Eosinophil granule proteins ECP and EPX as markers for a potential early-stage inflammatory lesion in female genital schistosomiasis (FGS)

Genital granulomas induced by Schistosoma haematobium eggs can manifest as different lesion types visible by colposcopy; rubbery papules (RP), homogenous sandy patches (HSP) and grainy sandy patches (GSP). Pronounced tissue eosinophilia is a candidate marker for active S. haematobium pathology, as viable schistosome egg granulomas often are eosinophil rich. Here it was investigated whether eosinophil granule proteins ECP (eosinophil cationic protein) and EPX (eosinophil protein-X) in urine and genital lavage can be used as markers for active FGS lesions.Uro-genital samples from 118 Malagasy women were analysed for ECP and EPX by standard sandwich avidin/biotin amplified ELISA.The women with RP lesions had significantly higher levels of ECP and EPX in both lavage and urine. Furthermore, women with RP lesions were significantly younger than those with GSP. This could indicate that RP lesions might be more recently established and thus represent an earlier inflammatory lesion stage.ECP in genital lavage might be a future tool aiding the identification of FGS pathology at a stage where reversibility remains a possibility following praziquantel treatment

Rapid clearance of Schistosoma mansoni circulating cathodic antigen after treatment shown by urine strip tests in a Ugandan fishing community - Relevance for monitoring treatment efficacy and re-infection.

UNLABELLED: Schistosomiasis control and elimination has priority in public health agendas in several sub-Saharan countries. However, achieving these goals remains a substantial challenge. In order to assess progress of interventions and treatment efficacy it is pertinent to have accurate, feasible and affordable diagnostic tools. Detection of Schistosoma mansoni infection by circulating cathodic antigen (CCA) in urine is an attractive option as this measure describes live worm infection noninvasively. In order to interpret treatment efficacy and re-infection levels, knowledge about clearance of this antigen is necessary. The current study aims to investigate, whether antigen clearance as a proxy for decreasing worm numbers is reflected in decreasing CCA levels in urine shortly after praziquantel treatment. Here CCA levels are measured 24 hours post treatment in response to both a single and two treatments. The study was designed as a series of cross-sectional urine and stool sample collections from 446 individuals nested in a two-arm randomised single blinded longitudinal clinical trial cohort matched by gender and age (ClinicalTrials.gov Identifier: NCT00215267) receiving one or two praziquantel treatments. CCA levels in urine were determined by carbon-conjugated monoclonal antibody lateral flow strip assay and eggs per gram faeces for S. mansoni and soil-transmitted helminths by Kato-Katz. Significant correlations between CCA levels and S. mansoni egg count at every measured time point were found and confirmed the added beneficial effect of a second treatment at two weeks after baseline. Furthermore, presence of hookworm was found not to be a confounder for CCA test specificity. Twenty-four hours post treatment measures of mean CCA scores showed significant reductions. In conclusion, removal of CCA in response to treatment is detectable as a decline in CCA in urine already after 24 hours. This has relevance for use and interpretation of laboratory based and point-of-care CCA tests in terms of treatment efficacy and re-infection proportions as this measure provides information on the presence of all actively feeding stages of S. mansoni, which conventional faecal microscopy methods do not accurately reflect. TRIAL REGISTRATION: ClinicalTrials.gov NCT00215267

Cross-sectoral partnerships for health in real-life : a case study of the Global Fund's country coordinating mechanism (CCM) in Ethiopia

No abstract available

Short term CCA scores in response to treatment.

<p>The mean CCA scores with 95% confidence intervals stratified by age groupings are shown for a) baseline and baseline+24hours (n_total = 392) and b) two weeks and two weeks + 24hours further stratified by treatment regimen (n_1Tx = 147, n_2Tx = 157). Only individuals, who gave a urine sample at a time point (bsl and/or 2wks) and another sample at +24hrs, are included. “Trace” is included as score 0,5.</p

Schematical overview of sampling time points and treatment regimens.

<p>Diagram showing the faecal (F) and urine (U) sample collection time points included in this study; baseline (bsl), baseline+24hours (bsl+24), two weeks (2wks), two weeks+24hours (2wks+24hrs), nine weeks (9wks) and two years (2yrs). Both praziquantel (PZQ) and albendazole (Alb) was administered to everyone at baseline and the end of the study (2yrs). An additional dose of PZQ was administered at the two week time point to the two treatments arm (2 Tx).</p

<i>S</i>. <i>mansoni</i> prevalence (%) measured by urine strip CCA or KK for both treatment arms over time.

<p><i>S</i>. <i>mansoni</i> prevalence (%) measured by urine strip CCA or KK for both treatment arms over time.</p

Comparison of CCA scores at +24hrs after baseline treatment vs. two weeks.

<p>Comparison of CCA scores at +24hrs after baseline treatment vs. two weeks.</p

Change in CCA score units in response to treatment 24 hours after baseline and two weeks.

<p>Change in CCA score units in response to treatment 24 hours after baseline and two weeks.</p