Open access peer-reviewed chapter

One Health Concept against Schistosomiasis: An Overview

Written By

Tonay Inceboz

Submitted: 08 July 2022 Reviewed: 02 August 2022 Published: 04 September 2022

DOI: 10.5772/intechopen.106912

From the Edited Volume

New Horizons for Schistosomiasis Research

Edited by Tonay Inceboz

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Abstract

Schistosomiasis (bilharziasis) is a parasitic disease caused by Schistosoma spp. that belongs to trematode worms. These worms are known as “blood parasites”. This disease is included in “neglected tropical diseases” and “water-borne diseases”. The main species are Schistosoma (S.) haematobium, S. japonicum, S. mansoni, S. intercalatum, S. mekongi, S. guineensis and S. intercalatum, though there are more than 20 different species. The parasite in the definitive host may affect many organs and systems. The disease may become chronic and lasts 3–8 years and even up to 20–30 years. The definitive host is primarily human; however, in endemic areas animals such as monkeys, cattle, horses, rodents, cats, dogs are reservoirs. According to World Health Organization (WHO), schistosomiasis affects 250 million people, and causes 1.9 million deaths yearly in endemic areas. Moreover, due to global warming, the spread of the disease may increase. The effective way to fight against schistosomiasis is following the “one-health system”. Indeed, to overcome or “eradicate” this disease, we have to strive against different forms at different evolutionary stages of the worm such as, forms in humans, domestic or wild animals, and freshwater snails. If we combine the knowledge of professionals, we may achieve this goal.

Keywords

  • schistosoma spp.
  • schistosomiasis
  • epidemiology
  • one health concept

1. Introduction

Schistosoma spp. spread over many continents around the world, primarily in Asia, Africa, and America. There are more than 20 types of Schistosoma in the world. This speciation is most likely due to differences in intermediate hosts and definitive hosts [1, 2, 3].

The 250 million cases of Schistosomiasis reported globally by WHO are distributed among different countries as follows:

In Africa; Nigeria 26.21%, Ethiopia 9.57%, the Democratic Republic of the Congo 7.74%, Mozambique 5.82%, Kenya 5.04%, United Republic of Tanzania 4.32%, Cameroon 4.30%, Uganda 3.66%, Malawi 2.89%, and Ghana 2.88%. Furthermore, there are high-risk countries such as Angola, Benin, Botswana, Burkina Faso, Burundi, Central African Republic, Chad, Côte d’Ivoire, Equatorial Guinea, Eritrea, Gabon, Gambia, Guinea, Guinea-Bissau, Liberia, Madagascar, Malawi, Mali, Mauritania, Namibia, Niger, Rwanda, São Tomé and Príncipe, Senegal, Sierra Leone, Republic of South Africa, Eswatini, Togo, Uganda, Zambia, and Zimbabwe [4]. Although they are located in the African continent; Morocco, Tunisia, and Algeria are at low risk for schistosomiasis [3, 5, 6].

Of the schistosomiasis cases in the Americas, 95.80% are in Brazil and 4.20% in the Bolivarian Republic of Venezuela [4]. Schistosoma mansoni is the only species present in Latin American and Caribbean countries [3]. It has been estimated that around 25 million people are at risk in the Americas. The risk is a “big public health problem,” especially in freshwater lakes and rivers in Southeastern Brazil, whereas St. Lucia and Suriname are at lower risk [7, 8].

In the Eastern Mediterranean region, the prevalence of schistosomiasis is 57.85% in Yemen, 38.36% in Sudan, 3.39% in Somalia, and 0.40% in Egypt. Iraq, Libya, Oman, Saudi Arabia, and Syrian Arab Republic are low-risk countries for Schistosomiasis. In the Western Pacific region, the Philippines (78.28%), China (19.37%), Lao People’s Democratic Republic (1.41%), and Cambodia (0.94%) are reported as endemic countries. Indonesia is an endemic country in South-East Asia, whereas India and Thailand have low risk. There have not been any reported cases in the European continent (Figure 1) [4].

Figure 1.

