Landscape of guidance documents used at TropNet and GeoSentinel centres for the clinical management of schistosomiasis outside endemic areas: A systematic appraisal

Abstract

Diagnosis; Migrants; Schistosomiasis

Diagnóstico; Migrantes; Esquistosomiasis

Diagnòstic; Migrants; Esquistosomiasi

Background The diagnostic and treatment approaches for schistosomiasis in individual patients, outside endemic areas, are not standardised. This study aimed to appraise the reference documents that the experts from the TropNet and GeoSentinel networks use in practice as guidance for the clinical management of their patients with (suspect) schistosomiasis. Methods We systematically appraised the following data from the referenced guidance documents: i) document type, ii) case definitions, iii) diagnostic techniques envisaged; iv) treatment recommendations; v) follow-up recommendations; vi) screening recommendations, and vii) symptom-based diagnostic suspicion. Results Twenty-two of the 30 responders (73.3 %) indicated 19 reference documents, three of which were WHO material not intended for individual clinical management. Only 4/19 (21.1 %) documents were national recommendations; no international guideline was indicated. Case definitions were explicitly presented in only one document (1/19; 5.3 %). Diagnostic tools were detailed in 11/16 (68.8 %) and follow-up guidance in 8/16 (50 %) documents. Treatment guidance was provided in 14/16 (87.5 %) documents. Conclusions Heterogeneity in clinical guidance was evident, although with noticeable overlap at least for chronic schistosomiasis. This confirms the need to formalise case definitions, which should be used to design trials to rigorously assess diagnostic tools and treatment schemes, and eventually come to harmonization of clinical management guidance.

This work was supported by a Cooperative Agreement between International Society of Travel Medicine and US Centers for Disease Control and Prevention [Federal Award Number: 5-U01CK000632-03-00] and by Italian Ministry of Health [Fondi Ricerca Corrente – L2] to IRCCS Sacro Cuore Don Calabria Hospital. The funders had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.