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Ramharter M, Butler J, Mombo-Ngoma G, Nordmann T, Davi SD, Zoleko Manego R. The African eye worm: current understanding of the epidemiology, clinical disease, and treatment of loiasis. THE LANCET. INFECTIOUS DISEASES 2024; 24:e165-e178. [PMID: 37858326 DOI: 10.1016/s1473-3099(23)00438-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 10/21/2023]
Abstract
Loa loa, the African eye worm, is a filarial pathogen transmitted by blood-sucking flies of the genus Chrysops. Loiasis primarily affects rural populations residing in the forest and adjacent savannah regions of central and west Africa, where more than 20 million patients are chronically infected in medium and high transmission regions. For a long time, loiasis has been regarded as a relatively benign condition. However, morbidity as measured by disability-adjusted life-years lost might be as high as 400 per 100 000 residents, and the population attributable fraction of death is estimated at 14·5% in highly endemic regions, providing unequivocal evidence for the substantial disease burden that loiasis exerts on affected communities. The clinical penetrance of loiasis is variable and might present with the classic signs of eye worm migration or transient Calabar swellings, but might include common, unspecific symptoms or rare but potentially life-threatening complications. Although adult worm migration seems most closely linked to symptomatic disease, high levels of microfilaraemia are associated with clinically important complications and death. Loiasis remains difficult to diagnose, treat, and control due to an absence of reliable point-of-care diagnostic assays, safe and efficacious drugs, and cost-effective prevention strategies. This Review summarises the major advances in our understanding of loiasis made over the past decade and highlights the many gaps that await to be addressed urgently.
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Affiliation(s)
- Michael Ramharter
- Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Division of Tropical Medicine, I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Centre de Recherche Médicale de Lambaréné, Lambaréné, Gabon; German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany.
| | | | - Ghyslain Mombo-Ngoma
- Department of Implementation Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Division of Tropical Medicine, I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Centre de Recherche Médicale de Lambaréné, Lambaréné, Gabon; German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Tamara Nordmann
- Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Division of Tropical Medicine, I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Saskia Dede Davi
- Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Division of Tropical Medicine, I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Rella Zoleko Manego
- Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Division of Tropical Medicine, I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Centre de Recherche Médicale de Lambaréné, Lambaréné, Gabon
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Sanya RE, Andia Biraro I, Nampijja M, Zziwa C, Nanyunja C, Nsubuga D, Kiwanuka S, Tumusiime J, Nassuuna J, Walusimbi B, Cose S, Ocama P, Grencis RK, Elliott AM, Webb EL. Contrasting impact of rural, versus urban, living on glucose metabolism and blood pressure in Uganda. Wellcome Open Res 2020; 5:39. [PMID: 32875121 PMCID: PMC7447960 DOI: 10.12688/wellcomeopenres.15616.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2020] [Indexed: 01/13/2023] Open
Abstract
Background: The burden of cardiometabolic diseases, including cardiovascular diseases and diabetes, is increasing in sub-Saharan Africa and this has been linked to urbanisation. Helminths, through their immunomodulatory properties, may protect against these disorders. We hypothesised that the rural environment protects against cardiometabolic diseases and that helminths may influence rural-urban disparity of cardiometabolic disease risk. Methods: We compared metabolic parameters of individuals aged ≥10 years living in rural, high-helminth-transmission and urban, lower-helminth-transmission settings in Uganda. Cross-sectional surveys were conducted in rural Lake Victoria island fishing communities and in urban sub-wards in Entebbe municipality. Helminth infection and outcomes, including insulin resistance (computed using the homeostatic model assessment of insulin resistance [HOMA-IR]), fasting blood glucose, fasting blood lipids, blood pressure, body mass index (BMI), waist and hip circumference, were assessed. Results: We analysed 1,898 rural and 930 urban participants. Adjusting for BMI, exercise, smoking, alcohol intake, age and sex, urban residents had lower mean fasting glucose (adjusted mean difference [95%CI] 0.18 [-0.32, -0.05] p=0.01) and HOMA-IR (-0.26 [-0.40, -0.11] p=0.001) but higher blood pressure (systolic, 5.45 [3.75, 7.15] p<0.001; diastolic, 1.93 [0.57, 3.29] p=0.006). Current helminth infection did not explain the observed differences. Conclusions: In the Ugandan context, living in rural fishing communities may protect against hypertension but worsen glucose metabolism.
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Affiliation(s)
- Richard E Sanya
- Immunomodulation and Vaccines Programme, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Irene Andia Biraro
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Margaret Nampijja
- Immunomodulation and Vaccines Programme, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Christopher Zziwa
- Immunomodulation and Vaccines Programme, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Carol Nanyunja
- Immunomodulation and Vaccines Programme, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Denis Nsubuga
- Immunomodulation and Vaccines Programme, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Samuel Kiwanuka
- Immunomodulation and Vaccines Programme, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Josephine Tumusiime
- Immunomodulation and Vaccines Programme, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Jacent Nassuuna
- Immunomodulation and Vaccines Programme, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Bridgious Walusimbi
- Immunomodulation and Vaccines Programme, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Stephen Cose
- Immunomodulation and Vaccines Programme, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Ponsiano Ocama
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Richard K Grencis
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Alison M Elliott
- Immunomodulation and Vaccines Programme, Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily L Webb
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Sanya RE, Andia Biraro I, Nampijja M, Zziwa C, Nanyunja C, Nsubuga D, Kiwanuka S, Tumusiime J, Nassuuna J, Walusimbi B, Cose S, Ocama P, Grencis RK, Elliott AM, Webb EL. Contrasting impact of rural, versus urban, living on glucose metabolism and blood pressure in Uganda. Wellcome Open Res 2020; 5:39. [DOI: 10.12688/wellcomeopenres.15616.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 11/20/2022] Open
Abstract
Background: The burden of cardiometabolic diseases, including cardiovascular diseases and diabetes, is increasing in sub-Saharan Africa and this has been linked to urbanisation. Helminths, through their immunomodulatory properties, may protect against these disorders. We hypothesised that the rural environment protects against cardiometabolic diseases and that helminths may influence rural-urban disparity of cardiometabolic disease risk. Methods: We compared metabolic parameters of individuals aged ≥10 years living in rural, high-helminth-transmission and urban, lower-helminth-transmission settings in Uganda. Cross-sectional surveys were conducted in rural Lake Victoria island communities and in urban sub-wards in Entebbe municipality. Helminth infection and outcomes, including insulin resistance (computed using the homeostatic model assessment of insulin resistance [HOMA-IR]), fasting blood glucose, fasting blood lipids, blood pressure, body mass index (BMI), waist and hip circumference, were assessed. Results: We analysed 1,898 rural and 930 urban participants. Adjusting for BMI, exercise, smoking, alcohol intake, age and sex, urban residents had lower mean fasting glucose (adjusted mean difference [95%CI] -0.13 [-0.24, -0.01] p=0.04) and HOMA-IR (-0.13 [-0.25, -0.01] p=0.04) but higher blood pressure (systolic, 4.64 [3.23, 6.06] p<0.001; diastolic, 1.89 [0.81, 2.97] p=0.001). Current helminth infection did not explain the observed differences. Conclusions: In low-income countries, rural living may protect against hypertension but impair glucose metabolism.
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Nalwoga A, Webb EL, Chihota B, Miley W, Walusimbi B, Nassuuna J, Sanya RE, Nkurunungi G, Labo N, Elliott AM, Cose S, Whitby D, Newton R. Kaposi's sarcoma-associated herpesvirus seropositivity is associated with parasite infections in Ugandan fishing communities on Lake Victoria islands. PLoS Negl Trop Dis 2019; 13:e0007776. [PMID: 31618208 PMCID: PMC6816576 DOI: 10.1371/journal.pntd.0007776] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 10/28/2019] [Accepted: 09/11/2019] [Indexed: 12/20/2022] Open
Abstract
We investigated the impact of helminths and malaria infection on Kaposi's sarcoma associated herpesvirus (KSHV) seropositivity, using samples and data collected from a cluster-randomised trial of intensive versus standard anthelminthic treatment. The trial was carried out in 2012 to 2016 among fishing communities on Lake Victoria islands in Uganda. Plasma samples from 2881 participants from two household surveys, the baseline (1310 participants) and the final (1571 participants) surveys were tested for KSHV IgG antibody responses to K8.1 and ORF73 recombinant proteins using ELISA. The baseline survey was carried out before the trial intervention while the final survey was carried out after three years of the trial intervention. Additionally, a subset sample of 372 participants from the final survey was tested for IgE, IgG and IgG4 antibody concentrations to S. mansoni adults worm antigen (SWA) and S. mansoni egg antigen (SEA) using ELISA. Infection by helminths (S. mansoni, N. americanus, T. trichiura and S. stercoralis) was diagnosed using real-time PCR, urine circulating cathodic antigen (CCA) and stool microscopy (Kato-Katz method) while malaria infection was diagnosed using microscopy. We analysed the relationship between helminth and malaria infections and KSHV seropositivity using regression modelling, allowing for survey design. At baseline, 56% of the participants were male while 48% of the participants were male in the final survey. The most prevalent helminth infection was S. mansoni (at baseline 52% and 34% in the final survey by microscopy, 86% by CCA and 50% by PCR in the final survey). KSHV seropositivity was 66% (baseline) and 56% (final survey) among those 1-12 years and >80% in those 13+ years in both surveys; malaria parasitaemia prevalence was 7% (baseline) and 4% (final survey). At baseline, individuals infected with S. mansoni (detected by microscopy) were more likely to be KSHV seropositive (aOR = 1.86 (1.16, 2.99) p = 0.012) and had higher anti-K8.1 antibody levels (acoefficient = 0.03 (0.01, 0.06) p = 0.02). In the final survey, S. mansoni (by microscopy, adjusted Odds Ratio (aOR = 1.43 (1.04-1.95), p = 0.028) and malaria parasitaemia (aOR = 3.49 (1.08-11.28), p = 0.038) were positively associated with KSHV seropositivity. Additionally, KSHV seropositive participants had higher S. mansoni-specific IgE and IgG antibody concentrations in plasma. Furthermore, HIV infected individuals on cART were less likely to be KSHV seropositive compared to HIV negative individuals (aOR = 0.46 (0.30, 0.71) p = 0.002). Schistosoma species skew the immune response towards Th2 and regulatory responses, which could impact on KSHV reactivation if co-infected with both organisms.
