Female Genital Schistosomiasis Lesions Explored Using Circulating Anodic Antigen as an Indicator for Live Schistosoma Worms

Frontiers in Tropical Diseases, vol. 3

Abstract

Background In areas where reinfection with schistosomiasis is rampant, it is not known if the lesions of Female Genital Schistosomaisis are a consequence of live worms, or caused by dead ova. Live schistosome worms regurgitate Circulating Anodic Antigen (CAA). We sought to explore the association between the different lesions of FGS (grainy sandy patches, homogenous yellow patches, rubbery papules and abnormal blood vessels) and the presence of live worms as indicated by S. haematobium-derived CAA in blood. Materials and Methods In this cross-sectional study, rural high schools were randomly selected from Ilembe, uThungulu and Ugu Districts on the East Coast of South Africa, KwaZulu-Natal Province. Serum samples for CAA analysis were collected from 246 female learners aged 16 - 23 years. Uncorrected chi-square and odds ratio with 95% confidence interval (CI) were used to evaluate the null hypothesis. Results CAA was positive in 82/246 (33%) of the participants. Sandy patches were found in 123 (50%) of the study population. Grainy sandy patches were significantly associated with CAA even after controlling for age (Adjusted Odds Ratio (AOR) 4.2, 95% CI 2.3 - 7.9, p < 0.001). Likewise, abnormal blood vessels were associated with CAA (AOR 3.0, 95% CI 1.5-4.5, p = 0.001) whereas homogenous yellow patches were not associated with CAA (p = 0.57). Rubbery papules were not found in this study population. Conclusion Grainy sandy patches and abnormal blood vessels are found more commonly in women who harbour live Schistosoma haematobium worms whilst homogenous yellow patches may indicate chronic tissue damage due to dead ova.

Authors 12

1. Takalani Girly Nemungadi corresponding

   Department of Health · University of KwaZulu-Natal

   Affiliation as printed

   Communicable Disease Control Directorate, National Department of Health, Pretoria, South Africa

   Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

2. Elisabeth Kleppa

   Oslo University Hospital

   Affiliation as printed

   Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway

3. Govert J. van Dam Aachen Department of Parasitology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands

4. Paul L. A. M. Corstjens Aachen Department of Cell and Chemical Biology

   Leiden University Medical Center

   Affiliation as printed

   Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands

5. Hashini Nilushika Galappaththi‐Arachchige

   Oslo University Hospital

   Affiliation as printed

   Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway

6. Pavitra Pillay

   Durban University of Technology

   Affiliation as printed

   Department of Biomedical and Clinical Technology, Durban University of Technology, Durban, South Africa

7. Svein Gunnar Gundersen

   University of Agder

   Affiliation as printed

   Institute for Global Development and Planning, University of Agder, Kristiansand, Norway

8. Birgitte Jyding Vennervald

   University of Copenhagen

   Affiliation as printed

   Section for Parasitology and Aquatic Pathobiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

9. Patricia Ndhlovu
   Affiliation as printed

   BRIGHT Academy, Ugu District, Durban, South Africa

10. Myra Taylor

    University of KwaZulu-Natal

    Affiliation as printed

    Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

11. Saloshni Naidoo

    University of KwaZulu-Natal

    Affiliation as printed

    Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

12. Eyrun Floerecke Kjetland

    Oslo University Hospital · University of KwaZulu-Natal

    Affiliation as printed

    Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

    Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway