1
|
Al-Tawfiq JA, Spinola SM. Infections caused by Haemophilus ducreyi: one organism, two stories. Clin Microbiol Rev 2024:e0013524. [PMID: 39287406 DOI: 10.1128/cmr.00135-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
SUMMARYChancroid, a sexually transmitted infection caused by Haemophilus ducreyi, is characterized by painful genital ulcers (GU) and inguinal lymphadenitis. H. ducreyi was recently described as a major cause of non-sexually transmitted cutaneous ulcers (CU) on the lower legs in children in yaws-endemic regions. This review explores the relationship between CU and GU strains of H. ducreyi; their clinical presentation, diagnosis, epidemiology, and treatment; and how findings from a human challenge model relate to GU and CU. We contrast the decline of GU with the persistence of CU caused by H. ducreyi. Factors such as transmission dynamics, control, and elimination efforts are discussed. Syndromic management and targeted treatment of sex workers can eradicate chancroid, while skin colonization by CU strains and environmental factors may necessitate topical treatments or vaccination for CU eradication. Efforts should focus on identifying additional reservoirs of CU strains, improving hygiene, and eliminating asymptomatic colonization to eradicate this painful infection in children.
Collapse
Affiliation(s)
- Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Department of Medicine, Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stanley M Spinola
- Department of Medicine, Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indiana University, Indianapolis, Indiana, USA
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indiana University, Indianapolis, Indiana, USA
| |
Collapse
|
2
|
Medappa M, Pospíšilová P, John LN, González-Beiras C, Vall-Mayans M, Mitjà O, Šmajs D. Sequence typing of Haemophilus ducreyi isolated from patients in the Namatanai region of Papua New Guinea: Infections by Class I and Class II strain types differ in ulcer duration and resurgence of infection after azithromycin treatment. PLoS Negl Trop Dis 2024; 18:e0012398. [PMID: 39146379 PMCID: PMC11349228 DOI: 10.1371/journal.pntd.0012398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 08/27/2024] [Accepted: 07/23/2024] [Indexed: 08/17/2024] Open
Abstract
Haemophilus ducreyi (HD) is an important cause of cutaneous ulcers in several endemic regions, including the Western Pacific Region, especially among children. An HD sequence typing on swab samples taken from 1,081 ulcers in the Namatanai district of Papua New Guinea, during the pilot study for treatment of yaws, has been performed using the Grant typing system. Of the 363 samples that tested positive for the 16S rDNA of HD, the dsrA sequences of 270 samples were determined. Altogether they revealed 8 HD strain types circulating in Namatanai, including seven strain types of Class I (I.3, I.4, I.5, I.9, I.10, I.11, I.12) and one strain of Class II (II.3); four Class I types (I.9, I.10, I.11, I.12) were novel. The southern region of Namatanai (Matalai Rural) was identified as the region with the lowest genotype diversity and with most infections caused by HD Class II. The middle and northern subdistricts were affected mainly by HD Class I. Analysis of patient characteristics revealed that Class II HD infections were more often represented by longer-lasting ulcers than Class I HD infections. An increase in the prevalence of the I.10 strain was found after azithromycin administration compared to the untreated population at baseline likely reflecting higher infectivity of HD Class I, and more specifically strain type I.10.
Collapse
Affiliation(s)
- Monica Medappa
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petra Pospíšilová
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lucy N. John
- National Department of Health, Aopi Centre, Port Moresby, Papua New Guinea
| | - Camila González-Beiras
- Skin Neglected Tropical Diseases and Sexually Transmitted Infection section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
- Universitat Autónoma de Barcelona, Bellaterra (Cerdanyola del Vallés), Spain
| | - Marti Vall-Mayans
- Universitat Autónoma de Barcelona, Bellaterra (Cerdanyola del Vallés), Spain
| | - Oriol Mitjà
- Skin Neglected Tropical Diseases and Sexually Transmitted Infection section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
- Universitat Autónoma de Barcelona, Bellaterra (Cerdanyola del Vallés), Spain
| | - David Šmajs
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| |
Collapse
|
3
|
Fortney KR, Brothwell JA, Batteiger TA, Duplantier R, Katz BP, Spinola SM. A Haemophilus ducreyi strain lacking the yfeABCD iron transport system is virulent in human volunteers. Infect Immun 2024; 92:e0005824. [PMID: 38780215 PMCID: PMC11237573 DOI: 10.1128/iai.00058-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
Haemophilus ducreyi causes the genital ulcer disease chancroid and painful cutaneous ulcers in children who live in the tropics. To acquire heme from the host, H. ducreyi expresses a TonB-dependent hemoglobin receptor, HgbA, which is necessary and sufficient for H. ducreyi to progress to the pustular stage of disease in a controlled human infection model. HgbA transports hemoglobin across the outer membrane; how heme is transported across the cytoplasmic membrane is unclear. In previous studies, transcripts encoding the YfeABCD heme transporter were upregulated in experimental lesions caused by H. ducreyi in human volunteers, suggesting the latter may have a role in virulence. Here we constructed a double deletion mutant, 35000HPΔyfeABΔyfeCD, which exhibited growth defects relative to its parent 35000HP in media containing human hemoglobin as an iron source. Five human volunteers were inoculated at three sites on the skin overlying the deltoid with each strain. The results of the trial showed that papules formed at 100% (95% CI, 71.5, 100) at both 35000HP and 35000HPΔyfeABΔyfeCD-inoculated sites (P = 1.0). Pustules formed at 60% (95% CI, 25.9, 94.1) at parent-inoculated sites and 53% (95% CI, 18.3, 88.4) at mutant-inoculated sites (P = 0.79). Thus, the ABC transporter encoded by yfeAB and yfeCD was dispensable for H. ducreyi virulence in humans. In the absence of YfeABCD, H. ducreyi likely utilizes other periplasmic binding proteins and ABC-transporters such as HbpA, SapABCDF, and DppBCDF to shuttle heme from the periplasm into the cytoplasm, underscoring the importance of redundancy of such systems in gram-negative pathogens.
Collapse
Affiliation(s)
- Kate R Fortney
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Julie A Brothwell
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Teresa A Batteiger
- Department of Medicine, Indiana University School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Rory Duplantier
- Department of Medicine, Indiana University School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Barry P Katz
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Stanley M Spinola
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indiana University, Indianapolis, Indiana, USA
- Department of Medicine, Indiana University School of Medicine, Indiana University, Indianapolis, Indiana, USA
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indiana University, Indianapolis, Indiana, USA
| |
Collapse
|
4
|
Boaitey YA, Owusu-Ofori A, Anyogu A, Aghakhanian F, Arora N, Parr JB, Bosshard PP, Raheem S, Gerbault P. Prevalence of yaws and syphilis in the Ashanti region of Ghana and occurrence of H. ducreyi, herpes simplex virus 1 and herpes simplex virus 2 in skin lesions associated with treponematoses. PLoS One 2024; 19:e0295088. [PMID: 38776332 PMCID: PMC11111032 DOI: 10.1371/journal.pone.0295088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/06/2024] [Indexed: 05/24/2024] Open
Abstract
Yaws affects children in tropical regions, while syphilis primarily affects sexually active adults worldwide. Despite various campaigns towards the eradication of yaws and elimination of syphilis, these two diseases are still present in Ghana. The aetiological agents of both diseases, two Treponema pallidum subspecies, are genetically similar. This study aimed to assess the prevalence of these treponematoses and the occurrence of pathogens causing similar skin lesions in the Ashanti region of Ghana. A point-of-care test was used to determine the seroprevalence of the treponematoses. Both yaws and syphilis were identified in the Ashanti region of Ghana. Multiplex PCR was used to identify treponemes and other pathogens that cause similar skin lesions. The results indicated that the seroprevalences of T. pallidum in individuals with yaws-like and syphilis-like lesions were 17.2% and 10.8%, respectively. Multiplex PCR results showed that 9.1%, 1.8% and 0.9% of yaws-like lesions were positive for Haemophilus ducreyi, herpes simplex virus-1 (HSV-1) and T. pallidum respectively. Among syphilis-like lesions, 28.3% were positive for herpes simplex virus -2 (HSV-2) by PCR. To our knowledge, this is the first time HSV-I and HSV-2 have been reported from yaws-like and syphilis-like lesions, respectively, in Ghana. The presence of other organisms apart from T. pallidum in yaws-like and syphilis-like lesions could impede the total healing of these lesions and the full recovery of patients. This may complicate efforts to achieve yaws eradication by 2030 and the elimination of syphilis and warrants updated empirical treatment guidelines for skin ulcer diseases.
Collapse
Affiliation(s)
- Yaw Agyekum Boaitey
- School of Life Sciences, University of Westminster, London, United Kingdom
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Alex Owusu-Ofori
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Amarachukwu Anyogu
- School of Biomedical Sciences, University of West London, London, United Kingdom
| | - Farhang Aghakhanian
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Natasha Arora
- Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Jonathan B. Parr
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | - Saki Raheem
- School of Life Sciences, University of Westminster, London, United Kingdom
| | - Pascale Gerbault
- Department of Genetic and Evolution, Laboratory of Anthropology, Genetic and Population, University of Geneva, Genève, Switzerland
| |
Collapse
|
5
|
Stabile HD, McCandless K, Donlan RA, Gaston JR, Humphreys TL. Transmission of viable Haemophilus ducreyi by Musca domestica. PLoS Negl Trop Dis 2024; 18:e0012194. [PMID: 38814945 PMCID: PMC11139276 DOI: 10.1371/journal.pntd.0012194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/06/2024] [Indexed: 06/01/2024] Open
Abstract
Haemophilus ducreyi was historically known as the causative agent of chancroid, a sexually-transmitted disease causing painful genital ulcers endemic in many low/middle-income nations. In recent years the species has been implicated as the causative agent of nongenital cutaneous ulcers affecting children of the South Pacific Islands and West African countries. Much is still unknown about the mechanism of H. ducreyi transmission in these areas, and recent studies have identified local insect species, namely flies, as potential transmission vectors. H. ducreyi DNA has been detected on the surface and in homogenates of fly species sampled from Lihir Island, Papua New Guinea. The current study develops a model system using Musca domestica, the common house fly, as a model organism to demonstrate proof of concept that flies are a potential vector for the transmission of viable H. ducreyi. Utilizing a green fluorescent protein (GFP)-tagged strain of H. ducreyi and three separate exposure methods, we detected the transmission of viable H. ducreyi by 86.11% ± 22.53% of flies sampled. Additionally, the duration of H. ducreyi viability was found to be directly related to the bacterial concentration, and transmission of H. ducreyi was largely undetectable within one hour of initial exposure. Push testing, Gram staining, and PCR were used to confirm the identity and presence of GFP colonies as H. ducreyi. This study confirms that flies are capable of mechanically transmitting viable H. ducreyi, illuminating the importance of investigating insects as vectors of cutaneous ulcerative diseases.
Collapse
Affiliation(s)
- Haley D. Stabile
- Department of Biology, Allegheny College, Meadville, Pennsylvania, United States of America
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, United States of America
| | - Kayla McCandless
- Department of Biology, Allegheny College, Meadville, Pennsylvania, United States of America
- Krystal Biotech, Inc., Pittsburgh, Pennsylvania, United States of America
| | - Rachel A. Donlan
- Department of Biology, Allegheny College, Meadville, Pennsylvania, United States of America
- University of Pittsburgh Medical Center, Department of Microbiology and Molecular Genetics, Pittsburgh, Pennsylvania, United States of America
| | - Jordan R. Gaston
- Department of Biology, Allegheny College, Meadville, Pennsylvania, United States of America
- University of Pittsburgh Medical Center, St. Margaret Hospital, Pittsburgh, Pennsylvania, United States of America
| | - Tricia L. Humphreys
- Department of Biology, Allegheny College, Meadville, Pennsylvania, United States of America
| |
Collapse
|
6
|
Agbanyo A, Agbavor B, Gyabaah S, Oppong MN, Dornu O, Antwi PB, Loglo AD, Abass KM, Amofa G, Kotey NK, Quao B, Frimpong M, Asiedu K, Amoako YA, Phillips RO. Implementation of an integrated control programme for neglected tropical diseases of the skin in Ghana: The essential role of the laboratory. J Clin Tuberc Other Mycobact Dis 2024; 35:100442. [PMID: 38680788 PMCID: PMC11046218 DOI: 10.1016/j.jctube.2024.100442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
Introduction In this study, we report on findings from approaches used, the outcomes and the lessons learnt from the laboratory support provided for integrated control of skin NTDs including Buruli ulcer (BU), and yaws in seven selected districts in Ghana. Methods Actions implemented from July 2018 to October 2022 included; training district-level health workers on specimen collection, storage, and transport to laboratories, integrated case searches, continual monitoring and supervision for trained health workers, laboratory confirmation of BU and yaws samples and providing results of the analysed samples to guide decision making. Descriptive analysis of data was performed. Results A total of 18,683 (including suspected BU 976; suspected yaws 10,995) individuals were screened for BU and yaws. Of 976 suspected BU cases, 16.8% [median (IQR) age 24 (12.0-37.8) years] were confirmed positive by IS2404 PCR; BU mostly presented as ulcers (78.7%); category I (37.2%) and category II (36%). 480 individuals (4.4%) had DPP positive yaws. Multiplex PCR analysis of 75 selected DPP positive cases identified; 7 DPP positive yaws cases as Treponema pallidum, 28 as Haemophilus ducreyi and 7 as Treponema pallidum/Haemophilus ducreyi coinfection. Laboratory results were sent to the districts within a median (IQR) of 5 (3 - 9) days. Conclusion The implementation of integrated diagnostic confirmation for skin NTDs is feasible with provision of timely results within a week. Multiplex diagnostic tools differentiated Treponema pallidum and Haemophilus ducreyi. There is a need to sustain active case search activities, enhance health worker training, and improve laboratory confirmation of cases as part of the overall strategy for the integrated control of skin neglected tropical diseases.
Collapse
Affiliation(s)
- Abigail Agbanyo
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bernadette Agbavor
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Solomon Gyabaah
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michael Ntiamoah Oppong
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Olivia Dornu
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Philemon Boasiako Antwi
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Aloysius Dzigbordi Loglo
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | | | | | - Michael Frimpong
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kingsley Asiedu
- Department for Control of Neglected Tropical Diseases, World Health Organisation, Geneva, Switzerland
| | - Yaw Ampem Amoako
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Richard Odame Phillips
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| |
Collapse
|
7
|
Handley BL, Sokana O, Addo KK, Wagner J, Fookes M, Harding-Esch E, Marks M, Thomson NR, Doyle RM. Using 16s rRNA sequencing to characterize the microbiome of tropical cutaneous ulcer disease: insights into the microbial landscape and implications for diagnosis and treatment. Microb Genom 2024; 10:001234. [PMID: 38739120 PMCID: PMC11165623 DOI: 10.1099/mgen.0.001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/02/2024] [Indexed: 05/14/2024] Open
Abstract
Cutaneous ulcers are common in yaws-endemic areas. Although often attributed to 'Treponema pallidum subsp. pertenue' and Haemophilus ducreyi, quantitative PCR has highlighted a significant proportion of these ulcers are negative for both pathogens and are considered idiopathic. This is a retrospective analysis utilising existing 16S rRNA sequencing data from two independent yaws studies that took place in Ghana and the Solomon Islands. We characterized bacterial diversity in 38 samples to identify potential causative agents for idiopathic cutaneous ulcers. We identified a diverse bacterial profile, including Arcanobacterium haemolyticum, Campylobacter concisus, Corynebacterium diphtheriae, Staphylococcus spp. and Streptococcus pyogenes, consistent with findings from previous cutaneous ulcer microbiome studies. No single bacterial species was universally present across all samples. The most prevalent bacterium, Campylobacter ureolyticus, appeared in 42% of samples, suggesting a multifactorial aetiology for cutaneous ulcers in yaws-endemic areas. This study emphasizes the need for a nuanced understanding of potential causative agents. The findings prompt further exploration into the intricate microbial interactions contributing to idiopathic yaw-like ulcers, guiding future research toward comprehensive diagnostic and therapeutic strategies.
