Impact of praziquantel treatment and early reinfection patterns in a mixed Schistosoma mansoni and Schistosoma haematobium infection focus in the Democratic Republic of Congo
5 affiliations
- 1Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.
- 2Université de Kikwit, Kikwit, Democratic Republic of the Congo.
- 3Institute of Tropical Medicine of Antwerp, Antwerp, Belgium.
- 4Programme National de Lutte contre la Trypanosomiase Humaine Africaine, Kinshasa, Democratic Republic of the Congo.
- 5Université de Kinshasa, Kinshasa, Democratic Republic of the Congo.
Abstract
Objective: To evaluate the impact of single versus mixed Schistosoma infections on the efficacy of PZQ treatment as well as on the dynamics of reinfection after treatment. Methods: We followed 388 randomly selected residents of a village co‑endemic for Schistosoma haematobium and S. mansoni, screening them for Schistosoma infection every three weeks across a nine‑week period. Kato-Katz stool examination was used to detect eggs of S. mansoni and urine filtration to detect eggs of S. haematobium. At every visit, those who were positive for schistosomiasis were treated with 40mg/kg praziquantel. Treatment outcomes (cure rate (CR), egg reduction rate (ERR), cumulative cure rate (CCR) and cumulative egg reduction rate (CERR)) and reinfection rates were compared between age groups, sex and pre-treatment co-infection status using McNemar and Wilcoxon tests. Results: Baseline infection prevalence was similar for S. mansoni (60.8%) and S. haematobium (60.3%), with 36.6% of mixed S. haematobium-S. mansoni infection. Infection intensity was higher in mixed compared to single infection (200.7 versus 70 epg for S. mansoni, p < 0.001; 29 versus 9.6 ep10mL for S. haematobium, p < 0.001). After one praziquantel treatment, CR of 62.7% and 94.6%, with ERR of 97.5% and 96.5%, were found for S. haematobium and S. mansoni, respectively. After 3 rounds of praziquantel treatment, CCR of 75% and 93.7%, with CERR of 95.6% and 97.5%, were recorded for S. haematobium and S. mansoni, respectively. In addition, treatment efficacy was significantly higher in single than in mixed infections (CR = 76.7% versus 58%, p = 0.01; ERR = 90.2% versus 96.5%, p < 0.001; CCR = 76.7% versus 58%, p = 0.01; CERR = 90.2% versus 96.5%, p < 0.001), and in older than in younger (<16 years) age groups. No significant associations were found between (co-)infection status and reinfection rate. Conclusion: Our results show that pre-treatment co-infection status can affect schistosomiasis treatment outcomes for S. haematobium but does not affect the post-treatment reinfection. These results could help in tailoring control activities in co-endemic areas. Author summary: Schistosomiasis is a neglected tropical disease caused by parasitic worms that infect more than 250 million people worldwide, particularly in sub-Saharan Africa. In many endemic communities, people are simultaneously infected with both Schistosoma haematobium and Schistosoma mansoni, yet little is known about whether these mixed infections influence the effectiveness of praziquantel, the only widely used drug for schistosomiasis control. We followed residents of a co-endemic village before and after repeated praziquantel treatment to compare treatment response and reinfection between individuals with single-species and mixed-species infections. We found that mixed infections were associated with substantially higher parasite burdens than single infections. Individuals with mixed infections, particularly those infected with S. haematobium, responded less well to treatment than those with single infections, whereas treatment efficacy improved with increasing age. In contrast, mixed infections did not increase the risk of becoming reinfected after treatment. These findings suggest that the presence of mixed schistosome infections should be considered when evaluating treatment outcomes and planning control programmes in co-endemic areas. Tailoring treatment and monitoring strategies to account for mixed infections could improve the effectiveness of schistosomiasis control efforts.
