Delay in schistosomiasis diagnosis and treatment: a multicenter cohort study in Italy

Author:

Comelli Agnese1,Riccardi Niccolò2,Canetti Diana2,Spinicci Michele3,Cenderello Giovanni45,Magro Paola1,Nicolini Laura Ambra6,Marchese Valentina1,Zammarchi Lorenzo3,Castelli Francesco1,Bartoloni Alessandro3,Di Biagio Antonio6,Caligaris Silvio1,Gaiera Giovanni2

Affiliation:

1. University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy

2. Clinic of Infectious Diseases, Vita-Salute San Raffaele University, Milan, Italy

3. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

4. Infectious Diseases Unit, EO Ospedali Galliera, Genoa, Italy

5. Infectious Diseases Unit, ASL-1 Imperiese, Sanremo, Italy

6. Infectious Diseases Unit, Policlinico San Martino Hospital, Genoa, Italy

Abstract

Abstract Background Barriers to access to care, different diagnostic strategies and low awareness remain challenging issues in the fight against schistosomiasis. Our study aims to examine management of schistosomiasis in migrants attending large tertiary hospitals in Italy, in order to call for a comprehensive approach. Methods A retrospective review of schistosomiasis cases was carried out between January 1, 2016, and December 31, 2017, in five large Infectious Disease Centers in Italy. We included all patients diagnosed with schistosomiasis. We differentiated among (i) asymptomatic patients diagnosed by serology either as healthy ‘migrant evaluation’ or as ‘late evaluation’ in patients followed because of a different infection and (ii) patients tested because of a suggestive clinical presentation. Patients characteristics and clinical data were recorded. Results One hundred forty-nine patients were included, 137 (91.9%) were male, the median age was 26 years and 70% of them came from Sub-Saharan Africa. Thirty-eight asymptomatic patients (25.5%) were diagnosed by serology [15, (10.1%) among ‘migrant evaluation’ and 23 (15.4%) among ‘late evaluation’ group], and 111 (74.5%) presented with signs/symptoms. The median diagnostic delay from arrival in Italy was 31 months: 110 for asymptomatic group and 16 months for symptomatic patients. Among the 111 symptomatic patients, 41 individuals were already followed in our clinics, and they never underwent screening before appearance of evident disease. Among patients with positive serology who were tested by microscopy, 32/86 (37.2%) had confirmed diagnosis. Forty-five (37.8%) patients presented radiologic abnormalities. Praziquantel was the treatment of choice (70.1% for 3 days and 29.9% in a single-day dose), and 77 (51.7%) were lost to follow-up. Conclusions In our centers, a high proportion of patients were tested late after arrival, and most of them presented with clinical apparent disease. Well-defined strategies and implementation of recent guidelines are needed to improve early diagnosis and to overcome heterogeneity of practice.

Publisher

Oxford University Press (OUP)

Subject

General Medicine

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