Collapse
Affiliation(s)
- Becca L. Handley
- Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Oliver Sokana
- Solomon Islands Ministry of Health, Honiara, Solomon Islands
| | - Kennedy Kwasi Addo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | | | - Emma Harding-Esch
- Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Marks
- Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Hospital for Tropical Diseases, London, UK
- University College London, London, UK
| | | | - Ronan M. Doyle
- Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
8
|
Ndzomo P, Tchatchouang S, Njih Tabah E, Njamnshi T, Tsanga MVN, Bondi JA, Handley R, González Beiras C, Tchatchueng J, Müller C, Lüert S, Knauf S, Boyomo O, Harding-Esch E, Mitja O, Crucitti T, Marks M, Eyangoh S. Prevalence and risk factors associated with Haemophilus ducreyi cutaneous ulcers in Cameroon. PLoS Negl Trop Dis 2023; 17:e0011553. [PMID: 38150487 PMCID: PMC10791135 DOI: 10.1371/journal.pntd.0011553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/09/2024] [Accepted: 12/15/2023] [Indexed: 12/29/2023] Open
Abstract
Epidemics of yaws-like cutaneous ulcers are regularly documented in children in the tropics. They occur mainly in poor and remote communities without access to health facilities. The integration of molecular tools into yaws control efforts has made it possible to describe Haemophilus ducreyi (HD) as a major cause of cutaneous ulcers. The objective of this study was to determine the prevalence of HD as cause of cutaneous ulcers, investigate its presence in asymptomatic individuals and identify associated risk factors. A cross-sectional study was conducted in yaws endemic districts of Cameroon. Participants included people presenting yaws-like ulcers and asymptomatic individuals. Swab samples were collected from each participant and tested for HD and Treponema pallidum (TP) using an established qPCR method. Additionally, demographic, habitat, proximity, and hygiene characteristics were collected using a structured questionnaire. A total of 443 individuals participated in the study, including 271 ulcer cases and 172 asymptomatic contacts. The prevalence of HD in ulcers was 30.3% (Confidence Interval (CI) 95% [24.8-35.7]) and the prevalence of asymptomatic HD carriage was 8.6% (CI95% [4.5-12.9]). TP was also detected in our sample among ulcer cases but in lower proportion (5.2% CI95% [2.5-7.8]) compared to HD. The adjusted logistic regression model showed that women were as much at risk of having HD cutaneous ulcer as men regardless of age. Physical proximity to a confirmed ulcer case was the major factor identified favouring HD transmission. HD ulcers were more likely to be present on Bantu individuals compared to Baka as well as HD colonization. These findings highlight HD as the most common cause of cutaneous ulcers in yaws-endemic communities in Cameroon. The exact implications of detecting HD on intact skin are not yet clear. Further studies are needed to understand the significance of this carriage in the spread dynamics of the disease.
Collapse
Affiliation(s)
- Philippe Ndzomo
- Centre Pasteur du Cameroun, Yaounde, Cameroon
- Department of Microbiology, Faculty of Science, University of Yaounde 1, Yaounde, Cameroon
| | | | - Earnest Njih Tabah
- National Yaws, Leishmaniasis, Leprosy and Buruli ulcer Control Programme, Ministry of Public Health, Yaounde, Cameroon
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, West Cameroon
| | - Theophilus Njamnshi
- National Yaws, Leishmaniasis, Leprosy and Buruli ulcer Control Programme, Ministry of Public Health, Yaounde, Cameroon
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | | | | | - Rebecca Handley
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Camila González Beiras
- Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Claudia Müller
- Institute of International Animal Health/One Health, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald—Insel Riems, Germany
| | - Simone Lüert
- Institute of International Animal Health/One Health, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald—Insel Riems, Germany
| | - Sascha Knauf
- Institute of International Animal Health/One Health, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald—Insel Riems, Germany
| | - Onana Boyomo
- Department of Microbiology, Faculty of Science, University of Yaounde 1, Yaounde, Cameroon
| | - Emma Harding-Esch
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oriol Mitja
- Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Tania Crucitti
- Experimental Bacteriology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom
- Division of Infection and Immunity, University College London, London, United Kingdom
| | | |
Collapse
|
9
|
Akuffo RA, Sanchez C, Amanor I, Amedior JS, Kotey NK, Anto F, Azurago T, Ablordey A, Owusu-Antwi F, Beshah A, Amoako YA, Phillips RO, Wilson M, Asiedu K, Ruiz-Postigo JA, Moreno J, Mokni M. Endemic infectious cutaneous ulcers syndrome in the Oti Region of Ghana: Study of cutaneous leishmaniasis, yaws and Haemophilus ducreyi cutaneous ulcers. PLoS One 2023; 18:e0292034. [PMID: 37756291 PMCID: PMC10529585 DOI: 10.1371/journal.pone.0292034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND A recent study detected cutaneous leishmaniasis (CL) in 31.9% of persons with skin ulcers in the Oti Region of Ghana, resulting in a need to investigate other potential causes of the unexplained skin ulcers. METHODOLOGY/PRINCIPAL FINDINGS A community based cross-sectional study was conducted in the Oti region to investigate skin ulcers of undetermined aetiologies. To confirm a diagnosis of cutaneous leishmaniasis, Buruli ulcer, Haemophilus ducreyi ulcers, or yaws, DNA obtained from each patient skin ulcer sample was systematically subjected to polymerase chain reaction (PCR) for Leishmania spp., Mycobacterium ulcerans, Haemophilus ducreyi, and Treponema pallidum sub species pertenue. A total of 101 skin ulcer samples were obtained from 101 persons. Co-infection of more than one organism was observed in 68.3% of the samples. Forty (39.6%) participants had a positive result for Leishmania spp., 68 (67.3%) for Treponema pallidum sub. Sp. pertenue, and 74 (73.3%) for H. ducreyi. Twenty (19.8%) of the patient ulcers were simultaneously infected with Leishmania spp., Treponema pallidum sub. Sp. pertenue, and H. ducreyi. None of the patients' lesions yielded a positive result for Mycobacterium ulcerans. CONCLUSIONS/SIGNIFICANCE This study detected single and mixed occurrence of the causative organisms of CL, yaws, and H. ducreyi cutaneous ulcers in CL endemic communities of the Oti Region in Ghana. These findings emphasize the importance of integrating multiple skin diseases on a common research platform and calls for the development of a comprehensive guideline for diagnosing and treating tropical ulcers in the study areas.
Collapse
Affiliation(s)
- Richard Adjei Akuffo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Carmen Sanchez
- WHO Collaborating Center for Leishmaniasis, Instituto de Salud Carlos III, CIBERINFEC, Madrid, Spain
| | - Ivy Amanor
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | | | - Francis Anto
- School of Public Health, University of Ghana, Accra, Ghana
| | | | - Anthony Ablordey
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | - Abate Beshah
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Yaw Ampem Amoako
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Richard Odame Phillips
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michael Wilson
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Kingsley Asiedu
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Jose-Antonio Ruiz-Postigo
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Javier Moreno
- WHO Collaborating Center for Leishmaniasis, Instituto de Salud Carlos III, CIBERINFEC, Madrid, Spain
| | - Mourad Mokni
- La Rabta Hospital Dermatology Department, Research Laboratory, Faculty of Medicine, University of al-Manar 2, Tunis, Tunisia
| |
Collapse
|
10
|
Dofitas B, Batac MC, Richardus JH. Finding Yaws among Indigenous People: Lessons from Case Detection Surveys in Luzon and Visayas Island Groups of the Philippines. Am J Trop Med Hyg 2023; 108:305-312. [PMID: 36572006 PMCID: PMC9896346 DOI: 10.4269/ajtmh.22-0566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/04/2022] [Indexed: 12/27/2022] Open
Abstract
Yaws is a chronic, highly contagious skin and bone infection caused by Treponema pallidum subspecies pertenue, usually affecting children in impoverished and remote communities. Yaws lesions have thick yellow crusts on pink papillomas that ulcerate and leave deep scars. Yaws cases were confirmed in the Liguasan Marsh, Mindanao Island group, Southern Philippines, in 2017, but there were no cases confirmed in the Luzon and Visayas Island groups. We aimed to detect at least one active or latent yaws case in the island groups of Luzon and Visayas. Active yaws surveillance was conducted by inviting healthcare providers to report yaws suspects. Five remote villages were included in the case detection surveys: three in Luzon and two in the Visayas Island groups. Two indigenous peoples communities were included: Aetas of Quezon and Dumagat/Remontados of Rizal provinces. Trained field personnel conducted free skin check-ups of children, household contacts, and community members. Yaws suspects underwent point-of-care serologic tests for T. pallidum and nontreponemal antibodies. A total of 239 participants were screened for skin diseases, and 103 had serologic tests. Only the Aetas of Quezon province, Luzon, had confirmed yaws cases. Nineteen cases (54.3%) were detected among 35 Aetas: five active yaws (four children, one adult), two latent yaws (adults), and 12 past yaws (1 child, 11 adults). An 8-year-old boy had yaws with skeletal deformities. We report the first yaws cases among the Aetas of Quezon, Luzon Island group. Active yaws surveillance and case detection in remote areas and among indigenous peoples should continue.
Collapse
Affiliation(s)
- Belen Dofitas
- Department of Dermatology, College of Medicine, University of the Philippines Manila, Manila, Philippines;,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands,Address correspondence to Belen Lardizabal Dofitas, Department of Dermatology, Out-patient Building, Philippine General Hospital, Padre Faura St., Ermita 1000, Manila 2801, Philippines. E-mail:
| | - Maria Christina Batac
- Department of Dermatology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
11
|
Griesenauer B, Xing Y, Fortney KR, Gao X, González-Beiras C, Nelson DE, Ren J, Mitjà O, Dong Q, Spinola SM. Two Streptococcus pyogenes emm types and several anaerobic bacterial species are associated with idiopathic cutaneous ulcers in children after community-based mass treatment with azithromycin. PLoS Negl Trop Dis 2022; 16:e0011009. [PMID: 36534698 PMCID: PMC9810193 DOI: 10.1371/journal.pntd.0011009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 01/03/2023] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In yaws-endemic areas, two-thirds of exudative cutaneous ulcers (CU) are associated with Treponema pallidum subsp. pertenue (TP) and Haemophilus ducreyi (HD); one-third are classified as idiopathic ulcers (IU). A yaws eradication campaign on Lihir Island in Papua New Guinea utilizing mass drug administration (MDA) of azithromycin initially reduced but failed to eradicate yaws; IU rates remained constant throughout the study. Using 16S rRNA gene sequencing, we previously determined that Streptococcus pyogenes was associated with some cases of IU. Here, we applied shotgun metagenomics to the same samples we analyzed previously by 16S rRNA sequencing to verify this result, identify additional IU-associated microorganisms, and determine why S. pyogenes-associated IU might have persisted after MDA of azithromycin. METHODOLOGY/PRINCIPAL FINDINGS We sequenced DNA extracted from 244 CU specimens separated into four groups based upon microorganism-specific PCR results (HD+, TP+, TP+HD+, and TP-HD- or IU). S. pyogenes was enriched in IU (24.71% relative abundance [RA]) specimens compared to other ulcer sub-groups, confirming our prior results. We bioinformatically identified the emm (M protein gene) types found in the S. pyogenes IU specimens and found matches to emm156 and emm166. Only ~39% of IU specimens contained detectable S. pyogenes, suggesting that additional organisms could be associated with IU. In the sub-set of S. pyogenes-negative IU specimens, Criibacterium bergeronii, a member of the Peptostreptococcaceae, and Fusobacterium necrophorum (7.07% versus 0.00% RA and 2.18% versus 0.00% RA, respectively), were enriched compared to the S. pyogenes-positive sub-set. Although a broad range of viruses were detected in the CU specimens, none were specifically associated with IU. CONCLUSIONS/SIGNIFICANCE Our observations confirm the association of S. pyogenes with IU in yaws-endemic areas, and suggest that additional anaerobic bacteria, but not other microorganisms, may be associated with this syndrome. Our results should aid in the design of diagnostic tests and selective therapies for CU.
Collapse
Affiliation(s)
- Brad Griesenauer
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana United States of America
| | - Yue Xing
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois United States of America
| | - Katherine R. Fortney
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana United States of America
| | - Xiang Gao
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois United States of America
| | | | - David E. Nelson
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana United States of America
| | - Jie Ren
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana United States of America
| | - Oriol Mitjà
- Carretera de Canyet, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Qunfeng Dong
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois United States of America
| | - Stanley M. Spinola
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana United States of America
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana United States of America
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana United States of America
| |
Collapse
|
12
|
Yalley AK, Ahiatrogah S, Kafintu-Kwashie AA, Amegatcher G, Prah D, Botwe AK, Adusei-Poku MA, Obodai E, Nii-Trebi NI. A Systematic Review on Suitability of Molecular Techniques for Diagnosis and Research into Infectious Diseases of Concern in Resource-Limited Settings. Curr Issues Mol Biol 2022; 44:4367-4385. [PMID: 36286015 PMCID: PMC9601131 DOI: 10.3390/cimb44100300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Infectious diseases significantly impact the health status of developing countries. Historically, infectious diseases of the tropics especially have received insufficient attention in worldwide public health initiatives, resulting in poor preventive and treatment options. Many molecular tests for human infections have been established since the 1980s, when polymerase chain reaction (PCR) testing was introduced. In spite of the substantial innovative advancements in PCR technology, which currently has found wide application in most viral pathogens of global concern, the development and application of molecular diagnostics, particularly in resource-limited settings, poses potential constraints. This review accessed data from sources including PubMed, Google Scholar, the Web of Knowledge, as well as reports from the World Health Organization’s Annual Meeting on infectious diseases and examined these for current molecular approaches used to identify, monitor, or investigate some neglected tropical infectious diseases. This review noted some growth efforts in the development of molecular techniques for diagnosis of pathogens that appear to be common in resource limited settings and identified gaps in the availability and applicability of most of these molecular diagnostics, which need to be addressed if the One Health goal is to be achieved.
Collapse
Affiliation(s)
- Akua K. Yalley
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra P.O. Box KB 143, Ghana
| | - Selasie Ahiatrogah
- Department of Obstetrics and Gynaecology, College of Medicine, Pan African University of Life and Earth Sciences Institute, University of Ibadan, Ibadan P.O. Box 22133, Nigeria
| | - Anna A. Kafintu-Kwashie
- Department of Medical Microbiology, University of Ghana Medical School, Accra GA-221-1570, Ghana
| | - Gloria Amegatcher
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra P.O. Box KB 143, Ghana
| | - Diana Prah
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Accra P.O. Box LG 54, Ghana
| | - Akua K. Botwe
- Molecular Biology Unit, Kintampo Health Research Centre, Ghana Health Service, Kintampo P.O. Box 200, Ghana
| | - Mildred A. Adusei-Poku
- Department of Medical Microbiology, University of Ghana Medical School, Accra GA-221-1570, Ghana
| | - Evangeline Obodai
- Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra P.O. Box LG 581, Ghana
| | - Nicholas I. Nii-Trebi
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra P.O. Box KB 143, Ghana
- Correspondence: ; Tel.: +233-54-827-6424
| |
Collapse
|
13
|
Handley BL, Tchatchouang S, Grout L, Johnson RC, Tabah EN, Boua B, Boock AU, Koffi AP, Phanzu DM, Kotey NK, Rogers E, Dofitas B, Jung Y, Maweke T, Beiras CG, Maman I, Basing LA, Ngazoa SK, Houezo JG, Togbey K, Telan EF, Sarmento N, Marion E, Addo KK, Mitjà O, Asiedu K, Harding-Esch E, Marks M. Evaluating the yaws diagnostic gap: A survey to determine the capacity of and barriers to improving diagnostics in all yaws-endemic countries. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.969219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BackgroundYaws, caused by Treponema pallidum subsp. pertenue, is a skin neglected tropical disease. It is targeted for eradication by 2030, primarily using mass drug administration (MDA) with azithromycin. Traditionally, diagnosis of yaws has relied on clinical examination and serological testing. However, these approaches have poor diagnostic performance. To achieve eradication, more accurate diagnostics are required to determine whether MDA should be initiated or continued as well as for post-elimination surveillance. Molecular tools will be crucial for detecting antimicrobial resistant cases, which have the potential to derail eradication efforts. In order to determine the feasibility of introducing novel, more accurate, diagnostics for yaws surveillance purposes, it is necessary to understand current in-country diagnostic capacity. This study therefore aimed to understand the current capacity of, and challenges to, improving diagnostics for yaws in all yaws-endemic countries worldwide.Methodology/principal findingsAn online survey was sent to all 15 yaws-endemic countries in July 2021. The survey asked about past prevalence estimates, the availability of different diagnostic tools, and perceived barriers to enhancing capacity. Fourteen countries responded to the survey, four of which did not have a current National Policy for yaws eradication in place. Over 95% of reported that yaws cases from the past five years had not been confirmed with serological or molecular tools, largely due to the limited supply of rapid serological tests. Only four countries reported having operational laboratories for molecular yaws diagnosis, with only one of these having a validated assay to detect azithromycin resistance.Conclusions and significanceThis study highlights the diagnostic capacity constraints across all respondent countries. Countries are in need of access to a sustainable supply of serological tests, and development of molecular testing facilities. Sufficient sustainable funding should be made available to ensure that appropriate diagnostic tools are available and utilised.
