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Moorthy GS, Rubach MP, Maze MJ, Refuerzo RP, Shirima GM, Lukambagire AS, Bodenham RF, Cash-Goldwasser S, Thomas KM, Sakasaka P, Mkenda N, Bowhay TR, Perniciaro JL, Nicholson WL, Kersh GJ, Kazwala RR, Mmbaga BT, Buza JJ, Maro VP, Haydon DT, Crump JA, Halliday JE. Prevalence and risk factors for Q fever, spotted fever group rickettsioses, and typhus group rickettsioses in a pastoralist community of northern Tanzania, 2016-2017. Trop Med Int Health 2024; 29:365-376. [PMID: 38480005 PMCID: PMC11073910 DOI: 10.1111/tmi.13980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND In northern Tanzania, Q fever, spotted fever group (SFG) rickettsioses, and typhus group (TG) rickettsioses are common causes of febrile illness. We sought to describe the prevalence and risk factors for these zoonoses in a pastoralist community. METHODS Febrile patients ≥2 years old presenting to Endulen Hospital in the Ngorongoro Conservation Area were enrolled from August 2016 through October 2017. Acute and convalescent blood samples were collected, and a questionnaire was administered. Sera were tested by immunofluorescent antibody (IFA) IgG assays using Coxiella burnetii (Phase II), Rickettsia africae, and Rickettsia typhi antigens. Serologic evidence of exposure was defined by an IFA titre ≥1:64; probable cases by an acute IFA titre ≥1:128; and confirmed cases by a ≥4-fold rise in titre between samples. Risk factors for exposure and acute case status were evaluated. RESULTS Of 228 participants, 99 (43.4%) were male and the median (interquartile range) age was 27 (16-41) years. Among these, 117 (51.3%) had C. burnetii exposure, 74 (32.5%) had probable Q fever, 176 (77.2%) had SFG Rickettsia exposure, 134 (58.8%) had probable SFG rickettsioses, 11 (4.8%) had TG Rickettsia exposure, and 4 (1.8%) had probable TG rickettsioses. Of 146 participants with paired sera, 1 (0.5%) had confirmed Q fever, 8 (5.5%) had confirmed SFG rickettsioses, and none had confirmed TG rickettsioses. Livestock slaughter was associated with acute Q fever (adjusted odds ratio [OR] 2.54, 95% confidence interval [CI] 1.38-4.76) and sheep slaughter with SFG rickettsioses case (OR 4.63, 95% CI 1.08-23.50). DISCUSSION Acute Q fever and SFG rickettsioses were detected in participants with febrile illness. Exposures to C. burnetii and to SFG Rickettsia were highly prevalent, and interactions with livestock were associated with increased odds of illness with both pathogens. Further characterisation of the burden and risks for these diseases is warranted.
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Affiliation(s)
- Ganga S. Moorthy
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Matthew P. Rubach
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, United States of America
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
- Programme in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Michael J. Maze
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Regina P. Refuerzo
- School of Biodiversity, One Health and Veterinary Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Gabriel M. Shirima
- Nelson Mandela African Institution of Science and Technology, School of Life Sciences and Bioengineering, Arusha, Tanzania
| | - AbdulHamid S. Lukambagire
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- EcoHealth Alliance, New York, United States of America
| | | | - Shama Cash-Goldwasser
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Kate M. Thomas
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | - Nestory Mkenda
- Endulen Hospital, Endulen, Ngorongoro Conservation Area, Tanzania
| | - Thomas R. Bowhay
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Jamie L. Perniciaro
- Rickettsial Zoonoses Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - William L. Nicholson
- Rickettsial Zoonoses Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Gilbert J. Kersh
- Rickettsial Zoonoses Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rudovick R. Kazwala
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Joram J. Buza
- Nelson Mandela African Institution of Science and Technology, School of Life Sciences and Bioengineering, Arusha, Tanzania
| | - Venance P. Maro
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Daniel T. Haydon
- School of Biodiversity, One Health and Veterinary Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - John A. Crump
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, United States of America
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Jo E.B. Halliday
- School of Biodiversity, One Health and Veterinary Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Smith S, Marquardt T, Jennison AV, D'Addona A, Stewart J, Yarwood T, Ho J, Binotto E, Harris J, Fahmy M, Esmonde J, Richardson M, Graham RMA, Gair R, Ariotti L, Preston-Thomas A, Rubenach S, O'Sullivan S, Allen D, Ragh T, Grayson S, Manoy S, Warner JM, Meumann EM, Robson JM, Hanson J. Clinical Manifestations and Genomic Evaluation of Melioidosis Outbreak among Children after Sporting Event, Australia. Emerg Infect Dis 2023; 29:2218-2228. [PMID: 37877500 PMCID: PMC10617349 DOI: 10.3201/eid2911.230951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
Melioidosis, caused by the environmental gram-negative bacterium Burkholderia pseudomallei, usually develops in adults with predisposing conditions and in Australia more commonly occurs during the monsoonal wet season. We report an outbreak of 7 cases of melioidosis in immunocompetent children in Australia. All the children had participated in a single-day sporting event during the dry season in a tropical region of Australia, and all had limited cutaneous disease. All case-patients had an adverse reaction to oral trimethoprim/sulfamethoxazole treatment, necessitating its discontinuation. We describe the clinical features, environmental sampling, genomic epidemiologic investigation, and public health response to the outbreak. Management of this outbreak shows the potential benefits of making melioidosis a notifiable disease. The approach used could also be used as a framework for similar outbreaks in the future.