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BibTeX
@article{madinga2026impact,
title = {{Impact of praziquantel treatment and early reinfection patterns in a mixed Schistosoma mansoni and Schistosoma haematobium infection focus in the Democratic Republic of Congo}},
author = {Joule Ntwan Madinga and Clementine Roucher and Sylvie Linsuke and Sylvain Baloji and Marie Hermy and Pascal Lutumba and Katja Polman},
journal = {PLOS Neglected Tropical Diseases},
year = {2026},
month = oct,
doi = {10.1371/journal.pntd.0014764},
url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014764},
note = {CC BY},
}
RIS
TY - JOUR
TI - Impact of praziquantel treatment and early reinfection patterns in a mixed Schistosoma mansoni and Schistosoma haematobium infection focus in the Democratic Republic of Congo
AU - Joule Ntwan Madinga
AU - Clementine Roucher
AU - Sylvie Linsuke
AU - Sylvain Baloji
AU - Marie Hermy
AU - Pascal Lutumba
AU - Katja Polman
PY - 2026
DA - 2026/10/09
JO - PLOS Neglected Tropical Diseases
DO - 10.1371/journal.pntd.0014764
UR - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014764
AB - Objective: To evaluate the impact of single versus mixed Schistosoma infections on the efficacy of PZQ treatment as well as on the dynamics of reinfection after treatment. Methods: We followed 388 randomly selected residents of a village co‑endemic for Schistosoma haematobium and S. mansoni, screening them for Schistosoma infection every three weeks across a nine‑week period. Kato-Katz stool examination was used to detect eggs of S. mansoni and urine filtration to detect eggs of S. haematobium. At every visit, those who were positive for schistosomiasis were treated with 40mg/kg praziquantel. Treatment outcomes (cure rate (CR), egg reduction rate (ERR), cumulative cure rate (CCR) and cumulative egg reduction rate (CERR)) and reinfection rates were compared between age groups, sex and pre-treatment co-infection status using McNemar and Wilcoxon tests. Results: Baseline infection prevalence was similar for S. mansoni (60.8%) and S. haematobium (60.3%), with 36.6% of mixed S. haematobium-S. mansoni infection. Infection intensity was higher in mixed compared to single infection (200.7 versus 70 epg for S. mansoni, p < 0.001; 29 versus 9.6 ep10mL for S. haematobium, p < 0.001). After one praziquantel treatment, CR of 62.7% and 94.6%, with ERR of 97.5% and 96.5%, were found for S. haematobium and S. mansoni, respectively. After 3 rounds of praziquantel treatment, CCR of 75% and 93.7%, with CERR of 95.6% and 97.5%, were recorded for S. haematobium and S. mansoni, respectively. In addition, treatment efficacy was significantly higher in single than in mixed infections (CR = 76.7% versus 58%, p = 0.01; ERR = 90.2% versus 96.5%, p < 0.001; CCR = 76.7% versus 58%, p = 0.01; CERR = 90.2% versus 96.5%, p < 0.001), and in older than in younger (<16 years) age groups. No significant associations were found between (co-)infection status and reinfection rate. Conclusion: Our results show that pre-treatment co-infection status can affect schistosomiasis treatment outcomes for S. haematobium but does not affect the post-treatment reinfection. These results could help in tailoring control activities in co-endemic areas. Author summary: Schistosomiasis is a neglected tropical disease caused by parasitic worms that infect more than 250 million people worldwide, particularly in sub-Saharan Africa. In many endemic communities, people are simultaneously infected with both Schistosoma haematobium and Schistosoma mansoni, yet little is known about whether these mixed infections influence the effectiveness of praziquantel, the only widely used drug for schistosomiasis control. We followed residents of a co-endemic village before and after repeated praziquantel treatment to compare treatment response and reinfection between individuals with single-species and mixed-species infections. We found that mixed infections were associated with substantially higher parasite burdens than single infections. Individuals with mixed infections, particularly those infected with S. haematobium, responded less well to treatment than those with single infections, whereas treatment efficacy improved with increasing age. In contrast, mixed infections did not increase the risk of becoming reinfected after treatment. These findings suggest that the presence of mixed schistosome infections should be considered when evaluating treatment outcomes and planning control programmes in co-endemic areas. Tailoring treatment and monitoring strategies to account for mixed infections could improve the effectiveness of schistosomiasis control efforts.
SN - 1935-2735
SN - 1935-2727
ER -