Schistosomiasis Morbidity Hotspots: Roles of the Human Host, the Parasite and Their Interface in the Development of Severe Morbidity

Patrice A. Mawa; Julien Kincaid-Smith; Edridah M. Tukahebwa; Joanne P. Webster; Shona Wilson

doi:10.3389/fimmu.2021.635869

journal article Open Access Mar 12, 2021

Schistosomiasis Morbidity Hotspots: Roles of the Human Host, the Parasite and Their Interface in the Development of Severe Morbidity

Patrice A. Mawa Julien Kincaid-Smith Edridah M. Tukahebwa

Joanne P. Webster Shona Wilson

Frontiers in Immunology Vol. 12 · Frontiers Media SA

View at Publisher Save 10.3389/fimmu.2021.635869

Abstract

Schistosomiasis is the second most important human parasitic disease in terms of socioeconomic impact, causing great morbidity and mortality, predominantly across the African continent. For intestinal schistosomiasis, severe morbidity manifests as periportal fibrosis (PPF) in which large tracts of macro-fibrosis of the liver, visible by ultrasound, can occlude the main portal vein leading to portal hypertension (PHT), sequelae such as ascites and collateral vasculature, and ultimately fatalities. For urogenital schistosomiasis, severe morbidity manifests as pathology throughout the urinary system and genitals, and is a definitive cause of squamous cell bladder carcinoma. Preventative chemotherapy (PC) programmes, delivered through mass drug administration (MDA) of praziquantel (PZQ), have been at the forefront of schistosomiasis control programmes in sub-Saharan Africa since their commencement in Uganda in 2003. However, despite many successes, ‘biological hotspots’ (as distinct from ‘operational hotspots’) of both persistent high transmission and morbidity remain. In some areas, this failure to gain control of schistosomiasis has devastating consequences, with not only persistently high infection intensities, but both “subtle” and severe morbidity remaining prevalent. These hotspots highlight the requirement to revisit research into severe morbidity and its mechanisms, a topic that has been out of favor during times of PC implementation. Indeed, the focality and spatially-structured epidemiology of schistosomiasis, its transmission persistence and the morbidity induced, has long suggested that gene-environmental-interactions playing out at the host-parasite interface are crucial. Here we review evidence of potential unique parasite factors, host factors, and their gene-environmental interactions in terms of explaining differential morbidity profiles in the human host. We then take the situation of schistosomiasis mansoni within the Albertine region of Uganda as a case study in terms of elucidating the factors behind the severe morbidity observed and the avenues and directions for future research currently underway within a new research and clinical trial programme (FibroScHot).

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Details

Published: Mar 12, 2021
Vol/Issue: 12
License: View

Authors

From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary’s Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) — all in London; the...

J

Joanne P. Webster

From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary’s Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) — all in London; the...

S

Shona Wilson

Cite This Article

Patrice A. Mawa, Julien Kincaid-Smith, Edridah M. Tukahebwa, et al. (2021). Schistosomiasis Morbidity Hotspots: Roles of the Human Host, the Parasite and Their Interface in the Development of Severe Morbidity. Frontiers in Immunology, 12. https://doi.org/10.3389/fimmu.2021.635869

Schistosomiasis Morbidity Hotspots: Roles of the Human Host, the Parasite and Their Interface in the Development of Severe Morbidity

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