Collapse
|
14
|
Deli J, González-Beiras C, Guldan GS, Moses RL, Dally J, Moseley R, Lundy FT, Corbacho-Monne M, Walker SL, Cazorla MU, Ouchi D, Fang R, Briggs M, Kiapranis R, Yahimbu M, Mitjà O, Prescott TAK. Ficus septica exudate, a traditional medicine used in Papua New Guinea for treating infected cutaneous ulcers: in vitro evaluation and clinical efficacy assessment by cluster randomised trial. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 99:154026. [PMID: 35278903 DOI: 10.1016/j.phymed.2022.154026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Infected cutaneous ulcers are major health problems for children living in rural areas of Papua New Guinea. The inaccessibility of affected populations and lack of access to basic healthcare, make a local plant-based therapy an attractive treatment option. We assessed Ficus septica exudate in biological assays relevant to wound healing. We then carried out a clinical trial to determine the exudate's efficacy in healing small cutaneous ulcers compared with Savlon antiseptic cream, and soap and water washing. METHODS Pre-clinical in vitro assessment of the exudate was carried out using assays to monitor the pro-inflammatory responses of M1 macrophages and neutrophils, antibacterial assays using known ulcer pathogens, an Ames test for mutagenicity and LC-MS chemical analysis of the exudate. An open label cluster-randomised clinical trial was performed, enrolling participants from three different clusters with skin lesions less than 1 cm in diameter. Each cluster comprising 50 participants was randomly assigned to one of three treatment arms namely topical exudate, topical Savlon antiseptic cream, and standard care (soap and water treatment), all administered daily for 2 days. The primary outcome was clinical healing/improvement measured at days 7 and 14, assessed by three dermatologists using blinded photographs. The primary analysis was assessed as non-inferiority of F. septica treatment based on the risk difference for healing/improvement. RESULTS In vitro, the exudate which is rich in the alkaloid ficuseptine, was found to be non-mutagenic whilst also inhibiting pro-inflammatory responses and exhibiting antibacterial activity. When administered to participants enrolled in the clinical trial, no significant differences were observed between the healing efficacy of F. septica exudate and the two comparator treatments (Savlon antiseptic cream and soap/water treatment). At day 14, but not at day 7, the efficacy of F. septica exudate for healing/improving the ulcers was non-inferior to Savlon antiseptic cream or water/soap treatment. CONCLUSIONS F. septica exudate is non-mutagenic and has both bactericidal and anti-inflammatory properties. When applied topically to small cutaneous ulcers, the exudate has a healing effect that is non-inferior to Savlon antiseptic cream and standard treatment with soap and water at day 14. Our findings, which should be confirmed in larger clinical trials, have important public health implications.
Collapse
Affiliation(s)
- John Deli
- Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea
| | - Camila González-Beiras
- Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain
| | - Georgia S Guldan
- Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea
| | - Rachael L Moses
- Oral and Biomedical Sciences, School of Dentistry, Cardiff Institute Tissue Engineering and Repair, Cardiff University, Cardiff, UK
| | - Jordanna Dally
- Oral and Biomedical Sciences, School of Dentistry, Cardiff Institute Tissue Engineering and Repair, Cardiff University, Cardiff, UK
| | - Ryan Moseley
- Oral and Biomedical Sciences, School of Dentistry, Cardiff Institute Tissue Engineering and Repair, Cardiff University, Cardiff, UK
| | - Fionnuala T Lundy
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, BT9 7BL, UK
| | - Marc Corbacho-Monne
- Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain
| | - Stephen L Walker
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maria Ubals Cazorla
- Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain
| | - Dan Ouchi
- Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain
| | - Rui Fang
- Royal Botanic Gardens, Kew, Richmond, Surrey, TW9 3AB, UK
| | - Marie Briggs
- Royal Botanic Gardens, Kew, Richmond, Surrey, TW9 3AB, UK
| | - Robert Kiapranis
- Papua New Guinea Forest Research Institute, Lae, Papua New Guinea
| | - Martha Yahimbu
- Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea
| | - Oriol Mitjà
- Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain and Lihir Medical Center-International SOS, Lihir Island, Papua New Guinea
| | | |
Collapse
|
15
|
Handley BL, González-Beiras C, Tchatchouang S, Basing LA, Hugues KA, Bakheit M, Becherer L, Ries C, Njih Tabah E, Crucitti T, Borst N, Lüert S, Frischmann S, Haerpfer T, Landmann E, Amanor I, Sylla A, Kouamé-Sina MS, Ndzomo-Ngono JP, Tano A, Arhinful D, Awondo P, Ngazoa Kakou S, Eyangoh S, Addo KK, Harding-Esch EM, Knauf S, Mitjà O, Marks M. LAMP4yaws: Treponema pallidum, Haemophilus ducreyi loop mediated isothermal amplification - protocol for a cross-sectional, observational, diagnostic accuracy study. BMJ Open 2022; 12:e058605. [PMID: 35351731 PMCID: PMC8966536 DOI: 10.1136/bmjopen-2021-058605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 02/18/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Yaws, caused by the bacterium Treponema pallidum subsp. pertenue, is a neglected tropical disease targeted for eradication by 2030. Improved diagnostics will be essential to meet this goal. Diagnosis of yaws has relied heavily on clinical and serological tools. However, the presence of coendemic cutaneous skin ulcer diseases, such as lesions caused by Haemophilus ducreyi (HD), means these techniques do not provide a reliable diagnosis. Thus, new diagnostic tools are needed. Molecular tools such as PCR are ideal, but often expensive as they require trained technicians and laboratory facilities, which are often not available to national yaws programmes. METHODS AND ANALYSIS The LAMP4yaws project is a cross-sectional, observational, diagnostic accuracy study of a combined Treponema pallidum (TP) and HD loop mediated isothermal amplification (TPHD-LAMP) test performed under real world conditions in three endemic countries in West Africa. Individuals with serologically confirmed yaws will be recruited in Cameroon, Côte d'Ivoire and Ghana. Each participant will provide paired swabs, one of which will be sent to the respective national reference laboratory for yaws quantitative PCR and the other will be tested for both TP and HD using the TPHD-LAMP test at local district laboratories. Sensitivity and specificity of the TPHD-LAMP test will be calculated against the reference standard qPCR. We will also assess the acceptability, feasibility and cost-effectiveness of the test. We anticipate that results from this study will support the adoption of the TPHD-LAMP test for use in global yaws eradication efforts. ETHICS AND DISSEMINATION We have received ethical approval from all relevant institutional and national ethical committees. All participants, or their parents or guardians, must provide written informed consent prior to study enrolment. Study results will be published in an open access journal and disseminated with partners and the World Health Organization. TRIAL REGISTRATION NUMBER NCT04753788.
Collapse
Affiliation(s)
- Becca Louise Handley
- Clinical Research Department, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Camila González-Beiras
- Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Laud Antony Basing
- University of Ghana Noguchi Memorial Institute for Medical Research, Accra, Greater Accra, Ghana
| | - Kouadio Aboh Hugues
- National Program of African Trypanosomiasis Elimination, Abidjan, Côte d'Ivoire
- Institut Pasteur de Cote d'Ivoire, Abidjan, Lagunes, Côte d'Ivoire
| | | | - Lisa Becherer
- IMTEK - Department of Microsystems Engineering, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christina Ries
- Institute of International Animal Health/One Health, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald - Insel Riems, Germany
| | - Earnest Njih Tabah
- National Buruli Ulcer, Leprosy, Yaws and Leishmaniasis Control Program, Ministry of Public Health, Yaounde, Centre Region, Cameroon
- Public Health & Epidemiology, University of Dschang, Yaounde, West Region, Cameroon
| | - Tania Crucitti
- Experimental Bacteriology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Nadine Borst
- IMTEK - Department of Microsystems Engineering, University of Freiburg, Freiburg im Breisgau, Germany
| | - Simone Lüert
- Institute of International Animal Health/One Health, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald - Insel Riems, Germany
| | | | - Tamara Haerpfer
- IMTEK - Department of Microsystems Engineering, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Ivy Amanor
- University of Ghana Noguchi Memorial Institute for Medical Research, Accra, Greater Accra, Ghana
| | - Aboubacar Sylla
- Institut Pasteur de Cote d'Ivoire, Abidjan, Lagunes, Côte d'Ivoire
| | | | | | - Adingra Tano
- Institut Pasteur de Cote d'Ivoire, Abidjan, Lagunes, Côte d'Ivoire
| | - Daniel Arhinful
- University of Ghana Noguchi Memorial Institute for Medical Research, Accra, Greater Accra, Ghana
| | | | | | | | - Kennedy Kwasi Addo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Emma Michele Harding-Esch
- Clinical Research Department, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Sascha Knauf
- Institute of International Animal Health/One Health, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald - Insel Riems, Germany
| | - Oriol Mitjà
- Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Michael Marks
- Clinical Research Department, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
- Hospital for Tropical Diseases, London, UK
| |
Collapse
|
16
|
Beiras CG, Marks M, Quintó L, Gavilán S, Kolmau R, Ubals M, Vall-Mayans M, Mitjà O. Yaws recurrence in children at continued risk of infection. PLoS Negl Trop Dis 2022; 16:e0010197. [PMID: 35312686 PMCID: PMC8970528 DOI: 10.1371/journal.pntd.0010197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/31/2022] [Accepted: 01/24/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In yaws-endemic areas, children with Treponema pallidum subsp. pertenue infection may suffer recurrent episodes due to either reinfection or relapse. However, the possibility of infection with other cutaneous ulcer causative agents and difficulties in interpreting standard laboratory results challenges the estimation of yaws recurrence rates. METHODS We estimated the rates of yaws recurrences in the Lihir Island (Papua New Guinea) using two approaches: passive surveillance based on a retrospective screening of electronic medical records of cutaneous ulcers diagnosed using serological testing between 2005 and 2016, and active surveillance conducted during a cross-sectional prevalence study which included PCR analyses of ulcers of all suspected cases of yaws. The risk of recurrent infection was assessed based on data from the passive surveillance analysis and using two Cox regression models (crude and multivariate), stratified by year of index episode. Data gathered from the active surveillance was used to characterize the recurrences and no hypothesis testing was performed. RESULTS The electronic medical records included 6,125 patients (7,889 ulcer episodes) with documented serological results of cutaneous ulcers of which1,486 were diagnosed with yaws. Overall, 1,246/6,125 patients (20.3%) presented more than once with a cutaneous ulcer, and 103/1,486 (6.7%) patients had multiple episodes of yaws. The risk of yaws recurrence significantly increased with age and was higher in patients with ≥3 recurrent episodes. In the active surveillance, we identified 50 individuals with recurrent cutaneous ulcer that had PCR results available for both the index and recurrent episode. Of 12 individuals with T. pallidum in the index ulcer, 8 (66%) had T. pallidum in subsequent assessments, relapse related to macrolide-resistance was identified in two of these cases. CONCLUSIONS Our results confirm the need for active follow-up of yaws patients after treatment, particularly children and individuals with a history of recurrence.
Collapse
Affiliation(s)
- Camila G. Beiras
- STI and Skin NTDs Unit, Department of Infectious Diseases and Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Michael Marks
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals, London, United Kingdom
| | - Llorenç Quintó
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Manhiça Health Research Institute (CISM), Manhiça, Mozambique
| | - Sergi Gavilán
- STI and Skin NTDs Unit, Department of Infectious Diseases and Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Reman Kolmau
- Lihir Medical Centre, International SOS, Londolovit, Papua New Guinea
| | - Maria Ubals
- STI and Skin NTDs Unit, Department of Infectious Diseases and Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Marti Vall-Mayans
- STI and Skin NTDs Unit, Department of Infectious Diseases and Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Oriol Mitjà
- STI and Skin NTDs Unit, Department of Infectious Diseases and Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Lihir Medical Centre, International SOS, Londolovit, Papua New Guinea
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| |
Collapse
|
17
|
John LN, Beiras CG, Houinei W, Medappa M, Sabok M, Kolmau R, Jonathan E, Maika E, Wangi JK, Pospíšilová P, Šmajs D, Ouchi D, Galván-Femenía I, Beale MA, Giacani L, Clotet B, Mooring EQ, Marks M, Vall-Mayans M, Mitjà O. Trial of Three Rounds of Mass Azithromycin Administration for Yaws Eradication. N Engl J Med 2022; 386:47-56. [PMID: 34986286 PMCID: PMC7612200 DOI: 10.1056/nejmoa2109449] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Treponema pallidum subspecies pertenue causes yaws. Strategies to better control, eliminate, and eradicate yaws are needed. METHODS In an open-label, cluster-randomized, community-based trial conducted in a yaws-endemic area of Papua New Guinea, we randomly assigned 38 wards (i.e., clusters) to receive one round of mass administration of azithromycin followed by two rounds of target treatment of active cases (control group) or three rounds of mass administration of azithromycin (experimental group); round 1 was administered at baseline, round 2 at 6 months, and round 3 at 12 months. The coprimary end points were the prevalence of active cases of yaws, confirmed by polymerase-chain-reaction assay, in the entire trial population and the prevalence of latent yaws, confirmed by serologic testing, in a subgroup of asymptomatic children 1 to 15 years of age; prevalences were measured at 18 months, and the between-group differences were calculated. RESULTS Of the 38 wards, 19 were randomly assigned to the control group (30,438 persons) and 19 to the experimental group (26,238 persons). A total of 24,848 doses of azithromycin were administered in the control group (22,033 were given to the participants at round 1 and 207 and 2608 were given to the participants with yaws-like lesions and their contacts, respectively, at rounds 2 and 3 [combined]), and 59,852 doses were administered in the experimental group. At 18 months, the prevalence of active yaws had decreased from 0.46% (102 of 22,033 persons) at baseline to 0.16% (47 of 29,954 persons) in the control group and from 0.43% (87 of 20,331 persons) at baseline to 0.04% (10 of 25,987 persons) in the experimental group (relative risk adjusted for clustering, 4.08; 95% confidence interval [CI], 1.90 to 8.76). The prevalence of other infectious ulcers decreased to a similar extent in the two treatment groups. The prevalence of latent yaws at 18 months was 6.54% (95% CI, 5.00 to 8.08) among 994 children in the control group and 3.28% (95% CI, 2.14 to 4.42) among 945 children in the experimental group (relative risk adjusted for clustering and age, 2.03; 95% CI, 1.12 to 3.70). Three cases of yaws with resistance to macrolides were found in the experimental group. CONCLUSIONS The reduction in the community prevalence of yaws was greater with three rounds of mass administration of azithromycin at 6-month intervals than with one round of mass administration of azithromycin followed by two rounds of targeted treatment. Monitoring for the emergence and spread of antimicrobial resistance is needed. (Funded by Fundació "la Caixa" and others; ClinicalTrials.gov number, NCT03490123.).
Collapse
Affiliation(s)
- Lucy N. John
- National Department of Health, Aopi Centre, Port Moresby, Papua New Guinea
- Infectious Diseases Department and Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia (Spain)
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
- Barcelona Institute for Global Health -Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Camila G. Beiras
- Infectious Diseases Department and Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia (Spain)
| | - Wendy Houinei
- National Department of Health, Aopi Centre, Port Moresby, Papua New Guinea
| | - Monica Medappa
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Maria Sabok
- New Ireland Provincial Health Authority, Kavieng, Papua New Guinea
| | - Reman Kolmau
- Lihir Medical Centre, International SOS, Lihir Island, Papua New Guinea
| | - Eunice Jonathan
- New Ireland Provincial Health Authority, Kavieng, Papua New Guinea
| | - Edward Maika
- New Ireland Provincial Health Authority, Kavieng, Papua New Guinea
| | - James K. Wangi
- WHO Representative Office in Papua New Guinea, Port Moresby, Papua New Guinea
| | - Petra Pospíšilová
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - David Šmajs
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Dan Ouchi
- Infectious Diseases Department and Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia (Spain)
| | - Iván Galván-Femenía
- Genomes for Life-GCAT lab Group, Institute for Health Science Research Germans Trias i Pujol, Badalona, Spain
- Institute for Research in Biomedicine, Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Mathew A Beale
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, United Kingdom
| | - Lorenzo Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases, and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Bonaventura Clotet
- Infectious Diseases Department and Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia (Spain)
- IrsiCaixa AIDS Research Institute, Badalona, Spain
- Universitat de Vic - Universitat Central de Catalunya, Vic, Spain
| | - Eric Q. Mooring
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Michael Marks
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals, London, United Kingdom
| | - Marti Vall-Mayans
- Infectious Diseases Department and Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia (Spain)
| | - Oriol Mitjà
- Infectious Diseases Department and Fight AIDS and Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia (Spain)
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
- Lihir Medical Centre, International SOS, Lihir Island, Papua New Guinea
- Universitat de Vic - Universitat Central de Catalunya, Vic, Spain
| |
Collapse
|
18
|
Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 833] [Impact Index Per Article: 277.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11-14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs.
