Schistosomiasis in immigrants, refugees and travellers in an Italian referral centre for tropical diseases

Abstract

BackgroundSchistosomiasis is one of the most important neglected tropical diseases. If unrecognised and untreated, the chronic infection can lead to irreversible complications.MethodsRetrospective 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).ResultsA 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).ConclusionsSymptoms, 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.Electronic supplementary materialThe online version of this article (10.1186/s40249-018-0440-5) contains supplementary material, which is available to authorized users.

Exotic Tourist Destinations and Transmission of Infections by Swimming Pools and Hot Springs—A Literature Review

“…In Corsica one outbreak involving 120 people infected after swimming in a fresh water swimming pool is one of the rare published cases [50]. Nevertheless, schistosomiasis is increasingly imported into temperate climates by immigrants and travellers to endemic areas [51,52,53,54]. Schistosomiasis in returning travellers is one of the most common imported tropical infections with potentially serious complications, which are preventable upon early diagnosis [55].…”

Children on the Move

“…However, data from Germany indicate no evidence of the benefit of routine stool screening to detect intestinal parasites among refugee minors [94]. Tissue-invasive parasitic infections, such as schistosomiasis and strongyloidiasis, must be included in the differential diagnosis of recently arrived immigrants and refugee children with unexplained eosinophilia (defined as an absolute eosinophil count greater than 450 cells/μL with negative stool testing for ova and parasites) [23,28,95,96]. Around 30 to 250 million people have schistosomiasis and strongyloidosis in endemic countries [4].…”

Infectious Diseases among Refugee Children

“…However, data from Germany indicate no evidence of the benefit of routine stool screening to detect intestinal parasites among refugee minors [94]. Tissue-invasive parasitic infections, such as schistosomiasis and strongyloidiasis, must be included in the differential diagnosis of recently arrived immigrants and refugee children with unexplained eosinophilia (defined as an absolute eosinophil count greater than 450 cells/µL with negative stool testing for ova and parasites) [23,28,95,96]. Around 30 to 250 million people have schistosomiasis and strongyloidosis in endemic countries [4].…”