{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T22:59:49Z","timestamp":1771455589973,"version":"3.50.1"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T00:00:00Z","timestamp":1616630400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T00:00:00Z","timestamp":1616630400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Poverty Foundation, Basel"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infect Dis Poverty"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Severe hepatosplenic complications arise in patients with chronic <jats:italic>Schistosoma mansoni<\/jats:italic> infection after heavy exposure to disease agents in endemic areas. These complications are rarely reported and, hence, underestimated.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>We report on eight patients with severe morbidity associated with <jats:italic>S. mansoni<\/jats:italic> infection in Ituri Province, northeastern Democratic Republic of Congo (DRC). The patients were identified during a community-based survey in 2017; one patient was seen at the district hospital. After taking the patients\u2019 history, a clinical examination and an abdominal ultrasonographical examination were performed. <jats:italic>S. mansoni<\/jats:italic> infection was diagnosed in fecal (Kato-Katz technique) and urine (point-of-case circulating cathodic antigen test) samples. These eight patients with severe intestinal and hepatosplenic complications were identified from four villages with high <jats:italic>S. mansoni<\/jats:italic> infection prevalence and related morbidity. The patients\u2019 ages ranged from 19 to 57\u00a0years; four patients were women. Three patients reported hematemesis. Two patients were severely anemic. All patients reported non-specific abdominal symptoms, such as diarrhea (six patients), abdominal pain (seven patients), and blood in the stool (five patients), as well as weight loss (two patients). Abdominal ultrasonography revealed ascites in four patients. All patients had portal hypertension with hepatomegaly (seven patients) or splenomegaly (five patients). Of the six patients with a discernable liver parenchyma pattern, five displayed pattern F and three patient displayed pattern E. Liver parenchyma was not visible for two patients with severe ascites. An <jats:italic>S. mansoni<\/jats:italic> infection was confirmed in six patients, with infection intensity ranging from light to heavy. All <jats:italic>S. mansoni<\/jats:italic> positive patients were treated with praziquantel (40 mg\/kg body weight) and referred to the district hospital for follow-up. One patient with severe ascites died two weeks after we saw her. Due to security and accessibility reasons, the villages could not be visited again and the patients were lost to follow-up.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Our observations of patients with severe schistosomiasis document the severe degree of endemicity of <jats:italic>S. mansoni<\/jats:italic> in the province and suggest an urgent need for adequate schistosomiasis control measures that target vulnerable population groups and address severe complications.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s40249-021-00815-6","type":"journal-article","created":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T02:02:43Z","timestamp":1616637763000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Patients with severe schistosomiasis mansoni in Ituri Province, Democratic Republic of the Congo"],"prefix":"10.1186","volume":"10","author":[{"given":"Maurice M.","family":"Nigo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Odermatt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David Wully","family":"Nigo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgette B.","family":"Salieb-Beugelaar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel","family":"Battegay","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick R.","family":"Hunziker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,3,25]]},"reference":[{"issue":"1","key":"815_CR1","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1038\/s41572-018-0013-8","volume":"4","author":"DP McManus","year":"2018","unstructured":"McManus DP, Dunne DW, Sacko M, Utzinger J, Vennervald BJ, Zhou XN. Schistosomiasis. Nat Rev Dis Primers. 