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Mendonça-Gomes JM, da Costa Araújo AP, da Luz TM, Charlie-Silva I, Braz HLB, Jorge RJB, Ahmed MAI, Nóbrega RH, Vogel CFA, Malafaia G. Environmental impacts of COVID-19 treatment: Toxicological evaluation of azithromycin and hydroxychloroquine in adult zebrafish. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 790:148129. [PMID: 34380260 PMCID: PMC8164503 DOI: 10.1016/j.scitotenv.2021.148129] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 05/08/2023]
Abstract
One of the most impact issues in recent years refers to the COVID-19 pandemic, the consequences of which thousands of deaths recorded worldwide, are still inferior understood. Its impacts on the environment and aquatic biota constitute a fertile field of investigation. Thus, to predict the impact of the indiscriminate use of azithromycin (AZT) and hydroxychloroquine (HCQ) in this pandemic context, we aim to assess their toxicological risks when isolated or in combination, using zebrafish (Danio rerio) as a model system. In summary, we observed that 72 h of exposure to AZT and HCQ (alone or in binary combination, both at 2.5 μg/L) induced the reduction of total protein levels, accompanied by increased levels of thiobarbituric acid reactive substances, hydrogen peroxide, reactive oxygen species and nitrite, suggesting a REDOX imbalance and possible oxidative stress. Molecular docking analysis further supported this data by demonstrating a strong affinity of AZT and HCQ with their potential antioxidant targets (catalase and superoxide dismutase). In the protein-protein interaction network analysis, AZT showed a putative interaction with different cytochrome P450 molecules, while HCQ demonstrated interaction with caspase-3. The functional enrichment analysis also demonstrated diverse biological processes and molecular mechanisms related to the maintenance of REDOX homeostasis. Moreover, we also demonstrated an increase in the AChE activity followed by a reduction in the neuromasts of the head when zebrafish were exposed to the mixture AZT + HCQ. These data suggest a neurotoxic effect of the drugs. Altogether, our study demonstrated that short exposure to AZT, HCQ or their mixture induced physiological alterations in adult zebrafish. These effects can compromise the health of these animals, suggesting that the increase of AZT and HCQ due to COVID-19 pandemic can negatively impact freshwater ecosystems.
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Affiliation(s)
| | - Amanda Pereira da Costa Araújo
- Laboratório de Pesquisas Biológicas, Instituto Federal Goiano, Urutaí, GO, Brazil; Programa de Pós-Graduação em Ciências Ambientais, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | | | - Ives Charlie-Silva
- Departamento de Farmacologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Roberta Jeane Bezerra Jorge
- Drug Research and Development Center, Federal University of Ceará, Brazil; Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Brazil
| | | | - Rafael Henrique Nóbrega
- Reproductive and Molecular Biology Group, Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University, Botucatu, SP, Brazil
| | - Christoph F A Vogel
- Department of Environmental Toxicology and Center for Health and the Environment, University of California, Davis, USA
| | - Guilherme Malafaia
- Laboratório de Pesquisas Biológicas, Instituto Federal Goiano, Urutaí, GO, Brazil; Programa de Pós-Graduação em Biotecnologia e Biodiversidade, Universidade Federal de Goiás, Goiânia, GO, Brazil; Programa de Pós-Graduação em Ecologia e Conservação de Recursos Naturais, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil; Programa de Pós-Graduação em Conservação de Recursos Naturais do Cerrado, Instituto Federal Goiano, Urutaí, GO, Brazil.
