Pathologic Mucosal Blood Vessels in Active Female Genital Schistosomiasis

Jourdan, P; Randrianasolo, Bodo; Feldmeier, Hermann; Chitsulo, Lester; Ravoniarimbinina, Pascaline; Roald, Borghild; Kjetland, Eyrun Floerecke

doi:10.1097/pgp.0b013e31824fe327

Cited by 16 publications

(15 citation statements)

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“…Microscopic examination of the abnormal mucosal blood vessels seen during colposcopy may portray dilated venules or granulation tissue rich in sprouting micro vessels [65] . Thrombosis has also been found to be associated with intravascular schistosome eggs [66] .…”

Section: Discussionmentioning

confidence: 99%

The Colposcopic Atlas of Schistosomiasis in the Lower Female Genital Tract Based on Studies in Malawi, Zimbabwe, Madagascar and South Africa

et al. 2014

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Background Schistosoma (S.) haematobium is a neglected tropical disease which may affect any part of the genital tract in women. Female genital schistosomiasis (FGS) may cause abnormal vaginal discharge, contact bleeding, genital tumours, ectopic pregnancies and increased susceptibility to HIV. Symptoms may mimic those typical of sexually transmitted infections (STIs) and women with genital schistosomiasis may be incorrectly diagnosed. An expert consensus meeting suggested that the following findings by visual inspection should serve as proxy indicators for the diagnosis of schistosomiasis of the lower genital tract in women from S. haematobium endemic areas: sandy patches appearing as (1) single or clustered grains or (2) sandy patches appearing as homogenous, yellow areas, or (3) rubbery papules. In this atlas we aim to provide an overview of the genital mucosal manifestations of schistosomiasis in women.Methodology/Principal findingsPhotocolposcopic images were captured from women, between 1994 and 2012 in four different study sites endemic for S. haematobium in Malawi, Zimbabwe, South Africa and Madagascar. Images and specimens were sampled from sexually active women between 15 and 49 years of age. Colposcopic images of other diseases are included for differential diagnostic purposes.SignificanceThis is the first atlas to present the clinical manifestations of schistosomiasis in the lower female genital tract. It will be freely available for online use, downloadable as a presentation and for print. It could be used for training purposes, further research, and in clinical practice.

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Section: Discussionmentioning

confidence: 99%

The Colposcopic Atlas of Schistosomiasis in the Lower Female Genital Tract Based on Studies in Malawi, Zimbabwe, Madagascar and South Africa

et al. 2014

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“…Even though most of the reviewed publications derive from single-standing studies, four major groups of scientists have contributed comprehensively to publishing the findings from their research. These groups comprised several researchers who collaborated on specific research programs on schistosomiasis and related aspects in Malawi, namely 1) a group from Malawi, particularly from institutions within the University of Malawi, involved in publishing 17 (36%) scientific papers [ 6 ],[ 19 ],[ 20 ],[ 23 ],[ 26 ],[ 29 ],[ 31 ],[ 55 ],[ 75 ],[ 80 ],[ 83 ],[ 84 ],[ 96 ],[ 99 ],[ 101 ],[ 102 ] as first authors; 2) a group from USA involved in publishing 13 (28%) scientific papers [ 32 ],[ 45 ],[ 61 ],[ 67 ]-[ 73 ],[ 100 ],[ 106 ],[ 107 ] as first authors; 3) a group from Denmark involved in publishing 10 (21%) scientific papers [ 6 ],[ 57 ]-[ 59 ],[ 63 ],[ 66 ],[ 74 ],[ 85 ],[ 105 ] as first authors and 4) a group from Norway involved in publishing 7 (15%) scientific papers [ 24 ],[ 27 ],[ 41 ]-[ 44 ],[ 109 ] as first authors. It was not uncommon for a number of authors or institutions to collaborate, especially the groups from Denmark and the USA, and the groups from University of Malawi and Norway.…”

