually does not improve significantly with treatment. Spinal cord schistosomiasis carries a guarded prognosis. Praziquantel should be administered as soon as possible. Praziquantel can safely be given to pregnant and lactating individuals; it decreases the disease burden and improves pregnancy and fetal outcomes. Programs targeting women during reproductive years will improve their reproductive life and well-being. Co-infection of schistosomiasis along with hepatitis, HIV, and malaria can raise the risk for hepatocellular carcinoma and increase the risk for mortality. Patients with heavier worm burdens are less likely to improve and are more likely to require re-treatment.
#2 The human-snail transmission environment shapes long term schistosomiasis control outcomes: Implications for improving the accuracy of predictive modeling | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0006514
Schistosomiasis is a chronic parasitic trematode disease that affects over 240 million people worldwide. […] Predictive mathematical models of Schistosoma transmission have often chosen to simplify or ignore the details of environmental human-snail interaction in their analyses. […] This heightens the importance of including the environmental complexity of vector-pathogen interaction in order to make more accurate projections. […] The proposed (modified) model was compared to a conventional model in terms of their predictions. […] In most cases, the modified model predicted more vigorous post-MDA rebound, with faster relapse to baseline levels of infection. […] The effect was pronounced in higher risk communities. […] When compared to observed data, only the modified system was able to successfully predict persistent rebound of Schistosoma infection.
#2 Schistosomiasis (Bilharzia): Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/228392-overview
Acute schistosomiasis is associated with a mortality rate of up to 25% in some series. Although most individuals with chronic schistosomiasis have few or no symptoms, significant morbidity can develop. Complaints are difficult to quantitate because of the geographic distribution of this infection in developing nations and the frequency of comorbid conditions such as viral hepatitis. Hepatosplenic disease with portal hypertension is the most common long-term, serious outcome, followed by cardiopulmonary involvement, obstructive nephropathy, bacteremia, and malignancy. Female genital infection can contribute to pregnancy complications, including reports of related ectopic pregnancy. Urogenital schistosomiasis is considered to be a risk factor for HIV infection, especially in women. End-stage hepatosplenic disease with variceal bleeding, pulmonary hypertension with cor pulmonale, and central nervous system disease are associated with high mortality rates. Carcinoma of the urinary tract, liver, and gallbladder may cause death. Although effective antihelminthic treatment exists, it may not reverse fibrosis and may not be readily available in endemic areas. Reinfection is extremely common in persons who live in, or return to, endemic areas. Repetitive treatment is necessary to prevent disease progression in this situation.
#3 A Nomogram for Predicting Prognosis of Advanced Schistosomiasis japonica in Dongzhi CountyâA Case Study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9866143/
Advanced schistosomiasis is the late stage of schistosomiasis, seriously jeopardizing the quality of life or lifetime of infected people. […] This study aimed to develop a nomogram for predicting mortality of patients with advanced schistosomiasis japonica, taking Dongzhi County of China as a case study. […] A nomogram was developed to predict prognosis of advanced schistosomiasis. It could guide clinical staff or policy makers to formulate intervention strategies or efficiently allocate resources against advanced schistosomiasis. […] The C-index, sensitivity, specificity, PPV, and NPV of the nomogram were 0.97 (95% [CI]: [0.950.99]), 0.78 (95% [CI]: [0.640.87]), 0.97 (95% [CI]: [0.940.98]), 0.78 (95% [CI]: [0.640.87]), 0.97 (95% [CI]: [0.940.98]) in the training set; and 0.98 (95% [CI]: [0.940.99]), 0.86 (95% [CI]: [0.640.96]), 0.97 (95% [CI]: [0.930.99]), 0.79 (95% [CI]: [0.570.92]), 0.98 (95% [CI]: [0.940.99]) in the validation set, respectively. […] The calibration curves showed that the model fitted well between the prediction and actual observation in both the training set and validation set. […] The decision and the clinical impact curves showed that the nomogram had good clinical use for discriminating patients with high risk of death.