2018;4(1):13.","journal-title":"Nat Rev Dis Primers"},{"issue":"2","key":"815_CR2","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1016\/j.bjid.2014.11.004","volume":"19","author":"AF Adenowo","year":"2015","unstructured":"Adenowo AF, Oyinloye BE, Ogunyinka BI, Kappo AP. Impact of human schistosomiasis in sub-Saharan Africa. Braz J Infect Dis. 2015;19(2):196\u2013205.","journal-title":"Braz J Infect Dis"},{"issue":"1","key":"815_CR3","doi-asserted-by":"publisher","first-page":"20","DOI":"10.3390\/tropicalmed5010020","volume":"5","author":"DW Gunda","year":"2020","unstructured":"Gunda DW, Kilonzo SB, Manyiri PM, Peck RN, Mazigo HD. Morbidity and mortality due to Schistosoma mansoni related periportal fibrosis: could early diagnosis of varices improve the outcome following available treatment modalities in sub Saharan Africa? A scoping review. Trop Med Infect Dis. 2020;5(1):20.","journal-title":"Trop Med Infect Dis"},{"issue":"7","key":"815_CR4","doi-asserted-by":"publisher","first-page":"e2118","DOI":"10.1371\/journal.pntd.0002118","volume":"7","author":"AW Rimoin","year":"2013","unstructured":"Rimoin AW, Hotez PJ. NTDs in the heart of darkness: The Democratic Republic of Congo\u2019s unknown burden of neglected tropical diseases. PLoS Negl Trop Dis. 2013;7(7):e2118.","journal-title":"PLoS Negl Trop Dis."},{"key":"815_CR5","doi-asserted-by":"publisher","DOI":"10.1101\/2020.08.10.20171090","author":"MM Nigo","year":"2020","unstructured":"Nigo MM, Odermatt P, Salieb-Beugelaar GB, Morozov O, Battegay M, Hunziker PR. Epidemiology of Schistosoma mansoni infection in Ituri Province, North-eastern Democratic Republic of the Congo. medRxiv. 2020. https:\/\/doi.org\/10.1101\/2020.08.10.20171090.","journal-title":"medRxiv."},{"key":"815_CR6","doi-asserted-by":"publisher","DOI":"10.1101\/2020.05.23.20108654","author":"MM Nigo","year":"2020","unstructured":"Nigo MM, Odermatt P, Nigo DW, Salieb-Beugelaar GB, Battegay M, Hunziker PR. Morbidity associated with Schstosoma mansoni in north-eastern Democratic Republic of the Congo. medRxiv. 2020. https:\/\/doi.org\/10.1101\/2020.05.23.20108654.","journal-title":"medRxiv."},{"key":"815_CR7","unstructured":"CAID CD. Cellules d'Analyse des Indicateurs de D\u00e9veloppement. Congo R. Indicateurs de d\u00e9veloppement. Donn\u00e9es administrative par province. Province de l'Ituri. 2017."},{"key":"815_CR8","unstructured":"START CENTER. Strategic analysis ratc. DRC survey: an overview of demographics, health, and financial services in the DRC. 2017."},{"key":"815_CR9","unstructured":"Program. WWaS. Water supply and sanitation in the Democratic Republic of Congo. Turning finance into services for 2015 and beyond. 2011."},{"key":"815_CR10","unstructured":"UNICEF\/WHO. Drinking water, sanitation, and hygiene database. 2017."},{"key":"815_CR11","unstructured":"WHO. Les bilharzioses humaines au Congo Belge et au Ruanda-Urundi. 1954."},{"key":"815_CR12","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1590\/S0074-02762001000900023","volume":"96","author":"J Richter","year":"2001","unstructured":"Richter J, Domingues ALC, Barata CH, Prata AR, Lambertucci JR. Report of the second satellite symposium on ultrasound in schistosomiasis. Mem Inst Oswaldo Cruz. 2001;96:151\u20136.","journal-title":"Mem Inst Oswaldo Cruz"},{"issue":"6","key":"815_CR13","first-page":"397","volume":"14","author":"N Katz","year":"1972","unstructured":"Katz N, Chaves A, Pellegrino J. A simple device for quantitative stool thick-smear technique in schistosomiasis mansoni. Rev Inst Med Trop Sao Paulo. 1972;14(6):397\u2013400.","journal-title":"Rev Inst Med Trop Sao Paulo"},{"issue":"6","key":"815_CR14","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1016\/S0035-9203(02)90316-0","volume":"96","author":"L Savioli","year":"2002","unstructured":"Savioli L, Stansfield S, Bundy DAP, Mitchell A, Bhatia R, Engels D, et al. Schistosomiasis and soil-transmitted helminth infections: forging control efforts. Trans R Soc Trop Med Hyg. 2002;96(6):577\u20139.","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"815_CR15","unstructured":"RMD. Schistosomiasis point-of-care circulating cathodic antigen (POC-CCA) cassette based test technical brochure. Rapid Medical Diagnostics. 2015."},{"key":"815_CR16","unstructured":"WHO. Haemoglobin measurement: reliability of some simple techniques for use in a primary health care setting. . Bull World Health Organ. 1983."},{"key":"815_CR17","unstructured":"WHO. Preventive chemotherapy in human helminthiasis. 2006."},{"issue":"6","key":"815_CR18","doi-asserted-by":"publisher","first-page":"1507","DOI":"10.4269\/ajtmh.18-0961","volume":"100","author":"AA Haggag","year":"2019","unstructured":"Haggag AA, Casacuberta Partal M, Rabiee A, Abd Elaziz KM, Campbell CH, Colley DG, et al. Multiple praziquantel treatments of Schistosoma mansoni egg-negative, CCA-positive schoolchildren in a very low endemic setting in Egypt do not consistently alter CCA results. Am J Trop Med Hyg. 2019;100(6):1507\u201311.","journal-title":"Am J Trop Med Hyg"},{"key":"815_CR19","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1186\/1471-2334-14-303","volume":"14","author":"AA Chofle","year":"2014","unstructured":"Chofle AA, Jaka H, Koy M, Smart