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Affiliation(s)
- Angela Nalwoga
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Emily L. Webb
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Belinda Chihota
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Wendell Miley
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | | | | | - Richard E. Sanya
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Gyaviira Nkurunungi
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nazzarena Labo
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | - Alison M. Elliott
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Stephen Cose
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Denise Whitby
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | - Robert Newton
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- University of York, York; United Kingdom
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Lule SA, Namara B, Akurut H, Lubyayi L, Nampijja M, Akello F, Tumusiime J, Aujo JC, Oduru G, Mentzer AJ, Smeeth L, Elliott AM, Webb EL. Blood pressure risk factors in early adolescents: results from a Ugandan birth cohort. J Hum Hypertens 2019; 33:679-692. [PMID: 30804461 PMCID: PMC6760975 DOI: 10.1038/s41371-019-0178-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 01/25/2019] [Accepted: 02/11/2019] [Indexed: 01/01/2023]
Abstract
We aimed to investigate life-course factors associated with blood pressure (BP) among Ugandan adolescents. Between 9th April 2003 and 24th November 2005, 2507 pregnant women from Entebbe municipality and Katabi sub-county were enrolled into a deworming trial. The resulting 2345 live-born offspring were followed to age 10 or 11 years, when between 20th May 2014 to 16th June 2016, BP was measured following standard protocols. Factors associated with BP were assessed using multivariable linear regression. BP was measured in 1119 adolescents with a median age of 10.2 years. Mean systolic BP and diastolic BP was 105.9 mmHg (standard deviation (SD) 8.2) and 65.2 mmHg (SD 7.3), respectively. Maternal gestational body mass index (BMI), higher maternal education status and family history of hypertension were positively associated with adolescent BP. Childhood (age ≤5 years) malaria was associated with lower adolescent systolic BP. Factors measured at time of BP measurement positively associated with systolic BP were age, BMI, waist circumference and Trichuris trichiura (whipworm) infection; higher vegetable consumption was associated with lower systolic BP. Results for diastolic BP were similar, except higher fruit, rather than higher vegetable consumption was associated with lower diastolic BP and there was no association with waist circumference or Trichuris trichiura infection. In summary, life-course exposures were associated with adolescent BP in this tropical birth cohort. Malaria early in life could impact later BP. Interventions initiated early in life targeting individuals with family history of hypertension, aiming to reduce adiposity (in pregnancy and adolescence) and promoting fruit and vegetable consumption might contribute to reducing the risk of high BP and subsequent cardiovascular diseases.
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Affiliation(s)
- Swaib A Lule
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,MRC/UVRI & LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda.
| | - Benigna Namara
- MRC/UVRI & LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Helen Akurut
- MRC/UVRI & LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Lawrence Lubyayi
- MRC/UVRI & LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | | | - Florence Akello
- MRC/UVRI & LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | | | - Judith C Aujo
- Department of Paediatrics, Mulago Hospital, P.O. Box 7051, Kampala, Uganda
| | - Gloria Oduru
- MRC/UVRI & LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | | | - Liam Smeeth
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Alison M Elliott
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,MRC/UVRI & LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Emily L Webb
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Abstract
A variety of arthropods, protozoa, and helminths infect the skin and subcutaneous tissues and may be identified by anatomic pathologists in standard cytology and histology preparations. The specific organisms seen vary greatly with the patient's exposure history, including travel to or residence in endemic countries. Arthropods are the most commonly encountered parasites in the skin and subcutaneous tissues and include Sarcoptes scabei, Demodex species, Tunga penetrans, and myiasis-causing fly larvae. Protozoal parasites such as Leishmania may also be common in some settings. Helminths are less often seen, and include round worms (eg, Dirofilaria spp.), tapeworms (eg, Taenia solium, Spirometra spp.), and flukes (eg, Schistosoma spp.). This review covers the epidemiologic and histopathologic features of common parasitic infections of the skin and subcutaneous tissues.
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Wajja A, Kizito D, Nassanga B, Nalwoga A, Kabagenyi J, Kimuda S, Galiwango R, Mutonyi G, Vermaak S, Satti I, Verweij J, Tukahebwa E, Cose S, Levin J, Kaleebu P, Elliott AM, McShane H. The effect of current Schistosoma mansoni infection on the immunogenicity of a candidate TB vaccine, MVA85A, in BCG-vaccinated adolescents: An open-label trial. PLoS Negl Trop Dis 2017; 11:e0005440. [PMID: 28472067 PMCID: PMC5417418 DOI: 10.1371/journal.pntd.0005440] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 02/27/2017] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Helminth infection may affect vaccine immunogenicity and efficacy. Adolescents, a target population for tuberculosis booster vaccines, often have a high helminth burden. We investigated effects of Schistosoma mansoni (Sm) on the immunogenicity and safety of MVA85A, a model candidate tuberculosis vaccine, in BCG-vaccinated Ugandan adolescents. METHODS In this phase II open label trial we enrolled 36 healthy, previously BCG-vaccinated adolescents, 18 with no helminth infection detected, 18 with Sm only. The primary outcome was immunogenicity measured by Ag85A-specific interferon gamma ELISpot assay. Tuberculosis and schistosome-specific responses were also assessed by whole-blood stimulation and multiplex cytokine assay, and by antibody ELISAs. RESULTS Ag85A-specific cellular responses increased significantly following immunisation but with no differences between the two groups. Sm infection was associated with higher pre-immunisation Ag85A-specific IgG4 but with no change in antibody levels following immunisation. There were no serious adverse events. Most reactogenicity events were of mild or moderate severity and resolved quickly. CONCLUSIONS The significant Ag85A-specific T cell responses and lack of difference between Sm-infected and uninfected participants is encouraging for tuberculosis vaccine development. The implications of pre-existing Ag85A-specific IgG4 antibodies for protective immunity against tuberculosis among those infected with Sm are not known. MVA85A was safe in this population. TRIAL REGISTRATION ClinicalTrials.gov NCT02178748.
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Affiliation(s)
- Anne Wajja
- Co-infection Studies Program, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
- * E-mail: ,
| | - Dennison Kizito
- Co-infection Studies Program, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Beatrice Nassanga
- Co-infection Studies Program, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Angela Nalwoga
- Co-infection Studies Program, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Joyce Kabagenyi
- Co-infection Studies Program, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Simon Kimuda
- Co-infection Studies Program, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Ronald Galiwango
- Co-infection Studies Program, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Gertrude Mutonyi
- Co-infection Studies Program, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Samantha Vermaak
- The Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - Iman Satti
- The Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - Jaco Verweij
- Laboratory for Medical Microbiology and Immunology & Laboratory for Clinical Pathology, St. Elisabeth Hospital, Tilburg, The Netherlands
| | | | - Stephen Cose
- Co-infection Studies Program, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jonathan Levin
- Co-infection Studies Program, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pontiano Kaleebu
- Co-infection Studies Program, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Alison M. Elliott
- Co-infection Studies Program, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen McShane
- The Jenner Institute, University of Oxford, Oxford, United Kingdom
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The impact of prenatal exposure to parasitic infections and to anthelminthic treatment on antibody responses to routine immunisations given in infancy: Secondary analysis of a randomised controlled trial. PLoS Negl Trop Dis 2017; 11:e0005213. [PMID: 28178298 PMCID: PMC5298230 DOI: 10.1371/journal.pntd.0005213] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/28/2016] [Indexed: 11/25/2022] Open
Abstract
Background Chronic parasitic infections are associated with active immunomodulation which may include by-stander effects on unrelated antigens. It has been suggested that pre-natal exposure to parasitic infections in the mother impacts immunological development in the fetus and hence the offspring’s response to vaccines, and that control of parasitic infection among pregnant women will therefore be beneficial. Methodology/Principal findings We used new data from the Entebbe Mother and Baby Study, a trial of anthelminthic treatment during pregnancy conducted in Uganda, to further investigate this hypothesis. 2705 mothers were investigated for parasitic infections and then randomised to albendazole (400mg) versus placebo and praziquantel (40mg/kg) during pregnancy in a factorial design. All mothers received sulfadoxine/pyrimethamine for presumptive treatment of malaria. Offspring received Expanded Programme on Immunisation vaccines at birth, six, 10 and 14 weeks. New data on antibody levels to diphtheria toxin, three pertussis antigens, Haemophilus influenzae type B (HiB) and Hepatitis B, measured at one year (April 2004 –May 2007) from 1379 infants were analysed for this report. Additional observational analyses relating maternal infections to infant vaccine responses were also conducted. Helminth infections were highly prevalent amongst mothers (hookworm 43.1%, Mansonella 20.9%, Schistosoma mansoni 17.3%, Strongyloides 11.7%, Trichuris 8.1%) and 9.4% had malaria at enrolment. In the trial analysis we found no overall effect of either anthelminthic intervention on the measured infant vaccine responses. In observational analyses, no species was associated with suppressed responses. Strongyloidiasis was associated with enhanced responses to pertussis toxin, HiB and Hep B vaccine antigens. Conclusions/Significance Our results do not support the hypothesis that routine anthelminthic treatment during pregnancy has a benefit for the infant’s vaccine response, or that maternal helminth infection has a net suppressive effect on the offspring’s response to vaccines. Trial Registration ISRCTN.com ISRCTN32849447 Parasitic infections, such as worms and malaria, have potent effects on the human immune system. These effects include modification of immune responses in the fetus and infant if a mother has a parasitic infection during pregnancy. These immunological changes can influence the way a child responds to the same infection when exposed in later life. It has been suggested that the immunological changes might also influence how the child responds to the vaccines given in infancy, and that treating mothers for parasitic infections when they are pregnant might be helpful. In this study we compared responses to vaccines between infants of mothers who had, or had not, been treated for worms while they were pregnant. We found no overall differences. We also compared vaccine responses between groups of mothers with and without parasitic infections. We found no evidence that the parasitic infections were associated with reduced responses in the children. This means that, although treating worms during pregnancy may have some benefits, improvements in the children’s responses to vaccines are not likely to be among them.