#4 Schistosomiasis (Bilharzia): Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/228392-overview
Acute schistosomiasis is associated with a mortality rate of up to 25% in some series. Although most individuals with chronic schistosomiasis have few or no symptoms, significant morbidity can develop. Complaints are difficult to quantitate because of the geographic distribution of this infection in developing nations and the frequency of comorbid conditions such as viral hepatitis. Hepatosplenic disease with portal hypertension is the most common long-term, serious outcome, followed by cardiopulmonary involvement, obstructive nephropathy, bacteremia, and malignancy. Female genital infection can contribute to pregnancy complications, including reports of related ectopic pregnancy. Urogenital schistosomiasis is considered to be a risk factor for HIV infection, especially in women. End-stage hepatosplenic disease with variceal bleeding, pulmonary hypertension with cor pulmonale, and central nervous system disease are associated with high mortality rates. Carcinoma of the urinary tract, liver, and gallbladder may cause death. Although effective antihelminthic treatment exists, it may not reverse fibrosis and may not be readily available in endemic areas. Reinfection is extremely common in persons who live in, or return to, endemic areas. Repetitive treatment is necessary to prevent disease progression in this situation.
#5 Schistosomiasis (Bilharzia): Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/228392-overview
Early disease usually improves with treatment. Surprisingly, patients with hepatic and urinary disease, even with fibrosis, may improve significantly over months or years following therapy. Renal and intestinal pathology also improves with treatment, as, usually, do brain lesions (depending on their location and size). Hepatosplenic schistosomiasis carries a relatively good prognosis because hepatic function is preserved until the end of the disease (unless variceal bleeding occurs). Although treatment is indicated for patients with end-stage complications of portal hypertension and severe pulmonary hypertension, these patients are much less likely to benefit from it. Indeed, cor pulmonale usually does not improve significantly with treatment. Spinal cord schistosomiasis carries a guarded prognosis. Praziquantel should be administered as soon as possible. Praziquantel can safely be given to pregnant and lactating individuals; it decreases the disease burden and improves pregnancy and fetal outcomes. Programs targeting women during reproductive years will improve their reproductive life and well-being. Co-infection of schistosomiasis along with hepatitis, HIV, and malaria can raise the risk for hepatocellular carcinoma and increase the risk for mortality. Patients with heavier worm burdens are less likely to improve and are more likely to require re-treatment.
#6 Schistosomiasis (Bilharzia): Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/228392-overview
Acute schistosomiasis is associated with a mortality rate of up to 25% in some series. Although most individuals with chronic schistosomiasis have few or no symptoms, significant morbidity can develop. Complaints are difficult to quantitate because of the geographic distribution of this infection in developing nations and the frequency of comorbid conditions such as viral hepatitis. Hepatosplenic disease with portal hypertension is the most common long-term, serious outcome, followed by cardiopulmonary involvement, obstructive nephropathy, bacteremia, and malignancy. Female genital infection can contribute to pregnancy complications, including reports of related ectopic pregnancy. Urogenital schistosomiasis is considered to be a risk factor for HIV infection, especially in women. End-stage hepatosplenic disease with variceal bleeding, pulmonary hypertension with cor pulmonale, and central nervous system disease are associated with high mortality rates. Carcinoma of the urinary tract, liver, and gallbladder may cause death. Although effective antihelminthic treatment exists, it may not reverse fibrosis and may not be readily available in endemic areas. Reinfection is extremely common in persons who live in, or return to, endemic areas. Repetitive treatment is necessary to prevent disease progression in this situation.
