4. Schistosomes Nov 22 2006 - Columbia University … · Schistosoma mansoni Schistosoma...
Transcript of 4. Schistosomes Nov 22 2006 - Columbia University … · Schistosoma mansoni Schistosoma...
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Helminths
• Phylum Nematoda (Roundworms) - “Nematodes”
• Phylum Platyhelminthes (Flatworms)
– Class Cestoidea (segmented flatworms) - “Cestodes”
– Class Trematoda (non-segmented flatworms) - “Trematodes”
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ND0.01 millionDracunculiasis
ND0.4 millionLeprosy
0.4 billion12 millionLeishmaniasis
0.1 billion16 millionChagas Disease
0.1 billion18 millionOnchocerciasis
0.5 billion84 millionTrachoma
1.0 billion120 millionLymphatic Filariasis
0.6 billion200 millionSchistosomiasis
ND500 millionAmebiasis
3.2 billion576 millionHookworm
3.2 billion604 milionTrichuriasis
4.2 billion807 millionAscariasisPopulation at-riskNumber of CasesDisease
The Most Common Neglected Infections of Poor People
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“I’m Mad as Hell and I am not goingto take it anymore!”
Network 1976, Paddy Chayevsky
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Millennium Development Goals“We will have time to reach the Millennium Development Goals –worldwide and in most, or even all, individual countries – but onlyif we break with business as usual.
We cannot win overnight. Success will require sustained actionacross the entire decade between now and the deadline. It takestime to train the teachers, nurses and engineers; to build the roads,schools and hospitals; to grow the small and large businesses ableto create the jobs and income needed. So we must start now. Andwe must more than double global development assistance over thenext few years. Nothing less will help to achievethe Goals.“
United Nations Secretary-GeneralKofi A. Annan, 2000
http://www.un.org/millenniumgoals/
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The M illennium Development Goals (MDGs)
1. Eradicate extreme poverty and hunger.2. Achieve universal primary education.3. Promote gender equality and empower women.4. Reduce child mortality.5. Improve maternal health.6. Combat HIV/AIDS, malaria and other diseases.7. Ensure environmental sustainability.8. Develop a global partnership for development.
The 2000 Millennium Declaration
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Helminths:Trematoda - non-segmented flat worms
The schistosomes:Schistosoma mansoniSchistosoma haematobiumSchistosoma japonicumSchistosoma mekongi
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Japan is schistosome-free as of 1976
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“It’s a *&^##@#*ing jungle out there!”
“Mr. Allnut, please! You must curtail your abuse of the English language!”
Simply by entering the water, these famous actors were at risk for acquiringSchistosomiasis. Filming of“The African Queen”was done on location, Lake Victoria, Kenya.
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Fishing and Bathing are High Risk in Endemic Zones
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Science Times Tuesday, November 1, 2004
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Aquatic freshwater snails are the intermediate hosts for all species
of schistosomes
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Schistosoma mansoni
Schistosoma japonicum
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Adult male and female Schistosoma mansoni
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One Effective Evolutionary Strategy for Survival:
Camouflage
�ecora�d Crab
�raying Man�� �argasso Sea Hors�
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Schistosome adults live up to 20 years in the bloodstream and avoidimmune attack employing a unique set of molecular mechanisms. Onescheme employs host serum proteins on the tegumental surface ascamouflage, much the same way as the decorated crab uses coral. If wecould unravel the molecular mechanism(s) as to how schistosomesaccomplish this astounding feat, perhaps we could eventually learn totransplant heterologous tissues at will!
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Schistosoma mansoni in situ
Worm pairsMesenteric vein
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Cross section of a pair of adult schistosomes
in situ in a mesenteric venule
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malemale
femalefemale
Female lies within gynecophoral canal. S.mansoni 300 eggs / day
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Embryonated egg of Schistosoma mansoni
Lateral spine
Miracidium (larva)
40 µm
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Embryonated egg of Schistosoma japonicum
Inapparent spine
Miracidium
20 µm
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Embryonated egg of Schistosoma mekongi
Miracidium
15 µm
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Biomphilaria glabrata, the most
common intermediate snail host
for Schistosoma mansoni
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Miracidium of Schistosoma mansonicaught in the act of hatching
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Miracidium of Schistosoma mansoni
Head
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SEM of a cercaria of Schistosoma mansoni
Photo: D. Scharf
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Oncomelania nosophora, a snail intermediatehost for Schistosoma japonicum
1 cm
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Pathogenesis caused by eggs:
1. Miracidium inside egg in small intestine releases proteases, dissolves tissues,induces bleeding and diarrhea.
2. Eggs (50% of those produced) wash back into liver, lodge in pre-sinusoidal capillaries, eventually block flow of blood.