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Webb EL, Nampijja M, Kaweesa J, Kizindo R, Namutebi M, Nakazibwe E, Oduru G, Kabubi P, Kabagenyi J, Nkurunungi G, Kizito D, Muhangi L, Akello M, Verweij JJ, Nerima B, Tukahebwa E, Elliott AM, Sanya R, Mirembe B, Okello J, Levin J, Zziwa C, Tumusiime J, Sewankambo M, Nsubuga D, Cose S, Wammes L, Niwagaba E, Kabami G, Abayo E, Muwonge F, Abiriga D, Nannozi V, Kaweesa J. Helminths are positively associated with atopy and wheeze in Ugandan fishing communities: results from a cross-sectional survey. Allergy 2016; 71:1156-69. [PMID: 26918891 PMCID: PMC4949563 DOI: 10.1111/all.12867] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2016] [Indexed: 01/15/2023]
Abstract
Background Parasitic helminths are potent immunomodulators and chronic infections may protect against allergy‐related disease and atopy. We conducted a cross‐sectional survey to test the hypothesis that in heavily helminth‐exposed fishing villages on Lake Victoria, Uganda, helminth infections would be inversely associated with allergy‐related conditions. Methods A household survey was conducted as baseline to an anthelminthic intervention trial. Outcomes were reported wheeze in last year, atopy assessed both by skin prick test (SPT) and by the measurement of allergen‐specific IgE to dust mites and cockroach in plasma. Helminth infections were ascertained by stool, urine and haemoparasitology. Associations were examined using multivariable regression. Results Two thousand three hundred and sixteen individuals were surveyed. Prevalence of reported wheeze was 2% in under‐fives and 5% in participants ≥5 years; 19% had a positive SPT; median Dermatophagoides‐specific IgE and cockroach‐specific IgE were 1440 and 220 ng/ml, respectively. S. mansoni, N. americanus, S. stercoralis, T. trichiura, M. perstans and A. lumbricoides prevalence was estimated as 51%, 22%, 12%, 10%, 2% and 1%, respectively. S. mansoni was positively associated with Dermatophagoides‐specific IgE [adjusted geometric mean ratio (aGMR) (95% confidence interval) 1.64 (1.23, 2.18)]; T. trichiura with SPT [adjusted odds ratio (aOR) 2.08 (1.38, 3.15)]; M. perstans with cockroach‐specific IgE [aGMR 2.37 (1.39, 4.06)], A. lumbricoides with wheeze in participants ≥5 years [aOR 6.36 (1.10, 36.63)] and with Dermatophagoides‐specific IgE [aGMR 2.34 (1.11, 4.95)]. No inverse associations were observed. Conclusions Contrary to our hypothesis, we found little evidence of an inverse relationship between helminths and allergy‐related outcomes, but strong evidence that individuals with certain helminths were more prone to atopy in this setting.
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Affiliation(s)
- E. L. Webb
- London School of Hygiene and Tropical Medicine London UK
| | - M. Nampijja
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - J. Kaweesa
- Vector Control Division Ministry of Health Kampala Uganda
| | - R. Kizindo
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - M. Namutebi
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | | | | | - P. Kabubi
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - J. Kabagenyi
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - G. Nkurunungi
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - D. Kizito
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - L. Muhangi
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - M. Akello
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - J. J. Verweij
- Laboratory for Medical Microbiology and Immunology St Elisabeth Hospital LC Tilburg the Netherlands
| | - B. Nerima
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - E. Tukahebwa
- Vector Control Division Ministry of Health Kampala Uganda
| | - A. M. Elliott
- London School of Hygiene and Tropical Medicine London UK
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
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Vaccination of Gerbils with Bm-103 and Bm-RAL-2 Concurrently or as a Fusion Protein Confers Consistent and Improved Protection against Brugia malayi Infection. PLoS Negl Trop Dis 2016; 10:e0004586. [PMID: 27045170 PMCID: PMC4821550 DOI: 10.1371/journal.pntd.0004586] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 03/08/2016] [Indexed: 12/26/2022] Open
Abstract
Background The Brugia malayi Bm-103 and Bm-RAL-2 proteins are orthologous to Onchocerca volvulus Ov-103 and Ov-RAL-2, and which were selected as the best candidates for the development of an O. volvulus vaccine. The B. malayi gerbil model was used to confirm the efficacy of these Ov vaccine candidates on adult worms and to determine whether their combination is more efficacious. Methodology and Principle Findings Vaccine efficacy of recombinant Bm-103 and Bm-RAL-2 administered individually, concurrently or as a fusion protein were tested in gerbils using alum as adjuvant. Vaccination with Bm-103 resulted in worm reductions of 39%, 34% and 22% on 42, 120 and 150 days post infection (dpi), respectively, and vaccination with Bm-RAL-2 resulted in worm reductions of 42%, 22% and 46% on 42, 120 and 150 dpi, respectively. Vaccination with a fusion protein comprised of Bm-103 and Bm-RAL-2 resulted in improved efficacy with significant reduction of worm burden of 51% and 49% at 90 dpi, as did the concurrent vaccination with Bm-103 and Bm-RAL-2, with worm reduction of 61% and 56% at 90 dpi. Vaccination with Bm-103 and Bm-RAL-2 as a fusion protein or concurrently not only induced a significant worm reduction of 61% and 42%, respectively, at 150 dpi, but also significantly reduced the fecundity of female worms as determined by embryograms. Elevated levels of antigen-specific IgG were observed in all vaccinated gerbils. Serum from gerbils vaccinated with Bm-103 and Bm-RAL-2 individually, concurrently or as a fusion protein killed third stage larvae in vitro when combined with peritoneal exudate cells. Conclusion Although vaccination with Bm-103 and Bm-RAL-2 individually conferred protection against B. malayi infection in gerbils, a more consistent and enhanced protection was induced by vaccination with Bm-103 and Bm-RAL-2 fusion protein and when they were used concurrently. Further characterization and optimization of these filarial vaccines are warranted. Onchocerciasis and Lymphatic filariasis (LF) are debilitating neglected tropical diseases (NTDs). Practical challenges in implementation of mass drug administration (MDA) such as prolonged treatment regime requirements and the possible emergence of drug resistance will likely impede the elimination of these NTDs. Hence, the availability of an efficacious prophylactic vaccine would be an invaluable tool. The objective of the present studies was to use the B. malayi-gerbil model of filariasis as a surrogate system to test the efficacy of filarial molecules as vaccine targets for an onchocerciasis vaccine. The vaccine efficacy of Onchocerca volvulus recombinant proteins Ov-RAL-2 and Ov-103 was recently demonstrated using a mouse diffusion chamber model. In this communication, we provide encouraging results on the vaccine efficacy of Bm-RAL-2 and Bm-103, individually or in combination. Our data demonstrate that vaccination with Bm-RAL-2 and Bm-103 concurrently and as a fusion protein confers not only a consistent and significant protection against B. malayi infection in gerbils, but also reduces the fecundity of female worms as demonstrated in embryogram analyses. Our results support the contention that Ov-RAL-2 and Ov-103 are excellent onchocerciasis vaccine candidates and that further investigations leading to their development as a vaccine are warranted.
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Siwila J, Mwase ET, Nejsum P, Simonsen PE. Filarial infections in domestic dogs in Lusaka, Zambia. Vet Parasitol 2015; 210:250-4. [PMID: 25944406 DOI: 10.1016/j.vetpar.2015.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 04/14/2015] [Accepted: 04/16/2015] [Indexed: 10/23/2022]
Abstract
Filariae are common parasites of dogs in many parts of the world, but little is known about the status of these infections in sub-Saharan Africa. A study was carried out to determine the occurrence and species of filariae among 272 dogs in Lusaka, Zambia. Giemsa stained blood smear and Knott's concentration methods revealed microfilariae in 16 (5.9%) of the dogs. PCR confirmed that most of these dogs had Acanthocheilonema reconditum infection. Ten (4.0%) of the examined dogs were positive for Dirofilaria immitis circulating antigen (by DiroCHEK(®) test), but D. immitis microfilariae were not identified in any of the dogs and the status of this infection remains unclear. Further studies are needed to explore the occurrence of filariae in Zambian dogs and the zoonotic potential for humans.
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Affiliation(s)
- Joyce Siwila
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, P.O. Box 32379, Lusaka, Zambia
| | - Enala T Mwase
- Department of Paraclinical Studies, School of Veterinary Studies, University of Zambia, P.O. Box 32379, Lusaka, Zambia
| | - Peter Nejsum
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlaegevej 100, 1870 Frederiksberg C, Denmark
| | - Paul E Simonsen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlaegevej 100, 1870 Frederiksberg C, Denmark.
