Morbidity burden of imported chronic schistosomiasis among West African migrants

Background: Past exposure to schistosomiasis is frequent among migrants from endemic countries, and chronic untreated infection may lead to long-term morbidities. Methods: We carried out a prospective population-based cross-sectional study among migrants from endemic Sub-Saharan countries living in Barcelona, Spain. Participants had not been previously diagnosed or treated for schistosomiasis. Clinical signs and symptoms were scrutinised through a systematic revision of electronic medical records and an on-site standardised questionnaire, and blood and urine samples were screened for Schistosoma. Findings: We recruited 522 eligible participants, 74.3% males, mean age 42.7 years (SD=11.5, range 18–76), Overall, 46.4% were from Senegal and 23.6% from Gambia. They had lived in the European Union for a median of 16 years (IQR 10–21). The prevalence of a Schistosoma-positive serology was 35.8%. S. haematobium eggs were observed in urine samples in 6 (1.2%) participants. The most prevalent symptoms among Schistosoma-positive participants were chronic abdominal pain (68.8%, OR=1.79; 95%CI 1.2–2.6), eosinophilia (44.9%, OR=2.69; 95%CI 1.8–4.0) and specific symptoms associated with urinary schistosomiasis, like self-reported episodes of haematuria (37.2%; OR=2.47; 95%CI 1.6–3.8), dysuria (47.9%, OR=1.84; 95%CI=1.3–2.7) and current renal insufficiency (13.4%; OR=2.35; 95%CI=1.3–4.3). We found a significant prevalence of gender-specific genital signs and symptoms among females (mainly menstrual disorders) and males (erectile dysfunction and pelvic pain). Individuals typically presented with a multitude of interconnected symptoms, most commonly chronic abdominal pain, which are often disregarded. Conclusions: Despite the lack of urine parasite identification, the high incidence of clinical signs and symptoms strongly correlated with a positive schistosomiasis serology suggests the existence of a heavy clinical burden among long-term West African migrants living for years/decades in the study region. More research is urgently required to determine whether these symptoms are the result of long-term sequelae or a persistent active Schistosoma infection.

This work was funded by the Fundació Lluita contra les Infeccions. AH have been supported by the Scolarship Department-Ministry of Higher Education (Egypt); Cultural Office of the Embassy of Egypt in Madrid. None of the funding sources had any role in the study design, analysis, interpretation and discussion of the results.

Peer Reviewed

Article signat per 27 autors/es Sílvia Roure a,b,c,⁎ , Xavier Vallès a,b,d,1 , Olga Pérez-Quílez a,1 , Israel López-Muñoz a,1 , Lluís Valerio a,1 , Laura Soldevila a,b,c,1 , Anna Chamorro b,2 , Elena Abad b,2 , Alaa H.A. Hegazy d,e,f,3 , Gema Fernández-Rivas e,3 , Ester Gorriz a,1 , Dolores Herena a,1 , Elia Fernández-Pedregal a,b,c,1 , Alba San José b,2 , Sergio España-Cueto a,b,c,1 , Roger Paredes b,c,3 , Jose Miranda-Sánchez g,4 , Maria Carme Miralles h,5 , Carmen Conde h,5 , Juan José Montero i,6 , Maria Amparo Núñez-Andrés j,7 , Josep M. Llibre b,c,3 , Mar Isnard g,4 , Josep Maria Bonet g,4 , Oriol Estrada k,3 , Núria Prat g,4 , Bonaventura Clotet b,l,m,2 a International Health Program (PROSICS), Direcció Territorial de Malalties Infeccioses Metropolitana Nord, Institut Català de la Salut, Badalona 08914, Spain b Fundació Lluita contra les Infeccions, Badalona, Spain c Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain d Germans Trias i Pujol Research Institute, Badalona, Spain e Microbiology Department, Germans Trias i Pujol University Hospital, Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Badalona, Spain f Faculty of Medicine, University of Asyut, El Fateh, Egypt g North Metropolitan Primary Care Directorate, Institut Català de la Salut, Sabadell, Spain h Primary Health Care Unit Canovelles, North Metropolitan Health Region from Barcelona, Institut Català de la Salut, Granollers, Spain i Primary Health Care Unit Mataró-3 (Rocafonda-Palau), North Metropolitan Health Region from Barcelona, Institut Català de la Salut, Mataró, Spain j Department of Civil and Environmental Engineering, Universitat Politècnica de Catalunya-BarcelonaTech, Barcelona, Spain k Directorate for Innovation and Interdisciplinary Cooperation, North Metropolitan Territorial Health Region, Institut Català de la Salut, Badalona, Spain l IrsiCaixa—Institut de Recerca de La SIDA, Hospital Universitari Germans Trias i Pujol, Badalona, Spain m Direcció Territorial Malalties Infeccioses, North Metropolitan Territorial Health Region, Institut Català de la Salut, Badalona, Spain

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