Collapse
|
19
|
Timothy JWS, Beale MA, Rogers E, Zaizay Z, Halliday KE, Mulbah T, Giddings RK, Walker SL, Thomson NR, Kollie KK, Pullan RL, Marks M. Epidemiologic and Genomic Reidentification of Yaws, Liberia. Emerg Infect Dis 2021; 27:1123-1132. [PMID: 33754988 PMCID: PMC8007311 DOI: 10.3201/eid2704.204442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We confirmed endemicity and autochthonous transmission of yaws in Liberia after a population-based, community-led burden estimation (56,825 participants). Serologically confirmed yaws was rare and focal at population level (24 cases; 2.6 [95% CI 1.4-3.9] cases/10,000 population) with similar clinical epidemiology to other endemic countries in West Africa. Unsupervised classification of spatially referenced case finding data indicated that yaws was more likely to occur in hard-to-reach communities; healthcare-seeking was low among communities, and clinical awareness of yaws was low among healthcare workers. We recovered whole bacterial genomes from 12 cases and describe a monophyletic clade of Treponema pallidum subspecies pertenue, phylogenetically distinct from known TPE lineages, including those affecting neighboring nonhuman primate populations (Taï Forest, Côte d'Ivoire). Yaws is endemic in Liberia but exhibits low focal population prevalence with evidence of a historical genetic bottleneck and subsequent local expansion. Reporting gaps appear attributable to challenging epidemiology and low disease awareness.
Collapse
|
20
|
Ulcerative skin lesions among children in Cameroon: It is not always Yaws. PLoS Negl Trop Dis 2021; 15:e0009180. [PMID: 33591973 PMCID: PMC7909670 DOI: 10.1371/journal.pntd.0009180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 02/26/2021] [Accepted: 01/26/2021] [Indexed: 11/19/2022] Open
Abstract
Outbreaks of yaws-like ulcerative skin lesions in children are frequently reported in tropical and sub-tropical countries. The origin of these lesions might be primarily traumatic or infectious; in the latter case, Treponema pallidum subspecies pertenue, the yaws agent, and Haemophilus ducreyi, the agent of chancroid, are two of the pathogens commonly associated with the aetiology of skin ulcers. In this work, we investigated the presence of T. p. pertenue and H. ducreyi DNA in skin ulcers in children living in yaws-endemic regions in Cameroon. Skin lesion swabs were collected from children presenting with yaws-suspected skin lesions during three outbreaks, two of which occurred in 2017 and one in 2019. DNA extracted from the swabs was used to amplify three target genes: the human β2-microglobulin gene to confirm proper sample collection and DNA extraction, the polA gene, highly conserved among all subspecies of T. pallidum, and the hddA gene of H. ducreyi. A fourth target, the tprL gene was used to differentiate T. p. pertenue from the other agents of human treponematoses in polA-positive samples. A total of 112 samples were analysed in this study. One sample, negative for β2-microglobulin, was excluded from further analysis. T. p. pertenue was only detected in the samples collected during the first 2017 outbreak (12/74, 16.2%). In contrast, H. ducreyi DNA could be amplified from samples from all three outbreaks (outbreak 1: 27/74, 36.5%; outbreak 2: 17/24, 70.8%; outbreak 3: 11/13, 84.6%). Our results show that H. ducreyi was more frequently associated to skin lesions in the examined children than T. p. pertenue, but also that yaws is still present in Cameroon. These findings strongly advocate for a continuous effort to determine the aetiology of ulcerative skin lesions during these recurring outbreaks, and to inform the planned mass treatment campaigns to eliminate yaws in Cameroon.
Collapse
|
21
|
Streptococcus pyogenes Is Associated with Idiopathic Cutaneous Ulcers in Children on a Yaws-Endemic Island. mBio 2021; 12:mBio.03162-20. [PMID: 33436440 PMCID: PMC7844543 DOI: 10.1128/mbio.03162-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Exudative cutaneous ulcers (CU) in yaws-endemic areas are associated with Treponema pallidum subsp. pertenue (TP) and Haemophilus ducreyi (HD), but one-third of CU cases are idiopathic (IU). Using mass drug administration (MDA) of azithromycin, a yaws eradication campaign on Lihir Island in Papua New Guinea reduced but failed to eradicate yaws; IU rates remained constant throughout the campaign. To identify potential etiologies of IU, we obtained swabs of CU lesions (n = 279) and of the skin of asymptomatic controls (AC; n = 233) from the Lihir Island cohort and characterized their microbiomes using a metagenomics approach. CU bacterial communities were less diverse than those of the AC. Using real-time multiplex PCR with pathogen-specific primers, we separated CU specimens into HD-positive (HD+), TP+, HD+TP+, and IU groups. Each CU subgroup formed a distinct bacterial community, defined by the species detected and/or the relative abundances of species within each group. Streptococcus pyogenes was the most abundant organism in IU (22.65%) and was enriched in IU compared to other ulcer groups. Follow-up samples (n = 31) were obtained from nonhealed ulcers; the average relative abundance of S. pyogenes was 30.11% in not improved ulcers and 0.88% in improved ulcers, suggesting that S. pyogenes in the not improved ulcers may be azithromycin resistant. Catonella morbi was enriched in IU that lacked S. pyogenes As some S. pyogenes and TP strains are macrolide resistant, penicillin may be the drug of choice for CU azithromycin treatment failures. Our study will aid in the design of diagnostic tests and selective therapies for CU.IMPORTANCE Cutaneous ulcers (CU) affect approximately 100,000 children in the tropics each year. While two-thirds of CU are caused by Treponema pallidum subspecies pertenue and Haemophilus ducreyi, the cause(s) of the remaining one-third is unknown. Given the failure of mass drug administration of azithromycin to eradicate CU, the World Health Organization recently proposed an integrated disease management strategy to control CU. Success of this strategy requires determining the unknown cause(s) of CU. By using 16S rRNA gene sequencing of swabs obtained from CU and the skin of asymptomatic children, we identified another possible cause of skin ulcers, Streptococcus pyogenes Although S. pyogenes is known to cause impetigo and cellulitis, this is the first report implicating the organism as a causal agent of CU. Inclusion of S. pyogenes into the integrated disease management plan will improve diagnostic testing and treatment of this painful and debilitating disease of children and strengthen elimination efforts.
Collapse
|
22
|
Becherer L, Knauf S, Marks M, Lueert S, Frischmann S, Borst N, von Stetten F, Bieb S, Adu-Sarkodie Y, Asiedu K, Mitjà O, Bakheit M. Multiplex Mediator Displacement Loop-Mediated Isothermal Amplification for Detection of Treponema pallidum and Haemophilus ducreyi. Emerg Infect Dis 2021; 26:282-288. [PMID: 31961303 PMCID: PMC6986840 DOI: 10.3201/eid2602.190505] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Yaws, a neglected tropical disease caused by the bacterium Treponema pallidum subspecies pertenue, manifests as ulcerative skin lesions. Nucleic acid amplification tests, like loop-mediated isothermal amplification (LAMP), are versatile tools to distinguish yaws from infections that cause similar skin lesions, primarily Haemophilus ducreyi. We developed a novel molecular test to simultaneously detect T. pallidum and H. ducreyi based on mediator displacement LAMP. We validated the T. pallidum and H. ducreyi LAMP (TPHD-LAMP) by testing 293 clinical samples from patients with yaws-like lesions. Compared with quantitative PCR, the TPHD-LAMP demonstrated high sensitivity and specificity for T. pallidum (84.7% sensitivity, 95.7% specificity) and H. ducreyi (91.6% sensitivity, 84.8% specificity). This novel assay provided rapid molecular confirmation of T. pallidum and H. ducreyi DNA and might be suitable for use at the point of care. TPHD-LAMP could support yaws eradication by improving access to molecular diagnostic tests at the district hospital level.
Collapse
|
23
|
Ameyaw E, Asafo-Agyei SB, Boakye-Yiadom AP, Baffoe-Sarpong K, Duku FA. Amputation in a 17 year old Ghanaian with type 1 diabetes: A Case Report. ENDOCRINE AND METABOLIC SCIENCE 2020. [DOI: 10.1016/j.endmts.2020.100070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
|
24
|
Frimpong M, Simpson SV, Ahor HS, Agbanyo A, Gyabaah S, Agbavor B, Amanor IB, Addo KK, Böhlken-Fascher S, Kissenkötter J, Wahed AAE, Phillips RO. Multiplex Recombinase Polymerase Amplification Assay for Simultaneous Detection of Treponema pallidum and Haemophilus ducreyi in Yaws-Like Lesions. Trop Med Infect Dis 2020; 5:tropicalmed5040157. [PMID: 33036234 PMCID: PMC7709673 DOI: 10.3390/tropicalmed5040157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 11/22/2022] Open
Abstract
Yaws is a skin debilitating disease caused by Treponema pallidum subspecies pertenue with most cases reported in children. World Health Organization (WHO) aims at total eradication of this disease through mass treatment of suspected cases followed by an intensive follow-up program. However, effective diagnosis is pivotal in the successful implementation of this control program. Recombinase polymerase amplification (RPA), an isothermal nucleic acid amplification technique offers a wider range of differentiation of pathogens including those isolated from chronic skin ulcers with similar characteristics such as Haemophilus ducreyi (H. ducreyi). We have developed a RPA assay for the simultaneous detection of Treponema pallidum (T. pallidum) and H. ducreyi (TPHD-RPA). The assay demonstrated no cross-reaction with other pathogens and enable detection of T. pallidum and H. ducreyi within 15 min at 42 °C. The RPA assay was validated with 49 clinical samples from individuals confirmed to have yaws by serological tests. Comparing the developed assay with commercial multiplex real-time PCR, the assay demonstrated 94% and 95% sensitivity for T. pallidum and H. ducreyi, respectively and 100% specificity. This simple novel TPHD-RPA assay enables the rapid detection of both T. pallidum and H. ducreyi in yaws-like lesions. This test could support the yaws eradication efforts by ensuring reliable diagnosis, to enable monitoring of program success and planning of follow-up interventions at the community level.
Collapse
Affiliation(s)
- Michael Frimpong
- Department of Molecular Medicine, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi AK-448, Ghana;
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi AK-312, Ghana; (A.A.); (S.G.); (B.A.); (R.O.P.)
- Correspondence:
| | - Shirley Victoria Simpson
- Bacteriology Department, Noguchi Memorial Institute of Medical Research, University of Ghana, Accra GA-337, Ghana; (S.V.S.); (I.B.A.); (K.K.A.)
| | - Hubert Senanu Ahor
- Department of Molecular Medicine, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi AK-448, Ghana;
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi AK-312, Ghana; (A.A.); (S.G.); (B.A.); (R.O.P.)
| | - Abigail Agbanyo
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi AK-312, Ghana; (A.A.); (S.G.); (B.A.); (R.O.P.)
| | - Solomon Gyabaah
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi AK-312, Ghana; (A.A.); (S.G.); (B.A.); (R.O.P.)
| | - Bernadette Agbavor
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi AK-312, Ghana; (A.A.); (S.G.); (B.A.); (R.O.P.)
| | - Ivy Brago Amanor
- Bacteriology Department, Noguchi Memorial Institute of Medical Research, University of Ghana, Accra GA-337, Ghana; (S.V.S.); (I.B.A.); (K.K.A.)
| | - Kennedy Kwasi Addo
- Bacteriology Department, Noguchi Memorial Institute of Medical Research, University of Ghana, Accra GA-337, Ghana; (S.V.S.); (I.B.A.); (K.K.A.)
| | - Susanne Böhlken-Fascher
- Division of Microbiology and Animal Hygiene, Georg-August University, D-37077 Goettingen, Germany; (S.B.-F.); (J.K.); (A.A.E.W.)
| | - Jonas Kissenkötter
- Division of Microbiology and Animal Hygiene, Georg-August University, D-37077 Goettingen, Germany; (S.B.-F.); (J.K.); (A.A.E.W.)
| | - Ahmed Abd El Wahed
- Division of Microbiology and Animal Hygiene, Georg-August University, D-37077 Goettingen, Germany; (S.B.-F.); (J.K.); (A.A.E.W.)
- Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, D-04103 Leipzig, Germany
| | - Richard Odame Phillips
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi AK-312, Ghana; (A.A.); (S.G.); (B.A.); (R.O.P.)
| |
Collapse
|
25
|
Munson M, Creswell B, Kondobala K, Ganiwu B, Lomotey RD, Oppong P, Agyeman FO, Kotye N, Diwura M, Ako EP, Simpson SV, Addo KK, Pickering H, Handley BL, Houghton J, Kwakye C, Marks M. Optimising the use of molecular tools for the diagnosis of yaws. Trans R Soc Trop Med Hyg 2020; 113:776-780. [PMID: 31608961 DOI: 10.1093/trstmh/trz083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Yaws is a neglected tropical disease and results in lesions of skin, soft tissues and bones. PCR plays an important part in surveillance. METHODS Children suspected to have yaws were enrolled. From the largest lesion, paired swabs were collected, one in transport medium and one as a dry swab. In children with multiple lesions we collected additional swabs from up to four subsequent lesions. Swabs in transport medium were maintained in a cold chain while dry swabs were stored at ambient temperature. Swabs were tested by PCR for Treponema pallidum and Haemophilus ducreyi. RESULTS Of 55 individuals, 10 (18%) had at least one positive PCR for T. pallidum and 12 (22%) had at least one positive result for H. ducreyi. Concordance was 100% between swabs in transport medium and dry swabs. One patient had PCR-confirmed yaws on the swab of a third lesion when both the first and second lesions were PCR-negative. CONCLUSIONS Storing swabs in transport medium and transporting in a cold chain did not improve yield, however, detection of T. pallidum is increased by swabbing additional lesions. As the target for yaws is eradication, approaches to sample collection need revisiting to ensure cases are not missed.
Collapse
Affiliation(s)
- Morgan Munson
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Benjamin Creswell
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | | | | | | | | | | | | | | | | | - Shirley Victoria Simpson
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Kennedy Kwasi Addo
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Harry Pickering
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Becca L Handley
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Joanna Houghton
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | | | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK.,Hospital for Tropical Diseases, Mortimer Market Centre, London, UK
| |
Collapse
|
26
|
Lubinza CKC, Lueert S, Hallmaier-Wacker LK, Ngadaya E, Chuma IS, Kazwala RR, Mfinanga SGM, Failing K, Roos C, Knauf S. Serosurvey of Treponema pallidum infection among children with skin ulcers in the Tarangire-Manyara ecosystem, northern Tanzania. BMC Infect Dis 2020; 20:392. [PMID: 32493291 PMCID: PMC7268494 DOI: 10.1186/s12879-020-05105-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The first yaws eradication campaign reduced the prevalence of yaws by 95%. In recent years, however, yaws has reemerged and is currently subject to a second, ongoing eradication campaign. Yet, the epidemiological status of Tanzania and 75 other countries with a known history of human yaws is currently unknown. Contrary to the situation in humans in Tanzania, recent infection of nonhuman primates (NHPs) with the yaws bacterium Treponema pallidum subsp. pertenue (TPE) have been reported. In this study, we consider a One Health approach to investigate yaws and describe skin ulcers and corresponding T. pallidum serology results among children living in the Tarangire-Manyara ecosystem, an area with increasing wildlife-human interaction in northern Tanzania. METHODS To investigate human yaws in Tanzania, we conducted a cross-sectional study to screen and interview skin-ulcerated children aged 6 to 15 years, who live in close proximity to two national parks with high numbers of naturally TPE-infected monkeys. Serum samples from children with skin ulcers were tested for antibodies against the bacterium using a treponemal (Treponema pallidum Particle Agglutination assay) and a non-treponemal (Rapid Plasma Reagin) test. RESULTS A total of 186 children aged between 6 and 15 years (boys: 10.7 ± 2.1 (mean ± SD), N = 132; girls: 10.9 ± 2.0 (mean ± SD), N = 54) were enrolled. Seven children were sampled at health care facilities and 179 at primary schools. 38 children (20.4%) reported active participation in bushmeat hunting and consumption and 26 (13.9%) reported at least one physical contact with a NHP. None of the lesions seen were pathognomonic for yaws. Two children tested positive for treponemal antibodies (1.2%) in the treponemal test, but remained negative in the non-treponemal test. CONCLUSIONS We found no serological evidence of yaws among children in the Tarangire-Manyara ecosystem. Nevertheless, the close genetic relationship of human and NHPs infecting TPE strains should lead to contact prevention with infected NHPs. Further research investigations are warranted to study the causes and possible prevention measures of spontaneous chronic ulcers among children in rural Tanzania and to certify that the country is free from human yaws.