This map shows the distribution of schistosomiasis in the world [9]. Link: https://apps.who.int/neglected_diseases/ntddata/sch/sch.html

The first tussle against schistosomiasis was via intravenous tartar emetic, a derivative of antimony, in Egypt and Sudan in 1920 [10]. Recently, WHO released a strategic plan under sustainable development objectives, aiming for the “total eradication of schistosomiasis,” which is an important public health target for the affected 78 countries and others [4, 11]. “Total eradication” is defined as the reduction of serious forms of schistosomiasis down to <1% [12]. According to WHO’s plan (intestinal treat all school-age children, also treat adults considered to be at and urogenital schistosomiasis), praziquantel treatment is expected to decrease morbidity as well as eradicate the disease. Additional protection measures such as, preventing water contamination and increasing awareness through education are the other tools to combat the disease (Figure 2) [11].

Figure 2.

Control of schistosomiasis.

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2. Quality assurance system of the management process of schistosomiasis

2.1 International organizations

There are many programs and organizations that work towards finding solutions against schistosomiasis such as WHO disability-adjusted life years (DALY), World Health Assembly (WHA), neglected tropical diseases (NTDs), soil-transmitted helminthiases (STH), and waterborne diseases [11].

Defining prudential targets according to previous data:

2.2 Local organizations

Local organizations have pivotal roles in combatting schistosomiasis. In Brazil, for instance, there are many organizations fighting against the disease: Schistosomiasis Control Programme (PCE), Secretary of Public Health Surveillance (SVS), the Secretary of Health in the State of Minas Gerais (SESMG), Superintendência de Controle de Endemias, Instituto Nacional de Pesquisas Espaciais, Centro de Pesquisas René Rachou. There are also some environmental institutes in Brazil such as moderate resolution imaging spectroradiometer (MODIS), the shuttle radar topography mission (SRTM), Center for Weather Forecast and Climate Studies (CPTEC) [11]. This “fight” should be handled in coordination with the Ministries of Health, Education, Agriculture, and Environment in endemic regions. This would be the most logical solution against parasitic infections because of the different life-cycle periods in intermediate/definitive hosts of the parasites.

I guess there is a Bilharziasis Institute in Egypt.

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3. The field of Research and Development

3.1 Schistosoma species

life cycle, diagnosis, epidemiology, geographic distribution, treatment, prevention, vaccines, etc.

3.2 Animals

3.2.1 Snails

Considering the “One Health Concept,” one of the most important elements to combat schistosomiasis is to prevent ecologic and geographic dissemination of Schistosoma during the development of snails [13, 14].

Infected definitive hosts, namely humans and the above-mentioned animals release Schistosoma eggs. When eggs become in contact with aquatic environment, miracidia − the second form of Schistosoma − develops in the eggs. Then, miracidia penetrate the snails and become still-sporocysts. These sporocysts transform into motile baby sporocysts by internal budding. This is followed by migration of baby sporocysts to the digestive system of the snails, where the sporocysts grow all their glands through cylinder-like processes. Many cercariae develop from tubules of sporocysts. Cercariae are freed from snails via rupture of the tubules. This process, from miracidium to cercaria, takes around 3−12 weeks [15].

Intermediate hosts for Schistosoma mansoni, Schistosoma haematobium, and S. japonicum are the snails Biomphalaria glabrata, Bulinus spp., and Oncomelania hupensis ssp., respectively. In Brazil, however, intermediate hosts for S. mansoni also include Biomphalaria tenagophila (Orbigny, 1835), Basilodes straminea (Dunker, 1848) B. peregrina (Orbigny, 1835), B. schrammi (Crosse, 1864), B. kuhniana (Clessin, 1883), B. intermedia (Paraense & Deslandes, 1962), B. amazonica (Paraense, 1966), B. oligoza(Paraense, 1974), B. occidentalis (Paraense, 1981), B. cousini (Paraense, 1966), and B. tenagophila guaibensis (Paraense, 1984).

The map (Figure XX) below demonstrates the worldwide distribution of the thirty-seven Biomphalaria species, the twenty-six neotropical Biomphalaria species, and the eleven snail species, and one subspecies naturally described in Brazil. An asterisk indicates S. mansoni host species [16, 17, 18].

