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Behera DK, Mishra S. The burden of diarrhea, etiologies, and risk factors in India from 1990 to 2019: evidence from the global burden of disease study. BMC Public Health 2022; 22:92. [PMID: 35027031 PMCID: PMC8759196 DOI: 10.1186/s12889-022-12515-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 01/05/2022] [Indexed: 01/16/2023] Open
Abstract
Background This study aims to measure the burden of diarrhea in India and analyze the trend of mortality associated with it for the past 30 years. We also intend to find the prevailing etiology and risk factors associated with diarrheal mortality in India. Methods The study has used the latest round of Global Burden of Disease (GBD) study-2019. GBD data is available across age groups and gender-wise over the period from 1990 to 2019. The study has identified 13 etiologies for the cause of diarrhea deaths and 20 risk factors to analyze the burden of disease. Results Our study shows, childhood diarrhea has declined over the years significantly, yet contributes to a larger share of DALYs associated with the disease. Among all the death cases of Diarrhea, in 2019, the most prevalent disease-causing pathogen is found to be Campylobacter. But Adenovirus is the major contributor to childhood diarrheal deaths. Though the burden of diarrhea is declining over the period, still there is a need to progress the interventions to prevent and control diarrhea rapidly to avoid the huge number of deaths and disabilities experienced in India. Conclusions Consumption of safe and clean water, proper sanitation facility in every household, required nutrition intake by mother and child, safe breastfeeding and stool disposal practices and careful case management, rotavirus vaccination are some of the effective interventions to be implemented all over the country. Further, evidence-based policies should be made and implemented to sustain diarrhea prevention programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12515-3.
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Affiliation(s)
- Deepak Kumar Behera
- Faculty of Health Economics, Department of Commerce, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576 104, India.
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Johansen ØH, Abdissa A, Zangenberg M, Mekonnen Z, Eshetu B, Bjørang O, Alemu Y, Sharew B, Langeland N, Robertson LJ, Hanevik K. Performance and operational feasibility of two diagnostic tests for cryptosporidiosis in children (CRYPTO-POC): a clinical, prospective, diagnostic accuracy study. THE LANCET. INFECTIOUS DISEASES 2020; 21:722-730. [PMID: 33278916 PMCID: PMC8064915 DOI: 10.1016/s1473-3099(20)30556-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/27/2020] [Accepted: 06/19/2020] [Indexed: 12/11/2022]
Abstract
Background Cryptosporidiosis is a common cause of diarrhoea in young children (aged younger than 24 months) in low-resource settings but is currently challenging to diagnose. Light-emitting diode fluorescence microscopy with auramine-phenol staining (LED-AP), recommended for tuberculosis testing, can also detect Cryptosporidium species. A lateral-flow test not requiring refrigerator storage (by contrast with most immunochromatographic lateral-flow assays) has also recently been developed for Cryptosporidium spp detection. We aimed to evaluate the diagnostic accuracy and operational feasibility of LED-AP and the lateral-flow test strip for cryptosporidiosis in children. Methods We did a prospective diagnostic accuracy study in two health-care facilities in Ethiopia, in a consecutive series of children younger than 5 years of age with diarrhoea (three or more loose stools within the previous 24 h) or dysentery (at least one loose stool with stains of blood within the previous 24 h). Stool samples were tested for Cryptosporidium spp by LED-AP and the lateral-flow test strip; accuracy of each test was estimated by independent and blind comparison with a composite reference standard comprising quantitative immunofluorescent antibody test (qIFAT), ELISA, and quantitative PCR (qPCR). Quantitative cutoff values for diarrhoea-associated infection were established in an embedded case-control substudy, with cases of cryptosporidiosis coming from the 15 districts in and around Jimma and the eight districts surrounding Serbo, and community controls without diarrhoea in the previous 48 h recruited by weekly frequency matching by geographical district of the household, age group, and enrolment week. Findings Stool samples from 912 children with diarrhoea or dysentery and 706 controls from the case-control substudy were tested between Dec 22, 2016, and July 6, 2018. Estimated reference-standard cutoff values for cryptosporidiosis positivity were 2·3 × 105 DNA copies per g of wet stool for qPCR, and 725 oocysts per g for qIFAT. LED-AP had a sensitivity for cryptosporidiosis of 88% (95% CI 79–94; 66 of 75 samples) and a specificity of 99% (98–99; 717 of 726 samples); the lateral-flow test strip had a sensitivity of 89% (79–94; 63 of 71 samples) and a specificity of 99% (97–99; 626 of 635 samples). Interpretation LED-AP has high sensitivity and specificity for cryptosporidiosis and should be considered as a dual-use technology that can be easily integrated with existing laboratory infrastructures in low-resource settings. The lateral-flow test strip has similar sensitivity and specificity and provides an alternative that does not require microscopy, although purchase cost of the test strip is unknown as it is not yet available on the market. Funding Norwegian Research Council GLOBVAC fund, The Bill & Melinda Gates Foundation, Norwegian Society for Medical Microbiology, University of Bergen, and Vestfold Hospital Trust.
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Affiliation(s)
- Øystein H Johansen
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Microbiology, Vestfold Hospital Trust, Tønsberg, Norway.
| | - Alemseged Abdissa
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Mike Zangenberg
- Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Microbiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Zeleke Mekonnen
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Beza Eshetu
- Department of Paediatrics and Child Health, Jimma Institute of Health, Jimma University, Jimma, Ethiopia
| | - Ola Bjørang
- Department of Microbiology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Yonas Alemu
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Bizuwarek Sharew
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Nina Langeland
- Department of Clinical Science, University of Bergen, Bergen, Norway; Norwegian National Advisory Unit on Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Lucy J Robertson
- Parasitology, Department of Paraclinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Oslo, Norway
| | - Kurt Hanevik
- Department of Clinical Science, University of Bergen, Bergen, Norway; Norwegian National Advisory Unit on Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
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Khadilkar VV, Mandlik RM, Palande SA, Pandit DS, Chawla M, Nadar R, Chiplonkar SA, Kadam SS, Khadilkar AA. Growth status of small for gestational age Indian children from two socioeconomic strata. Indian J Endocrinol Metab 2016; 20:531-535. [PMID: 27366721 PMCID: PMC4911844 DOI: 10.4103/2230-8210.183473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AIMS To assess growth and factors associated with growth in children born small for gestational age (SGA) from two socioeconomic strata in comparison to age- and sex-matched healthy controls. METHODS Retrospective study conducted at two hospitals in Pune, 0.5-5 years, 618 children: 189-SGA from upper socioeconomic strata (USS), 217-SGA from lower socioeconomic strata (LSS), and 212 appropriate for gestational age healthy controls were randomly selected. Birth and maternal history, socioeconomic status, length/height, and weight of children were recorded. Anthropometric data were converted to Z scores (height for age Z-score [HAZ], weight for age Z-score [WAZ]) using WHO AnthroPlus software. RESULTS The HAZ and WAZ of the SGA group were significantly lower as compared to the controls and that of the LSS SGAs were lower than USS SGAs (P < 0.05). Thirty two percent children were stunted (HAZ <-2.0) in USS and 49% in LSS (P < 0.05). Twenty nine percent children in the USS SGA group were stunted at 2 years and 17% at 5 years. In the LSS SGA group, 54% children were stunted at 2 years and 46% at 5 years. Generalized linear model revealed normal vaginal delivery (β = 0.625) and mother's age (β =0.072) were positively associated and high SES (β = -0.830), absence of major illness (β = -1.01), higher birth weight (β = -1.34) were negatively associated for risk of stunting (P < 0.05). CONCLUSION Children born SGA showed poor growth as compared to controls. Special attention to growth is necessary in children from LSS, very low birth weight babies, and those with major illnesses during early years of life.