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Nampijja M, Webb EL, Kaweesa J, Kizindo R, Namutebi M, Nakazibwe E, Oduru G, Kabuubi P, Kabagenyi J, Kizito D, Muhangi L, Akello M, Verweij JJ, Nerima B, Tukahebwa E, Elliott AM. The Lake Victoria Island Intervention Study on Worms and Allergy-related diseases (LaVIISWA): study protocol for a randomised controlled trial. Trials 2015; 16:187. [PMID: 25902705 PMCID: PMC4413531 DOI: 10.1186/s13063-015-0702-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 04/01/2015] [Indexed: 01/15/2023] Open
Abstract
Background The Hygiene Hypothesis proposes that infection exposure protects against inflammatory conditions. Helminths possess allergen-like molecules and may specifically modulate allergy-related immunological pathways to inhibit responses which protect against them. Mass drug administration is recommended for helminth-endemic communities to control helminth-induced pathology, but may also result in increased rates of inflammation-mediated diseases in resource-poor settings. Immunological studies integrated with implementation of helminth control measures may elucidate how helminth elimination contributes to ongoing epidemics of inflammatory diseases. We present the design of the Lake Victoria Island Intervention Study on Worms and Allergy-related diseases (LaVIISWA), a cluster-randomised trial evaluating the risks and benefits of intensive versus standard anthelminthic treatment for allergy-related diseases and other health outcomes. Methods/Design The setting is comprised of island fishing communities in Mukono district, Uganda. Twenty-six communities have been randomised in a 1:1 ratio to receive standard or intensive anthelminthic intervention for a three-year period. Baseline characteristics were collected immediately prior to intervention rollout, commenced in February 2013. Primary outcomes are reported wheeze in the past 12 months and atopy (skin prick test response and allergen-specific immunoglobulin (asIg) E concentration). Secondary outcomes are visible flexural dermatitis, helminth infections, haemoglobin, growth parameters, hepatosplenomegaly, and responses to vaccine antigens. The trial provides a platform for in-depth analysis of clinical and immunological consequences of the contrasting interventions. Discussion The baseline survey has been completed successfully in a challenging environment. Baseline characteristics were balanced between trial arms. Prevalence of Schistosoma mansoni, hookworm, Strongyloides stercoralis and Trichuris trichiura was 52%, 23%, 13%, and 12%, respectively; 31% of Schistosoma mansoni infections were heavy (>400 eggs/gram). The prevalence of reported wheeze and positive skin prick test to any allergen was 5% and 20%, respectively. Respectively, 77% and 87% of participants had Dermatophagoides- and German cockroach-specific IgE above 0.35 kUA/L. These characteristics suggest that the LaVIISWA study will provide an excellent framework for investigating beneficial and detrimental effects of worms and their treatment, and the mechanisms of such effects. Trial registration This trial was registered with Current Controlled Trials (identifier: ISRCTN47196031) on 7 September 2012. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0702-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Emily L Webb
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - James Kaweesa
- Vector Control Division, Ministry of Health, PO Box 1661, Kampala, Uganda.
| | - Robert Kizindo
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda.
| | - Milly Namutebi
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda.
| | | | - Gloria Oduru
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda.
| | - Prossy Kabuubi
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda.
| | - Joyce Kabagenyi
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda.
| | - Dennison Kizito
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda.
| | - Lawrence Muhangi
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda.
| | - Mirriam Akello
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda.
| | - Jaco J Verweij
- Laboratory for Medical Microbiology and Immunology, St Elisabeth Hospital, Postbus 90151, 5000 LC, Tilburg, the Netherlands.
| | - Barbara Nerima
- Uganda Virus Research Institute, PO Box 49, Entebbe, Uganda.
| | - Edridah Tukahebwa
- Vector Control Division, Ministry of Health, PO Box 1661, Kampala, Uganda.
| | - Alison M Elliott
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda. .,London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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13
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Lule SA, Mawa PA, Nkurunungi G, Nampijja M, Kizito D, Akello F, Muhangi L, Elliott AM, Webb EL. Factors associated with tuberculosis infection, and with anti-mycobacterial immune responses, among five year olds BCG-immunised at birth in Entebbe, Uganda. Vaccine 2014; 33:796-804. [PMID: 25529292 PMCID: PMC4317190 DOI: 10.1016/j.vaccine.2014.12.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/17/2014] [Accepted: 12/08/2014] [Indexed: 11/24/2022]
Abstract
Urban residence and history of TB contact/disease were associated with increased risk of latent TB infection at age five years. BCG vaccine strain, LTBI, HIV and malaria infections, and anthropometry predict anti-mycobacterial immune responses. Helminth infections do not influence response to BCG vaccination. Cytokine responses at one year were not associated with LTBI at age five years.
Background BCG is used widely as the sole licensed vaccine against tuberculosis, but it has variable efficacy and the reasons for this are still unclear. No reliable biomarkers to predict future protection against, or acquisition of, TB infection following immunisation have been identified. Lessons from BCG could be valuable in the development of effective tuberculosis vaccines. Objectives Within the Entebbe Mother and Baby Study birth cohort in Uganda, infants received BCG at birth. We investigated factors associated with latent tuberculosis infection (LTBI) and with cytokine response to mycobacterial antigen at age five years. We also investigated whether cytokine responses at one year were associated with LTBI at five years of age. Methods Blood samples from age one and five years were stimulated using crude culture filtrates of Mycobacterium tuberculosis in a six-day whole blood assay. IFN-γ, IL-5, IL-13 and IL-10 production was measured. LTBI at five years was determined using T-SPOT.TB® assay. Associations with LTBI at five years were assessed using multivariable logistic regression. Multiple linear regression with bootstrapping was used to determine factors associated with cytokine responses at age five years. Results LTBI prevalence was 9% at age five years. Only urban residence and history of TB contact/disease were positively associated with LTBI. BCG vaccine strain, LTBI, HIV infection, asymptomatic malaria, growth z-scores, childhood anthelminthic treatment and maternal BCG scar were associated with cytokine responses at age five. Cytokine responses at one year were not associated with acquisition of LTBI by five years of age. Conclusion Although multiple factors influenced anti-myocbacterial immune responses at age five, factors likely to be associated with exposure to infectious cases (history of household contact, and urban residence) dominated the risk of LTBI.
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Affiliation(s)
| | - Patrice A Mawa
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda
| | | | | | - Dennison Kizito
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda
| | | | - Lawrence Muhangi
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda
| | - Alison M Elliott
- MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda; London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Emily L Webb
- London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Biraro IA, Egesa M, Toulza F, Levin J, Cose S, Joloba M, Smith S, Dockrell HM, Katamba A, Elliott AM. Impact of co-infections and BCG immunisation on immune responses among household contacts of tuberculosis patients in a Ugandan cohort. PLoS One 2014; 9:e111517. [PMID: 25372043 PMCID: PMC4221037 DOI: 10.1371/journal.pone.0111517] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 09/30/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Tuberculosis incidence in resource poor countries remains high. We hypothesized that immune modulating co-infections such as helminths, malaria, and HIV increase susceptibility to latent tuberculosis infection (LTBI), thereby contributing to maintaining the tuberculosis epidemic. METHODS Adults with sputum-positive tuberculosis (index cases) and their eligible household contacts (HHCs) were recruited to a cohort study between May 2011 and January 2012. HHCs were investigated for helminths, malaria, and HIV at enrolment. HHCs were tested using the QuantiFERON-TB Gold In-Tube (QFN) assay at enrolment and six months later. Overnight whole blood culture supernatants from baseline QFN assays were analyzed for cytokine responses using an 11-plex Luminex assay. Associations between outcomes (LTBI or cytokine responses) and exposures (co-infections and other risk factors) were examined using multivariable logistic and linear regression models. RESULTS We enrolled 101 index cases and 291 HHCs. Among HHCs, baseline prevalence of helminths was 9% (25/291), malaria 16% (47/291), HIV 6% (16/291), and LTBI 65% (179/277). Adjusting for other risk factors and household clustering, there was no association between LTBI and any co-infection at baseline or at six months: adjusted odds ratio (95% confidence interval (CI); p-value) at baseline for any helminth, 1.01 (0.39-2.66; 0.96); hookworm, 2.81 (0.56-14.14; 0.20); malaria, 1.06 (0.48-2.35; 0.87); HIV, 0.74 (0.22-2.47; 0.63). HHCs with LTBI had elevated cytokine responses to tuberculosis antigens but co-infections had little effect on cytokine responses. Exploring other risk factors, Th1 cytokines among LTBI-positive HHCs with BCG scars were greatly reduced compared to those without scars: (adjusted geometric mean ratio) IFNγ 0.20 (0.09-0.42), <0.0001; IL-2 0.34 (0.20-0.59), <0.0001; and TNFα 0.36 (0.16-0.79), 0.01. CONCLUSIONS We found no evidence that co-infections increase the risk of LTBI, or influence the cytokine response profile among those with LTBI. Prior BCG exposure may reduce Th1 cytokine responses in LTBI.
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Affiliation(s)
- Irene A. Biraro
- College of Health Sciences, Makerere University, Kampala, Uganda
- * E-mail:
| | - Moses Egesa
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Frederic Toulza
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jonathan Levin
- Medical Research Council/Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Stephen Cose
- Medical Research Council/Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Moses Joloba
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Steven Smith
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hazel M. Dockrell
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Achilles Katamba
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Alison M. Elliott
- Medical Research Council/Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Oliveira P, Braga C, Alexander N, Brandão E, Silva A, Wanderley L, Aguiar AM, Diniz G, Medeiros Z, Rocha A. Evaluation of diagnostic tests for Wuchereria bancrofti infection in Brazilian schoolchildren. Rev Soc Bras Med Trop 2014; 47:359-66. [PMID: 25075488 DOI: 10.1590/0037-8682-0093-2014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/30/2014] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Since the launch of the Global Programme to Eliminate Lymphatic Filariasis, more than 70% of the endemic countries have implemented mass drug administration (MDA) to interrupt disease transmission. The monitoring of filarial infection in sentinel populations, particularly schoolchildren, is recommended to assess the impact of MDA. A key issue is choosing the appropriate tools for these initial assessments (to define the best intervention) and for monitoring transmission. METHODS This study compared the pre-MDA performance of five diagnostic methods, namely, thick film test, Knott's technique, filtration, Og4C3-ELISA, and the AD12-ICT card test, in schoolchildren from Brazil. Venous and capillary blood samples were collected between 11 pm and 1 am. The microfilarial loads were analyzed with a negative binomial regression, and the prevalence and associated 95% confidence intervals were estimated for all methods. The accuracies of the AD12-ICT card and Og4C3-ELISA tests were assessed against the combination of parasitological test results. RESULTS A total of 805 schoolchildren were examined. The overall and stratified prevalence by age group and gender detected by Og4C3-ELISA and AD12-ICT were markedly higher than the prevalence estimated by the parasitological methods. The sensitivity of the AD12-ICT card and Og4C3-ELISA tests was approximately 100%, and the positive likelihood ratios were above 6. The specificity of the Og4C3-ELISA was higher than that of the AD12-ICT at different prevalence levels. CONCLUSIONS The ICT card test should be the recommended tool for monitoring school-age populations living in areas with ongoing or completed MDA.