LR, Kabangila R, Ewings FM, et al. Oesophageal varices, schistosomiasis, and mortality among patients admitted with haematemesis in Mwanza, Tanzania: a prospective cohort study. BMC Infect Dis. 2014;14:303.","journal-title":"BMC Infect Dis"},{"issue":"4","key":"815_CR20","doi-asserted-by":"publisher","first-page":"3225","DOI":"10.4314\/ahs.v19i4.46","volume":"19","author":"CK Opio","year":"2019","unstructured":"Opio CK, Rejani L, Kazibwe F, Ocama P. The diagnostic accuracy of routine clinical findings for detection of esophageal varices in rural sub-Saharan Africa where schistosomiasis is endemic. Afr Health Sci. 2019;19(4):3225\u201334.","journal-title":"Afr Health Sci"},{"issue":"5","key":"815_CR21","doi-asserted-by":"publisher","first-page":"251","DOI":"10.4254\/wjh.v5.i5.251","volume":"5","author":"CM Moore","year":"2013","unstructured":"Moore CM, Van Thiel DH. Cirrhotic ascites review: pathophysiology, diagnosis and management. World J Hepatol. 2013;5(5):251\u201363.","journal-title":"World J Hepatol"},{"issue":"5","key":"815_CR22","doi-asserted-by":"publisher","first-page":"1299","DOI":"10.1128\/JCM.01847-16","volume":"55","author":"S Makiala-Mandanda","year":"2017","unstructured":"Makiala-Mandanda S, Le Gal F, Ngwaka-Matsung N, Ahuka-Mundeke S, Onanga R, Bivigou-Mboumba B, et al. High prevalence and diversity of hepatitis viruses in suspected cases of yellow fever in the Democratic Republic of Congo. J Clin Microbiol. 2017;55(5):1299\u2013312.","journal-title":"J Clin Microbiol"},{"issue":"1","key":"815_CR23","first-page":"36","volume":"216","author":"JB Parr","year":"2017","unstructured":"Parr JB, Verity R, Doctor SM, Janko M, Carey-Ewend K, Turman BJ, et al. Pfhrp2-deleted Plasmodium falciparum parasites in the Democratic Republic of the Congo: a national cross-sectional survey. J Infect Dis. 2017;216(1):36\u201344.","journal-title":"J Infect Dis"},{"key":"815_CR24","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2017.28.215.12395","author":"SN Kabwama","year":"2017","unstructured":"Kabwama SN, Mafigiri R, Balinandi S, Kagirita A, Riolexus AA, Zhu BP. Risk factors for hematemesis in Hoima and Buliisa Districts, Western Uganda, September-\u2013October 2015. Pan Afr Med J. 2017. https:\/\/doi.org\/10.11604\/pamj.2017.28.215.12395.","journal-title":"Pan Afr Med J."}],"container-title":["Infectious Diseases of Poverty"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s40249-021-00815-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s40249-021-00815-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s40249-021-00815-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T02:02:52Z","timestamp":1616637772000},"score":1,"resource":{"primary":{"URL":"https:\/\/idpjournal.biomedcentral.com\/articles\/10.1186\/s40249-021-00815-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,25]]},"references-count":24,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["815"],"URL":"https:\/\/doi.org\/10.1186\/s40249-021-00815-6","relation":{},"ISSN":["2049-9957"],"issn-type":[{"value":"2049-9957","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,25]]},"assertion":[{"value":"26 April 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 March 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 March 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Patient examinations were part of a larger study, which was approved by the Swiss Ethical Commission (Ethikkommission in Nordwest- and Zentralschweiz, Ref. No. UBE-15\/78) and by the University of Kisangani\u2019s Research Ethical Commission, (Ref No: CER\/003\/GEAK\/2016). Authorization was granted by the Nyankunde Higher Institute of Medical Techniques (Ref No 70\/ISTM-N\/SGAC\/2017), Bunia, DRC. Permission for field work was obtained from the Ituri Provincial Health Division (Ref. 054\/433\/DPS\/IT\/06\/2016 and Ref. 054\/472\/DPS\/IT\/06\/2017) and from all relevant health districts. Prior to enrollment, the study objectives and procedures were explained in the local language to each participant and all of their questions were answered. Written informed consent was obtained from all study participants aged 15\u00a0years and older. Parents or legal guardians signed assent forms for participants aged 14\u00a0years and younger. Adolescents (15\u201317\u00a0years) signed the informed consent forms in agreement with the parents \/ guardians and in the presence of the village health volunteer.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"Written informed consent was obtained and included permission for taking photographs and publishing anonymized data.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publication"}},{"value":"The authors have no competing interests to declare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"39"}}