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Affiliation(s)
- Vaman V. Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Rubina M. Mandlik
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Sonal A. Palande
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Deepa S. Pandit
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Meghna Chawla
- Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Ruchi Nadar
- St. Martha's Hospital, Bengaluru, Karnataka, India
| | - Shashi A. Chiplonkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Sandeep S. Kadam
- Ratna Memorial Hospital, Maharashtra Medical Foundation, Pune, Maharashtra, India
| | - Anuradha A. Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
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Jafarzadeh SR, Johnson WO, Gardner IA. Bayesian modeling and inference for diagnostic accuracy and probability of disease based on multiple diagnostic biomarkers with and without a perfect reference standard. Stat Med 2015; 35:859-76. [DOI: 10.1002/sim.6745] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 09/02/2015] [Accepted: 09/05/2015] [Indexed: 11/05/2022]
Affiliation(s)
- S. Reza Jafarzadeh
- Department of Medicine and Epidemiology; University of California; Davis CA U.S.A
| | | | - Ian A. Gardner
- Department of Medicine and Epidemiology; University of California; Davis CA U.S.A
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Lindsay B, Saha D, Sanogo D, Das SK, Omore R, Farag TH, Nasrin D, Li S, Panchalingam S, Levine MM, Kotloff K, Nataro JP, Magder L, Hungerford L, Faruque ASG, Oundo J, Hossain MA, Adeyemi M, Stine OC. Association Between Shigella Infection and Diarrhea Varies Based on Location and Age of Children. Am J Trop Med Hyg 2015; 93:918-24. [PMID: 26324734 DOI: 10.4269/ajtmh.14-0319] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 06/01/2015] [Indexed: 11/07/2022] Open
Abstract
Molecular identification of the invasion plasmid antigen-H (ipaH) gene has been established as a useful detection mechanism for Shigella spp. The Global Enteric Multicenter Study (GEMS) identified the etiology and burden of moderate-to-severe diarrhea (MSD) in sub-Saharan Africa and south Asia using a case-control study and traditional culture techniques. Here, we used quantitative polymerase chain reaction (qPCR) to identify Shigella spp. in 2,611 stool specimens from GEMS and compared these results to those using culture. Demographic and nutritional characteristics were assessed as possible risk factors. The qPCR identified more cases of shigellosis than culture; however, the distribution of demographic characteristics was similar by both methods. In regression models adjusting for Shigella quantity, age, and site, children who were exclusively breast-fed had significantly lower odds of MSD compared with children who were not breast-fed (odds ratio [OR] = 0.47, 95% confidence interval (CI) = 0.28-0.81). The association between Shigella quantity and MSD increased with age, with a peak in children of 24-35 months of age (OR = 8.2, 95% CI = 4.3-15.7) and the relationship between Shigella quantity and disease was greatest in Bangladesh (OR = 13.2, 95% CI = 7.3-23.8). This study found that qPCR identified more cases of Shigella and age, site, and breast-feeding status were significant risk factors for MSD.
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Affiliation(s)
- Brianna Lindsay
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Debasish Saha
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Doh Sanogo
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Sumon Kumar Das
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Richard Omore
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Tamer H Farag
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Dilruba Nasrin
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Shan Li
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Sandra Panchalingam
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Myron M Levine
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Karen Kotloff
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - James P Nataro
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Laurence Magder
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Laura Hungerford
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - A S G Faruque
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Joseph Oundo
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - M Anowar Hossain
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Mitchell Adeyemi
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Oscar Colin Stine
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
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Joshi S, Kulkarni V, Gangakhedkar R, Mahajan U, Sharma S, Shirole D, Chandhiok N. Cost-effectiveness of a repeat HIV test in pregnancy in India. BMJ Open 2015; 5:e006718. [PMID: 26068507 PMCID: PMC4466614 DOI: 10.1136/bmjopen-2014-006718] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 03/05/2015] [Accepted: 03/27/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate cost-effectiveness of second HIV test in pregnancy. BACKGROUND Current strategy of single HIV test during pregnancy in India can miss new HIV infections acquired after the first test or those HIV infections that were missed in the first test due to a false-negative HIV test. METHODS Between August 2011 and April 2013, 9097 pregnant HIV uninfected women were offered a second HIV test near term (34 weeks or beyond) or within 4 weeks of postpartum period. A decision analysis model was used to evaluate cost-effectiveness of a second HIV test in pregnant women near term. PRIMARY AND SECONDARY OUTCOME Our key outcome measures include programme cost with addition of second HIV test in pregnant women and quality-adjusted life years (QALYs) gained. RESULTS We detected 4 new HIV infections in the second test. Thus HIV incidence among pregnant women was 0.12 (95% 0.032 to 0.297) per 100 person women years (PWY). Current strategy of a single HIV test is 8.2 times costlier for less QALYs gained as compared to proposed repeat HIV testing of pregnant women who test negative during the first test. CONCLUSIONS Our results warrant consideration at the national level for including a second HIV test of all pregnant women in the national programme. However prior to allocation of resources for a second HIV test in pregnancy, appropriate strategies will have to be planned for improving compliance for prevention of mother-to-child transmission of HIV and reducing loss-to-follow-up of those women detected with HIV. TRIAL REGISTRATION NUMBER CTRI/2013/12/004183.
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Affiliation(s)
- Smita Joshi
- Department of Preventive Oncology, Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Pune, Maharashtra, India
| | - Vinay Kulkarni
- Prayas Health Group, Amrita Clinic, Pune, Maharashtra, India
| | | | - Uma Mahajan
- Department of Preventive Oncology, Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Pune, Maharashtra, India
| | | | - Devendra Shirole
- Kamla Nehru Hospital, Pune Municipal Corporation, Pune, Maharashtra, India
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Consolidating HIV testing in a public health laboratory for efficient and sustainable early infant diagnosis (EID) in Uganda. J Public Health Policy 2015; 36:153-69. [PMID: 25811386 DOI: 10.1057/jphp.2015.7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Uganda introduced an HIV Early Infant Diagnosis (EID) program in 2006, and then worked to improve the laboratory, transportation, and clinical elements. Reported here are the activities involved in setting up a prospective analysis in which the Ministry of Health, with its NGO partners, determined it would be more effective and efficient to consolidate the initial eight-laboratory system for EID testing of HIV dried blood samples offered by two nongovernmental partners operating research facilities into a single well-equipped and staffed laboratory within the Ministry. A retrospective analysis confirmed that redesign reduced overhead cost per PCR test of HIV dried blood samples from US$22.20 to an average of $5. Along with the revamped system of sample collection, transportation, and result communication, Uganda has been able to vastly increase the HIV diagnosis of babies and engagement of them and their mothers in clinical care, including antiretroviral therapy. Uganda reduced turnaround times for results reporting to clinicians from more than a month in 2006 to just 2 weeks by 2014, even as samples tested increased dramatically. The next challenge is overcoming loss of babies and mothers to follow up.