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Affiliation(s)
- Paula Oliveira
- Serviço de Referência Nacional em Filarioses, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - Cynthia Braga
- Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - Neal Alexander
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Eduardo Brandão
- Serviço de Referência Nacional em Filarioses, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - Almerice Silva
- Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - Leandro Wanderley
- Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - Ana Maria Aguiar
- Serviço de Referência Nacional em Filarioses, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - George Diniz
- Departamento de Saúde Coletiva, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - Zulma Medeiros
- Serviço de Referência Nacional em Filarioses, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - Abraham Rocha
- Serviço de Referência Nacional em Filarioses, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
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Mpairwe H, Ndibazza J, Webb EL, Nampijja M, Muhangi L, Apule B, Lule S, Akurut H, Kizito D, Kakande M, Jones FM, Fitzsimmons CM, Muwanga M, Rodrigues LC, Dunne DW, Elliott AM. Maternal hookworm modifies risk factors for childhood eczema: results from a birth cohort in Uganda. Pediatr Allergy Immunol 2014; 25:481-8. [PMID: 25171741 PMCID: PMC4312885 DOI: 10.1111/pai.12251] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Worms may protect against allergy. Early-life worm exposure may be critical, but this has not been fully investigated. OBJECTIVES To investigate whether worms in pregnancy and in early childhood are associated with childhood eczema incidence. METHODS The Entebbe Mother and Baby Study, an anthelminthic treatment trial, enrolled pregnant women between 2003 and 2005 in Uganda. Mothers were investigated for worms during pregnancy and children annually. Eczema was doctor-diagnosed from birth to age five years. A planned observational analysis was conducted within the trial cohort to investigate associations between worms and eczema. RESULTS Data for 2345 live-born children were analysed. Hookworm was the most prevalent maternal worm (45%). Childhood worms were less prevalent. Eczema incidence was 4.68/100 person-years. Maternal hookworm was associated with reduced eczema incidence [adjusted hazard ratio (95% confidence interval), p-value: 0.71(0.51-0.99), 0.04] and modified effects of known risk factors for eczema: Dermatophagoides-specific IgE in children was positively associated with eczema incidence if the mother had no hookworm [2.72(1.11-6.63), 0.03], but not if the mother had hookworm [0.41(0.10-1.69), 0.22], interaction p-value = 0.03. Similar interactions were seen for maternal history of eczema {[2.87(1.31-6.27, 0.008) vs. [0.73(0.23-2.30), 0.60], interaction p-value = 0.05}, female gender {[1.82(1.22-2.73), 0.004 vs. [0.96(0.60-1.53), 0.87], interaction p-value = 0.04} and allergen-specific IgE. Childhood Trichuris trichiura and hookworm were inversely associated with eczema. CONCLUSIONS Maternal hookworm modifies effects of known risk factors for eczema. Mechanisms by which early-life worm exposures influence allergy need investigation. Worms or worm products, and intervention during pregnancy have potential for primary prevention of allergy.
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Kizito D, Tweyongyere R, Namatovu A, Webb EL, Muhangi L, Lule SA, Bukenya H, Cose S, Elliott AM. Factors affecting the infant antibody response to measles immunisation in Entebbe-Uganda. BMC Public Health 2013; 13:619. [PMID: 23816281 PMCID: PMC3733798 DOI: 10.1186/1471-2458-13-619] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 06/25/2013] [Indexed: 11/24/2022] Open
Abstract
Background Vaccine failure is an important concern in the tropics with many contributing elements. Among them, it has been suggested that exposure to natural infections might contribute to vaccine failure and recurrent disease outbreaks. We tested this hypothesis by examining the influence of co-infections on maternal and infant measles-specific IgG levels. Methods We conducted an observational analysis using samples and data that had been collected during a larger randomised controlled trial, the Entebbe Mother and Baby Study (ISRCTN32849447). For the present study, 711 pregnant women and their offspring were considered. Helminth infections including hookworm, Schistosoma mansoni and Mansonella perstans, along with HIV, malaria, and other potential confounding factors were determined in mothers during pregnancy and in their infants at age one year. Infants received their measles immunisation at age nine months. Levels of total IgG against measles were measured in mothers during pregnancy and at delivery, as well as in cord blood and from infants at age one year. Results Among the 711 pregnant women studied, 66% had at least one helminth infection at enrolment, 41% had hookworm, 20% M. perstans and 19% S. mansoni. Asymptomatic malaria and HIV prevalence was 8% and 10% respectively. At enrolment, 96% of the women had measles-specific IgG levels considered protective (median 4274 mIU/ml (IQR 1784, 7767)). IgG levels in cord blood were positively correlated to maternal measles-specific IgG levels at delivery (r = 0.81, p < 0.0001). Among the infants at one year of age, median measles-specific IgG levels were markedly lower than in maternal and cord blood (median 370 mIU/ml (IQR 198, 656) p < 0.0001). In addition, only 75% of the infants had measles-specific IgG levels considered to be protective. In a multivariate regression analysis, factors associated with reduced measles-specific antibody levels in infancy were maternal malaria infection, infant malaria parasitaemia, infant HIV and infant wasting. There was no association with maternal helminth infection. Conclusion Malaria and HIV infection in mothers during pregnancy, and in their infants, along with infant malnutrition, may result in reduction of the antibody response to measles immunisation in infancy. This re-emphasises the importance of malaria and HIV control, and support for infant nutrition, as these interventions may have benefits for vaccine efficacy in tropical settings.
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Affiliation(s)
- Dennison Kizito
- Co-infection Studies Programme, MRC/UVRI Uganda Research Unit on AIDS, Uganda Virus Research Institute, PO BOX 49, Entebbe, Uganda.
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Wakeham K, Webb EL, Sebina I, Nalwoga A, Muhangi L, Miley W, Johnston WT, Ndibazza J, Whitby D, Newton R, Elliott AM. Risk factors for seropositivity to Kaposi sarcoma-associated herpesvirus among children in Uganda. J Acquir Immune Defic Syndr 2013; 63:228-33. [PMID: 23403859 PMCID: PMC3707567 DOI: 10.1097/qai.0b013e31828a7056] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 01/18/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Determinants of Kaposi sarcoma-associated herpesvirus (KSHV) seropositivity among children living in sub-Saharan African populations where infection is endemic are not well understood. Local environmental factors, including other infectious agents, may be key. METHODS Within the context of a well-characterized birth cohort, we examined associations between various factors and antibodies against KSHV, measured in stored plasma samples from 1823 mother-child pairs in Entebbe, Uganda. RESULTS Seroprevalence increased with increasing age of the child (P = 0.0003) and was higher among those with KSHV seropositive mothers than in those without (12% vs 9%; odds ratio: 1.4, 95% confidence interval: 1.1 to 2.0). It was also higher among children with HIV infection (29% vs 10%; odds ratio: 3.1, 95% confidence interval: 1.2 to 8.3) or malaria parasitemia (30% vs 10%; odds ratio: 4.1, 95% confidence interval: 2.4 to 7.0) than in children without. These associations were not explained by socioeconomic status. CONCLUSIONS The finding that KSHV serostatus is associated with malaria parasitemia in children is novel. In a country endemic for KSHV, malaria may be a cofactor for KSHV infection or reactivation among children.
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Affiliation(s)
- Katie Wakeham
- Medical Research Council, Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda.
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Graves PM, Makita L, Susapu M, Brady MA, Melrose W, Capuano C, Zhang Z, Dapeng L, Ozaki M, Reeve D, Ichimori K, Kazadi WM, Michna F, Bockarie MJ, Kelly-Hope LA. Lymphatic filariasis in Papua New Guinea: distribution at district level and impact of mass drug administration, 1980 to 2011. Parasit Vectors 2013; 6:7. [PMID: 23311302 PMCID: PMC3606332 DOI: 10.1186/1756-3305-6-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 12/23/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) caused by Wuchereria bancrofti is present at high prevalence in some parts of Papua New Guinea. However, there has been no rigorous data-based representative assessment of nationwide prevalence of LF. The LF programme has been daunted by the scope of the problem, and progress on mass drug administration (MDA) has been slow and lacking in resources. METHODS A systematic literature review identified LF surveys in Papua New Guinea between 1980 and 2011. Results were extracted by location, time period and test used (blood slide, immunochromatographic test (ICT) or Og4C3 ELISA) and combined by district. Three criteria schemes based on the Global Programme to Eliminate Lymphatic Filariasis guidelines, with modifications, were developed to classify and prioritize districts by prevalence level. Results of repeated surveys in the same sites were used to investigate the impact of MDA on LF prevalence over the time period. RESULTS There were 312 distinct survey sites identified in 80 of the 89 districts over the 31-year period. The overall LF prevalence in the sites tested was estimated at 18.5 to 27.5% by blood slide for microfilariae (Mf), 10.1% to 12.9% by ICT and 45.4% to 48.8% by Og4C3. Biases in site selection towards areas with LF, and change in type of assay used, affected the prevalence estimates, but overall decline in prevalence over the time period was observed. Depending on the criteria used, 34 to 36 districts (population 2.7 to 2.9 million) were classed as high endemic (≥5% prevalence), 15 to 25 districts (1.7 to 1.9 million) as low endemic (<5%) and 20 to 31 (1.3 to 2.2 million) as non-endemic. Nine districts (0.7 million) had no information. The strong impact of MDA, especially on microfilaria (Mf) prevalence, was noted in sites with repeat surveys. CONCLUSIONS This analytical review of past surveys of LF in Papua New Guinea enables better estimation of the national burden, identifies gaps in knowledge, quantifies and locates the population at risk, and can be used to predict the likely impact of MDA and/or vector control. Better targeting of districts by level of prevalence will strengthen the control programme, facilitate monitoring of the disease trend and increase the likelihood of reaching the target of LF elimination by 2020.