#7 A Nomogram for Predicting Prognosis of Advanced Schistosomiasis japonica in Dongzhi CountyâA Case Study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9866143/
Advanced schistosomiasis is the late stage of schistosomiasis, seriously jeopardizing the quality of life or lifetime of infected people. […] This study aimed to develop a nomogram for predicting mortality of patients with advanced schistosomiasis japonica, taking Dongzhi County of China as a case study. […] A nomogram was developed to predict prognosis of advanced schistosomiasis. It could guide clinical staff or policy makers to formulate intervention strategies or efficiently allocate resources against advanced schistosomiasis. […] The C-index, sensitivity, specificity, PPV, and NPV of the nomogram were 0.97 (95% [CI]: [0.950.99]), 0.78 (95% [CI]: [0.640.87]), 0.97 (95% [CI]: [0.940.98]), 0.78 (95% [CI]: [0.640.87]), 0.97 (95% [CI]: [0.940.98]) in the training set; and 0.98 (95% [CI]: [0.940.99]), 0.86 (95% [CI]: [0.640.96]), 0.97 (95% [CI]: [0.930.99]), 0.79 (95% [CI]: [0.570.92]), 0.98 (95% [CI]: [0.940.99]) in the validation set, respectively. […] The calibration curves showed that the model fitted well between the prediction and actual observation in both the training set and validation set. […] The decision and the clinical impact curves showed that the nomogram had good clinical use for discriminating patients with high risk of death.
#8 A Nomogram for Predicting Prognosis of Advanced Schistosomiasis japonica in Dongzhi CountyâA Case Study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9866143/
Advanced schistosomiasis is the late stage of schistosomiasis, seriously jeopardizing the quality of life or lifetime of infected people. […] This study aimed to develop a nomogram for predicting mortality of patients with advanced schistosomiasis japonica, taking Dongzhi County of China as a case study. […] A nomogram was developed to predict prognosis of advanced schistosomiasis. It could guide clinical staff or policy makers to formulate intervention strategies or efficiently allocate resources against advanced schistosomiasis. […] The C-index, sensitivity, specificity, PPV, and NPV of the nomogram were 0.97 (95% [CI]: [0.950.99]), 0.78 (95% [CI]: [0.640.87]), 0.97 (95% [CI]: [0.940.98]), 0.78 (95% [CI]: [0.640.87]), 0.97 (95% [CI]: [0.940.98]) in the training set; and 0.98 (95% [CI]: [0.940.99]), 0.86 (95% [CI]: [0.640.96]), 0.97 (95% [CI]: [0.930.99]), 0.79 (95% [CI]: [0.570.92]), 0.98 (95% [CI]: [0.940.99]) in the validation set, respectively. […] The calibration curves showed that the model fitted well between the prediction and actual observation in both the training set and validation set. […] The decision and the clinical impact curves showed that the nomogram had good clinical use for discriminating patients with high risk of death.
#9 Role of a schistosoma haematobium specific microRNA as a predictive and prognostic tool for bilharzial bladder cancer in Egypt | Scientific Reports
https://www.nature.com/articles/s41598-020-74807-1
Urinary Sha-miR-71a MAPK-3 revealed enhanced expression in BBC (p-value = 0.001) compared to non-bilharzial bladder cancer (NBBC) cases. […] Both biomarkers showed a positive correlation. […] Our results revealed that IHA is a reliable test in the diagnosis of bilharziasis associated with bladder cancer, and that Sha-miR-71a and MAPK-3 provide non-invasive specific biomarkers to diagnose BBC, as well as a potential role in testing bilharzial patients for risk to develop cancer. […] This indicates its specificity in the diagnosis of bilharzial bladder cancer. […] We do not believe that this is attributed to the control of bilharziasis for several reasons. […] This means that MAPK-3 and epigenetic regulator sha-miR-71a, both must be elevated to diagnose BBC. […] The ROC curve analysis revealed urinary sha-miR-71a and MAPK-3 to be diagnostic for BBC at a cut off 10.5 and 6.2 with 88%, 87% sensitivity and 100%, 100% specificity, respectively. […] Both urinary biomarkers were found to be statistically correlated. They can be potential biomarkers providing a non-invasive, easy and specific tool that can be of diagnostic and prognostic value.