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Patzi-Vargas S, Zaidi MB, Perez-Martinez I, León–Cen M, Michel-Ayala A, Chaussabel D, Estrada-Garcia T. Diarrheagenic Escherichia coli carrying supplementary virulence genes are an important cause of moderate to severe diarrhoeal disease in Mexico. PLoS Negl Trop Dis 2015; 9:e0003510. [PMID: 25738580 PMCID: PMC4349884 DOI: 10.1371/journal.pntd.0003510] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 01/01/2015] [Indexed: 11/22/2022] Open
Abstract
Diarrheagenic Escherichia coli (DEC) cause acute and persistent diarrhoea worldwide, but little is known about their epidemiology in Mexico. We determined the prevalence of bacterial enteropathogens in 831 children with acute diarrhoea over a four-year period in Yucatan, Mexico. Six DEC supplementary virulence genes (SVG), mainly associated with enteroaggregative E. coli (EAEC), were sought in 3100 E. coli isolates. DEC was the most common bacterial enteropathogen (28%), surpassing Salmonella (12%) and Shigella (9%). Predominant DEC groups were diffusely adherent E. coli (DAEC) (35%), EAEC (24%), and enteropathogenic E. coli (EPEC) (19%). Among children with DEC infections, 14% had severe illness mainly caused by EPEC (26%) and DAEC (18%); 30% had moderate diarrhoea mainly caused by DAEC (36%), mixed DEC infections (33%) and EAEC (32%). DAEC was most prevalent during spring, while ETEC, EAEC and EPEC predominated in summer. EAEC was more frequent in children 6–24 months old than in those younger than 6 months of age (P = 0.008, OR = 4.2, 95% CI, 1.3–13.9). The presence of SVG dispersin, (aatA), dispersin-translocator (aatA), enteroaggregative heat-stable toxin 1 (astA), plasmid encoded toxin (pet), cytolethal distending toxin (cdt) was higher in DEC than non-DEC strains, (36% vs 26%, P <0.0001, OR = 1.5, 95% CI, 1.3–1.8). 98% of EAEC-infected children harboured strains with SVG; 85% carried the aap-aatA gene combination, and 33% of these also carried astA. 28% of both EPEC and ETEC, and 6% of DAEC patients had strains with SVG. 54% of EPEC patients carried pet-positive strains alone or in combination with astA; only this DEC group harboured cdt-positive isolates. All ETEC patients carried astA- or astA-aap-positive strains. astA and aap were the most common SVG in DAEC (3% and 2%) and non-DEC strains (21% and 13%). DEC carrying SVG are an important cause of moderate to severe bacterial diarrhoea in Mexican children. Diarrhoea is an important cause of illness and death among young children in low- and middle-income countries. Nonetheless, very few epidemiological studies of diarrhoea have been conducted in Mexico during the last two decades. In recent years, a group of bacteria known as diarrheagenic Escherichia coli (DEC) have been recognized as a major cause of diarrheal illness worldwide. This group cannot be identified by the conventional biochemical methods used for other diarrhoeal pathogens such as Salmonella or Shigella, which limits its identification. We conducted a study in Yucatan, Mexico, to identify the bacterial causes of acute diarrhoea in children less than five years of age who required hospitalization. All DEC strains were further characterized for the presence of six E. coli supplementary virulence genes (SVG). Of the 831 children with acute diarrhoea, a bacterial pathogen was found in 56%. DEC was the most prevalent (28%) pathogen, surpassing Salmonella and Shigella. Among children with DEC diarrhoea, 44% were moderately or severely ill. Thirty-six percent of the DEC strains had one or more SVG, which were more common in older children. Our results strongly suggest that DEC carrying SVG are an important cause of moderate to severe bacterial diarrhoeal disease in Mexico.
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Affiliation(s)
| | - Mussaret Bano Zaidi
- Microbiology Research Laboratory and Paediatric Emergency Department, Hospital General O’Horán, Mérida, Yucatán, México
- Infectious Diseases Research Unit, Hospital Regional de Alta Especialidad de La Península de Yucatán, Mérida, Yucatán, México
| | | | - Magda León–Cen
- Microbiology Research Laboratory and Paediatric Emergency Department, Hospital General O’Horán, Mérida, Yucatán, México
| | - Alba Michel-Ayala
- Microbiology Research Laboratory and Paediatric Emergency Department, Hospital General O’Horán, Mérida, Yucatán, México
| | - Damien Chaussabel
- Department of Systems Immunology, Benaroya Research Institute, Seattle, Washington, United States of America
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9
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Peeling RW, McNerney R. Emerging technologies in point-of-care molecular diagnostics for resource-limited settings. Expert Rev Mol Diagn 2014; 14:525-34. [DOI: 10.1586/14737159.2014.915748] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Chang J, Omuomo K, Anyango E, Kingwara L, Basiye F, Morwabe A, Shanmugam V, Nguyen S, Sabatier J, Zeh C, Ellenberger D. Field evaluation of Abbott Real Time HIV-1 Qualitative test for early infant diagnosis using dried blood spots samples in comparison to Roche COBAS Ampliprep/COBAS TaqMan HIV-1 Qual test in Kenya. J Virol Methods 2014; 204:25-30. [PMID: 24726703 DOI: 10.1016/j.jviromet.2014.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 03/11/2014] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
Abstract
Timely diagnosis and treatment of infants infected with HIV are critical for reducing infant mortality. High-throughput automated diagnostic tests like Roche COBAS AmpliPrep/COBAS TaqMan HIV-1 Qual Test (Roche CAPCTM Qual) and the Abbott Real Time HIV-1 Qualitative (Abbott Qualitative) can be used to rapidly expand early infant diagnosis testing services. In this study, the performance characteristics of the Abbott Qualitative were evaluated using two hundred dried blood spots (DBS) samples (100 HIV-1 positive and 100 HIV-1 negative) collected from infants attending the antenatal facilities in Kisumu, Kenya. The Abbott Qualitative results were compared to the diagnostic testing completed using the Roche CAPCTM Qual in Kenya. The sensitivity and specificity of the Abbott Qualitative were 99.0% (95% CI: 95.0-100.0) and 100.0% (95% CI: 96.0-100.0), respectively, and the overall reproducibility was 98.0% (95% CI: 86.0-100.0). The limits of detection for the Abbott Qualitative and Roche CAPCTM Qual were 56.5 and 6.9copies/mL at 95% CIs (p=0.005), respectively. The study findings demonstrate that the Abbott Qualitative test is a practical option for timely diagnosis of HIV in infants.
