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. 2018 Jun 16;7(1):55.
doi: 10.1186/s40249-018-0440-5.

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

Valentina Marchese  1   2 , Anna Beltrame  3 , Andrea Angheben  1 , Geraldo Badona Monteiro  1 , Giovanni Giorli  1 , Francesca Perandin  1 , Dora Buonfrate  1 , Zeno Bisoffi  1
Affiliations

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

Valentina Marchese et al. Infect Dis Poverty. .

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.

Keywords: Europe; Italy; Neglected tropical diseases, immigrants; Refugees; Schistosomiasis; Travellers.

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Conflict of interest statement

Ethics approval and consent to participate

The study protocol received ethical approval and consent from the competent Ethics Committee (Comitato Etico per la sperimentazione Clinica delle Province di Verona e Rovigo) on the 16th May 2017 (protocol n 24 123). Each patient gave written informed consent to participate in the study and for the collection of data and biological samples for study purpose.

Consent for publication

Each patient gave written consent to publish ultrasound image.

Competing interests

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Geographical distribution of the places of exposure (data are the number of patients)
Fig. 2
Fig. 2
Pseudopolyp of the urinary bladder in an immigrant with S. haematobium infection
See this image and copyright information in PMC

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