Collapse
Affiliation(s)
- Clara K C Lubinza
- National Institute for Medical Research, Muhimbili Medical Research Centre, P.O. Box 3436, Dar es Salaam, Tanzania.,College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, P.O. Box 3021, Morogoro, Tanzania
| | - Simone Lueert
- Work Group Neglected Tropical Diseases, Infection Biology Unit, Deutsches Primatezentrum GmbH, Leibniz Institute for Primate Research, Kellnerweg 4, 37077, Goettingen, Germany.,Primate Genetics Laboratory, Deutsches Primatenzentrum GmbH, Leibniz Institute for Primate Research, Kellnerweg 4, 37077, Goettingen, Germany
| | - Luisa K Hallmaier-Wacker
- Work Group Neglected Tropical Diseases, Infection Biology Unit, Deutsches Primatezentrum GmbH, Leibniz Institute for Primate Research, Kellnerweg 4, 37077, Goettingen, Germany.,Primate Genetics Laboratory, Deutsches Primatenzentrum GmbH, Leibniz Institute for Primate Research, Kellnerweg 4, 37077, Goettingen, Germany
| | - Esther Ngadaya
- National Institute for Medical Research, Muhimbili Medical Research Centre, P.O. Box 3436, Dar es Salaam, Tanzania
| | - Idrissa S Chuma
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, P.O. Box 3021, Morogoro, Tanzania
| | - Rudovick R Kazwala
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, P.O. Box 3021, Morogoro, Tanzania
| | - Sayoki G M Mfinanga
- National Institute for Medical Research, Muhimbili Medical Research Centre, P.O. Box 3436, Dar es Salaam, Tanzania.,Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.,School of Life Sciences and Bioengineering, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
| | - Klaus Failing
- Unit for Biomathematics and Data Processing, Faculty of Veterinary Medicine, Justus Liebig-University-Giessen, Giessen, Germany
| | - Christian Roos
- Primate Genetics Laboratory, Deutsches Primatenzentrum GmbH, Leibniz Institute for Primate Research, Kellnerweg 4, 37077, Goettingen, Germany.,Gene Bank of Primates, Deutsches Primatenzentrum GmbH, Leibniz Institute for Primate Research, Kellnerweg 4, 37077, Goettingen, Germany
| | - Sascha Knauf
- Work Group Neglected Tropical Diseases, Infection Biology Unit, Deutsches Primatezentrum GmbH, Leibniz Institute for Primate Research, Kellnerweg 4, 37077, Goettingen, Germany. .,Division Microbiology and Animal Hygiene, Department for Animal Sciences, Georg-August-University, Burkhardtweg 2, 37077, Goettingen, Germany.
| |
Collapse
|
27
|
Basing LAW, Simpson SV, Adu-Sarkodie Y, Linnes JC. A Loop-Mediated Isothermal Amplification Assay for the Detection of Treponema pallidum subsp. pertenue. Am J Trop Med Hyg 2020; 103:253-259. [PMID: 32314703 DOI: 10.4269/ajtmh.19-0243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The eradication of yaws caused by Treponema pallidum subsp. pertenue is constrained by the lack of rapid, accurate diagnosis. We sought to develop a molecular point-of-care test for the diagnosis of yaws. A loop-mediated isothermal amplification (LAMP) assay with primers targeting the conserved gene, tp0967, with visual detection by lateral flow test strip was developed and optimized. The limit of detection was evaluated while 63 samples from clinical cases of yaws and five samples with polymerase chain reaction (PCR)-confirmed syphilis were used to determine the sensitivity and specificity of the assay compared with the current molecular testing protocol. The developed LAMP assay was found to be optimal when run at 65°C for 30 minutes. The limit of detection from extracted DNA was 2.7 × 104 DNA copies/mL. The sensitivity of the LAMP assay using unextracted and DNA extracted samples were 0.67 and 1.00, respectively. None of the syphilis samples tested positive in any of the assays. We show the development of a fast and sensitive LAMP assay for yaws detected by lateral flow test strip. Using extracted DNA, the assay sensitivity is at par with real-time PCR-based detection. The assay can be adapted to minimal sample processing required for infield detection without DNA extraction.
Collapse
Affiliation(s)
| | | | | | - Jacqueline C Linnes
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
| |
Collapse
|
28
|
Dofitas BL, Kalim SP, Toledo CB, Richardus JH. Yaws in the Philippines: first reported cases since the 1970s. Infect Dis Poverty 2020; 9:1. [PMID: 31996251 PMCID: PMC6990502 DOI: 10.1186/s40249-019-0617-6] [Citation(s) in RCA: 150] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/16/2019] [Indexed: 11/17/2022] Open
Abstract
Background Yaws is a chronic, highly contagious skin and bone infection affecting children living in impoverished, remote communities and caused by Treponema pallidum subspecies pertenue. The Philippines was thought to be free of yaws following the 1950s eradication campaign but it has been reported in the Liguasan Marsh area, Central Mindanao. This is the first documentation of yaws cases in the Philippines since the 1970s. We describe active and latent yaws recently detected in the Southern Philippines. Case presentation Cross-sectional surveys and screening of skin diseases were conducted in one randomly selected public elementary school per selected municipality in Liguasan Marsh, covering three municipalities per province. Yaws suspects underwent screening and confirmatory serologic tests for Treponema pallidum using Dual Path Platform Syphilis Screen and Confirm Assay (DPP) and Treponema pallidum Particle Agglutination (TPPA). Children with yaws skin lesions and reactive confirmatory tests for T. pallidum and non-treponemal antibodies were considered confirmed yaws cases. Four children aged 5–10 years old had confirmed secondary yaws in Tulunan Municipality, Cotabato Province and in Lambayong Municipality, Sultan Kudarat Province. All had secondary yaws lesions such as moist, cauliflower-like papillomas, thick yellow crusts on pink papules and nodules, whitish, papulosquamous papules and plaques, or hypopigmented patches with small papules on the periphery. Yaws papillomas and erosions were also found on the soles of the feet of one child. The index case had a skin punch biopsy of a partially treated papilloma on his axilla. Histopathological findings showed lichenoid psoriasiform dermatitis with plasma cells, consistent with yaws. Conclusions The clinical, serological, and histopathological confirmation of four yaws cases among children has made the Philippines the 14th country endemic for yaws. This report can help health personnel recognize hidden cases of yaws based on skin signs and serological tests. Yaws remained unrecognized and unreported in the Philippines and in countries previously endemic for yaws probably due to the unsustained integration of the yaws program in the general health services and complacency after the 1950s eradication campaign. Our findings have provided the necessary evidence and stimulus to develop a yaws control and eradication program as one of the country’s neglected tropical diseases.
Collapse
Affiliation(s)
- Belen Lardizabal Dofitas
- Philippine Leprosy Mission, Inc., University of the Philippines Manila - College of Medicine, Manila, the Philippines. .,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Sherjan P Kalim
- Cotabato Regional and Medical Center - Department of Pathology, Cotabato City, the Philippines
| | - Camille B Toledo
- Rural Health Unit, Municipality of Tulunan, North Cotabato province & Southern Philippines Medical Center, Davao City, the Philippines
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
29
|
Grant JC, González-Beiras C, Amick KM, Fortney KR, Gangaiah D, Humphreys TL, Mitjà O, Abecasis A, Spinola SM. Multiple Class I and Class II Haemophilus ducreyi Strains Cause Cutaneous Ulcers in Children on an Endemic Island. Clin Infect Dis 2019; 67:1768-1774. [PMID: 29897409 DOI: 10.1093/cid/ciy343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/18/2018] [Indexed: 12/14/2022] Open
Abstract
Background Together with Treponema pallidum subspecies pertenue, Haemophilus ducreyi is a major cause of exudative cutaneous ulcers (CUs) in children. For H. ducreyi, both class I and class II strains, asymptomatic colonization, and environmental reservoirs have been found in endemic regions, but the epidemiology of this infection is unknown. Methods Based on published whole-genome sequences of H. ducreyi CU strains, a single-locus typing system was developed and applied to H. ducreyi-positive CU samples obtained prior to, 1 year after, and 2 years after the initiation of a mass drug administration campaign to eradicate CU on Lihir Island in Papua New Guinea. DNA from the CU samples was amplified with class I and class II dsrA-specific primers and sequenced; the samples were classified into dsrA types, which were geospatially mapped. Selection pressure analysis was performed on the dsrA sequences. Results Thirty-seven samples contained class I sequences, 27 contained class II sequences, and 13 contained both. There were 5 class I and 4 class II types circulating on the island; 3 types accounted for approximately 87% of the strains. The composition and geospatial distribution of the types varied little over time and there was no evidence of selection pressure. Conclusions Multiple strains of H. ducreyi cause CU on an endemic island and coinfections are common. In contrast to recent findings with T. pallidum pertenue, strain composition is not affected by antibiotic pressure, consistent with environmental reservoirs of H. ducreyi. Such reservoirs must be addressed to achieve eradication of H. ducreyi.
Collapse
Affiliation(s)
- Jacob C Grant
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis
| | | | - Kristen M Amick
- Department of Biology, Allegheny College, Meadville, Pennsylvania
| | - Kate R Fortney
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis
| | - Dharanesh Gangaiah
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis
| | | | - Oriol Mitjà
- Lihir Medical Centre-International SOS, Newcrest Mining, Lihir Island, Papua New Guinea.,Barcelona Institute for Global Health, Hospital Clinic, University of Barcelona, Spain.,School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby
| | - Ana Abecasis
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Lisbon, Portugal
| | - Stanley M Spinola
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis.,Department of Medicine, Indiana University School of Medicine, Indianapolis.,Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis
| |
Collapse
|
30
|
A Class I Haemophilus ducreyi Strain Containing a Class II hgbA Allele Is Partially Attenuated in Humans: Implications for HgbA Vaccine Efficacy Trials. Infect Immun 2019; 87:IAI.00112-19. [PMID: 31036601 DOI: 10.1128/iai.00112-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/21/2019] [Indexed: 12/15/2022] Open
Abstract
Haemophilus ducreyi causes chancroid and is a major cause of cutaneous ulcers in children. Due to environmental reservoirs, both class I and class II H. ducreyi strains persist in cutaneous ulcer regions of endemicity following mass drug administration of azithromycin, suggesting the need for a vaccine. The hemoglobin receptor (HgbA) is a leading vaccine candidate, but its efficacy in animal models is class specific. Controlled human infection models can be used to evaluate vaccines, but only a class I strain (35000HP) has been characterized in this model. As a prelude to evaluating HgbA vaccines in the human model, we tested here whether a derivative of 35000HP containing a class II hgbA allele (FX548) is as virulent as 35000HP in humans. In eight volunteers infected at three sites with each strain, the papule formation rate was 95.8% for 35000HP versus 62.5% for FX548 (P = 0.021). Excluding doses of FX548 that were ≥2-fold higher than those of 35000HP, the pustule formation rate was 25% for 35000HP versus 11.7% for FX548 (P = 0.0053). By Western blot analysis, FX548 and 35000HP expressed equivalent amounts of HgbA in whole-cell lysates and outer membranes. The growth of FX548 and 35000HP was similar in media containing hemoglobin or hemin. By whole-genome sequencing and single-nucleotide polymorphism analysis, FX548 contained no mutations in open reading frames other than hgbA We conclude that by an unknown mechanism, FX548 is partially attenuated in humans and is not a suitable strain for HgbA vaccine efficacy trials in the model.
Collapse
|
31
|
Determination of an Interaction Network between an Extracellular Bacterial Pathogen and the Human Host. mBio 2019; 10:mBio.01193-19. [PMID: 31213562 PMCID: PMC6581864 DOI: 10.1128/mbio.01193-19] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Dual RNA sequencing (RNA-seq) offers the promise of determining an interactome at a transcriptional level between a bacterium and the host but has yet to be done on any bacterial infection in human tissue. We performed dual RNA-seq and metabolomics analyses on wounded and infected sites following experimental infection of the arm with H. ducreyi. Our results suggest that H. ducreyi survives in an abscess by utilizing l-ascorbate as an alternative carbon source, possibly taking advantage of host ascorbic acid recycling, and that H. ducreyi also adapts by upregulating genes involved in anaerobic metabolism and inorganic ion and nutrient transport. To our knowledge, this is the first description of an interaction network between a bacterium and the human host at a site of infection. A major gap in understanding infectious diseases is the lack of information about molecular interaction networks between pathogens and the human host. Haemophilus ducreyi causes the genital ulcer disease chancroid in adults and is a leading cause of cutaneous ulcers in children in the tropics. We developed a model in which human volunteers are infected on the upper arm with H. ducreyi until they develop pustules. To define the H. ducreyi and human interactome, we determined bacterial and host transcriptomic and host metabolomic changes in pustules. We found that in vivoH. ducreyi transcripts were distinct from those in the inocula, as were host transcripts in pustule and wounded control sites. Many of the upregulated H. ducreyi genes were found to be involved in ascorbic acid and anaerobic metabolism and inorganic ion/nutrient transport. The top 20 significantly expressed human pathways showed that all were involved in immune responses. We generated a bipartite network for interactions between host and bacterial gene transcription; multiple positively correlated networks contained H. ducreyi genes involved in anaerobic metabolism and host genes involved with the immune response. Metabolomic studies showed that pustule and wounded samples had different metabolite compositions; the top ion pathway involved ascorbate and aldarate metabolism, which correlated with the H. ducreyi transcriptional response and upregulation of host genes involved in ascorbic acid recycling. These data show that an interactome exists between H. ducreyi and the human host and suggest that H. ducreyi exploits the metabolic niche created by the host immune response.
Collapse
|
32
|
Kositz C, Butcher R, Marks M. New Diagnostics for Yaws. Am J Trop Med Hyg 2018; 96:3-4. [PMID: 28077737 PMCID: PMC5239706 DOI: 10.4269/ajtmh.16-0639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/06/2016] [Indexed: 11/07/2022] Open
Affiliation(s)
- Christian Kositz
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robert Butcher
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michael Marks
- The Hospital for Tropical Diseases, London, United Kingdom.,Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
33
|
Pediatric travelers presenting to an Australian emergency department (2014-2015): A retrospective, cross-sectional analysis. Travel Med Infect Dis 2018; 31:101345. [PMID: 30395939 DOI: 10.1016/j.tmaid.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 10/26/2018] [Accepted: 11/01/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Epidemiological data on pediatric travelers are lacking, especially from Oceania. We aimed to evaluate travelers presenting to a pediatric emergency department in Sydney during a time of heightened travel surveillance. METHOD Cases between December 2014 and February 2015 were ascertained by screening medical records for key terms and visa status, as well as laboratory data for malaria testing. Cases were restricted to communicable diseases and evidence of travel within 21 days. RESULTS 104 children were identified. 82 children were Australian-resident travelers returning from abroad, 11 were visitors to Australia, 8 were recent migrants/refugees and 3 were medical transfers. Travel and behavioral patterns were characterized by exposures to low-income countries in the Asia-Pacific, visiting families and relatives, prolonged exposure periods and limited uptake of prophylaxis. Intrinsic vulnerabilities included extremes of age (median: 3.3 years) and pre-existing co-morbidities (6.7%). Common syndromes were respiratory (38.5%), systemic febrile illness (19.2%), acute diarrhea (17.3%) and dermatological conditions (9.6%). A minority were diagnosed with tropical infections: four typhoid or paratyphoid fever, two dengue and one tropical ulcer. CONCLUSIONS Young travelers are a heterogeneous group who present with a broad spectrum of diseases, from the benign to the life-threatening. Our data may be used to inform diagnostic approaches, empiric therapies and contribute towards public health strategies.
