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      Asian Schistosomiasis: Current Status and Prospects for Control Leading to Elimination

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          Abstract

          Schistosomiasis is an infectious disease caused by helminth parasites of the genus Schistosoma. Worldwide, an estimated 250 million people are infected with these parasites with the majority of cases occurring in sub-Saharan Africa. Within Asia, three species of Schistosoma cause disease. Schistosoma japonicum is the most prevalent, followed by S. mekongi and S. malayensis. All three species are zoonotic, which causes concern for their control, as successful elimination not only requires management of the human definitive host, but also the animal reservoir hosts. With regard to Asian schistosomiasis, most of the published research has focused on S. japonicum with comparatively little attention paid to S. mekongi and even less focus on S. malayensis. In this review, we examine the three Asian schistosomes and their current status in their endemic countries: Cambodia, Lao People’s Democratic Republic, Myanmar, and Thailand ( S. mekongi); Malaysia ( S. malayensis); and Indonesia, People’s Republic of China, and the Philippines ( S. japonicum). Prospects for control that could potentially lead to elimination are highlighted as these can inform researchers and disease control managers in other schistosomiasis-endemic areas, particularly in Africa and the Americas.

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          Schistosomiasis

          Schistosomiasis (bilharzia) is a neglected tropical disease caused by parasitic flatworms (blood flukes) of the genus Schistosoma, with considerable morbidity in parts of the Middle East, South America, Southeast Asia and, particularly, in sub-Saharan Africa. Infective larvae grow in an intermediate host (fresh-water snails) before penetrating the skin of the definitive human host. Mature adult worms reside in the mesenteric (Schistosoma mansoni and Schistosoma japonicum) or pelvic (Schistosoma haematobium) veins, where female worms lay eggs, which are secreted in stool or urine. Eggs trapped in the surrounding tissues and organs, such as the liver and bladder, cause inflammatory immune responses (including granulomas) that result in intestinal, hepato-splenic or urogenital disease. Diagnosis requires the detection of eggs in excreta or worm antigens in the serum, and sensitive, rapid, point-of-care tests for populations living in endemic areas are needed. The anti-schistosomal drug praziquantel is safe and efficacious against adult worms of all the six Schistosoma spp. infecting humans; however, it does not prevent reinfection and the emergence of drug resistance is a concern. Schistosomiasis elimination will require a multifaceted approach, including: treatment; snail control; information, education and communication; improved water, sanitation and hygiene; accurate diagnostics; and surveillance-response systems that are readily tailored to social-ecological settings.
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            Susceptibility or resistance of praziquantel in human schistosomiasis: a review.

            Since praziquantel was developed in 1970s, it has replaced other antischistosomal drugs to become the only drug of choice for treatment of human schistosomiases, due to high efficacy, excellent tolerability, few and transient side effects, simple administration, and competitive cost. Praziquantel-based chemotherapy has been involved in the global control strategy of the disease and led to the control strategy shifting from disease control to morbidity control, which has greatly reduced the prevalence and intensity of infections. Given that the drug has been widely used for morbidity control in endemic areas for more than three decades, the emergence of resistance of Schistosoma to praziquantel under drug selection pressure has been paid much attention. It is possible to induce resistance of Schistosoma mansoni and Schistosoma japonicum to praziquantel in mice under laboratorial conditions, and a reduced susceptibility to praziquantel in the field isolates of S. mansoni has been found in many foci. In addition, there are several schistosomiasis cases caused by Schistosoma haematobium infections in which repeated standard treatment fails to clear the infection. However, in the absence of exact mechanisms of action of praziquantel, the mechanisms of drug resistance in schistosomes remain unclear. The present review mainly demonstrates the evidence of drug resistance in the laboratory and field and the mechanism of praziquantel resistance and proposes some strategies for control of praziquantel resistance in schistosomes.
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              FLOTAC: new multivalent techniques for qualitative and quantitative copromicroscopic diagnosis of parasites in animals and humans.

              Accurate diagnosis of parasitic infections is of pivotal importance for both individual patient management and population-based studies, such as drug efficacy trials and surveillance of parasitic disease control and elimination programs, in both human and veterinary public health. In this study, we present protocols for the FLOTAC basic, dual and double techniques, which are promising new multivalent, sensitive, accurate and precise methods for qualitative and quantitative copromicroscopic analysis. These various methods make use of the FLOTAC apparatus, a cylindrical device with two 5-ml flotation chambers, which allows up to 1 g of stool to be prepared for microscopic analysis. Compared with currently more widely used diagnostic methods for parasite detection in animals (e.g., McMaster and Wisconsin techniques) and humans (e.g., Kato-Katz and ether-based concentration techniques), the FLOTAC techniques show higher sensitivity and accuracy. All FLOTAC techniques can be performed on fresh fecal material as well as preserved stool samples, and require approximately 12-15 min of preparation time before microscopic analysis.
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                Author and article information

                Journal
                Trop Med Infect Dis
                Trop Med Infect Dis
                tropicalmed
                Tropical Medicine and Infectious Disease
                MDPI
                2414-6366
                26 February 2019
                March 2019
                : 4
                : 1
                : 40
                Affiliations
                [1 ]QIMR Berghofer Medical Research Institute, Herston, QLD 4006, Australia; Catherine.Gordon@ 123456qimrberghofer.edu.au (C.A.G.); Yuesheng.Li@ 123456qimrberghofer.edu.au (Y.L.); Don.McManus@ 123456qimrberghofer.edu.au (D.P.M.)
                [2 ]Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT 2601, Australia; Johanna.Kurscheid@ 123456anu.edu.au
                [3 ]School of Public Health, University of Queensland, Herston, QLD 4006, Australia; g.williams@ 123456sph.uq.edu.au
                [4 ]Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia; archie.clements@ 123456curtin.edu.au
                [5 ]Telethon Kids Institute, Nedlands, WA 6009, Australia
                [6 ]Center for Disease Control and Prevention, National Institute for Parasitic Diseases, Shanghai 200025, China; zhouxn1@ 123456chinacdc.cn
                [7 ]Swiss Tropical and Public Health Institute, CH-4002 Basel, Switzerland; juerg.utzinger@ 123456swisstph.ch
                [8 ]University of Basel, CH-4003 Basel, Switzerland
                Author notes
                [* ]Correspondence: darren.gray@ 123456anu.edu.au ; Tel.: +61-2-61258595
                [†]

                Joint first authors.

                Author information
                https://orcid.org/0000-0002-1509-5220
                https://orcid.org/0000-0002-6858-7501
                https://orcid.org/0000-0003-1417-8427
                https://orcid.org/0000-0001-6443-1449
                Article
                tropicalmed-04-00040
                10.3390/tropicalmed4010040
                6473711
                30813615
                81b4cb10-ba08-408e-8080-c115ea7076f4
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 14 January 2019
                : 12 February 2019
                Categories
                Review

                asia,control,elimination,epidemiology,schistosoma japonicum,schistosoma malayensis,schistosoma mekongi,schistosomiasis

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