#10 Role of a schistosoma haematobium specific microRNA as a predictive and prognostic tool for bilharzial bladder cancer in Egypt | Scientific Reports
https://www.nature.com/articles/s41598-020-74807-1
Urinary Sha-miR-71a MAPK-3 revealed enhanced expression in BBC (p-value = 0.001) compared to non-bilharzial bladder cancer (NBBC) cases. […] Both biomarkers showed a positive correlation. […] Our results revealed that IHA is a reliable test in the diagnosis of bilharziasis associated with bladder cancer, and that Sha-miR-71a and MAPK-3 provide non-invasive specific biomarkers to diagnose BBC, as well as a potential role in testing bilharzial patients for risk to develop cancer. […] This indicates its specificity in the diagnosis of bilharzial bladder cancer. […] We do not believe that this is attributed to the control of bilharziasis for several reasons. […] This means that MAPK-3 and epigenetic regulator sha-miR-71a, both must be elevated to diagnose BBC. […] The ROC curve analysis revealed urinary sha-miR-71a and MAPK-3 to be diagnostic for BBC at a cut off 10.5 and 6.2 with 88%, 87% sensitivity and 100%, 100% specificity, respectively. […] Both urinary biomarkers were found to be statistically correlated. They can be potential biomarkers providing a non-invasive, easy and specific tool that can be of diagnostic and prognostic value.
#11 Schistosomiasis (Bilharzia): Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/228392-overview
Early disease usually improves with treatment. Surprisingly, patients with hepatic and urinary disease, even with fibrosis, may improve significantly over months or years following therapy. Renal and intestinal pathology also improves with treatment, as, usually, do brain lesions (depending on their location and size). Hepatosplenic schistosomiasis carries a relatively good prognosis because hepatic function is preserved until the end of the disease (unless variceal bleeding occurs). Although treatment is indicated for patients with end-stage complications of portal hypertension and severe pulmonary hypertension, these patients are much less likely to benefit from it. Indeed, cor pulmonale usually does not improve significantly with treatment. Spinal cord schistosomiasis carries a guarded prognosis. Praziquantel should be administered as soon as possible. Praziquantel can safely be given to pregnant and lactating individuals; it decreases the disease burden and improves pregnancy and fetal outcomes. Programs targeting women during reproductive years will improve their reproductive life and well-being. Co-infection of schistosomiasis along with hepatitis, HIV, and malaria can raise the risk for hepatocellular carcinoma and increase the risk for mortality. Patients with heavier worm burdens are less likely to improve and are more likely to require re-treatment.
#12 Schistosomiasis (Bilharzia): Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/228392-overview
Acute schistosomiasis is associated with a mortality rate of up to 25% in some series. Although most individuals with chronic schistosomiasis have few or no symptoms, significant morbidity can develop. Complaints are difficult to quantitate because of the geographic distribution of this infection in developing nations and the frequency of comorbid conditions such as viral hepatitis. Hepatosplenic disease with portal hypertension is the most common long-term, serious outcome, followed by cardiopulmonary involvement, obstructive nephropathy, bacteremia, and malignancy. Female genital infection can contribute to pregnancy complications, including reports of related ectopic pregnancy. Urogenital schistosomiasis is considered to be a risk factor for HIV infection, especially in women. End-stage hepatosplenic disease with variceal bleeding, pulmonary hypertension with cor pulmonale, and central nervous system disease are associated with high mortality rates. Carcinoma of the urinary tract, liver, and gallbladder may cause death. Although effective antihelminthic treatment exists, it may not reverse fibrosis and may not be readily available in endemic areas. Reinfection is extremely common in persons who live in, or return to, endemic areas. Repetitive treatment is necessary to prevent disease progression in this situation.