To identify the Schistosoma from snails, many molecular-based techniques such as PCR, qPCR, loop-mediated isothermal amplification (LAMP), environmental DNA analysis (eDNA), and droplet digital PCR (ddPCR) are commonly used [15].

The relationship of snail species (intermediate host) with Schistosoma spp. as well as with predator fish should be investigated. This would be a good area for future research. It is also essential to preserve the ecological balance and prevent anthropogenic harm to nature (Figure 3).

Figure 3.

This map shows the distribution of Biomphalaria species in the World (according Palasio, R.G.S., 2011) [17, 18]. Link: https://www.academia.edu/17716515/Pattern_of_Genetic_Divergence_of_Mitochondrial_DNA_Sequences_in_Biomphalaria_tenagophila_Complex_Species_Based_on_Barcode_and_Morphological_Analysis

3.2.2 Domestic animals

It is of utmost importance to look for faunas of infection in wild and farm animals as definitive hosts and snails as intermediate hosts. Definitive hosts for Schistosoma spp. in animals are: S. bovis in cattle; S. mattheei in sheep and goats; Cercopithecus sabaus in monkeys; S. indicum, S. spindale, and S.nasale in horses, swines, and dogs; and S. japonicum in dogs [19].

3.2.3 Wild animals

In which region, where wild animals may be infected by Schistosoma spp. should be considered.

In Brazil, there are shrewmice (Oxymycterus sp., Necromys lasiurus, Holochilus spp., Akodon spp., Sooretamys spp., Calomys spp., Proechimys sp., Cavia aperea, and Rattus rattus and Rattus norvegicus) infected with Schistosoma spp. (S. manoni, S. bovis, Sirthenea rodhaini ve S. kisumuensis). S. malayensis can be found in Mueller mice (Rattus muelleri) in Malaysia; however, it is rare to be present in humans. S. ovuncatum and S. sinesium were found in R. rattus in Thailand [20, 21].

The research in Senegal revealed that there was hybridization between S. bovis and S. haematobium, between S. haematobium and S. curassoni in humans, and between S. bovis and S. curassoni in cattle [22, 23].

3.2.4 Humans

It is important to know which Schistosoma spp. may cause infection in humans in different regions, and how human organs would respond in reaction to such infections.

If snails are infected with Schistosoma spp. cercariae can be released into the freshwater bodies such as lakes and rivers. Humans may become infected if these cercariae perforate and enter through the skin. This may cause inflammation, papule formation, and itching on the skin. In addition, if humans drink the infected water that contains cercariae, the infection may occur via the mucosal route [4].

Schistosoma spp. infection may cause the involvement of many organs and systems in human, such as the liver, lungs, heart, gastrointestinal tractus, and urogenital system.

There are two phases of the Schistosoma infection in humans. In the acute phase, common symptoms are fever, cough, rash, arthralgia, malaise, anorexia, vomiting, and diarrhea [1]. “Katayama syndrome” is one of the early clinical effects in hypersensitive patients infected with Schistosoma spp. (Schistosoma mansoni, S. japonicum). It occurs within 14−84 days of infection and is manifested by nocturnal fever, cough, myalgia, headache, and abdominal tenderness [12425].

In the chronic phase of schistosomiasis, clinical findings such as vaginal bleeding, dysuria, hematuria, anemia, bladder carcinoma (S. haematobium), hematochezia, cirrhosis, neurological problems, and even death may occur [1, 24].

Schistosomiasis is a treatable disease if diagnosed. Thus, awareness of this disease and early diagnosis is very important to eradicate it.

3.2.5 Water

Stream, river, lake, pond, waterfall, fluvial environment, flora, flood, dams, and drainage systems are key elements in the spread of Schistosoma spp.

Many problems are arising due to global warming, one of which is heavier flooding [26]. Floodwater may lead to exposure of humans and animals to infected water, mainly in endemic areas. Especially, S. mansoni, S. japonicum, S. haematobium, S. mekongi, S. intercalatum, and S. guineensis are considered waterborne parasites [27]. As a result of floods, flood fighters, as well as the public, may be at risk of infection [28, 29]. In addition, more than 40 different animal species may become infected by consuming contaminated water. These animals are not only farm animals such as cattle and sheep but also wild animals such as mice, rats, and deer in the nature [30, 31, 32]. One should be cautious when grassing the farm animals immediately after the flood. It is also necessary to detect and isolate the infected animals. There is unfortunately no preventive measure of control for Schistosoma in wild animals except sampling and examining.