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Braddick M, Woods ML, Prabhaharan S. Acute Q fever in third trimester pregnancy. BMJ Case Rep 2021; 14:e242558. [PMID: 34389589 PMCID: PMC8365830 DOI: 10.1136/bcr-2021-242558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 11/03/2022] Open
Abstract
A 29-year-old gravida 2 para 1 woman presented at 29 weeks gestation with fevers, back pain, thrombocytopenia and hepatitis. PCR testing of blood samples detected Coxiella burnetii and paired serology later confirmed the diagnosis of acute Q fever in pregnancy. The patient was treated empirically with oral clarithromycin and experienced a symptomatic and biochemical improvement. Therapy was changed to oral trimethoprim/sulphamethoxazole but was complicated by a delayed cutaneous reaction, prompting recommencement of clarithromycin. Therapy continued until delivery of a healthy girl at 39 weeks and 3 days. Q fever in pregnancy is likely under-reported and is associated with the development of chronic infection and obstetric complications. Treatment with clarithromycin is an alternative to trimethoprim/sulphamethoxazole in the setting of drug intolerance.
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Affiliation(s)
- Maxwell Braddick
- Infectious Diseases, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Marion L Woods
- Infectious Diseases, Townsville Hospital and Health Service, Townsville, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Suji Prabhaharan
- General Medicine, Townsville Hospital and Health Service, Townsville, Queensland, Australia
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da Luz TM, Araújo APDC, Estrela FN, Braz HLB, Jorge RJB, Charlie-Silva I, Malafaia G. Can use of hydroxychloroquine and azithromycin as a treatment of COVID-19 affect aquatic wildlife? A study conducted with neotropical tadpole. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 780:146553. [PMID: 33774288 PMCID: PMC7969824 DOI: 10.1016/j.scitotenv.2021.146553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/11/2021] [Accepted: 03/13/2021] [Indexed: 05/03/2023]
Abstract
The impacts on human health and the economic and social disruption caused by the pandemic COVID-19 have been devastating. However, its environmental consequences are poorly understood. Thus, to assess whether COVID-19 therapy based on the use of azithromycin (AZT) and hydroxychloroquine (HCQ) during the pandemic affects wild aquatic life, we exposed (for 72 h) neotropical tadpoles of the species Physalaemus cuvieri to the water containing these drugs to 12.5 μg/L. We observed that the increase in superoxide dismutase and catalase in tadpoles exposed to AZT (alone or in combination with HCQ) was predominant to keep the production of NO, ROS, TBARS and H2O2 equitable between the experimental groups. In addition, the uptake of AZT and the strong interaction of AZT with acetylcholinesterase (AChE), predicted by the molecular docking analysis, were associated with the anticholinesterase effect observed in the groups exposed to the antibiotic. However, the unexpected increase in butyrylcholinesterase (BChE) in these same groups suggests its constitutive role in maintaining cholinergic homeostasis. Therefore, taken together, our data provide a pioneering evidence that the exposure of P. cuvieri tadpoles to AZT (alone or in combination with HCQ) in a predictably increased environmental concentration (12.5 μg/L) elicits a compensatory adaptive response that can have, in the short period of exposure, guaranteed the survival of the animals. However, the high energy cost for maintaining physiological homeostasis, can compromise the growth and development of animals and, therefore, in the medium-long term, have a general negative effect on the health of animals. Thus, it is possible that COVID-19 therapy, based on the use of AZT, affects wild aquatic life, which requires greater attention to the impacts that this drug may represent.
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Affiliation(s)
| | | | - Fernanda Neves Estrela
- Laboratório de Pesquisas Biológicas, Instituto Federal Goiano, Urutaí, GO, Brazil; Programa de Pós-Graduação em Biotecnologia e Biodiversidade, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Helyson Lucas Bezerra Braz
- Programa de Pós-Graduação em Ciências Morfofuncionais, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | | | - Ives Charlie-Silva
- Programa de Pós-Graduação em Ciências Morfofuncionais, Universidade Federal do Ceará, Fortaleza, CE, Brazil; Institute de Ciências Biológicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Guilherme Malafaia
- Laboratório de Pesquisas Biológicas, Instituto Federal Goiano, Urutaí, GO, Brazil; Programa de Pós-Graduação em Biotecnologia e Biodiversidade, Universidade Federal de Goiás, Goiânia, GO, Brazil; Programa de Pós-Graduação em Ecologia e Conservação de Recursos Naturais, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil; Programa de Pós-Graduação em Conservação de Recursos Naturais do Cerrado, Instituto Federal Goiano, Urutaí, GO, Brazil.
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