#13 Improving spatial prediction of Schistosoma haematobium prevalence in southern Ghana through new remote sensors and local water access profiles | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0006517
Schistosomiasis is a water-related neglected tropical disease. […] The study helps to understand localized drivers of schistosomiasis transmission. Specifically, unsatisfactory water quality in boreholes perpetuates reliance on surface water bodies, indirectly increasing schistosomiasis risk and resulting in rapid reinfection (up to 40% prevalence six months following preventive chemotherapy). […] Considering WASH-related risk factors in schistosomiasis prediction can help shift the focus of control strategies from treating symptoms to reducing exposure. […] In our study, variables of improved and unimproved water access were not predictive of schistosomiasis risk, consistently with the findings of Lai et al. […] However, high iron concentration in groundwater was associated with increased schistosomiasis risk.
#14 Improving spatial prediction of Schistosoma haematobium prevalence in southern Ghana through new remote sensors and local water access profiles | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0006517
Schistosomiasis is a water-related neglected tropical disease. […] The study helps to understand localized drivers of schistosomiasis transmission. Specifically, unsatisfactory water quality in boreholes perpetuates reliance on surface water bodies, indirectly increasing schistosomiasis risk and resulting in rapid reinfection (up to 40% prevalence six months following preventive chemotherapy). […] Considering WASH-related risk factors in schistosomiasis prediction can help shift the focus of control strategies from treating symptoms to reducing exposure. […] In our study, variables of improved and unimproved water access were not predictive of schistosomiasis risk, consistently with the findings of Lai et al. […] However, high iron concentration in groundwater was associated with increased schistosomiasis risk.
#15 Improving spatial prediction of Schistosoma haematobium prevalence in southern Ghana through new remote sensors and local water access profiles | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0006517
The final model results confirmed this hypothesis, with groundwater iron content being the predominant schistosomiasis risk factor with a much higher IncNodePurity value as compared to any of the environmental variables. […] Overall, the models had relatively low predictive power and predicted prevalence values deviated substantially from the observed values, indicating overprediction in the low-prevalence range and underprediction in the high-prevalence range. […] Despite the challenges and limitations, our study makes important contributions to the modeling approaches of schistosomiasis transmission at small spatial extents.
#16 The impact of mass drug administration on Schistosoma haematobium infection: what is required to achieve morbidity control and elimination? | Parasites & Vectors | Full Text
https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-020-04409-3
Schistosomiasis remains an endemic parasitic disease causing much morbidity and, in some cases, mortality. […] The first goal is morbidity control, which is defined by achieving less than 5% prevalence of heavy intensity infection in school-aged children (SAC). The second goal is elimination as a public health problem (EPHP), achieved when the prevalence of heavy intensity infection in SAC is reduced to less than 1%. […] We find that targeting SAC only can achieve the morbidity goal for all transmission settings, regardless of the burden of infection in adults. The EPHP goal can be achieved in low transmission settings, but in some moderate to high settings community-wide treatment is needed. […] We show that the key determinants of achieving the WHO goals are the precise form of the age-intensity of infection profile and the baseline SAC prevalence. Additionally, we find that the higher the burden of infection in adults, the higher the chances that adults need to be included in the treatment programme to achieve EPHP.
#17 The impact of mass drug administration on Schistosoma haematobium infection: what is required to achieve morbidity control and elimination? | Parasites & Vectors | Full Text
https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-020-04409-3
Schistosomiasis remains an endemic parasitic disease causing much morbidity and, in some cases, mortality. […] The first goal is morbidity control, which is defined by achieving less than 5% prevalence of heavy intensity infection in school-aged children (SAC). The second goal is elimination as a public health problem (EPHP), achieved when the prevalence of heavy intensity infection in SAC is reduced to less than 1%. […] We find that targeting SAC only can achieve the morbidity goal for all transmission settings, regardless of the burden of infection in adults. The EPHP goal can be achieved in low transmission settings, but in some moderate to high settings community-wide treatment is needed. […] We show that the key determinants of achieving the WHO goals are the precise form of the age-intensity of infection profile and the baseline SAC prevalence. Additionally, we find that the higher the burden of infection in adults, the higher the chances that adults need to be included in the treatment programme to achieve EPHP.