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Affiliation(s)
- Patricia M Graves
- Department of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Cairns and Townsville, Queensland, Australia
- James Cook University, PO Box 6811, Cairns, Queensland, 4870, Australia
| | - Leo Makita
- Department of Health, Port Moresby, Papua New Guinea
| | - Melinda Susapu
- Department of Health, Port Moresby, Papua New Guinea
- WHO, Port Moresby, Papua New Guinea
| | - Molly A Brady
- Current address: WHO, Regional Office for the Western Pacific, Manila, Philippines
| | - Wayne Melrose
- Department of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Cairns and Townsville, Queensland, Australia
| | - Corinne Capuano
- Current address: WHO, Regional Office for the Western Pacific, Manila, Philippines
| | | | | | - Masayo Ozaki
- WHO, Pacific Programme to Eliminate Lymphatic Filariasis (PacELF), Suva, Republic of Fiji
- Current address: University of Alabama School of Medicine, Birmingham, Alabama, USA
| | - David Reeve
- Department of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Cairns and Townsville, Queensland, Australia
| | | | | | - Frederick Michna
- Department of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Cairns and Townsville, Queensland, Australia
| | - Moses J Bockarie
- Liverpool School of Tropical Medicine (LSTM), Centre for Neglected Tropical Diseases, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Louise A Kelly-Hope
- Liverpool School of Tropical Medicine (LSTM), Centre for Neglected Tropical Diseases, Liverpool, United Kingdom of Great Britain and Northern Ireland
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Impact of anthelminthic treatment in pregnancy and childhood on immunisations, infections and eczema in childhood: a randomised controlled trial. PLoS One 2012; 7:e50325. [PMID: 23236367 PMCID: PMC3517620 DOI: 10.1371/journal.pone.0050325] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 10/17/2012] [Indexed: 12/14/2022] Open
Abstract
Background Helminth infections may modulate immune responses to unrelated pathogens and allergens; these effects may commence prenatally. We addressed the hypothesis that anthelminthic treatment in pregnancy and early childhood would improve responses to immunisation and modulate disease incidence in early childhood with both beneficial and detrimental effects. Methods and Findings A randomised, double-blind, placebo-controlled trial was conducted in Entebbe, Uganda [ISRCTN32849447]. In three independent randomisations, 2507 pregnant women were allocated to receive single-dose albendazole or placebo, and praziquantel or placebo; 2016 of their offspring were randomised to receive quarterly single-dose albendazole or placebo from age 15 months to 5 years. Primary outcomes were post-immunisation recall responses to BCG and tetanus antigens, and incidence of malaria, diarrhoea, and pneumonia; incidence of eczema was an important secondary outcome. Analysis was by intention-to-treat. Of 2345 live births, 1622 (69%) children remained in follow-up at age 5 years. 68% of mothers at enrolment, and 11% of five-year-olds, had helminth infections. Maternal hookworm and Schistosoma mansoni were effectively treated by albendazole and praziquantel, respectively; and childhood hookworm and Ascaris by quarterly albendazole. Incidence rates of malaria, diarrhoea, pneumonia, and eczema were 34, 65, 10 and 5 per 100 py, respectively. Albendazole during pregnancy caused an increased rate of eczema in the children (HR 1.58 (95% CI 1.15–2.17), p = 0.005). Quarterly albendazole during childhood was associated with reduced incidence of clinical malaria (HR 0.85 (95% CI 0.73–0.98), p = 0.03). There were no consistent effects of the interventions on any other outcome. Conclusions Routine use of albendazole in pregnancy may not always be beneficial, even in tropical developing countries. By contrast, regular albendazole treatment in preschool children may have an additional benefit for malaria control where helminths and malaria are co-endemic. Given the low helminth prevalence in our children, the effect of albendazole on malaria is likely to be direct. Trial registration Current Controlled Trials ISRCTN32849447
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Effects of maternal worm infections and anthelminthic treatment during pregnancy on infant motor and neurocognitive functioning. J Int Neuropsychol Soc 2012; 18:1019-30. [PMID: 23158229 PMCID: PMC3948080 DOI: 10.1017/s1355617712000768] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We tested the hypothesis that maternal worm infections in pregnancy affect infant motor and neurocognitive development, and that anthelminthic treatment during pregnancy can reverse these effects. We used measures which examine infant motor, cognitive and executive function, including inhibition. We assessed 983 Ugandan infants aged 15 months, using locally appropriate measures within the Entebbe Mother and Baby Study, a trial of anthelminthic treatment during pregnancy. Key exposures were maternal worm infections and anthelminthic treatment during pregnancy. Effects of other health and social factors were controlled for statistically. Of the five major worm species found in the pregnant women, two had influences on the developmental measures: Maternal Mansonella perstans and Strongyloides stercoralis infections showed negative associations with the A-not B-task, and Language, respectively. Performance on other psychomotor and cognitive measures was associated with illnesses during infancy and infants' behavior during assessment, but not with maternal worm infections. There were no positive effects of maternal anthelminthic treatment on infant abilities. Mansonella perstans and Strongyloides stercoralis infection during pregnancy seem associated with impaired early executive function and language, respectively, but single-dose anthelminthic treatment during pregnancy was not beneficial. The biological mechanisms that could underlie these neurocognitive effects are discussed.
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Webb EL, Kyosiimire-Lugemwa J, Kizito D, Nkurunziza P, Lule S, Muhangi L, Muwanga M, Kaleebu P, Elliott AM. The effect of anthelmintic treatment during pregnancy on HIV plasma viral load: results from a randomized, double-blind, placebo-controlled trial in Uganda. J Acquir Immune Defic Syndr 2012; 60:307-13. [PMID: 22728750 PMCID: PMC3383620 DOI: 10.1097/qai.0b013e3182511e42] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To investigate the effect of helminth infections and their treatment during pregnancy on HIV load, we conducted a 2 × 2 factorial randomized controlled trial of albendazole versus placebo and praziquantel versus placebo in pregnant women in Entebbe, Uganda. METHODS Two hundred sixty-four HIV-infected pregnant women from the Entebbe Mother and Baby Study (ISRCTN 32849447) were included in this analysis. Women were tested for helminth infections at enrollment, and mean HIV load was compared between infected and uninfected groups. The effect of anthelmintic treatment on HIV load was evaluated at 6 weeks after treatment and at delivery using linear regression and adjusting for enrollment viral load. RESULTS Hookworm and Trichuris infections were associated with higher mean viral load at enrollment [adjusted mean difference 0.24 log10 copies/mL, 95% confidence interval (CI): 0.01 to 0.47, P = 0.03, and 0.37 log(10) copies/mL, 95% CI: 0.00 to 0.74, P = 0.05, respectively]. There were no associations between viral load and other helminth species. There was some evidence that albendazole reduced viral load at 6 weeks after treatment (adjusted mean difference -0.17, 95% CI: -0.36 to 0.01, P = 0.07); however, this effect did not differ according to mother's hookworm infection status and had diminished at delivery (adjusted mean difference -0.11, 95% CI: -0.28 to 0.07, P = 0.23). There was no effect of praziquantel treatment on HIV load at any time point. CONCLUSIONS Infection with some soil-transmitted helminth species is associated with increased HIV load in pregnancy. Treatment with albendazole causes a small decrease in HIV load; however, this may not represent a direct effect of worm removal.
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Affiliation(s)
- Emily L Webb
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Webb EL, Mawa PA, Ndibazza J, Kizito D, Namatovu A, Kyosiimire-Lugemwa J, Nanteza B, Nampijja M, Muhangi L, Woodburn PW, Akurut H, Mpairwe H, Akello M, Lyadda N, Bukusuba J, Kihembo M, Kizza M, Kizindo R, Nabulime J, Ameke C, Namujju PB, Tweyongyere R, Muwanga M, Whitworth JAG, Elliott AM. Effect of single-dose anthelmintic treatment during pregnancy on an infant's response to immunisation and on susceptibility to infectious diseases in infancy: a randomised, double-blind, placebo-controlled trial. Lancet 2011; 377:52-62. [PMID: 21176950 PMCID: PMC3018567 DOI: 10.1016/s0140-6736(10)61457-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Helminth infections affect the human immune response. We investigated whether prenatal exposure to and treatment of maternal helminth infections affects development of an infant's immune response to immunisations and unrelated infections. METHODS In this randomised, double-blind, placebo-controlled trial, we enrolled 2507 women in the second or third trimester of pregnancy who were planning to deliver in Entebbe General Hospital, Entebbe, Uganda. With a computer-generated random number sequence in blocks of 100, we assigned patients to 440 mg albendazole and 40 mg/kg praziquantel (n=628), 440 mg albendazole and a praziquantel-matching placebo (n=625), 40 mg/kg praziquantel and an albendazole-matching placebo (n=626), or an albendazole-matching placebo and praziquantel-matching placebo (n=628). All participants and hospital staff were masked to allocation. Primary outcomes were immune response at age 1 year to BCG, tetanus, and measles immunisation; incidence of infectious diseases during infancy; and vertical HIV transmission. Analysis was by intention-to-treat. This trial is registered, number ISRCTN32849447. FINDINGS Data were available at delivery for 2356 women, with 2345 livebirths; 2115 (90%) of liveborn infants remained in follow-up at 1 year of age. Neither albendazole nor praziquantel treatments affected infant response to BCG, tetanus, or measles immunisation. However, in infants of mothers with hookworm infection, albendazole treatment reduced interleukin-5 (geometric mean ratio 0·50, 95% CI 0·30-0·81, interaction p=0·02) and interleukin-13 (0·52, 0·34-0·82, 0·0005) response to tetanus toxoid. The rate per 100 person-years of malaria was 40·9 (95% CI 38·3-43·7), of diarrhoea was 134·1 (129·2-139·2), and of pneumonia was 22·3 (20·4-24·4). We noted no effect on infectious disease incidence for albendazole treatment (malaria [hazard ratio 0·95, 95% CI 0·79-1.14], diarrhoea [1·06, 0·96-1·16], pneumonia [1·11, 0·90-1·38]) or praziquantel treatment (malaria [1·00, 0·84-1·20], diarrhoea [1·07, 0·98-1·18], pneumonia [1·00, 0·80-1·24]). In HIV-exposed infants, 39 (18%) were infected at 6 weeks; vertical transmission was not associated with albendazole (odds ratio 0·70, 95% CI 0·35-1·42) or praziquantel (0·60, 0·29-1·23) treatment. INTERPRETATION These results do not accord with the recently advocated policy of routine antenatal anthelmintic treatment, and the value of such a policy may need to be reviewed. FUNDING Wellcome Trust.
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Affiliation(s)
- Emily L Webb
- London School of Hygiene and Tropical Medicine, London, UK.