The countries especially located in endemic areas should consider their ecological circumstances and receive consultation before building dams. Early warning systems for floods should be developed. Infectivity and potential risks of snail habitats should be evaluated in areas surrounding dams. The preventive measures against allowing the snails in drinking water and farming water springs should be taken. In the case of presence of infected snails in dam-water, the use of molluscicides should be considered [30, 33, 34, 35].

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4. Education

4.1 Training of educators

Multidisciplinary international meetings should be held to define strategies for action plans against schistosomiasis.

4.2 Public education

People at risk − especially in endemic areas − such as young groups, soldiers, security forces, foresters, government officers, mountaineers, and water sporters should be trained periodically.

WHO’s course of action set out the targets as eradicating schistosomiasis until 2025 (Table 1) [61].

SpeciesNatural definitive host species (excluding humans)Human public health importanceintermediate host snailMolluscivoresGeographic DistributionReferences
1. Mansoni group
1.1.Schistosoma mansoniNonhuman primates (including apes), rodents, insectivores, artiodactylids (waterbuck), procyonids (raccoon)HighBiomphalaria pfeifferiAfrica, Middle East, South America, (Brazil, Venezuela,Surinam) Caribbean[36]
1.2. Schistosoma edwardienseHippopotamusBiomphalaria sudanica, Bulinus truncatus, or Ceratophallus natalensis.Lake Edward, Western Uganda[37]
1.3.Schistosoma hippopotamiWild, hippopotamus
Artiodactyilds
Biomphalaria sudanica, Bulinus truncatus, or Ceratophallus natalensis.Africa[37]
1.4.Schistosoma rodhainiWild rodents, never in human beings.Planorbis
(P. pfeifferi),
P. tanganikanus, African (P. boissyi = P. alexandrina), American (P. glabratus)
Africa, Congo
Elisabethville, Albertville and Sakania,
[37]
2.Haematobium group
2.1.Schistosoma haematobiumHumans, Nonhuman primates (not apes),
artiodactylids (pigs, buffalo)
HighBulinus globosus
Bulinusnyassanus
B. truncatus
B. succinoides
Trematocranus
placodon
Africa, Middle East[38]
2.2.Schistosoma intercalatumHumans, Possibly rodentsLowBulinus sppCentral Africa (D.R. Congo only)[39]
2.3.Schistosoma bovisWild Artiodactyla, domestic (cattle, goats, sheep, horses and camels) artiodactylsLowBulinus spp.
B. globosus, Beroe forskalii, Baebius nyassanus and B. truncatus), Planorbarius metidjensis
in Africa north of the equator, Europe (Sardinia, Corsica, Spain), and the Middle East as far as Iraq[40, 41]
2.4.Schistosoma curassonidomestic artiodactyls(cattle, sheep, and goats)LowAfrica[22]
2.5.Schistosoma guineensisHumans, Possibly rodentsLowBulinus forskaliiWest Africa (Lower Guinea)[42]
2.6.Schistosoma kisumuensisRodents, non-human primates, ArtiodactylsBulinusAfrica, Lake Victoria Basin, Kenya[20, 21]
2.7.Schistosoma leiperiWild artiodactyls, (antelope), BALB/c mice and in Mastomys coucha
domestic artiodactyls
LowBulinusAfrica[43]
2.8.Schistosoma margrebowieiWild artiodactyls (antelope), BALB/c mice, and in M. coucha, domestic artiodactylsLowBulinus natalensisAfrica[43]
2.9.Schistosoma mattheeiHumans, Nonhuman primates (not apes), Wild artiodactyls (cattle, antelope), domestic artiodactylsLowBulinus globosusSouthern Africa[44]
3.Indicum group
3.1.Schistosoma indicum (pulmonary Schistosomiasis)Domestic artiodactyls, (sheep, goat, water buffalo, cattle, camel, horse, donkey, dog, but not pigs) perissodactylsIndoplanorbis exustus, Lymnaea luteolaW&S Asia, India and other Asian countries[45, 46, 47]