#18 The impact of mass drug administration on Schistosoma haematobium infection: what is required to achieve morbidity control and elimination? | Parasites & Vectors | Full Text
https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-020-04409-3
In low transmission settings, treating 75% of SAC every 3 years, can achieve both goals with a high probability (0.95 for morbidity control and 0.75 for elimination as a public health problem), regardless of the age-intensity profile of infection. […] In moderate transmission settings, the predictions depend on the burden of infection in adults. […] Including adults in our treatment programme can also achieve the EPHP goal with a high probability. […] For a moderate burden of infection intensity in adults, the stochastic model predicts that the morbidity control goal can be achieved within 15 years of starting treatment. […] The EPHP goal can be achieved with a probability of nearly 0.65 when the baseline SAC prevalence is between 50% and 68% (moderate R0 value) and reduces to 0.5 when the baseline SAC prevalence increases to 70% (high R0 value).
#19 The impact of mass drug administration on Schistosoma haematobium infection: what is required to achieve morbidity control and elimination? | Parasites & Vectors | Full Text
https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-020-04409-3
In low transmission settings, treating 75% of SAC every 3 years, can achieve both goals with a high probability (0.95 for morbidity control and 0.75 for elimination as a public health problem), regardless of the age-intensity profile of infection. […] In moderate transmission settings, the predictions depend on the burden of infection in adults. […] Including adults in our treatment programme can also achieve the EPHP goal with a high probability. […] For a moderate burden of infection intensity in adults, the stochastic model predicts that the morbidity control goal can be achieved within 15 years of starting treatment. […] The EPHP goal can be achieved with a probability of nearly 0.65 when the baseline SAC prevalence is between 50% and 68% (moderate R0 value) and reduces to 0.5 when the baseline SAC prevalence increases to 70% (high R0 value).
#20 The impact of mass drug administration on Schistosoma haematobium infection: what is required to achieve morbidity control and elimination? | Parasites & Vectors | Full Text
https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-020-04409-3
For a low burden of infection intensity in adults, the stochastic model predicts that both WHO goals can be achieved within 15 years of starting treatment for baseline SAC prevalence between 50% and 70%. […] The current guidelines may achieve the morbidity control goal but to achieve elimination as a public health problem they need to be adapted.
#21 The human-snail transmission environment shapes long term schistosomiasis control outcomes: Implications for improving the accuracy of predictive modeling | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0006514
Efficiency of human-to-snail transmission is likely to be much higher than predicted by standard models, which, in practice, will make local elimination by implementation of MDA alone highly unlikely, even over a multi-decade period. […] The observed impact of varying location-specific snail inputs sheds light on the diverse MDA response patterns noted in operational research on schistosomiasis control, such as the recent SCORE project. […] In practice, though, recent projections of standard models have failed to capture the variability of MDA program impact on community levels of infection, especially in high-risk zones. […] Inclusion of a revised, nonlinear form for the models snail infection function had profound effects on long term predictions of the impact of MDA programs for Schistosoma control. […] The efficiency of human-to-snail transmission is likely to be much higher than predicted in standard models, which makes local elimination by implementation of MDA, alone, highly unlikely.
#22 The human-snail transmission environment shapes long term schistosomiasis control outcomes: Implications for improving the accuracy of predictive modeling | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0006514
Efficiency of human-to-snail transmission is likely to be much higher than predicted by standard models, which, in practice, will make local elimination by implementation of MDA alone highly unlikely, even over a multi-decade period. […] The observed impact of varying location-specific snail inputs sheds light on the diverse MDA response patterns noted in operational research on schistosomiasis control, such as the recent SCORE project. […] In practice, though, recent projections of standard models have failed to capture the variability of MDA program impact on community levels of infection, especially in high-risk zones. […] Inclusion of a revised, nonlinear form for the models snail infection function had profound effects on long term predictions of the impact of MDA programs for Schistosoma control. […] The efficiency of human-to-snail transmission is likely to be much higher than predicted in standard models, which makes local elimination by implementation of MDA, alone, highly unlikely.