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Affiliation(s)
- Joy Chang
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
| | - Kenneth Omuomo
- Kenya Medical Research Institute (CDC/KEMRI), Kisumu, Kenya
| | - Emily Anyango
- Kenya Medical Research Institute (CDC/KEMRI), Kisumu, Kenya
| | | | - Frank Basiye
- Centers for Disease Control and Prevention (CDC), Kenya
| | - Alex Morwabe
- Kenya Medical Research Institute (CDC/KEMRI), Kisumu, Kenya
| | | | - Shon Nguyen
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Clement Zeh
- Kenya Medical Research Institute (CDC/KEMRI), Kisumu, Kenya
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Abou Tayoun AN, Burchard PR, Malik I, Scherer A, Tsongalis GJ. Democratizing molecular diagnostics for the developing world. Am J Clin Pathol 2014; 141:17-24. [PMID: 24343733 DOI: 10.1309/ajcpa1l4kpxbjnpg] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Infectious diseases that are largely treatable continue to pose a tremendous burden on the developing world despite the availability of highly potent drugs. The high mortality and morbidity rates of these diseases are largely due to a lack of affordable diagnostics that are accessible to resource-limited areas and that can deliver high-quality results. In fact, modified molecular diagnostics for infectious diseases were rated as the top biotechnology to improve health in developing countries. METHODS In this review, we describe the characteristics of accessible molecular diagnostic tools and discuss the challenges associated with implementing such tools at low infrastructure sites. RESULTS We highlight our experience as part of the "Grand Challenge" project supported by the Gates Foundation for addressing global health inequities and describe issues and solutions associated with developing adequate technologies or molecular assays needed for broad access in the developing world. CONCLUSIONS We believe that sharing this knowledge will facilitate the development of new molecular technologies that are extremely valuable for improving global health.
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Affiliation(s)
| | - Paul R. Burchard
- Department of Pathology, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Imran Malik
- Department of Electrical Engineering, California Institute of Technology, Pasadena, CA
| | - Axel Scherer
- Department of Electrical Engineering, California Institute of Technology, Pasadena, CA
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12
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Duran C, Nato F, Dartevelle S, Thi Phuong LN, Taneja N, Ungeheuer MN, Soza G, Anderson L, Benadof D, Zamorano A, Diep TT, Nguyen TQ, Nguyen VH, Ottone C, Bégaud E, Pahil S, Prado V, Sansonetti P, Germani Y. Rapid diagnosis of diarrhea caused by Shigella sonnei using dipsticks; comparison of rectal swabs, direct stool and stool culture. PLoS One 2013; 8:e80267. [PMID: 24278267 PMCID: PMC3838397 DOI: 10.1371/journal.pone.0080267] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 10/11/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We evaluated a dipstick test for rapid detection of Shigella sonnei on bacterial colonies, directly on stools and from rectal swabs because in actual field situations, most pathologic specimens for diagnosis correspond to stool samples or rectal swabs. METHODOLOGY/PRINCIPAL FINDINGS The test is based on the detection of S. sonnei lipopolysaccharide (LPS) O-side chains using phase I-specific monoclonal antibodies coupled to gold particles, and displayed on a one-step immunochromatographic dipstick. A concentration as low as 5 ng/ml of LPS was detected in distilled water and in reconstituted stools in 6 minutes. This is the optimal time for lecture to avoid errors of interpretation. In distilled water and in reconstituted stools, an unequivocal positive reaction was obtained with 4 x 10(6) CFU/ml of S. sonnei. The specificity was 100% when tested with a battery of Shigella and different unrelated strains. When tested on 342 rectal swabs in Chile, specificity (281/295) was 95.3% (95% CI: 92.9% - 97.7%) and sensitivity (47/47) was 100%. Stool cultures and the immunochromatographic test showed concordant results in 95.5 % of cases (328/342) in comparative studies. Positive and negative predictive values were 77% (95% CI: 65% - 86.5%) and 100% respectively. When tested on 219 stools in Chile, Vietnam, India and France, specificity (190/198) was 96% (95% CI 92%-98%) and sensitivity (21/21) was 100%. Stool cultures and the immunochromatographic test showed concordant results in 96.3 % of cases (211/219) in comparative studies. Positive and negative predictive values were 72.4% (95% CI 56.1%-88.6%) and 100 %, respectively. CONCLUSION This one-step dipstick test performed well for diagnosis of S. sonnei both on stools and on rectal swabs. These data confirm a preliminary study done in Chile.
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Affiliation(s)
- Claudia Duran
- Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Faridabano Nato
- Institut Pasteur, Plate-Forme 5 - Production de Protéines recombinantes et d'Anticorps, Paris, France
| | - Sylvie Dartevelle
- Institut Pasteur, Plate-Forme 5 - Production de Protéines recombinantes et d'Anticorps, Paris, France
| | - Lan Nguyen Thi Phuong
- Pasteur Institute of Ho Chi Minh City, Department of Immunology & Microbiology, Ho Chi Minh City, Vietnam
| | - Neelam Taneja
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Marie Noëlle Ungeheuer
- Institut Pasteur, Plate-forme Investigation Clinique et Accès aux Ressources Biologiques, Paris, France
| | | | | | - Dona Benadof
- Hospital Roberto del Río-Santiago, Región Metropolitana, Chili
| | | | - Tai The Diep
- Pasteur Institute of Ho Chi Minh City, Department of Immunology & Microbiology, Ho Chi Minh City, Vietnam
| | | | | | - Catherine Ottone
- Institut Pasteur, Plate-forme Investigation Clinique et Accès aux Ressources Biologiques, Paris, France
| | - Evelyne Bégaud
- Institut Pasteur, Centre de Ressources Biologiques, Paris, France
| | - Sapna Pahil
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Valeria Prado
- Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Philippe Sansonetti
- Institut Pasteur, Unité de Pathogénie Microbienne Moléculaire, INSERM U786, Paris, France
| | - Yves Germani
- Institut Pasteur, Unité de Pathogénie Microbienne Moléculaire, INSERM U786, Paris, France
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Kiyaga C, Sendagire H, Joseph E, McConnell I, Grosz J, Narayan V, Esiru G, Elyanu P, Akol Z, Kirungi W, Musinguzi J, Opio A. Uganda's new national laboratory sample transport system: a successful model for improving access to diagnostic services for Early Infant HIV Diagnosis and other programs. PLoS One 2013; 8:e78609. [PMID: 24236026 PMCID: PMC3827263 DOI: 10.1371/journal.pone.0078609] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 09/13/2013] [Indexed: 11/19/2022] Open
Abstract
Introduction Uganda scaled-up Early HIV Infant Diagnosis (EID) when simplified methods for testing of infants using dried blood spots (DBS) were adopted in 2006 and sample transport and management was therefore made feasible in rural settings. Before this time only 35% of the facilities that were providing EID services were reached through the national postal courier system, Posta Uganda. The transportation of samples during this scale-up, therefore, quickly became a challenge and varied from facility to facility as different methods were used to transport the samples. This study evaluates a novel specimen transport network system for EID testing. Methods A retrospective study was done in mid-2012 on 19 pilot hubs serving 616 health facilities in Uganda. The effect on sample-result turnaround time (TAT) and the cost of DBS sample transport on 876 sample-results was analyzed. Results The HUB network system provided increased access to EID services ranging from 36% to 51%, drastically reduced transportation costs by 62%, reduced turn-around times by 46.9% and by a further 46.2% through introduction of SMS printers. Conclusions The HUB model provides a functional, reliable and efficient national referral network against which other health system strengthening initiatives can be built to increase access to critical diagnostic and treatment monitoring services, improve the quality of laboratory and diagnostic services, with reduced turn-around times and improved quality of prevention and treatment programs thereby reducing long-term costs.