Section: Reviewmentioning

confidence: 99%

Schistosomiasis in Malawi: a systematic review

Makaula¹,

Sadalaki

Muula

et al. 2014

Parasites Vectors

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IntroductionSchistosomiasis remains an important public health problem that undermines social and economic development in tropical regions of the world, mainly Sub-Saharan Africa. We are not aware of any systematic review of the literature of the epidemiology and transmission of schistosomiasis in Malawi since 1985. Therefore, we reviewed the current state of knowledge of schistosomiasis epidemiology and transmission in this country and identified knowledge gaps and relevant areas for future research and research governance.MethodsWe conducted computer-aided literature searches of Medline, SCOPUS and Google Scholar using the keywords: “schistosomiasis”, “Bilharzia”, “Bulinus” and “Biomphalaria” in combination with “Malawi”. These searches were supplemented by iterative reviews of reference lists for relevant publications in peer reviewed international scientific journals or other media. The recovered documents were reviewed for their year of publication, location of field or laboratory work, authorship characteristics, ethics review, funding sources as well as their findings regarding parasite and intermediate host species, environmental aspects, geographical distribution, seasonality of transmission, and infection prevalence and intensities.ReviewA total of 89 documents satisfied the inclusion criteria and were reviewed. Of these, 76 were published in international scientific journals, 68 were peer reviewed and 54 were original research studies. Most of the documents addressed urinary schistosomiasis and about two thirds of them dealt with the definitive host. Few documents addressed the parasites and the intermediate hosts. While urinary schistosomiasis occurs in most parts of Malawi, intestinal schistosomiasis mainly occurs in the central and southern highlands, Likoma Island and Lower Shire. Studies in selected communities estimated prevalence rates of up to 94.9% for Schistosoma haematobium and up to 67.0% for Schistosoma mansoni with considerable geographical variation. The main intermediate host species are Bulinus globosus and Bulinus nyassanus for urinary schistosomiasis and Biomphalaria pfeifferi for intestinal schistosomiasis. Seasonality of transmission tends to vary according to geographical, environmental, biological and behavioural factors.ConclusionTransmission of schistosomiasis in Malawi appears to be highly focal, with considerable variation in space and time. Many locations have not been covered by epidemiological investigations and, thus, information on the transmission of schistosomiasis in Malawi remains fragmented. Functional infection risk assessment systems based on systematic investigations and surveillance are required for developing informed prevention and control strategies.Electronic supplementary materialThe online version of this article (doi:10.1186/s13071-014-0570-y) contains supplementary material, which is available to authorized users.

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“…Lower genital tract sandy patches are pathognomonic for female genital schistosomiasis and are associated with neovascularisation and friable mucosa that can result in contact bleeding (appendix). 41,42 Female genital schistosomiasis causes pain and has been associated with stress incontinence, infertility, and increased risk of abortion. Unfortunately, treatment might not resolve these advanced forms of genital tract damage and there is growing evidence that such lesions can increase transmission of HIV.…”

Section: Introductionmentioning

confidence: 99%

Human schistosomiasis

et al. 2014

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Human schistosomiasis—or bilharzia—is a parasitic disease caused by trematode flukes of the genus Schistosoma. By conservative estimates, at least 230 million people worldwide are infected with Schistosoma spp. Adult schistosome worms colonise human blood vessels for years, successfully evading the immune system while excreting hundreds to thousands of eggs daily, which must either leave the body in excreta or become trapped in nearby tissues. Trapped eggs induce a distinct immune-mediated granulomatous response that causes local and systemic pathological effects ranging from anaemia, growth stunting, impaired cognition, and decreased physical fitness, to organ-specific effects such as severe hepatosplenism, periportal fibrosis with portal hypertension, and urogenital inflammation and scarring. At present, preventive public health measures in endemic regions consist of treatment once every 1 or 2 years with the isoquinolinone drug, praziquantel, to suppress morbidity. In some locations, elimination of transmission is now the goal; however, more sensitive diagnostics are needed in both the field and clinics, and integrated environmental and health-care management will be needed to ensure elimination.

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Pathologic Mucosal Blood Vessels in Active Female Genital Schistosomiasis

Cited by 16 publications

References 13 publications

The Colposcopic Atlas of Schistosomiasis in the Lower Female Genital Tract Based on Studies in Malawi, Zimbabwe, Madagascar and South Africa

The Colposcopic Atlas of Schistosomiasis in the Lower Female Genital Tract Based on Studies in Malawi, Zimbabwe, Madagascar and South Africa

Schistosomiasis in Malawi: a systematic review

Human schistosomiasis

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