Collapse
|
34
|
Mooring EQ, Mitjà O, Murray MB. Spatial-temporal clustering analysis of yaws on Lihir Island, Papua New Guinea to enhance planning and implementation of eradication programs. PLoS Negl Trop Dis 2018; 12:e0006840. [PMID: 30372426 PMCID: PMC6224128 DOI: 10.1371/journal.pntd.0006840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/08/2018] [Accepted: 09/12/2018] [Indexed: 12/04/2022] Open
Abstract
Background In the global program for the eradication of yaws, assessments of the prevalence of the disease are used to decide where to initiate mass treatment. However, the smallest administrative unit that should be used as the basis for making decisions is not clear. We investigated spatial and temporal clustering of yaws to help inform the choice of implementation unit. Methodology/Principal findings We analyzed 11 years of passive surveillance data on incident yaws cases (n = 1448) from Lihir Island, Papua New Guinea. After adjusting for age, sex, and trends in health-seeking, we detected three non-overlapping spatial-temporal clusters (p < 1 × 10−17, p = 1.4 × 10−14, p = 1.4 × 10−8). These lasted from 28 to 47 months in duration and each encompassed between 4 and 6 villages. We also assessed spatial clustering of prevalent yaws cases (n = 532) that had been detected in 7 biannual active case finding surveys beginning in 2013. We identified 1 statistically significant cluster in each survey. We considered the possibility that schools that serve multiple villages might be loci of transmission, but we found no evidence that incident cases of yaws among 8- to 14-year-olds clustered within primary school attendance areas (p = 0.6846). Conclusions/Significance These clusters likely reflect transmission of yaws across village boundaries; villages may be epidemiologically linked to a degree such that mass drug administration may be more effectively implemented at a spatial scale larger than the individual village. The World Health Organization aims to eradicate yaws using mass drug administration (MDA), which consists of treating everyone in an administrative unit with antibiotics. Prevalence assessments are used to identify endemic communities for mass treatment programs, but the spatial scale (eg, village, sub-district, district, or province) at which mass treatment should be implemented is currently unclear. The administrative unit which is used as the basis for making decisions about implementing MDA is called the implementation unit. For example, if the implementation unit is the sub-district, then public health officials must determine for each sub-district whether MDA is warranted. All villages in the same sub-district will necessarily have the same treatment status, whereas all sub-districts in the same district need not share a treatment status. The choice of implementation unit depends on many factors; one of these is the underlying transmission patterns of the disease. Using data from Lihir Island, Papua New Guinea, we found that geographic clusters of yaws often spanned multiple villages. These clusters likely reflect transmission of the disease across village boundaries and suggest that it may be best to implement MDA at a spatial scale larger than the individual village, for example at sub-district level.
Collapse
Affiliation(s)
- Eric Q. Mooring
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Oriol Mitjà
- Lihir Medical Centre-International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona, Barcelona, Spain
- Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Megan B. Murray
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Partners In Health, Boston, Massachusetts, United States of America
| |
Collapse
|
35
|
Advances in the Treatment of Yaws. Trop Med Infect Dis 2018; 3:tropicalmed3030092. [PMID: 30274488 PMCID: PMC6161241 DOI: 10.3390/tropicalmed3030092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 11/17/2022] Open
Abstract
Yaws is one of the three endemic treponematoses and is recognised by the World Health Organization as a neglected tropical disease. Yaws is currently reported in 15 countries in the Pacific, South-East Asia, West and Central Africa, predominantly affects children, and results in destructive lesions of the skin and soft tissues. For most of the twentieth century penicillin-based treatment was the standard of care and resistance to penicillin has still not been described. Recently, oral azithromycin has been shown to be an effective treatment for yaws, facilitating renewed yaws eradication efforts. Resistance to azithromycin is an emerging threat and close surveillance will be required as yaws eradication efforts are scaled up globally.
Collapse
|
36
|
González-Beiras C, Kapa A, Vall-Mayans M, Paru R, Gavilán S, Houinei W, Bieb S, Sanz S, Martins R, Mitjà O. Single-Dose Azithromycin for the Treatment of Haemophilus ducreyi Skin Ulcers in Papua New Guinea. Clin Infect Dis 2018; 65:2085-2090. [PMID: 29020192 DOI: 10.1093/cid/cix723] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/11/2017] [Indexed: 01/09/2023] Open
Abstract
Background Haemophilus ducreyi (HD) and Treponema pallidum subspecies pertenue (TP) are major causative agents of cutaneous ulcer (CU) in the tropics. Azithromycin is recommended to treat sexually transmitted HD infections and has good in vitro activity against HD strains from both genital and skin ulcers. We investigated the efficacy of oral single-dose azithromycin on HD-CU. Methods We conducted a community-based cohort study in Lihir Island, Papua New Guinea, from October 2014 through May 2016. Consenting patients with skin ulcers >1 cm in diameter were eligible for this study and had collected a lesional swab for polymerase chain reaction (PCR). All participants were treated with single-dose azithromycin (30 mg/kg) and were followed up for assessment of clinical resolution. We retrospectively classified patients according to PCR results into HD, TP, and PCR-negative groups. The primary endpoint was healing rates of HD-CU at 14 days after treatment. Results We obtained full outcome data from 246 patients; 131 (53.3%) were HD PCR positive, 37 (15.0%) were TP positive, and 78 (31.7%) were negative for all tests. Healing rates were 88.5% (95% confidence interval [CI], .82-.93) in the HD group, 78.4% [95% CI, .63-.89] in the TP group, and 74.4% (95% CI, .64-.83) in the PCR-negative group. If we included the participants with improved ulcers, the healing rates increased to 94.7%, 97.3%, and 89.7% respectively. HD cases classified as not healed all converted to HD-negative PCR. Conclusions Based upon clinical resolution and PCR conversion to HD negative, a single oral dose of azithromycin is efficacious for the treatment of HD-CU. These results have implications for the treatment of individual patients and for the use of antibiotics in public health strategies to control CU in the tropics.
Collapse
Affiliation(s)
- Camila González-Beiras
- Barcelona Institute for Global Health, Hospital Clinic, University of Barcelona, Spain.,Global Public Health PhD Program, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Portugal
| | - August Kapa
- Lihir Medical Centre-International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
| | - Marti Vall-Mayans
- Sexually Transmitted Infections Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - Raymond Paru
- Lihir Medical Centre-International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
| | - Sergi Gavilán
- Barcelona Institute for Global Health, Hospital Clinic, University of Barcelona, Spain
| | - Wendy Houinei
- Disease Control Branch, National Department of Health, Port Moresby, Papua New Guinea
| | - Sibauk Bieb
- Disease Control Branch, National Department of Health, Port Moresby, Papua New Guinea
| | - Sergi Sanz
- Barcelona Institute for Global Health, Hospital Clinic, University of Barcelona, Spain
| | - Rosario Martins
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Portugal
| | - Oriol Mitjà
- Barcelona Institute for Global Health, Hospital Clinic, University of Barcelona, Spain.,Lihir Medical Centre-International SOS, Newcrest Mining, Lihir Island, Papua New Guinea.,School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby
| |
Collapse
|
37
|
Noguera-Julian M, González-Beiras C, Parera M, Ubals M, Kapa A, Paredes R, Mitjà O. Etiological Characterization of the Cutaneous Ulcer Syndrome in Papua New Guinea Using Shotgun Metagenomics. Clin Infect Dis 2018; 68:482-489. [DOI: 10.1093/cid/ciy502] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 06/13/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marc Noguera-Julian
- IrsiCaixa AIDS Research Institute, Badalona, Spain
- Universitat Autònoma de Barcelona, Spain
- Universitat de Vic-Universitat Central de Catalunya, Vic, Spain
| | | | | | - Maria Ubals
- Barcelona Institute for Global Health, Hospital Clínic-University of Barcelona, Spain
| | - August Kapa
- Lihir Medical Center–International SOS, Newcrest Mining, Papua New Guinea
| | - Roger Paredes
- IrsiCaixa AIDS Research Institute, Badalona, Spain
- Universitat Autònoma de Barcelona, Spain
- Universitat de Vic-Universitat Central de Catalunya, Vic, Spain
- HIV Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Oriol Mitjà
- Barcelona Institute for Global Health, Hospital Clínic-University of Barcelona, Spain
- Lihir Medical Center–International SOS, Newcrest Mining, Papua New Guinea
| |
Collapse
|
38
|
de Sarom A, Kumar Jaiswal A, Tiwari S, de Castro Oliveira L, Barh D, Azevedo V, Jose Oliveira C, de Castro Soares S. Putative vaccine candidates and drug targets identified by reverse vaccinology and subtractive genomics approaches to control Haemophilus ducreyi, the causative agent of chancroid. J R Soc Interface 2018; 15:20180032. [PMID: 29792307 PMCID: PMC6000166 DOI: 10.1098/rsif.2018.0032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/30/2018] [Indexed: 12/13/2022] Open
Abstract
Chancroid is a sexually transmitted infection (STI) caused by the Gram-negative bacterium Haemophilus ducreyi The control of chancroid is difficult and the only current available treatment is antibiotic therapy; however, antibiotic resistance has been reported in endemic areas. Owing to recent outbreaks of STIs worldwide, it is important to keep searching for new treatment strategies and preventive measures. Here, we applied reverse vaccinology and subtractive genomic approaches for the in silico prediction of potential vaccine and drug targets against 28 strains of H. ducreyi We identified 847 non-host homologous proteins, being 332 exposed/secreted/membrane and 515 cytoplasmic proteins. We also checked their essentiality, functionality and virulence. Altogether, we predicted 13 candidate vaccine targets and three drug targets, where two vaccines (A01_1275, ABC transporter substrate-binding protein; and A01_0690, Probable transmembrane protein) and three drug targets (A01_0698, Purine nucleoside phosphorylase; A01_0702, Transcription termination factor; and A01_0677, Fructose-bisphosphate aldolase class II) are harboured by pathogenicity islands. Finally, we applied a molecular docking approach to analyse each drug target and selected ZINC77257029, ZINC43552589 and ZINC67912117 as promising molecules with favourable interactions with the target active site residues. Altogether, the targets identified here may be used in future strategies to control chancroid worldwide.
Collapse
Affiliation(s)
- Alissa de Sarom
- Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Arun Kumar Jaiswal
- Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sandeep Tiwari
- Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Letícia de Castro Oliveira
- Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Debmalya Barh
- Centre for Genomics and Applied Gene Technology, Institute of Integrative Omics and Applied Biotechnology, Nonakuri, Purba Medinipur, West Bengal, India
| | - Vasco Azevedo
- Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Carlo Jose Oliveira
- Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Siomar de Castro Soares
- Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
- Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
39
|
Mitjà O, Godornes C, Houinei W, Kapa A, Paru R, Abel H, González-Beiras C, Bieb SV, Wangi J, Barry AE, Sanz S, Bassat Q, Lukehart SA. Re-emergence of yaws after single mass azithromycin treatment followed by targeted treatment: a longitudinal study. Lancet 2018; 391:1599-1607. [PMID: 29428183 PMCID: PMC5920722 DOI: 10.1016/s0140-6736(18)30204-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/29/2017] [Accepted: 11/23/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Yaws is a substantial cause of chronic disfiguring ulcers in children in at least 14 countries in the tropics. WHO's newly adopted strategy for yaws eradication uses a single round of mass azithromycin treatment followed by targeted treatment programmes, and data from pilot studies have shown a short-term significant reduction of yaws. We assessed the long-term efficacy of the WHO strategy for yaws eradication. METHODS Between April 15, 2013, and Oct 24, 2016, we did a longitudinal study on a Papua New Guinea island (Lihir; 16 092 population) in which yaws was endemic. In the initial study, the participants were followed for 12 months; in this extended follow-up study, clinical, serological, and PCR surveys were continued every 6 months for 42 months. We used genotyping and travel history to identify importation events. Active yaws confirmed by PCR specific for Treponema pallidum was the primary outcome indicator. The study is registered with ClinicalTrials.gov, number NCT01955252. FINDINGS Mass azithromycin treatment (coverage rate of 84%) followed by targeted treatment programmes reduced the prevalence of active yaws from 1·8% to a minimum of 0·1% at 18 months (difference from baseline -1·7%, 95% CI, -1·9 to -1·4; p<0·0001), but the infection began to re-emerge after 24 months with a significant increase to 0·4% at 42 months (difference from 18 months 0·3%, 95% CI 0·1 to 0·4; p<0·0001). At each timepoint after baseline, more than 70% of the total community burden of yaws was found in individuals who had not had the mass treatment or as new infections in non-travelling residents. At months 36 and 42, five cases of active yaws, all from the same village, showed clinical failure following azithromycin treatment, with PCR-detected mutations in the 23S ribosomal RNA genes conferring resistance to azithromycin. A sustained decrease in the prevalence of high-titre latent yaws from 13·7% to <1·5% in asymptomatic children aged 1-5 years old and of genetic diversity of yaws strains from 0·139 to less than 0·046 between months 24 and 42 indicated a reduction in transmission of infection. INTERPRETATION The implementation of the WHO strategy did not, in the long-term, achieve elimination in a high-endemic community mainly due to the individuals who were absent at the time of mass treatment in whom yaws reactivated; repeated mass treatment might be necessary to eliminate yaws. To our knowledge, this is the first report of the emergence of azithromycin-resistant T p pertenue and spread within one village. Communities' surveillance should be strengthened to detect any possible treatment failure and biological markers of resistance. FUNDING ISDIN laboratories, Newcrest Mining Limited, and US Public Health Service National Institutes of Health.
Collapse
Affiliation(s)
- Oriol Mitjà
- Barcelona Institute for Global Health, Hospital Clinic-University of Barcelona, Barcelona, Spain; Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea; Lihir Medical Center, International SOS-Newcrest Mining, Lihir Island, Papua New Guinea.
| | - Charmie Godornes
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Wendy Houinei
- Disease Control Branch, National Department of Health, Port Moresby, Papua New Guinea
| | - August Kapa
- Lihir Medical Center, International SOS-Newcrest Mining, Lihir Island, Papua New Guinea
| | - Raymond Paru
- Lihir Medical Center, International SOS-Newcrest Mining, Lihir Island, Papua New Guinea
| | - Haina Abel
- Lihir Medical Center, International SOS-Newcrest Mining, Lihir Island, Papua New Guinea
| | - Camila González-Beiras
- Barcelona Institute for Global Health, Hospital Clinic-University of Barcelona, Barcelona, Spain; Lisbon Institute of Hygiene and Tropical Medicine, Lisbon, Portugal
| | - Sibauk V Bieb
- Disease Control Branch, National Department of Health, Port Moresby, Papua New Guinea
| | - James Wangi
- Office of the World Health Organization (WHO) Representative for Papua New Guinea, WHO, Port Moresby, Papua New Guinea
| | - Alyssa E Barry
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Sergi Sanz
- Barcelona Institute for Global Health, Hospital Clinic-University of Barcelona, Barcelona, Spain; Biostatistics Unit, Department of Public Health, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Quique Bassat
- Barcelona Institute for Global Health, Hospital Clinic-University of Barcelona, Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Paediatric Infectious Diseases Unit, Paediatric Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Sheila A Lukehart
- Department of Medicine, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| |
Collapse
|
40
|
van Hattem JM, Langeveld TJC, Bruisten SM, Kolader M, Grobusch MP, de Vries HJC, de Bree GJ. Haemophilus ducreyi cutaneous ulcer contracted at Seram Island, Indonesia, presented in the Netherlands. PLoS Negl Trop Dis 2018; 12:e0006273. [PMID: 29649298 PMCID: PMC5896912 DOI: 10.1371/journal.pntd.0006273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Overview We describe the first case of a cutaneous ulcer caused by Haemophilus ducreyi imported from Indonesia to the Netherlands. Skin infections caused by H. ducreyi are uncommon in travellers and have been described in just a few case reports and were all contracted on the Pacific Islands. The case A 22-year-old healthy male visited the Center of Tropical Medicine and Travel Medicine in February 2017 with a cutaneous ulcer of the right lateral malleolus 4 weeks after returning from Indonesia (Seram and Ambon Islands). He had noticed a small skin abrasion on the right ankle after slipping on a rock during a jungle trip on Seram Island. Back in the Netherlands, a painful ulcer developed at the same body location, and despite treatment with flucloxacillin, his complaints worsened. A swab that was taken for culture showed growth of small grey colonies that were characterised as H. ducreyi with matrix-assisted laser desorption/ionisation time-of-flight (MALDI-TOF) mass spectrometry. Treatment with ciprofloxacin for the diagnosis of H. ducreyi cutaneous ulcer was started, and the ulcer clearly diminished, leaving only a small healing ulcer. Discussion H. ducreyi is normally the causative agent of genital ulcers but is increasingly recognised as a cause of chronic skin ulcers, e.g., in Papua New Guinea. In our patient, the infection was very likely contracted in the Maluku province of Indonesia and imported into the Netherlands. No reports of infection with H. ducreyi from Indonesia could be found in literature, but this case indicates that H. ducreyi is present in at least one of the northeastern islands of Indonesia, which is important for local healthcare. Additionally, it illustrates the role of this agent as a cause of cutaneous ulcers in previously healthy travellers.