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Affiliation(s)
| | - Hakim Sendagire
- Ministry of Health, Kampala, Uganda
- College of Health Sciences, Makerere University, Kampala, Uganda
- * E-mail:
| | - Eleanor Joseph
- Clinton Foundation Health Access Initiative, Kampala, Uganda
| | - Ian McConnell
- Clinton Foundation Health Access Initiative, Kampala, Uganda
| | - Jeff Grosz
- Clinton Foundation Health Access Initiative, Kampala, Uganda
| | - Vijay Narayan
- Clinton Foundation Health Access Initiative, Kampala, Uganda
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Abstract
Determining the microbiologic etiology of enteric infection remains an elusive goal. Conventional approaches, including culture, microscopy, and antigen-based tests have significant limitations such as limit of detection and the need for multiple procedures. Molecular diagnostics, especially PCR based tests, are rapidly changing research and practice in infectious diseases. Diarrheal disease, with its broad range of potential infectious etiologies, is well suited for multiplex molecular testing. This review highlights examples of currently employed molecular tests, as well as ways in which these tests can be applied in the future. The absence of a gold standard for the microbiologic cause of diarrhea means that the clinical significance of detected organisms may not always be clear. Conventional wisdom is that there should be one main pathogen causing diarrhea, however our thinking is challenged by increased detection of mixed infections. Thus, the successful incorporation of molecular diagnostics for diarrheal disease into practice will require both a careful understanding of the technical aspects and research to define their clinical utility.
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15
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Palamountain KM, Baker J, Cowan EP, Essajee S, Mazzola LT, Metzler M, Schito M, Stevens WS, Young GJ, Domingo GJ. Perspectives on introduction and implementation of new point-of-care diagnostic tests. J Infect Dis 2012; 205 Suppl 2:S181-90. [PMID: 22402038 DOI: 10.1093/infdis/jis203] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In recent years, there has been significant investment from both the private and public sectors in the development of diagnostic technologies to meet the need for human immunodeficiency virus (HIV) and tuberculosis testing in low-resource settings. Future investments should ensure that the most appropriate technologies are adopted in settings where they will have a sustainable impact. Achieving these aims requires the involvement of many stakeholders, as their needs, operational constraints, and priorities are often distinct. Here, we discuss these considerations from different perspectives representing those of various stakeholders involved in the development, introduction, and implementation of diagnostic tests. We also discuss some opportunities to address these considerations.
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Affiliation(s)
- Kara M Palamountain
- Kellogg School of Management, Northwestern University, Evanston, Illinois, USA
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Multisite performance evaluation of an enzyme-linked immunosorbent assay for detection of Giardia, Cryptosporidium, and Entamoeba histolytica antigens in human stool. J Clin Microbiol 2012; 50:1762-3. [PMID: 22378909 DOI: 10.1128/jcm.06483-11] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
A novel fecal antigen detection assay for fresh and frozen human samples that detects but does not differentiate Giardia spp, Cryptosporidium spp, and Entamoeba histolytica, the Tri-Combo parasite screen, was compared to three established enzyme-linked immunosorbent assays (ELISAs) at three international sites. It exhibited 97.9% sensitivity and 97.0% specificity, with positive and negative predictive values of 93.4% and 99.1%, respectively. The Tri-Combo test proved a reliable means to limit the use of individual parasite ELISAs to positive samples.
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Peeling RW, Nwaka S. Drugs and diagnostic innovations to improve global health. Infect Dis Clin North Am 2012; 25:693-705, xi. [PMID: 21896368 DOI: 10.1016/j.idc.2011.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Infectious diseases remain the major cause of morbidity and mortality in the developing world. Affordable effective drugs and diagnostics are critical for patient management and disease control but the development of new drugs and diagnostics is too slow to keep up with the emergence and spread of infectious diseases around the world. Innovative collaborative research and development involving disease endemic countries and developed countries are urgently needed to accelerate progress along the path from discovery to product adoption. These emerging approaches and the need for increased investment in human and financial resources to support them are discussed.
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Affiliation(s)
- Rosanna W Peeling
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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18
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Abstract
PURPOSE OF REVIEW Diarrheal disease causes substantial morbidity and mortality worldwide; however, defining the microbiologic causes are challenging due to the large number of potential enteropathogens that require testing, insensitivity of existing conventional methods, the frequent occurrence of mixed infections, and high rates of background carriage in many communities. RECENT FINDINGS Here we review recent detection methods for enteropathogens with a particular focus on nucleic acid amplification assays. SUMMARY Nucleic acid amplification assays with high sensitivity and throughput now allow screening for multiple enteropathogens in stool samples. Interpretation will be complicated by high rates of mixed infections and background carriage in many communities. Therefore, new detection techniques, including quantitative methods, will need to be utilized in conjunction with the clinical context and careful study design. These methods should yield new insights into the causes and epidemiology of diarrhea.
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Taneja N, Nato F, Dartevelle S, Sire JM, Garin B, Thi Phuong LN, Diep TT, Shako JC, Bimet F, Filliol I, Muyembe JJ, Ungeheuer MN, Ottone C, Sansonetti P, Germani Y. Dipstick test for rapid diagnosis of Shigella dysenteriae 1 in bacterial cultures and its potential use on stool samples. PLoS One 2011; 6:e24830. [PMID: 21984895 PMCID: PMC3184949 DOI: 10.1371/journal.pone.0024830] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 08/22/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We describe a test for rapid detection of S. dysenteriae 1 in bacterial cultures and in stools, at the bedside of patients. METHODOLOGY/PRINCIPAL FINDINGS The test is based on the detection of S. dysenteriae 1 lipopolysaccharide (LPS) using serotype 1-specific monoclonal antibodies coupled to gold particles and displayed on a one-step immunochromatographic dipstick. A concentration as low as 15 ng/ml of LPS was detected in distilled water and in reconstituted stools in 10 minutes. In distilled water and in reconstituted stools, an unequivocal positive reaction was obtained with 1.6×10⁶ CFU/ml and 4.9×10⁶ CFU/ml of S. dysenteriae 1, respectively. Optimal conditions to read the test have been determined to limit the risk of ambiguous results due to appearance of a faint yellow test band in some negative samples. The specificity was 100% when tested with a battery of Shigella and unrelated strains in culture. When tested on 328 clinical samples in India, Vietnam, Senegal and France by laboratory technicians and in Democratic Republic of Congo by a field technician, the specificity (312/316) was 98.7% (95% CI:96.6-99.6%) and the sensitivity (11/12) was 91.7% (95% CI:59.8-99.6%). Stool cultures and the immunochromatographic test showed concordant results in 98.4 % of cases (323/328) in comparative studies. Positive and negative predictive values were 73.3% (95% CI:44.8-91.1%) and 99.7% (95% CI:98-100%). CONCLUSION The initial findings presented here for a simple dipstick-based test to diagnose S. dysenteriae 1 demonstrates its promising potential to become a powerful tool for case management and epidemiological surveys.