#23 The human-snail transmission environment shapes long term schistosomiasis control outcomes: Implications for improving the accuracy of predictive modeling | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0006514
Schistosomiasis is a chronic parasitic trematode disease that affects over 240 million people worldwide. […] Predictive mathematical models of Schistosoma transmission have often chosen to simplify or ignore the details of environmental human-snail interaction in their analyses. […] This heightens the importance of including the environmental complexity of vector-pathogen interaction in order to make more accurate projections. […] The proposed (modified) model was compared to a conventional model in terms of their predictions. […] In most cases, the modified model predicted more vigorous post-MDA rebound, with faster relapse to baseline levels of infection. […] The effect was pronounced in higher risk communities. […] When compared to observed data, only the modified system was able to successfully predict persistent rebound of Schistosoma infection.
#24 The human-snail transmission environment shapes long term schistosomiasis control outcomes: Implications for improving the accuracy of predictive modeling | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0006514
Efficiency of human-to-snail transmission is likely to be much higher than predicted by standard models, which, in practice, will make local elimination by implementation of MDA alone highly unlikely, even over a multi-decade period. […] The observed impact of varying location-specific snail inputs sheds light on the diverse MDA response patterns noted in operational research on schistosomiasis control, such as the recent SCORE project. […] In practice, though, recent projections of standard models have failed to capture the variability of MDA program impact on community levels of infection, especially in high-risk zones. […] Inclusion of a revised, nonlinear form for the models snail infection function had profound effects on long term predictions of the impact of MDA programs for Schistosoma control. […] The efficiency of human-to-snail transmission is likely to be much higher than predicted in standard models, which makes local elimination by implementation of MDA, alone, highly unlikely.
#25 Schistosomiasis (Bilharzia): Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/228392-overview
Early disease usually improves with treatment. Surprisingly, patients with hepatic and urinary disease, even with fibrosis, may improve significantly over months or years following therapy. Renal and intestinal pathology also improves with treatment, as, usually, do brain lesions (depending on their location and size). Hepatosplenic schistosomiasis carries a relatively good prognosis because hepatic function is preserved until the end of the disease (unless variceal bleeding occurs). Although treatment is indicated for patients with end-stage complications of portal hypertension and severe pulmonary hypertension, these patients are much less likely to benefit from it. Indeed, cor pulmonale usually does not improve significantly with treatment. Spinal cord schistosomiasis carries a guarded prognosis. Praziquantel should be administered as soon as possible. Praziquantel can safely be given to pregnant and lactating individuals; it decreases the disease burden and improves pregnancy and fetal outcomes. Programs targeting women during reproductive years will improve their reproductive life and well-being. Co-infection of schistosomiasis along with hepatitis, HIV, and malaria can raise the risk for hepatocellular carcinoma and increase the risk for mortality. Patients with heavier worm burdens are less likely to improve and are more likely to require re-treatment.
#26 Schistosomiasis (Bilharzia): Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/228392-overview
Acute schistosomiasis is associated with a mortality rate of up to 25% in some series. Although most individuals with chronic schistosomiasis have few or no symptoms, significant morbidity can develop. Complaints are difficult to quantitate because of the geographic distribution of this infection in developing nations and the frequency of comorbid conditions such as viral hepatitis. Hepatosplenic disease with portal hypertension is the most common long-term, serious outcome, followed by cardiopulmonary involvement, obstructive nephropathy, bacteremia, and malignancy. Female genital infection can contribute to pregnancy complications, including reports of related ectopic pregnancy. Urogenital schistosomiasis is considered to be a risk factor for HIV infection, especially in women. End-stage hepatosplenic disease with variceal bleeding, pulmonary hypertension with cor pulmonale, and central nervous system disease are associated with high mortality rates. Carcinoma of the urinary tract, liver, and gallbladder may cause death. Although effective antihelminthic treatment exists, it may not reverse fibrosis and may not be readily available in endemic areas. Reinfection is extremely common in persons who live in, or return to, endemic areas. Repetitive treatment is necessary to prevent disease progression in this situation.