Collapse
Affiliation(s)
- Jarne M. van Hattem
- Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- * E-mail:
| | - Tessa J. C. Langeveld
- Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Internal Medicine, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Sylvia M. Bruisten
- Public Health Laboratory (PHL), Department of Infectious Diseases, GGD/Public Health Service Amsterdam, Amsterdam, the Netherlands
- Amsterdam Infection & Immunity Institute (AI&II), Amsterdam, the Netherlands
| | - Marion Kolader
- Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin P. Grobusch
- Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Henry J. C. de Vries
- Amsterdam Infection & Immunity Institute (AI&II), Amsterdam, the Netherlands
- STI Outpatient Clinic, Department of Infectious Diseases, GGD/Public Health Service Amsterdam, Amsterdam, the Netherlands
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Godelieve J. de Bree
- Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
41
|
Marks M, Fookes M, Wagner J, Ghinai R, Sokana O, Sarkodie YA, Solomon AW, Mabey DC, Thomson NR. Direct Whole-Genome Sequencing of Cutaneous Strains of Haemophilus ducreyi. Emerg Infect Dis 2018; 24:786-789. [PMID: 29553314 PMCID: PMC5875288 DOI: 10.3201/eid2404.171726] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Haemophilus ducreyi, which causes chancroid, has emerged as a cause of pediatric skin disease. Isolation of H. ducreyi in low-income settings is challenging, limiting phylogenetic investigation. Next-generation sequencing demonstrates that cutaneous strains arise from class I and II H. ducreyi clades and that class II may represent a distinct subspecies.
Collapse
Affiliation(s)
| | | | - Josef Wagner
- London School of Hygiene & Tropical Medicine, London, UK (M. Marks, R. Ghinai, A.W. Solomon, D.C.W. Mabey, N.R. Thomson)
- Hospital for Tropical Diseases, London (M. Marks, A.W. Solomon, D.C.W. Mabey)
- Wellcome Trust Sanger Centre, Cambridge, UK (M. Fookes, J. Wagner, N.R. Thomson)
- Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands (O. Sokana)
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (Y.-A. Sarkodie)
| | - Rosanna Ghinai
- London School of Hygiene & Tropical Medicine, London, UK (M. Marks, R. Ghinai, A.W. Solomon, D.C.W. Mabey, N.R. Thomson)
- Hospital for Tropical Diseases, London (M. Marks, A.W. Solomon, D.C.W. Mabey)
- Wellcome Trust Sanger Centre, Cambridge, UK (M. Fookes, J. Wagner, N.R. Thomson)
- Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands (O. Sokana)
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (Y.-A. Sarkodie)
| | - Oliver Sokana
- London School of Hygiene & Tropical Medicine, London, UK (M. Marks, R. Ghinai, A.W. Solomon, D.C.W. Mabey, N.R. Thomson)
- Hospital for Tropical Diseases, London (M. Marks, A.W. Solomon, D.C.W. Mabey)
- Wellcome Trust Sanger Centre, Cambridge, UK (M. Fookes, J. Wagner, N.R. Thomson)
- Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands (O. Sokana)
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (Y.-A. Sarkodie)
| | - Yaw-Adu Sarkodie
- London School of Hygiene & Tropical Medicine, London, UK (M. Marks, R. Ghinai, A.W. Solomon, D.C.W. Mabey, N.R. Thomson)
- Hospital for Tropical Diseases, London (M. Marks, A.W. Solomon, D.C.W. Mabey)
- Wellcome Trust Sanger Centre, Cambridge, UK (M. Fookes, J. Wagner, N.R. Thomson)
- Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands (O. Sokana)
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (Y.-A. Sarkodie)
| | - Anthony W. Solomon
- London School of Hygiene & Tropical Medicine, London, UK (M. Marks, R. Ghinai, A.W. Solomon, D.C.W. Mabey, N.R. Thomson)
- Hospital for Tropical Diseases, London (M. Marks, A.W. Solomon, D.C.W. Mabey)
- Wellcome Trust Sanger Centre, Cambridge, UK (M. Fookes, J. Wagner, N.R. Thomson)
- Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands (O. Sokana)
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (Y.-A. Sarkodie)
| | - David C.W. Mabey
- London School of Hygiene & Tropical Medicine, London, UK (M. Marks, R. Ghinai, A.W. Solomon, D.C.W. Mabey, N.R. Thomson)
- Hospital for Tropical Diseases, London (M. Marks, A.W. Solomon, D.C.W. Mabey)
- Wellcome Trust Sanger Centre, Cambridge, UK (M. Fookes, J. Wagner, N.R. Thomson)
- Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands (O. Sokana)
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (Y.-A. Sarkodie)
| | - Nicholas R. Thomson
- London School of Hygiene & Tropical Medicine, London, UK (M. Marks, R. Ghinai, A.W. Solomon, D.C.W. Mabey, N.R. Thomson)
- Hospital for Tropical Diseases, London (M. Marks, A.W. Solomon, D.C.W. Mabey)
- Wellcome Trust Sanger Centre, Cambridge, UK (M. Fookes, J. Wagner, N.R. Thomson)
- Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands (O. Sokana)
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (Y.-A. Sarkodie)
| |
Collapse
|
42
|
Marks M, Mitjà O, Bottomley C, Kwakye C, Houinei W, Bauri M, Adwere P, Abdulai AA, Dua F, Boateng L, Wangi J, Ohene SA, Wangnapi R, Simpson SV, Miag H, Addo KK, Basing LA, Danavall D, Chi KH, Pillay A, Ballard R, Solomon AW, Chen CY, Bieb SV, Adu-Sarkodie Y, Mabey DCW, Asiedu K. Comparative efficacy of low-dose versus standard-dose azithromycin for patients with yaws: a randomised non-inferiority trial in Ghana and Papua New Guinea. Lancet Glob Health 2018; 6:e401-e410. [PMID: 29456191 PMCID: PMC7116878 DOI: 10.1016/s2214-109x(18)30023-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/12/2017] [Accepted: 01/11/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND A dose of 30 mg/kg of azithromycin is recommended for treatment of yaws, a disease targeted for global eradication. Treatment with 20 mg/kg of azithromycin is recommended for the elimination of trachoma as a public health problem. In some settings, these diseases are co-endemic. We aimed to determine the efficacy of 20 mg/kg of azithromycin compared with 30 mg/kg azithromycin for the treatment of active and latent yaws. METHODS We did a non-inferiority, open-label, randomised controlled trial in children aged 6-15 years who were recruited from schools in Ghana and schools and the community in Papua New Guinea. Participants were enrolled based on the presence of a clinical lesion that was consistent with infectious primary or secondary yaws and a positive rapid diagnostic test for treponemal and non-treponemal antibodies. Participants were randomly assigned (1:1) to receive either standard-dose (30 mg/kg) or low-dose (20 mg/kg) azithromycin by a computer-generated random number sequence. Health-care workers assessing clinical outcomes in the field were not blinded to the patient's treatment, but investigators involved in statistical or laboratory analyses and the participants were blinded to treatment group. We followed up participants at 4 weeks and 6 months. The primary outcome was cure at 6 months, defined as lesion healing at 4 weeks in patients with active yaws and at least a four-fold decrease in rapid plasma reagin titre from baseline to 6 months in patients with active and latent yaws. Active yaws was defined as a skin lesion that was positive for Treponema pallidum ssp pertenue in PCR testing. We used a non-inferiority margin of 10%. This trial was registered with ClinicalTrials.gov, number NCT02344628. FINDINGS Between June 12, 2015, and July 2, 2016, 583 (65·1%) of 895 children screened were enrolled; 292 patients were assigned a low dose of azithromycin and 291 patients were assigned a standard dose of azithromycin. 191 participants had active yaws and 392 had presumed latent yaws. Complete follow-up to 6 months was available for 157 (82·2%) of 191 patients with active yaws. In cases of active yaws, cure was achieved in 61 (80·3%) of 76 patients in the low-dose group and in 68 (84·0%) of 81 patients in the standard-dose group (difference 3·7%; 95% CI -8·4 to 15·7%; this result did not meet the non-inferiority criterion). There were no serious adverse events reported in response to treatment in either group. The most commonly reported adverse event at 4 weeks was gastrointestinal upset, with eight (2·7%) participants in each group reporting this symptom. INTERPRETATION In this study, low-dose azithromycin did not meet the prespecified non-inferiority margin compared with standard-dose azithromycin in achieving clinical and serological cure in PCR-confirmed active yaws. Only a single participant (with presumed latent yaws) had definitive serological failure. This work suggests that 20 mg/kg of azithromycin is probably effective against yaws, but further data are needed. FUNDING Coalition for Operational Research on Neglected Tropical Diseases.
Collapse
Affiliation(s)
- Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases; London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, London, UK
| | - Oriol Mitjà
- Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain; Lihir Medical Centre, International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
| | - Christian Bottomley
- Clinical Research Department, Faculty of Infectious and Tropical Diseases and MRC Tropical Epidemiology Group, Faculty of Epidemiology and Public Health
| | | | - Wendy Houinei
- Department of Health, Port Moresby, Papua New Guinea
| | - Mathias Bauri
- Department of Health, Port Moresby, Papua New Guinea
| | | | | | | | | | - James Wangi
- World Health Organization Country Office, Port Moresby, Papua New Guinea
| | | | | | | | - Helen Miag
- Department of Health, Port Moresby, Papua New Guinea
| | - Kennedy K Addo
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Laud A Basing
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Damien Danavall
- Molecular Diagnostics and Typing Laboratory, Laboratory Reference and Research Branch, Division of STD Prevention
| | - Kai H Chi
- Molecular Diagnostics and Typing Laboratory, Laboratory Reference and Research Branch, Division of STD Prevention
| | - Allan Pillay
- Molecular Diagnostics and Typing Laboratory, Laboratory Reference and Research Branch, Division of STD Prevention
| | - Ronald Ballard
- Molecular Diagnostics and Typing Laboratory, Laboratory Reference and Research Branch, Division of STD Prevention Center for Global Health
| | - Anthony W Solomon
- Centers for Disease Control and Prevention, Atlanta, GA, USA; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Cheng Y Chen
- Molecular Diagnostics and Typing Laboratory, Laboratory Reference and Research Branch, Division of STD Prevention
| | - Sibauk V Bieb
- Centers for Disease Control and Prevention, Atlanta, GA, USA; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland Department of Public Health, National Department of Health, Waigani, Papua New Guinea
| | - Yaw Adu-Sarkodie
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - David CW Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases; London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, London, UK
| | - Kingsley Asiedu
- Centers for Disease Control and Prevention, Atlanta, GA, USA; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | | |
Collapse
|
43
|
Knauf S, Lüert S, Šmajs D, Strouhal M, Chuma IS, Frischmann S, Bakheit M. Gene target selection for loop-mediated isothermal amplification for rapid discrimination of Treponema pallidum subspecies. PLoS Negl Trop Dis 2018; 12:e0006396. [PMID: 29649256 PMCID: PMC5978989 DOI: 10.1371/journal.pntd.0006396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 04/24/2018] [Accepted: 03/21/2018] [Indexed: 11/19/2022] Open
Abstract
We show proof of concept for gene targets (polA, tprL, and TP_0619) that can be used in loop-mediated isothermal amplification (LAMP) assays to rapidly differentiate infection with any of the three Treponema pallidum subspecies (pallidum (TPA), pertenue (TPE), and endemicum (TEN)) and which are known to infect humans and nonhuman primates (NHPs). Four TPA, six human, and two NHP TPE strains, as well as two human TEN strains were used to establish and validate the LAMP assays. All three LAMP assays were highly specific for the target DNA. Amplification was rapid (5-15 min) and within a range of 10E+6 to 10E+2 of target DNA molecules. Performance in NHP clinical samples was similar to the one seen in human TPE strains. The newly designed LAMP assays provide proof of concept for a diagnostic tool that enhances yaws clinical diagnosis. It is highly specific for the target DNA and does not require expensive laboratory equipment. Test results can potentially be interpreted with the naked eye, which makes it suitable for the use in remote clinical settings.
Collapse
Affiliation(s)
- Sascha Knauf
- Work Group Neglected Tropical Diseases, Infection Biology Unit, German Primate Center, Leibniz- Institute for Primate Research, Göttingen, Germany
| | - Simone Lüert
- Work Group Neglected Tropical Diseases, Infection Biology Unit, German Primate Center, Leibniz- Institute for Primate Research, Göttingen, Germany
| | - David Šmajs
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Michal Strouhal
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Idrissa S. Chuma
- Work Group Neglected Tropical Diseases, Infection Biology Unit, German Primate Center, Leibniz- Institute for Primate Research, Göttingen, Germany
- Sokoine University of Agriculture, Faculty of Veterinary Medicine, Morogoro, Tanzania
| | | | | |
Collapse
|
44
|
Abdulai AA, Agana-Nsiire P, Biney F, Kwakye-Maclean C, Kyei-Faried S, Amponsa-Achiano K, Simpson SV, Bonsu G, Ohene SA, Ampofo WK, Adu-Sarkodie Y, Addo KK, Chi KH, Danavall D, Chen CY, Pillay A, Sanz S, Tun Y, Mitjà O, Asiedu KB, Ballard RC. Community-based mass treatment with azithromycin for the elimination of yaws in Ghana-Results of a pilot study. PLoS Negl Trop Dis 2018; 12:e0006303. [PMID: 29566044 PMCID: PMC5863939 DOI: 10.1371/journal.pntd.0006303] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 02/06/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The WHO yaws eradication strategy consists of one round of total community treatment (TCT) of single-dose azithromycin with coverage of > 90%.The efficacy of the strategy to reduce the levels on infection has been demonstrated previously in isolated island communities in the Pacific region. We aimed to determine the efficacy of a single round of TCT with azithromycin to achieve a decrease in yaws prevalence in communities that are endemic for yaws and surrounded by other yaws-endemic areas. METHODS Surveys for yaws seroprevalence and prevalence of skin lesions were conducted among schoolchildren aged 5-15 years before and one year after the TCT intervention in the Abamkrom sub-district of Ghana. We used a cluster design with the schools as the primary sampling unit. Among 20 eligible primary schools in the sub district, 10 were assigned to the baseline survey and 10 to the post-TCT survey. The field teams conducted a physical examination for skin lesions and a dual point-of-care immunoassay for non-treponemal and treponemal antibodies of all children present at the time of the visit. We also undertook surveys with non-probabilistic sampling to collect lesion swabs for etiology and macrolide resistance assessment. RESULTS At baseline 14,548 (89%) of 16,287 population in the sub-district received treatment during TCT. Following one round of TCT, the prevalence of dual seropositivity among all children decreased from 10.9% (103/943) pre-TCT to 2.2% (27/1211) post-TCT (OR 0.19; 95%CI 0.09-0.37). The prevalence of serologically confirmed skin lesions consistent with active yaws was reduced from 5.7% (54/943) pre-TCT to 0.6% (7/1211) post-TCT (OR 0.10; 95% CI 0.25-0.35). No evidence of resistance to macrolides against Treponema pallidum subsp. pertenue was seen. DISCUSSION A single round of high coverage TCT with azithromycin in a yaws affected sub-district adjoining other endemic areas is effective in reducing the prevalence of seropositive children and the prevalence of early skin lesions consistent with yaws one year following the intervention. These results suggest that national yaws eradication programmes may plan the gradual expansion of mass treatment interventions without high short-term risk of reintroduction of infection from contiguous untreated endemic areas.