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Affiliation(s)
- Neelam Taneja
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Faridabano Nato
- Plate-Forme 5 - Production de Protéines recombinantes et d'Anticorps, Institut Pasteur, Paris, France
| | - Sylvie Dartevelle
- Plate-Forme 5 - Production de Protéines recombinantes et d'Anticorps, Institut Pasteur, Paris, France
| | - Jean Marie Sire
- Laboratoire de Biologie Médicale, Institut Pasteur de Dakar, Dakar, Sénégal
| | - Benoit Garin
- Laboratoire de Biologie Médicale, Institut Pasteur de Dakar, Dakar, Sénégal
| | - Lan Nguyen Thi Phuong
- Department of Immunology and Microbiology, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tai The Diep
- Department of Immunology and Microbiology, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | - François Bimet
- Centre de Ressources Biologiques, Institut Pasteur, Paris, France
| | - Ingrid Filliol
- Centre National de Référence des Escherichia coli et Shigella, Unité de Recherche et d'Expertise des Bactéries Pathogènes Entériques, Institut Pasteur, Paris, France
| | - Jean-Jacques Muyembe
- Institut National de Recherche Biomédicale, Kinshasa, République Démocratique du Congo
| | - Marie Noëlle Ungeheuer
- Plate-forme Investigation Clinique et Accès aux Ressources Biologiques, Institut Pasteur, Paris, France
| | - Catherine Ottone
- Plate-forme Investigation Clinique et Accès aux Ressources Biologiques, Institut Pasteur, Paris, France
| | - Philippe Sansonetti
- Unité de Pathogénie Microbienne Moléculaire, Institut Pasteur, Paris, France
| | - Yves Germani
- Unité de Pathogénie Microbienne Moléculaire, Institut Pasteur, Paris, France
- BioSpeedia Société par Actions Simplifée, Orsay, France
- * E-mail:
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Brokx SJ, Wernimont AK, Dong A, Wasney GA, Lin YH, Lew J, Vedadi M, Lee WH, Hui R. Characterization of 14-3-3 proteins from Cryptosporidium parvum. PLoS One 2011; 6:e14827. [PMID: 21853016 PMCID: PMC3154893 DOI: 10.1371/journal.pone.0014827] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 09/13/2010] [Indexed: 11/18/2022] Open
Abstract
UNLABELLED The parasite Cryptosporidium parvum has three 14-3-3 proteins: Cp14ε, Cp14a and Cp14b, with only Cp14ε similar to human 14-3-3 proteins in sequence, peptide-binding properties and structure. Structurally, Cp14a features the classical 14-3-3 dimer but with a uniquely wide pocket and a disoriented RRY triad potentially incapable of binding phosphopeptides. The Cp14b protein deviates from the norm significantly: (i) In one subunit, the phosphorylated C-terminal tail is bound in the binding groove like a phosphopeptide. This supports our binding study indicating this protein was stabilized by a peptide mimicking its last six residues. (ii) The other subunit has eight helices instead of nine, with αA and αB forming a single helix and occluding the peptide-binding cleft. (iii) The protein forms a degenerate dimer with the two binding grooves divided and facing opposite directions. These features conspire to block and disrupt the bicameral substrate-binding pocket, suggesting a possible tripartite auto-regulation mechanism that has not been observed previously. ENHANCED VERSION This article can also be viewed as an enhanced version in which the text of the article is integrated with interactive 3D representations and animated transitions. Please note that a web plugin is required to access this enhanced functionality. Instructions for the installation and use of the web plugin are available in Text S1.
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Affiliation(s)
- Stephen J. Brokx
- Structural Genomics Consortium, University of Toronto, Toronto, Ontario, Canada
| | - Amy K. Wernimont
- Structural Genomics Consortium, University of Toronto, Toronto, Ontario, Canada
| | - Aiping Dong
- Structural Genomics Consortium, University of Toronto, Toronto, Ontario, Canada
| | - Gregory A. Wasney
- Structural Genomics Consortium, University of Toronto, Toronto, Ontario, Canada
| | - Yu-Hui Lin
- Structural Genomics Consortium, University of Toronto, Toronto, Ontario, Canada
| | - Jocelyne Lew
- Structural Genomics Consortium, University of Toronto, Toronto, Ontario, Canada
| | - Masoud Vedadi
- Structural Genomics Consortium, University of Toronto, Toronto, Ontario, Canada
| | - Wen Hwa Lee
- Structural Genomics Consortium, University of Oxford, Headington, Oxford, United Kingdom
| | - Raymond Hui
- Structural Genomics Consortium, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Ciaranello AL, Park JE, Ramirez-Avila L, Freedberg KA, Walensky RP, Leroy V. Early infant HIV-1 diagnosis programs in resource-limited settings: opportunities for improved outcomes and more cost-effective interventions. BMC Med 2011; 9:59. [PMID: 21599888 PMCID: PMC3129310 DOI: 10.1186/1741-7015-9-59] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 05/20/2011] [Indexed: 02/07/2023] Open
Abstract
Early infant diagnosis (EID) of HIV-1 infection confers substantial benefits to HIV-infected and HIV-uninfected infants, to their families, and to programs providing prevention of mother-to-child transmission (PMTCT) services, but has been challenging to implement in resource-limited settings. In order to correctly inform parents/caregivers of infant infection status and link HIV-infected infants to care and treatment, a 'cascade' of events must successfully occur. A frequently cited barrier to expansion of EID programs is the cost of the required laboratory assays. However, substantial implementation barriers, as well as personnel and infrastructure requirements, exist at each step in the cascade. In this update, we review challenges to uptake at each step in the EID cascade, highlighting that even with the highest reported levels of uptake, nearly half of HIV-infected infants may not complete the cascade successfully. We next synthesize the available literature about the costs and cost effectiveness of EID programs; identify areas for future research; and place these findings within the context of the benefits and challenges to EID implementation in resource-limited settings.
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Affiliation(s)
- Andrea L Ciaranello
- Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA
| | - Ji-Eun Park
- Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lynn Ramirez-Avila
- Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA
- Division of Infectious Diseases, Children's Hospital Boston, Boston, MA, USA
| | - Kenneth A Freedberg
- Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA
- Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for AIDS Research, Harvard Medical School, Boston, MA, USA
| | - Rochelle P Walensky
- Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA
- Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for AIDS Research, Harvard Medical School, Boston, MA, USA
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA, USA
| | - Valeriane Leroy
- Inserm, Unité 897, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Bordeaux Segalen, Bordeaux, France
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Grundmann N, Iliff P, Stringer J, Wilfert C. Presumptive diagnosis of severe HIV infection to determine the need for antiretroviral therapy in children less than 18 months of age. Bull World Health Organ 2011; 89:513-20. [PMID: 21734765 DOI: 10.2471/blt.11.085977] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 03/24/2011] [Accepted: 04/08/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To develop a new algorithm for the presumptive diagnosis of severe disease associated with human immunodeficiency virus (HIV) infection in children less than 18 months of age for the purpose of identifying children who require antiretroviral therapy (ART). METHODS A conditional probability model was constructed and non-virologic parameters in various combinations were tested in a hypothetical cohort of 1000 children aged 6 weeks, 6 months and 12 months to assess the sensitivity, specificity, and positive and negative predictive values of these algorithms for identifying children in need of ART. The modelled parameters consisted of clinical criteria, rapid HIV antibody testing and CD4+ T-lymphocyte (CD4) count. FINDINGS In children younger than 18 months, the best-performing screening algorithm, consisting of clinical symptoms plus antibody testing plus CD4 count, showed a sensitivity ranging from 71% to 80% and a specificity ranging from 92% to 99%. Positive and negative predictive values were between 61% and 97% and between 95% and 96%, respectively. In the absence of virologic tests, this alternate algorithm for the presumptive diagnosis of severe HIV disease makes it possible to correctly initiate ART in 91% to 98% of HIV-positive children who are at highest risk of dying. CONCLUSION The algorithms presented in this paper have better sensitivity and specificity than clinical parameters, with or without rapid HIV testing, for the presumptive diagnosis of severe disease in HIV-positive children less than 18 months of age. If implemented, they can increase the number of HIV-positive children successfully initiated on ART.