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Elliott AM, Mawa PA, Webb EL, Nampijja M, Lyadda N, Bukusuba J, Kizza M, Namujju PB, Nabulime J, Ndibazza J, Muwanga M, Whitworth JAG. Effects of maternal and infant co-infections, and of maternal immunisation, on the infant response to BCG and tetanus immunisation. Vaccine 2010; 29:247-55. [PMID: 21040693 PMCID: PMC3021124 DOI: 10.1016/j.vaccine.2010.10.047] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 10/14/2010] [Accepted: 10/18/2010] [Indexed: 01/29/2023]
Abstract
Some vaccines show poor efficacy in tropical countries. Within a birth cohort in Uganda, we investigated factors that might influence responses to BCG and tetanus immunisation. Whole blood assay responses to crude culture filtrate proteins of Mycobacterium tuberculosis (cCFP)) and tetanus toxoid (TT) were examined among 1506 and 1433 one-year-olds, respectively. Maternal Mansonella perstans infection was associated with higher interleukin (IL)-10 responses to both immunogens but no reduction in gamma interferon (IFN-γ), IL-5 and IL-13 responses; other maternal helminth infections showed little effect. Tetanus immunisation during pregnancy was associated with higher infant responses to TT; maternal BCG scar (from past immunisation) with lower infant IL-5 and IL-13 responses to cCFP. IFN-γ, IL-5 and IL-13 to TT were reduced in HIV-exposed-uninfected infants; infant malaria and HIV were associated with lower IFN-γ, IL-5 and IL-13 responses to both immunogens. We conclude that maternal helminth infections are unlikely to explain poor vaccine efficacy in the tropics. Effects of maternal immunisation on infant responses to vaccines should be explored. Prevention of infant malaria and HIV could contribute to effectiveness of immunisation programmes.
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Affiliation(s)
- Alison M Elliott
- MRC/UVRI Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda.
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Ndibazza J, Muhangi L, Akishule D, Kiggundu M, Ameke C, Oweka J, Kizindo R, Duong T, Kleinschmidt I, Muwanga M, Elliott AM. Effects of deworming during pregnancy on maternal and perinatal outcomes in Entebbe, Uganda: a randomized controlled trial. Clin Infect Dis 2010; 50:531-40. [PMID: 20067426 DOI: 10.1086/649924] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Helminth infections during pregnancy may be associated with adverse outcomes, including maternal anemia, low birth weight, and perinatal mortality. Deworming during pregnancy has therefore been strongly advocated, but its benefits have not been rigorously evaluated. METHODS In Entebbe, Uganda, 2507 pregnant women were recruited to a randomized, double-blind, placebo-controlled trial investigating albendazole and praziquantel in a 2 x 2 factorial design [ISRCTN32849447]. Hematinics and sulphadoxine-pyrimethamine for presumptive treatment of malaria were provided routinely. Maternal and perinatal outcomes were recorded. Analyses were by intention to treat. RESULTS At enrollment, 68% of women had helminths, 45% had hookworm, 18% had Schistosoma mansoni infection; 40% were anemic (hemoglobin level, <11.2 g/dL). At delivery, 35% were anaemic; there was no overall effect of albendazole (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.79-1.15) or praziquantel (OR, 1.00; 95% CI, 0.83-1.21) on maternal anemia, but there was a suggestion of benefit of albendazole among women with moderate to heavy hookworm (OR, 0.45; 95% CI, 0.21-0.98; P=.15 for interaction). There was no effect of either anthelminthic treatment on mean birth weight (difference in mean associated with albendazole: -0.00 kg; 95% CI, -0.05 to 0.04 kg; difference in mean associated with praziquantel: -0.01 kg; 95% CI, -0.05 to 0.04 kg) or on proportion of low birth weight. Anthelminthic use during pregnancy showed no effect on perinatal mortality or congenital anomalies. CONCLUSIONS In our study area, where helminth prevalence was high but infection intensity was low, there was no overall effect of anthelminthic use during pregnancy on maternal anemia, birth weight, perinatal mortality, or congenital anomalies. The possible benefit of albendazole against anemia in pregnant women with heavy hookworm infection warrants further investigation.
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Affiliation(s)
- J Ndibazza
- Medical Research Council/Uganda Virus Research Institute-Uganda Research Unit on AIDS, Entebbe, Uganda.
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Woodburn PW, Muhangi L, Hillier S, Ndibazza J, Namujju PB, Kizza M, Ameke C, Omoding NE, Booth M, Elliott AM. Risk factors for helminth, malaria, and HIV infection in pregnancy in Entebbe, Uganda. PLoS Negl Trop Dis 2009; 3:e473. [PMID: 19564904 PMCID: PMC2696595 DOI: 10.1371/journal.pntd.0000473] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 06/01/2009] [Indexed: 01/31/2023] Open
Abstract
Background Infections during pregnancy may have serious consequences for both mother and baby. Assessment of risk factors for infections informs planning of interventions and analysis of the impact of infections on health outcomes. Objectives To describe risk factors for helminths, malaria and HIV in pregnant Ugandan women before intervention in a trial of de-worming in pregnancy. Methods The trial recruited 2,507 pregnant women between April 2003 and November 2005. Participants were interviewed and blood and stool samples obtained; location of residence at enrolment was mapped. Demographic, socioeconomic, behavioral and other risk factors were modelled using logistic regression. Results There was a high prevalence of helminth, malaria and HIV infection, as previously reported. All helminths and malaria parasitemia were more common in younger women, and education was protective against every infection. Place of birth and/or tribe affected all helminths in a pattern consistent with the geographical distribution of helminth infections in Uganda. Four different geohelminths (hookworm, Trichuris, Ascaris and Trichostrongylus) showed a downwards trend in prevalence during the enrolment period. There was a negative association between hookworm and HIV, and between hookworm and low CD4 count among HIV-positive women. Locally, high prevalence of schistosomiasis and HIV occurred in lakeshore communities. Conclusions Interventions for helminths, malaria and HIV need to target young women both in and out of school. Antenatal interventions for malaria and HIV infection must continue to be promoted. Women originating from a high risk area for a helminth infection remain at high risk after migration to a lower-risk area, and vice versa, but overall, geohelminths seem to be becoming less common in this population. High risk populations, such as fishing communities, require directed effort against schistosomiasis and HIV infection. Infections in pregnancy can cause miscarriage, stillbirth, maternal mortality, and low birth weight and have other long-term complications for mother and baby, although the full impact of many infections, particularly worm infections, is not yet fully understood. There is a high burden of infectious disease in many developing countries. In this analysis, we identified which factors put pregnant women in Entebbe, Uganda, at particular risk for worm infections, malaria, HIV, and, where possible, rarer infections including syphilis. The women in this study, and their children, will be followed up to determine the long-term effects of exposure of the fetus to these maternal infections on health during childhood. The findings of this baseline analysis will help in the interpretation of the long-term outcomes. The findings also highlight which groups are most at risk of each infection, and this may help in targeting interventions to prevent, treat, or mitigate the impact of infections in pregnancy.
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Hillier SD, Booth M, Muhangi L, Nkurunziza P, Khihembo M, Kakande M, Sewankambo M, Kizindo R, Kizza M, Muwanga M, Elliott AM. Plasmodium falciparum and helminth coinfection in a semi urban population of pregnant women in Uganda. J Infect Dis 2008; 198:920-7. [PMID: 18721060 PMCID: PMC2886962 DOI: 10.1086/591183] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Helminth infections and malaria are widespread in the tropics. Recent studies suggest helminth infections may increase susceptibility to Plasmodium falciparum infection. If confirmed, this increased susceptibility could be particularly important during pregnancy-induced immunosuppression. OBJECTIVE To evaluate the geographical distribution of P. falciparum-helminth coinfection and the associations between P. falciparum infection and infection with various parasite species in pregnant women in Entebbe, Uganda. METHODS A cross-sectional study was conducted at baseline during a trial of antihelminthic drugs during pregnancy. Helminth and P. falciparum infections were quantified in 2,507 asymptomatic women. Subjects' socioeconomic and demographic characteristics and geographical details were recorded. RESULTS Hookworm and Mansonella perstans infections were associated with P. falciparum infection, but the effect of hookworm infection was seen only in the absence of M. perstans infection. The odds ratio [OR] for P. falciparum infection, adjusted for age, tribe, socioeconomic status, HIV infection status, and location was as follows: for individuals infected with hookworm but not M. perstans, 1.53 (95% confidence interval [CI], 1.09-2.14); for individuals infected with M. perstans but not hookworm, 2.33 (95% CI, 1.47-3.69); for individuals infected with both hookworm and M. perstans, 1.85 (CI, 1.24-2.76). No association was observed between infection with Schistosoma mansoni, Trichuris, or Strongyloides species and P. falciparum infection. CONCLUSIONS Hookworm-P. falciparum coinfection and M. perstans-P. falciparum coinfection among pregnant women in Entebbe is more common than would be expected by chance. Further studies are needed to elucidate the mechanism of this association. A helminth-induced increase in susceptibility to P. falciparum could have important consequences for pregnancy outcome and responses to P. falciparum infection in infancy.
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Affiliation(s)
- Stephen D Hillier
- The University of Birmingham Medical School, Birmingham, United Kingdom.
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Muhangi L, Woodburn P, Omara M, Omoding N, Kizito D, Mpairwe H, Nabulime J, Ameke C, Morison LA, Elliott AM. Associations between mild-to-moderate anaemia in pregnancy and helminth, malaria and HIV infection in Entebbe, Uganda. Trans R Soc Trop Med Hyg 2007; 101:899-907. [PMID: 17555783 PMCID: PMC1950430 DOI: 10.1016/j.trstmh.2007.03.017] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 03/23/2007] [Accepted: 03/23/2007] [Indexed: 11/25/2022] Open
Abstract
It is suggested that helminths, particularly hookworm and schistosomiasis, may be important causes of anaemia in pregnancy. We assessed the associations between mild-to-moderate anaemia (haemoglobin >8.0 g/dl and <11.2 g/dl) and helminths, malaria and HIV among 2507 otherwise healthy pregnant women at enrolment to a trial of deworming in pregnancy in Entebbe, Uganda. The prevalence of anaemia was 39.7%. The prevalence of hookworm was 44.5%, Mansonella perstans 21.3%, Schistosoma mansoni 18.3%, Strongyloides 12.3%, Trichuris 9.1%, Ascaris 2.3%, asymptomatic Plasmodium falciparum parasitaemia 10.9% and HIV 11.9%. Anaemia showed little association with the presence of any helminth, but showed a strong association with malaria (adjusted odds ratio (AOR) 3.22, 95% CI 2.43–4.26) and HIV (AOR 2.46, 95% CI 1.90–3.19). There was a weak association between anaemia and increasing hookworm infection intensity. Thus, although highly prevalent, helminths showed little association with mild-to-moderate anaemia in this population, but HIV and malaria both showed a strong association. This result may relate to relatively good nutrition and low helminth infection intensity. These findings are pertinent to estimating the disease burden of helminths and other infections in pregnancy. [Clinical Trial No. ISRCTN32849447]
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Affiliation(s)
- Lawrence Muhangi
- MRC/UVRI Uganda Research Unit on AIDS, Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda.