#27 Schistosomiasis (Bilharzia): Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/228392-overview
Early disease usually improves with treatment. Surprisingly, patients with hepatic and urinary disease, even with fibrosis, may improve significantly over months or years following therapy. Renal and intestinal pathology also improves with treatment, as, usually, do brain lesions (depending on their location and size). Hepatosplenic schistosomiasis carries a relatively good prognosis because hepatic function is preserved until the end of the disease (unless variceal bleeding occurs). Although treatment is indicated for patients with end-stage complications of portal hypertension and severe pulmonary hypertension, these patients are much less likely to benefit from it. Indeed, cor pulmonale usually does not improve significantly with treatment. Spinal cord schistosomiasis carries a guarded prognosis. Praziquantel should be administered as soon as possible. Praziquantel can safely be given to pregnant and lactating individuals; it decreases the disease burden and improves pregnancy and fetal outcomes. Programs targeting women during reproductive years will improve their reproductive life and well-being. Co-infection of schistosomiasis along with hepatitis, HIV, and malaria can raise the risk for hepatocellular carcinoma and increase the risk for mortality. Patients with heavier worm burdens are less likely to improve and are more likely to require re-treatment.
#28 Schistosomiasis (Bilharzia): Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/228392-overview
Acute schistosomiasis is associated with a mortality rate of up to 25% in some series. Although most individuals with chronic schistosomiasis have few or no symptoms, significant morbidity can develop. Complaints are difficult to quantitate because of the geographic distribution of this infection in developing nations and the frequency of comorbid conditions such as viral hepatitis. Hepatosplenic disease with portal hypertension is the most common long-term, serious outcome, followed by cardiopulmonary involvement, obstructive nephropathy, bacteremia, and malignancy. Female genital infection can contribute to pregnancy complications, including reports of related ectopic pregnancy. Urogenital schistosomiasis is considered to be a risk factor for HIV infection, especially in women. End-stage hepatosplenic disease with variceal bleeding, pulmonary hypertension with cor pulmonale, and central nervous system disease are associated with high mortality rates. Carcinoma of the urinary tract, liver, and gallbladder may cause death. Although effective antihelminthic treatment exists, it may not reverse fibrosis and may not be readily available in endemic areas. Reinfection is extremely common in persons who live in, or return to, endemic areas. Repetitive treatment is necessary to prevent disease progression in this situation.
#29 Improving spatial prediction of Schistosoma haematobium prevalence in southern Ghana through new remote sensors and local water access profiles | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0006517
Schistosomiasis is a water-related neglected tropical disease. […] The study helps to understand localized drivers of schistosomiasis transmission. Specifically, unsatisfactory water quality in boreholes perpetuates reliance on surface water bodies, indirectly increasing schistosomiasis risk and resulting in rapid reinfection (up to 40% prevalence six months following preventive chemotherapy). […] Considering WASH-related risk factors in schistosomiasis prediction can help shift the focus of control strategies from treating symptoms to reducing exposure. […] In our study, variables of improved and unimproved water access were not predictive of schistosomiasis risk, consistently with the findings of Lai et al. […] However, high iron concentration in groundwater was associated with increased schistosomiasis risk.
#30 Improving spatial prediction of Schistosoma haematobium prevalence in southern Ghana through new remote sensors and local water access profiles | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0006517
The final model results confirmed this hypothesis, with groundwater iron content being the predominant schistosomiasis risk factor with a much higher IncNodePurity value as compared to any of the environmental variables. […] Overall, the models had relatively low predictive power and predicted prevalence values deviated substantially from the observed values, indicating overprediction in the low-prevalence range and underprediction in the high-prevalence range. […] Despite the challenges and limitations, our study makes important contributions to the modeling approaches of schistosomiasis transmission at small spatial extents.