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Affiliation(s)
- Nicolas Grundmann
- Stanford University School of Medicine, Medical School Office Building (Room 323), 251 Campus Drive, Stanford, CA 94305-5404, United States of America.
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Predictors of successful early infant diagnosis of HIV in a rural district hospital in Zambézia, Mozambique. J Acquir Immune Defic Syndr 2011; 56:e104-9. [PMID: 21266912 DOI: 10.1097/qai.0b013e318207a535] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND A key challenge inhibiting the timely initiation of pediatric antiretroviral treatment is the loss to follow-up of mothers and their infants between the time of mothers' HIV diagnoses in pregnancy and return after delivery for early infant diagnosis of HIV. We sought to identify barriers to follow-up of HIV-exposed infants in rural Zambézia Province, Mozambique. METHODS We determined follow-up rates for early infant diagnosis and age at first test in a retrospective cohort of 443 HIV-infected mothers and their infants. Multivariable logistic regression models were used to identify factors associated with successful follow-up. RESULTS Of the 443 mother-infant pairs, 217 (49%) mothers enrolled in the adult HIV care clinic, and only 110 (25%) infants were brought for early infant diagnosis. The predictors of follow-up for early infant diagnosis were larger household size (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.09-1.53), independent maternal source of income (OR, 10.8; 95% CI, 3.42-34.0), greater distance from the hospital (OR, 2.14; 95% CI, 1.01-4.51), and maternal receipt of antiretroviral therapy (OR, 3.15; 95% CI, 1.02-9.73). The median age at first test among 105 infants was 5 months (interquartile range, 2-7); 16% of the tested infants were infected. CONCLUSIONS Three of four HIV-infected women in rural Mozambique did not bring their children for early infant HIV diagnosis. Maternal receipt of antiretroviral therapy has favorable implications for maternal health that will increase the likelihood of early infant diagnosis. We are working with local health authorities to improve the linkage of HIV-infected women to HIV care to maximize early infant diagnosis and care.
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Abstract
Currently, the majority of HIV-infected infants are found within limited-resource settings, where inadequate screening for HIV due to the lack of access to simple and affordable point-of-care tests impedes implementation of antiretroviral therapy. Here we report development of a low-cost dipstick p24 antigen assay using a visual readout format that can facilitate the diagnosis of HIV for infants in resource-poor conditions. A heat shock methodology was developed to optimize disruption of immune complexes present in the plasma of infected infants. The analytical sensitivity of the assay using recombinant p24 antigen is 50 pg/mL (2 pM) with whole virus detection as low as 42.5k RNA copies per milliliter plasma. In a blinded study comprising 51 archived infant samples from the Women and Infants Transmission Study, our assay demonstrated an overall sensitivity and specificity of 90% and 100%, respectively. In field evaluations of 389 fresh samples from South African infants, a sensitivity of 95% and specificity of 99% was achieved. The assay is simple to perform, requires minimal plasma volume (25 μL), and yields a result in less than 40 minutes making it ideal for implementation in resource-limited settings.
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Peeling RW, Mabey D. Point-of-care tests for diagnosing infections in the developing world. Clin Microbiol Infect 2010; 16:1062-9. [PMID: 20670288 DOI: 10.1111/j.1469-0691.2010.03279.x] [Citation(s) in RCA: 306] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Infectious diseases continue to cause an enormous burden of death and disability in developing countries. Increasing access to appropriate treatment for infectious diseases could have a major impact on disease burden. Some common infections can be managed syndromically without the need for diagnostic tests, but this is not appropriate for many infectious diseases, in which a positive diagnostic test is needed before treatment can be given. Since many people in developing countries do not have access to laboratory services, diagnosis depends on the availability of point of care (POC) tests. Historically there has been little investment in POC tests for diseases that are common in developing countries, but that is now changing. Lack of regulation of diagnostic tests in many countries has resulted in the widespread use of sub-standard POC tests, especially for malaria, making it difficult for manufacturers of reliable POC tests to compete. In recent years increased investment, technological advances, and greater awareness about the importance of reliable diagnostic tests has resulted in rapid progress. Rapid, reliable and affordable POC tests, requiring no equipment and minimal training, are now available for HIV infection, syphilis and malaria, but POC tests for other infections are urgently needed. Many countries do not have established criteria for licensing and introducing new diagnostic tests, and many clinicians in developing countries have become disillusioned with diagnostic tests and prefer to rely on clinical judgment. Continuing advocacy and training in the use of POC tests are needed, and systems for quality control of POC tests need to be developed if they are to achieve their maximum potential.
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Affiliation(s)
- R W Peeling
- Diagnostic Research, London School of Hygiene and Tropical Medicine, London, UK.
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26
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Putignani L, Menichella D. Global distribution, public health and clinical impact of the protozoan pathogen cryptosporidium. Interdiscip Perspect Infect Dis 2010; 2010:753512. [PMID: 20706669 PMCID: PMC2913630 DOI: 10.1155/2010/753512] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 01/07/2010] [Accepted: 05/11/2010] [Indexed: 12/19/2022] Open
Abstract
Cryptosporidium spp. are coccidians, oocysts-forming apicomplexan protozoa, which complete their life cycle both in humans and animals, through zoonotic and anthroponotic transmission, causing cryptosporidiosis. The global burden of this disease is still underascertained, due to a conundrum transmission modality, only partially unveiled, and on a plethora of detection systems still inadequate or only partially applied for worldwide surveillance. In children, cryptosporidiosis encumber is even less recorded and often misidentified due to physiological reasons such as early-age unpaired immunological response. Furthermore, malnutrition in underdeveloped countries or clinical underestimation of protozoan etiology in developed countries contribute to the underestimation of the worldwide burden. Principal key indicators of the parasite distribution were associated to environmental (e.g., geographic and temporal clusters, etc.) and host determinants of the infection (e.g., age, immunological status, travels, community behaviours). The distribution was geographically mapped to provide an updated picture of the global parasite ecosystems. The present paper aims to provide, by a critical analysis of existing literature, a link between observational epidemiological records and new insights on public health, and diagnostic and clinical impact of cryptosporidiosis.
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Affiliation(s)
- Lorenza Putignani
- Microbiology Unit, Bambino Gesù Pediatric Hospital, Scientific Institute, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Donato Menichella
- Microbiology Unit, Bambino Gesù Pediatric Hospital, Scientific Institute, Piazza Sant'Onofrio 4, 00165 Rome, Italy
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27
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Palamountain KM, Stewart KA, Krauss A, Kelso D, Diermeier D. University leadership for innovation in global health and HIV/AIDS diagnostics. Glob Public Health 2010; 5:189-96. [PMID: 20119876 DOI: 10.1080/17441690903456274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Medical products used in the developed world often fail to adequately serve resource-limited settings where electricity, transportation and health care workers are not readily available. We suggest that the problem is not only a lack of coordinated financial resources to purchase existing medical products, but also a lack of products that are specifically designed for resource-limited settings. While donor organisations with a focus on global health are increasingly willing to bear the additional financial risk for the research and development of such high-impact medical products, corporations are still reluctant to take their best scientists and engineers away from more commercially attractive projects. Universities, on the other hand, given their teaching and research missions, are well positioned to engage in such high-risk development projects. A group of biomedical, engineering, business and social science researchers at Northwestern University (NU) propose a creative model to address significant social and health needs. The team's initial product focus is a rapid test for diagnosing infants with HIV. The NU model aligns the incentives and expertise of industry, donors and academia to innovate medical products, such as the infant HIV diagnostic test, for resource-limited settings.