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Elliott AM, Kizza M, Quigley MA, Ndibazza J, Nampijja M, Muhangi L, Morison L, Namujju PB, Muwanga M, Kabatereine N, Whitworth JAG. The impact of helminths on the response to immunization and on the incidence of infection and disease in childhood in Uganda: design of a randomized, double-blind, placebo-controlled, factorial trial of deworming interventions delivered in pregnancy and early childhood [ISRCTN32849447]. Clin Trials 2007; 4:42-57. [PMID: 17327245 PMCID: PMC2643383 DOI: 10.1177/1740774506075248] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Helminths have profound effects on the immune response, allowing long-term survival of parasites with minimal damage to the host. Some of these effects "spill-over", altering responses to non-helminth antigens or allergens. It is suggested that this may lead to impaired responses to immunizations and infections, while conferring benefits against inflammatory responses in allergic and autoimmune disease. These effects might develop in utero, through exposure to maternal helminth infections, or through direct exposure in later life. PURPOSE To determine the effects of helminths and their treatment in pregnancy and in young children on immunological and disease outcomes in childhood. METHODS The trial has three randomized, double-blind, placebo-controlled interventions at two times, in two people: a pregnant woman and her child. Pregnant women are randomized to albendazole or placebo and praziquantel or placebo. At age 15 months their children are randomized to three-monthly albendazole or placebo, to continue to age five years. The proposed designation for this sequence of interventions is a 2 x 2(x2) factorial design. Children are immunized with BCG and against polio, Diphtheria, tetanus, Pertussis, Haemophilus, hepatitis B and measles. Primary immunological outcomes are responses to BCG antigens and tetanus toxoid in whole blood cytokine assays and antibody assays at one, three and five years of age. Primary disease outcomes are incidence of malaria, pneumonia, diarrhoea, tuberculosis, measles, vertical HIV transmission, and atopic disease episodes, measured at clinic visits and twice-monthly home visits. Effects on anaemia, growth and intellectual development are also assessed. CONCLUSION This trial, with a novel design comprising related interventions in pregnant women and their offspring, is the first to examine effects of helminths and their treatment in pregnancy and early childhood on immunological, infectious disease and allergic disease outcomes. The results will enhance understanding of both detrimental and beneficial effects of helminth infection and inform policy.
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Nuchprayoon S, Junpee A, Nithiuthai S, Chungpivat S, Suvannadabba S, Poovorawan Y. Detection of filarial parasites in domestic cats by PCR-RFLP of ITS1. Vet Parasitol 2006; 140:366-72. [PMID: 16713099 DOI: 10.1016/j.vetpar.2006.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Revised: 01/09/2006] [Accepted: 04/03/2006] [Indexed: 10/24/2022]
Abstract
Lymphatic filariasis has been targeted by the World Health Organization (WHO) to be eliminated by the year 2020. In addition to chemotherapy and vector control, the control of reservoir hosts is necessary for the control program to succeed. Malayan filariasis, caused by Brugia malayi, is endemic in the South of Thailand where domestic cats serve as the major reservoir host. However, in nature, domestic cats also carry B. pahangi, Dirofilaria immitis and D. repens infections and it is difficult to distinguish the different filarial species from each other just by morphology. To assess the burden of filarial parasites, we performed a study on domestic cats in an endemic area of malayan filariasis in the Prasang district, of Surat Thani, a province in Southern Thailand. Together with Giemsa staining and acid phosphatase activity studies, we performed PCR-RFLP analysis on the first internal transcribed spacer (ITS1) region of ribosomal DNA (rDNA). PCR-RFLP with Ase I could clearly differentiate between B. malayi, B. pahangi, D. immitis and D. repens. Out of the 52 cats studied, filarial parasites were identified in 5 (9.5%) cats, of which 4 (7.6%) were B. pahangi and 1 (1.9%) D. immitis. This PCR-RFLP technique detected two additional cats that were not detected by microscopy. The domestic cats are not an important host of B. malayi in this region. We could develop the PCR-RFLP assay test for differentiating filarial nematodes which can be applied to survey human, animal reservoir hosts and mosquito vectors in endemic areas.
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Affiliation(s)
- Surang Nuchprayoon
- Lymphatic Filariasis Research Unit, Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
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Pérez-Arellano J, Andrade M, López-Abán J, Carranza C, Muro A. Helmintos y aparato respiratorio. Arch Bronconeumol 2006. [DOI: 10.1157/13084399] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pérez-Arellano JL, Andrade MA, López-Abán J, Carranza C, Muro A. Helminths and the Respiratory System. ACTA ACUST UNITED AC 2006; 42:81-91. [PMID: 16539938 DOI: 10.1016/s1579-2129(06)60122-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- J L Pérez-Arellano
- Unidad de Enfermedades Infecciosas y Medicina Tropical, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain.
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Elliott AM, Namujju PB, Mawa PA, Quigley MA, Nampijja M, Nkurunziza PM, Belisle JT, Muwanga M, Whitworth JAG. A randomised controlled trial of the effects of albendazole in pregnancy on maternal responses to mycobacterial antigens and infant responses to Bacille Calmette-Guérin (BCG) immunisation [ISRCTN32849447]. BMC Infect Dis 2005; 5:115. [PMID: 16371154 PMCID: PMC1352364 DOI: 10.1186/1471-2334-5-115] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2005] [Accepted: 12/21/2005] [Indexed: 11/18/2022] Open
Abstract
Background Maternal schistosomiasis and filariasis have been shown to influence infant responses to neonatal bacille Calmette-Guérin (BCG) immunisation but the effects of maternal hookworm, and of de-worming in pregnancy, are unknown. Methods In Entebbe, Uganda, we conducted a randomised, double-blind, placebo-controlled trial of a single dose of 400 mg of albendazole in the second trimester of pregnancy. Neonates received BCG. Interferon-gamma (IFN-γ) and interleukin (IL)-5 responses to a mycobacterial antigen (crude culture filtrate proteins (CFP) of Mycobacterium tuberculosis) were measured in a whole blood assay. We analysed results for binary variables using χ2 tests and logistic regression. We analysed continuous variables using Wilcoxon's tests. Results Maternal hookworm was associated with reduced maternal IFN-γ responses to CFP (adjusted odds ratio for IFN-γ > median response: 0.14 (95% confidence interval 0.02–0.83, p = 0.021). Conversely, maternal hookworm was associated with subsequent increased IFN-γ responses in their one-year-old infants (adjusted OR 17.65 (1.20–258.66; p = 0.013)). Maternal albendazole tended to reduce these effects. Conclusion Untreated hookworm infection in pregnancy was associated with reduced maternal IFN-γ responses to mycobacterial antigens, but increased responses in their infants one year after BCG immunisation. The mechanisms of these effects, and their implications for protective immunity remain, to be determined.
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Affiliation(s)
- Alison M Elliott
- Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda
- London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | | | - Patrice A Mawa
- Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Oxford University, Old Road Campus, Headington, Oxford OX3 7LF, UK
- London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | | | | | - John T Belisle
- Department of Microbiology, Colorado State University, Fort Collins, Colorado 80523, USA
| | | | - James AG Whitworth
- Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda
- London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Walther M, Muller R. Diagnosis of human filariases (except onchocerciasis). ADVANCES IN PARASITOLOGY 2003; 53:149-93. [PMID: 14587698 DOI: 10.1016/s0065-308x(03)53004-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The traditional method of diagnosing filarial infections is to examine blood or skin samples for microfilariae and for many this is still the standard procedure. However, since the present global campaign to eliminate lymphatic filariasis new diagnostic tools have emerged like PCR, antigen detection using finger-prick blood taken during the day and ultrasound to visualize adult worms. The last two can be applied in endemic countries with limited resources and enable the detection of early infections. As well as their value in control schemes, the latter is particularly important for the individual since recent research has shown that damage is usually caused long before symptoms appear. The usefulness in different situations and the advantages and disadvantages of the various new tools for diagnosis of lymphatic filariasis are discussed. For loiasis, immunodiagnostic methods have not been very successful but repetitive DNA sequences in the Loa genome have been found to be species specific. Techniques based on them are particularly useful for diagnosing cases of occult infection without microfilaraemia. There have been no advances in the diagnosis of Mansonella perstans but both immunodiagnostic and PCR tests show promise in differentiating M. streptocerca, and the latter in differentiating M.ozzardi, from Onchocerca. In addition to the human filariae, the dog parasites Dirofilaria immitis and D. repens can also occur in humans but do not produce microfilariae in them. ELISAs and PCR probes have been devised and can usefully differentiate between pulmonary dirofilariasis and lung cancer.
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Affiliation(s)
- Michael Walther
- Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Old Road, Headington, Oxford OX3 7LJ, UK
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Abstract
Lymphatic filariasis has afflicted people in the tropical areas of the world for thousands of years but even up to comparatively recent times it has been poorly understood and its importance under recognised. In the last 2 decades or so there has been a flurry of activity in filariasis research, which has provided new insights into the global problem of filariasis, the pathogenesis of filarial disease, diagnosis and control.
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Affiliation(s)
- Wayne D Melrose
- Lymphatic Filariasis Support Centre, School of Public Health and Tropical Medicine, James Cook University, Townsville, QLD 4811, Australia.
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