Collapse
Affiliation(s)
- Abdul Aziz Abdulai
- West Akim District Health Administration, Ghana Health Service, Asamankese, Ghana
| | | | - Frank Biney
- District Hospital Laboratory, Ghana Health Service, Asamankese, Ghana
| | | | | | | | | | - George Bonsu
- Expanded Programme on Immunization, Ghana Health Service, Accra, Ghana
| | | | | | - Yaw Adu-Sarkodie
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kennedy Kwasi Addo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Kai-Hua Chi
- Laboratory Reference and Research Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Damien Danavall
- Laboratory Reference and Research Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Cheng Y. Chen
- Laboratory Reference and Research Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Allan Pillay
- Laboratory Reference and Research Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sergi Sanz
- Barcelona Institute for Global Health, Hospital Clinic – University of Barcelona, Barcelona, Spain
| | - Ye Tun
- Center for Global Health, Centers of Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Oriol Mitjà
- Barcelona Institute for Global Health, Hospital Clinic – University of Barcelona, Barcelona, Spain
- Department of Community Health, Lihir Medical Centre, Lihir Island, Papua, New Guinea
| | - Kingsley Bampoe Asiedu
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
- * E-mail:
| | - Ronald C. Ballard
- Center for Global Health, Centers of Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
45
|
Šmajs D, Strouhal M, Knauf S. Genetics of human and animal uncultivable treponemal pathogens. INFECTION GENETICS AND EVOLUTION 2018; 61:92-107. [PMID: 29578082 DOI: 10.1016/j.meegid.2018.03.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
Abstract
Treponema pallidum is an uncultivable bacterium and the causative agent of syphilis (subsp. pallidum [TPA]), human yaws (subsp. pertenue [TPE]), and bejel (subsp. endemicum). Several species of nonhuman primates in Africa are infected by treponemes genetically undistinguishable from known human TPE strains. Besides Treponema pallidum, the equally uncultivable Treponema carateum causes pinta in humans. In lagomorphs, Treponema paraluisleporidarum ecovar Cuniculus and ecovar Lepus are the causative agents of rabbit and hare syphilis, respectively. All uncultivable pathogenic treponemes harbor a relatively small chromosome (1.1334-1.1405 Mbp) and show gene synteny with minimal genetic differences (>98% identity at the DNA level) between subspecies and species. While uncultivable pathogenic treponemes contain a highly conserved core genome, there are a number of highly variable and/or recombinant chromosomal loci. This is also reflected in the occurrence of intrastrain heterogeneity (genetic diversity within an infecting bacterial population). Molecular differences at several different chromosomal loci identified among TPA strains or isolates have been used for molecular typing and the epidemiological characterization of syphilis isolates. This review summarizes genome structure of uncultivable pathogenic treponemes including genetically variable regions.
Collapse
Affiliation(s)
- David Šmajs
- Department of Biology, Masaryk University, Kamenice 5, Building A6, 625 00 Brno, Czech Republic.
| | - Michal Strouhal
- Department of Biology, Masaryk University, Kamenice 5, Building A6, 625 00 Brno, Czech Republic.
| | - Sascha Knauf
- Work Group Neglected Tropical Diseases, Pathology Unit, German Primate Center, Leibniz Institute for Primate Research, Kellnerweg 4, 37077 Göttingen, Germany,.
| |
Collapse
|
46
|
Marks M, Fookes M, Wagner J, Butcher R, Ghinai R, Sokana O, Sarkodie YA, Lukehart SA, Solomon AW, Mabey DCW, Thomson N. Diagnostics for Yaws Eradication: Insights From Direct Next-Generation Sequencing of Cutaneous Strains of Treponema pallidum. Clin Infect Dis 2018; 66:818-824. [PMID: 29045605 PMCID: PMC5848336 DOI: 10.1093/cid/cix892] [Citation(s) in RCA: 22] [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: 04/19/2017] [Accepted: 10/13/2017] [Indexed: 11/23/2022] Open
Abstract
Background Yaws-like chronic ulcers can be caused by Treponema pallidum subspecies pertenue, Haemophilus ducreyi, or other, still-undefined bacteria. To permit accurate evaluation of yaws elimination efforts, programmatic use of molecular diagnostics is required. The accuracy and sensitivity of current tools remain unclear because our understanding of T. pallidum diversity is limited by the low number of sequenced genomes. Methods We tested samples from patients with suspected yaws collected in the Solomon Islands and Ghana. All samples were from patients whose lesions had previously tested negative using the Centers for Disease Control and Prevention (CDC) diagnostic assay in widespread use. However, some of these patients had positive serological assays for yaws on blood. We used direct whole-genome sequencing to identify T. pallidum subsp pertenue strains missed by the current assay. Results From 45 Solomon Islands and 27 Ghanaian samples, 11 were positive for T. pallidum DNA using the species-wide quantitative polymerase chain reaction (PCR) assay, from which we obtained 6 previously undetected T. pallidum subsp pertenue whole-genome sequences. These show that Solomon Islands sequences represent distinct T. pallidum subsp pertenue clades. These isolates were invisible to the CDC diagnostic PCR assay, due to sequence variation in the primer binding site. Conclusions Our data double the number of published T. pallidum subsp pertenue genomes. We show that Solomon Islands strains are undetectable by the PCR used in many studies and by health ministries. This assay is therefore not adequate for the eradication program. Next-generation genome sequence data are essential for these efforts.
Collapse
Affiliation(s)
- Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London
- Hospital for Tropical Diseases, London
| | - Maria Fookes
- Wellcome Trust Sanger Centre, Cambridge, United Kingdom
| | - Josef Wagner
- Wellcome Trust Sanger Centre, Cambridge, United Kingdom
| | - Robert Butcher
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London
| | - Rosanna Ghinai
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London
| | - Oliver Sokana
- Solomon Islands Ministry of Health and Medical Services, Honiara
| | - Yaw-Adu Sarkodie
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sheila A Lukehart
- Departments of Medicine and Global Health, University of Washington, Seattle
| | - Anthony W Solomon
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London
- Hospital for Tropical Diseases, London
| | - David C W Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London
- Hospital for Tropical Diseases, London
| | - Nicholas Thomson
- Wellcome Trust Sanger Centre, Cambridge, United Kingdom
- Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
| |
Collapse
|
47
|
Boehm A, Bruyère F. [Dermato-urology: Male genital lesions urologist should know]. Prog Urol 2018; 28:251-281. [PMID: 29428190 DOI: 10.1016/j.purol.2018.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 12/13/2017] [Accepted: 01/02/2018] [Indexed: 10/18/2022]
Abstract
This article aimed to gather male genital dermatoses that may lead to consult a urologist, except pre-neoplastic or neoplastic lesion. METHOD This review is based on a research on Pubmed and EM-consult database, in English and in French, using the following key terms "male genital dermatoses", "male genital lesions", "balanitis", "balanoposthitis", "dermatoses des organes génitaux externes masculines", "lésions des organes génitaux externes de l'homme", "balanoposthites". RESULTS It highlights normal morphological aspects, acute balanoposthitis (nonspecific, infectious, allergic, irritative and traumatic), common skin disease localized to male genital and male genital specific dermatoses. CONCLUSION Any suspicious, fixed, must lead to a skin biopsy.
Collapse
Affiliation(s)
- A Boehm
- Service d'urologie, CHRU de Tours, université François-Rabelais, 37000 Tours, France.
| | - F Bruyère
- Service d'urologie, CHRU de Tours, université François-Rabelais, 37000 Tours, France; Université François-Rabelais de Tours, PRES centre Val-de-Loire, 37000 Tours, France
| |
Collapse
|
48
|
Godornes C, Giacani L, Barry AE, Mitja O, Lukehart SA. Development of a Multilocus Sequence Typing (MLST) scheme for Treponema pallidum subsp. pertenue: Application to yaws in Lihir Island, Papua New Guinea. PLoS Negl Trop Dis 2017; 11:e0006113. [PMID: 29281641 PMCID: PMC5760108 DOI: 10.1371/journal.pntd.0006113] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/09/2018] [Accepted: 11/14/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Yaws is a neglected tropical disease, caused by Treponema pallidum subsp. pertenue. The disease causes chronic lesions, primarily in young children living in remote villages in tropical climates. As part of a global yaws eradication campaign initiated by the World Health Organization, we sought to develop and evaluate a molecular typing method to distinguish different strains of T. pallidum subsp. pertenue for disease control and epidemiological purposes. METHODS AND PRINCIPAL FINDINGS Published genome sequences of strains of T. pallidum subsp. pertenue and pallidum were compared to identify polymorphic genetic loci among the strains. DNA from a number of existing historical Treponema isolates, as well as a subset of samples from yaws patients collected in Lihir Island, Papua New Guinea, were analyzed using these targets. From these data, three genes (tp0548, tp0136 and tp0326) were ultimately selected to give a high discriminating capability among the T. pallidum subsp. pertenue samples tested. Intragenic regions of these three target genes were then selected to enhance the discriminating capability of the typing scheme using short readily amplifiable loci. This 3-gene multilocus sequence typing (MLST) method was applied to existing historical human yaws strains, the Fribourg-Blanc simian isolate, and DNA from 194 lesion swabs from yaws patients on Lihir Island, Papua New Guinea. Among all samples tested, fourteen molecular types were identified, seven of which were found in patient samples and seven among historical isolates or DNA. Three types (JG8, TD6, and SE7) were predominant on Lihir Island. CONCLUSIONS This MLST approach allows molecular typing and differentiation of yaws strains. This method could be a useful tool to complement epidemiological studies in regions where T. pallidum subsp. pertenue is prevalent with the overall goals of improving our understanding of yaws transmission dynamics and helping the yaws eradication campaign to succeed.
Collapse
Affiliation(s)
- Charmie Godornes
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Lorenzo Giacani
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Alyssa E. Barry
- Division of Population Health and Immunity, Walter and Eliza Hall Institute, Parkville, Australia
- Department of Medical Biology, University of Melbourne, Parkville, Australia
| | - Oriol Mitja
- Barcelona Institute for Global Health, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
- Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
- Lihir Medical Center, International SOS-Newcrest Mining, Lihir Island, Papua New Guinea
| | - Sheila A. Lukehart
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| |
Collapse
|
49
|
Mitjà O, González-Beiras C, Godornes C, Kolmau R, Houinei W, Abel H, Kapa A, Paru R, Bieb SV, Wangi J, Sanz S, Asiedu K, Lukehart SA, Bassat Q. Effectiveness of single-dose azithromycin to treat latent yaws: a longitudinal comparative cohort study. LANCET GLOBAL HEALTH 2017; 5:e1268-e1274. [PMID: 29107621 DOI: 10.1016/s2214-109x(17)30388-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 09/04/2017] [Accepted: 09/15/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Treatment of latent yaws is a crucial component of the WHO yaws eradication strategy to prevent relapse and the resulting transmission to uninfected children. We assessed the effectiveness of single-dose azithromycin to treat patients with latent yaws. METHODS This population-based cohort study included children (age <20 years) living on Lihir Island, Papua New Guinea, with high-titre (rapid plasma reagin titre ≥1:8) latent or active yaws, between April, 2013, and May, 2015. Latent yaws was defined as lack of suspicious skin lesions or presence of ulcers negative for Treponema pallidum subsp pertenue on PCR, and active yaws was defined as ulcers positive for T pertenue on PCR. All children received one oral dose of 30 mg/kg azithromycin. The primary endpoint was serological cure, defined as a two-dilution decrease in rapid plasma reagin titre by 24 months after treatment. Treatment of latent yaws was taken to be non-inferior to that of active yaws if the lower limit of the two-sided 95% CI for the difference in rates was higher than or equal to -10%. This study is registered with ClinicalTrials.gov, number NCT01955252. FINDINGS Of 311 participants enrolled, 273 (88%; 165 with latent yaws and 108 with active yaws) completed follow-up. The primary endpoint was achieved in 151 (92%) participants with latent yaws and 101 (94%) with active yaws (risk difference -2·0%, 95% CI -8·3 to 4·3), meeting the prespecified criteria for non-inferiority. INTERPRETATION On the basis of decline in serological titre, oral single-dose azithromycin was effective in participants with latent yaws. This finding supports the WHO strategy for the eradication of yaws based on mass administration of the entire endemic community irrespective of clinical status. FUNDING Newcrest Mining Limited and ISDIN laboratories.
Collapse
Affiliation(s)
- Oriol Mitjà
- Barcelona Institute for Global Health, Hospital Clinic-University of Barcelona, Barcelona, Spain; Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea; Lihir Medical Centre, International SOS-Newcrest Mining, Lihir Island, Papua New Guinea.
| | - Camila González-Beiras
- Barcelona Institute for Global Health, Hospital Clinic-University of Barcelona, Barcelona, Spain; Lisbon Institute of Hygiene and Tropical Medicine, Lisbon, Portugal
| | - Charmie Godornes
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Reman Kolmau
- Lihir Medical Centre, International SOS-Newcrest Mining, Lihir Island, Papua New Guinea
| | - Wendy Houinei
- Disease Control Branch, National Department of Health, Port Moresby, Papua New Guinea
| | - Haina Abel
- Lihir Medical Centre, International SOS-Newcrest Mining, Lihir Island, Papua New Guinea
| | - August Kapa
- Lihir Medical Centre, International SOS-Newcrest Mining, Lihir Island, Papua New Guinea
| | - Raymond Paru
- Lihir Medical Centre, International SOS-Newcrest Mining, Lihir Island, Papua New Guinea
| | - Sibauk V Bieb
- Disease Control Branch, National Department of Health, Port Moresby, Papua New Guinea
| | - James Wangi
- Office of the WHO Representative for Papua New Guinea, WHO, Port Moresby, Papua New Guinea
| | - Sergi Sanz
- Barcelona Institute for Global Health, Hospital Clinic-University of Barcelona, Barcelona, Spain; Biostatistics Unit, Department of Public Health, Faculty of Medicine, University of Barcelona, Spain
| | - Kingsley Asiedu
- Department of Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland
| | - Sheila A Lukehart
- Department of Medicine, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Quique Bassat
- Barcelona Institute for Global Health, Hospital Clinic-University of Barcelona, Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Paediatric Infectious Diseases Unit, Paediatric Department, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| |
Collapse
|
50
|
Prescott TAK, Homot P, Lundy FT, Fang R, Patrick S, Cámara-Leret R, Kiapranis R. Tropical ulcer plant treatments used by Papua New Guinea's Apsokok nomads. JOURNAL OF ETHNOPHARMACOLOGY 2017; 205:240-245. [PMID: 28478094 DOI: 10.1016/j.jep.2017.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/21/2017] [Accepted: 05/02/2017] [Indexed: 06/07/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The tropical ulcer is a debilitating bacterial infection that is common in Papua New Guinea. Deploying healthcare infrastructure to remote and inaccessible rainforest locations is not practical, therefore local plants may be the best treatment option. Here we present an ethnobotanical survey of the tropical ulcer plant medicines used by the semi-nomadic Apsokok who roam the remote central mountains of Papua New Guinea's West New Britain Province. In vitro biological activity in assays relevant to tropical ulcer wound healing is also presented. MATERIALS AND METHODS Focus groups and semi-structured interviews were used to acquire information on the uses of plants, vouchers of which were identified by comparison with authentic herbarium specimens. Antibacterial disc diffusion assays with Staphylococcus aureus and Fusobacterium ulcerans, MMP-9 enzyme inhibition and dermal fibroblast stimulation assays were carried out on plant saps and aqueous extracts of plant material. LC-MS was used to identify known plant metabolites. RESULTS The ethnobotanical survey identified sixteen species that were used to treat tropical ulcers, all of which were applied topically. A subset of twelve species were investigated further in vitro. Four species produced zones of inhibition with S. aureus, all 12 species provided low level inhibition of MMP-9 and 8 species stimulated dermal fibroblast proliferation, although cytotoxicity occurred at higher concentrations. The extract of Homalium foetidum Benth. inhibited S. aureus and MMP-9 while at lower sub-cytotoxic concentrations stimulated fibroblast proliferation. Trans-3-O-p-coumaroylquinic acid cis-3-O-p-coumaroylquinic acid were detected in the aqueous extract of H. foetidum. CONCLUSIONS Topical application of plant saps to wounds results in very high localised concentrations of plant metabolites which is likely to result in inhibition of MMP proteases. H. foetidum is a candidate plant for tropical ulcer treatment in remote areas.
Collapse
Affiliation(s)
| | - Peter Homot
- Papua New Guinea Forest Research Institute, Lae, Papua New Guinea.
| | - Fionnuala T Lundy
- Centre for Experimental Medicine, Queen's University Belfast, BT9 7BL, UK.
| | - Rui Fang
- Royal Botanic Gardens, Kew, Richmond, Surrey TW9 3AB, UK.
| | - Sheila Patrick
- Centre for Experimental Medicine, Queen's University Belfast, BT9 7BL, UK.
| | | | - Robert Kiapranis
- Papua New Guinea Forest Research Institute, Lae, Papua New Guinea.
| |
Collapse
|