Abstract
Cercarial dermatitis (CD) is an allergic skin disease that rises in consequence of infection by invasive stages (cercariae) of trematodes of the family Schistosomatidae. CD has been considered a re-emerging disease, human cases have been reported from all continents, and tourism-threatening outbreaks occur even in frequented recreational areas. Although the symptoms of CD are generally known, the data on immune response in human patients are sporadic and incomprehensive. In the present study, we attempted to correlate the symptoms, personal history, and time course of CD in human patients with differential cell counts, dynamics of selected cytokines, and dynamics and quality of antibody response. By a systematic follow-up, we obtained a uniquely complex dataset from ten persons accidentally and concurrently infected by the same parasite species in the same locality. The onset of CD was significantly faster, and the symptoms were heavier in participants with a history of CD if compared to naive ones, who, however, also developed some of the symptoms. The repeatedly infected persons had elevated proportion of eosinophils 1 week post exposure (p.e.) and a stronger specific IgG but not IgM response, whereas specific IgE response was not observed. Increased serum levels of IL-4 occurred 1 and 3 week(s) p.e. in all participants. There was high variability in individual immunoblot patterns of IgG response, and no antigen with a universal diagnostic potential was confirmed. The presented analyses suggested that a complex approach can improve the accuracy of the diagnosis of CD, but component data should be interpreted carefully.
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Acknowledgements
We thank all participants who agreed to participate in this study. We are also grateful to Mrs. Markéta Leissová, National Reference Laboratory for Tissue Helminthiases, Prague, for the collections of blood samples.
Funding
The work on the project was funded by Czech Science Foundation (Grant Nos. 13-29577S and 18-11140S) and by the project “Centre for Research of Pathogenicity and Virulence of Parasites” (no. CZ.02.1.01/0.0/0.0/16_019/0000759) funded by European Regional Development Fund and Ministry of Education, Youth and Sports of the Czech Republic. Charles University institutional support (PROGRES Q43, UNCE 204017, and SVV 244-260432/2017) applied to JB, TM, LT, PH, and LM.
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This research was performed in accordance with the legislation of the Czech Republic and the European Union. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.The study was approved by the Institutional Review Board of the Charles University, Faculty of Science (approval no. 2017/22). This article does not contain any studies with animals performed by any of the authors.
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Online Resource 1
Example of an unfilled questionnaire used for gaining data from individual participants (PDF 250 kb)
Upper section of the questionnaire serves for internal identification of participants, anamnestic data, and other facts which could possibly affect course of infection. Lower section includes scoring table for three categories of clinical symptoms based on individual perception of each participant. Columns in yellow are highlighting days of blood sampling. Original questionnaire in Czech was translated to English for the purpose of this article. Hpe, hours post exposure, dpe, days post exposure
Online Resource 2
Results of personal evaluation of regional symptoms of cercarial dermatitis in individual participants (PDF 73 kb)
Original data from questionnaires used for evaluation of regional clinical score are shown. For each participant, the data were summed and statistical analysis was performed for particular groups as presented in Fig. 5. Hpe, hours post exposure, dpe, days post exposure. Colours correspond to participant groups from cluster analyses – red for g I., blue for g II., green for g III., black for participant #10 (see Fig. 4 in the main article)
Online Resource 3
Results of personal evaluation of local symptoms of cercarial dermatitis in individual participants (PDF 76 kb)
Original data from questionnaires used for evaluation of local clinical score are shown. For each participant, the data were summed and statistical analysis was performed for particular groups as presented in Fig. 6. Hpe, hours post exposure, dpe, days post exposure. Colours correspond to participant groups from cluster analyses – red for g I., blue for g II., green for g III., black for participant #10 (see Fig. 4 in the main article)
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Macháček, T., Turjanicová, L., Bulantová, J. et al. Cercarial dermatitis: a systematic follow-up study of human cases with implications for diagnostics. Parasitol Res 117, 3881–3895 (2018). https://doi.org/10.1007/s00436-018-6095-0
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DOI: https://doi.org/10.1007/s00436-018-6095-0