3. Blockage of portal circulation results in portal hypertension.
4. Portal hypertension leads to induction of embryonic circulatory paths, eggs then by-pass liver. Toxic brain syndrome may ensue.
5. Adults avoid immune detection by:a. camouflage strategy, incorporating host serum proteins on tegumental
surface.b. synthesizing β-2 microglobulin-like molecule on tegumental surface.
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Immunity and Schistosomiasis
Parasiteantigen
Th2 protective immune responses and IgE. Down-regulated Th1 response increase susceptibility to other Infectious Diseases eg HIV
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Population Genetics of Susceptibility
More worms correlated with increased egg production andpathology
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Schistosome egg in tissue of the smallintestine. Note intense granuloma
Egg
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Pipe stem fibrosis in liver due to heavy
infection with Schistosoma mansoni.
Note normal liver tissue next to fibrotic vessels
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Granuloma in liver surrounding eggs
of Schistosoma mansoni
Lateral
spine
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Granuloma surrounding an egg of Schistosomamansoni in liver tissue
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Clinical Disease:Acute Phase
1.“Katayama Fever”2. Paralysis3. CNS involvement
Chronic Phase1. GI bleeding and diarrhea2. Portal hypertension due to blockage of pre-sinusoidal capillaries3. Esophageal varices4. Ascites5. Rupture of varices, bleeding, death6. Cor pulmonale, right side heart failure, death7. Toxic brain syndrome
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Diagnosis:
1. Microscopic examination of feces, urine, rectal “snip” for eggs.
2. Capture ELISA for detecting circulating antigens (experimental).
3. Serological tests (e.g., ELISA): indirect measureof exposure, not active disease.
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Biopsy of rectal tissue revealingeggs of Schistosoma mansoni
Calcified eggindicates chronic Infection.
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N
N
O
CO
Drug of Choice:Praziquantel
Mode of Action:Interferes with Ca2+ ion channels, leads to disrupted tegument.
This drug is more effective if the patient has already developed antibodies against tegumental antigens.
N
N
O
CO
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Did Katyama fever stop Mao’sAdvance on Taiwan?
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Prevention is the bestpublic health controlapproach to any infectiousdisease
Shanghai delta:Oncomelania snailsremoved by hand
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Schistosoma haematobium
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Embryonated egg of Schistosoma haematobium
Terminal spine
Miracidium
20 µm
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Schistosoma haematobium eggs in bladder wall
Terminal spine
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Histological section of bladder with pseudopolyp dueto chronic infection with Schistosoma haematobium
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Pathogenesis:
Eggs lodge in bladder wall, induce cellular changesassociated with granuloma formation.
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Clinical Disease:
1. Squamous cell epithelioma
2. Calcification of dome of bladder due to accumulation of dead eggs
3. Hydronephrosis
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Schistosoma mansoni
Schistosoma haematobium
Schistosoma japonicum
Schistosoma mekongi
Summary of Schistosome Egg Morphology
75 µm 30 µm
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“Swimmer’s Itch”
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Cercaria of Schistosoma mansoni
in skin surrounded by eosinophils
Cercaria
Eosinophils
Eosinophils and specific IgE antibodies combine to kill the parasiteTh2 protective mechanism:
See:http://www.brown.edu/Courses/Bio_160/Projects1999/schisto/schistobody.html
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Medical Ecology:Transmission is encouraged by:
1. Dam building, irrigation projects (e.g., 3 GorgesDam, China).
2. Reservoir hosts (primates, oxen).
3. Indiscriminate dispersal of feces and urine into environment.
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Lake Nasser and the Aswan high dam in Egypt
Dam
NASA photo courtesy S. Musgrave, P&S class of 1964
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Prevention and Control:1. Sanitary disposal of feces
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Prevention and Control (cont’d)2. Public health education.
3. Snail control.
4. Community-based drug programs (praziquantel).
5. Vaccine development for reservoir hosts (e.g., water buffalo).
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Global Network for Neglected Tropical Diseases
http://www.GNNTDC.org
• Schistosomiasis Control Initiative
• International Trachoma Initiative
• Helen Keller International
• Liverpool School - GAELF
• Human Hookworm Vaccine Initiative
• Earth Institute at Columbia Univ.
• Task Force for Child Survival– Mectizan Donation Program
– Albendazole Donation Program
– Mebendazole Donation Program