3.2.Schistosoma nasale (nasal cavity)domestic artiodactyls, buffaloesBithynia tentaculata, Indoplanorbis exustusW&S Asia[19]
3.3.Schistosoma spindale (examining mesentery of the animals)Humans (dermatit), domestic artiodactyls (cattle, water buffaloes (Bubalus bubalis), goats
(Artiodactyla, Ruminantia, Bandicota indica, Rattus argentivente,Rattusdiardi,Rattus tiomanicusjalorensis
Indoplanorbis exustusW&S Asia
Bangladesh, South India, Malaysia
[48, 49]
4.Japonicum group
4.1.Schistosoma japonicumHumans, Nonhuman primates, artiodactylids (cats, dogs, goats, horses, pigs, water buffalos in particular), carnivores, rodents, perissodactylids (horses)HighOncomelania hupensisEast Asia (China, Philippines, Indonesia)[50]
4.2.Schistosoma malayensisHumans, Rodents (van Mueller’s rat) Sundamys muelleriLowRobertsiella (R. gismanni, R. kaporensis și, R. silvicolaSoutheast Asia
Peninsular Malaysia
[20, 21]
4.3.Schistosoma mekongiHumans, domestic artiodactyls, carnivors (dogs), Carnivoresartiodactylids(pigs)ModerateTricula apertaSE Asia (Vietnam, Cambodia, Laos, Thailand)[24, 51]
4.4.Schistosoma ovuncatumRodents, nonhuman primates
Rattus rattus, Laboratory host: Mus musculus
Tricula bollingiThailand and Southeast Asian[52]
4.5.Schistosoma sinensiumRodents, and laboratory rabbitsTricula bollingi
Tricula (pomatiopsida:Triculinae) T. hortensis
E&SE Asia
Southern China, southeast Asia, and Northern India
[53, 54]
Schistosoma incognitumPigs, dogs and a variety of rodents (R. Rattus)Radix rubiginosaAsia
southeastern India (Bengal), Java, and Thailand
[55]
5. New species (Orientobilharzia differs)
5.1.Schistosoma turkestanicumCattle, sheep, goats, buffaloesportal veins or intestinal veinsRadix luteolaAsia, China, India, Mongolia, Pakistan, Iraq, and Iran in Asia, and Russia[47]
5.2.Schistosoma bomfordiLymnaea rubiginosa,
Radix luteola
Nepal[47]
5.3.Schistosoma datta
5.4.Schistosoma harinasutaiBuffaloeRadix rubiginosaThailand, Southern Laos[56]
6. Hybrids
6.1.S. haematobium-S. guineenis hybris (1996)Cameroon[57]
6.2. S. mansoni-Sirthenea rodhaini hybrid (2003)Kenya[58]
6.3. S. haematobium–S. bovis hybrids (2009)Senegalese, Corsica[22, 59]
6.4. S. haematobium–S. mansoni hybrid (2019)Côte d’Ivoire.[60]

Table 1.

Schematic phylogeny of interrelationships between members of the genus Schistosoma and definitive host and intermediate host vertebrates.

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5. Conclusion

  1. Schistosomiasis is a “neglected disease” around the world.

  2. Schistosomiasis is a waterborne disease.

  3. Schistosoma spp. is present in humans and animals, which are definitive hosts in both urban and rural areas.

  4. There is a risk of an increase in schistosomiasis due to global warming in tropical and subtropical areas.

  5. Bioturbation due to dams, factories, and drainage systems should be avoided since these may cause an increase in Schistosoma spp. and further differentiation of Schistosoma spp. into new types.

  6. If necessary, double-layer gloves and waterproof boots should be used in contact with infected water. If there is a direct skin contact, alcohol swabs should be used. Drinking water should be boiled and vegetables should be cooked before consumption, particularly in endemic areas [35].

Considering the “One Health Concept,” all related individuals and groups, including parasitologists, veterinarians, public health professionals, biologists, molecular biologists, and geographers should work hand-in-hand to prevent, detect, treat, and eradicate Schistosomiasis.

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Written By

Tonay Inceboz

Submitted: 08 July 2022 Reviewed: 02 August 2022 Published: 04 September 2022