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Affiliation(s)
- K M Palamountain
- Kellogg School of Management, Northwestern University, Evanston, IL, USA.
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Nitazoxanide inhibits biofilm production and hemagglutination by enteroaggregative Escherichia coli strains by blocking assembly of AafA fimbriae. Antimicrob Agents Chemother 2010; 54:1526-33. [PMID: 20086145 DOI: 10.1128/aac.01279-09] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Enteroaggregative Escherichia coli (EAEC) strains have emerged as common causes of persistent diarrhea and malnutrition among children and HIV-infected persons. During infection, EAEC typically adheres to the intestinal mucosa via fimbrial adhesins, which results in a characteristic aggregative pattern. In the study described here we investigated whether the broad-spectrum antiparasitic and antidiarrheal drug nitazoxanide (NTZ) might be active against EAEC in vitro. While E. coli strains were resistant to NTZ in rich Luria-Bertani medium (MIC > 64 microg/ml), the drug was slightly inhibitory in a minimal medium supplemented with glucose (MinA-G medium; MIC, approximately 32 microg/ml). NTZ also inhibited biofilm production by strain EAEC 042 in both Dulbecco's modified Eagle's medium and MinA-G medium with a 50% inhibitory concentration of approximately 12 microg/ml. Immunofluorescence and immunoblot analyses with antibody against the major fimbrial subunit AafA of aggregative adherence fimbriae vaariant II (AAF/II) established that the numbers of AAF/II filaments on bacteria grown in the presence of NTZ were dramatically reduced. Comparative quantitative reverse transcription-PCR and reporter gene fusions (aafA::phoA) indicated that aafA expression was unaffected by NTZ, while aggR transcript levels and aggR::lacZ expression were increased approximately 10- and 2.5-fold, respectively, compared with that for the untreated controls. More generally, NTZ inhibited hemagglutination (HA) of red blood cells by the non-biofilm-producing strain JM221 expressing either AAF/I or type I fimbriae. Our findings suggest that the inhibitory action of NTZ on biofilm formation and HA is likely due to inhibition of fimbrial assembly. Antimicrobial agents that inhibit the assembly or function of fimbrial filaments should be good candidates for the prevention of infection.
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Wang Z, Chin SY, Chin CD, Sarik J, Harper M, Justman J, Sia SK. Microfluidic CD4+ T-Cell Counting Device Using Chemiluminescence-Based Detection. Anal Chem 2009; 82:36-40. [PMID: 19938816 DOI: 10.1021/ac902144w] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Zuankai Wang
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, New York 10027, Department of Electrical Engineering, Columbia University, 1300 South West Mudd 500, West 120th Street, New York, New York 10027, and International Center for AIDS Care and Treatment Programs, Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Sau Yin Chin
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, New York 10027, Department of Electrical Engineering, Columbia University, 1300 South West Mudd 500, West 120th Street, New York, New York 10027, and International Center for AIDS Care and Treatment Programs, Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Curtis D. Chin
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, New York 10027, Department of Electrical Engineering, Columbia University, 1300 South West Mudd 500, West 120th Street, New York, New York 10027, and International Center for AIDS Care and Treatment Programs, Mailman School of Public Health, Columbia University, New York, New York 10032
| | - John Sarik
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, New York 10027, Department of Electrical Engineering, Columbia University, 1300 South West Mudd 500, West 120th Street, New York, New York 10027, and International Center for AIDS Care and Treatment Programs, Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Maritza Harper
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, New York 10027, Department of Electrical Engineering, Columbia University, 1300 South West Mudd 500, West 120th Street, New York, New York 10027, and International Center for AIDS Care and Treatment Programs, Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Jessica Justman
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, New York 10027, Department of Electrical Engineering, Columbia University, 1300 South West Mudd 500, West 120th Street, New York, New York 10027, and International Center for AIDS Care and Treatment Programs, Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Samuel K. Sia
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, New York 10027, Department of Electrical Engineering, Columbia University, 1300 South West Mudd 500, West 120th Street, New York, New York 10027, and International Center for AIDS Care and Treatment Programs, Mailman School of Public Health, Columbia University, New York, New York 10032
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Fontaine O, Kosek M, Bhatnagar S, Boschi-Pinto C, Chan KY, Duggan C, Martinez H, Ribeiro H, Rollins NC, Salam MA, Santosham M, Snyder JD, Tsai AC, Vargas B, Rudan I. Setting research priorities to reduce global mortality from childhood diarrhoea by 2015. PLoS Med 2009; 6:e41. [PMID: 19278292 PMCID: PMC2653551 DOI: 10.1371/journal.pmed.1000041] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Olivier Fontaine and colleagues applied a priority-setting methodology to identify research priorities aimed at reducing global diarrhea mortality by 2015.
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31
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dos Ramos Farías MS, Garcia MN, Dilernia D, Rabinovich RD, Avila MM. Centrifugation improves the detection of HIV-1 p24 antigen in plasma from children born to mothers infected with HIV-1. J Virol Methods 2009; 158:6-10. [PMID: 19187789 DOI: 10.1016/j.jviromet.2009.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 12/19/2008] [Accepted: 01/13/2009] [Indexed: 11/29/2022]
Abstract
Detection of HIV proteins and/or nucleic acids is necessary for the diagnosis of perinatal HIV infection. Despite its low sensitivity, detection of p24 antigen in plasma is a simple and economic method for the diagnosis of HIV in exposed children. The aim of this study was to improve the sensitivity of detection of p24 using centrifugation of plasma. Forty-seven selected stored samples from 37 children (23 infected, 14 uninfected, median age of 137 days) were examined. Plasma samples (volume 0.3-1.5 ml) were defrosted, centrifuged at 23,500 x g at 4 degrees C for 60 min and determination of p24 was carried out in the resuspended pellet (0.12 ml). In 32 plasma samples from infected children, p24 was found originally in 6 (18.7%) and resulted positive in 24 (75%) pellets. When only one sample per child was considered, sensitivity was significantly higher in pellets, 3/23 uncentrifuged plasma samples and 15/23 pellets (McNemar Test, p<0.001). Specificity was 100%. The absorbance/cut-off ratio was always higher in the pellets from positive children (p=0.028). Plasma samples with volumes of 1 ml or more achieved a higher sensitivity (91.7% vs. 36.4%, p=0.009). Centrifugation of plasma samples prior to determination of p24 in pediatric patients resulted in a significant increase in sensitivity.
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Affiliation(s)
- María Sol dos Ramos Farías
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Paraguay, Buenos Aires, Argentina
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32
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Affiliation(s)
- Eric R Houpt
- Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA 22908, USA.
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Morbidity and mortality among a cohort of human immunodeficiency virus type 1-infected and uninfected pregnant women and their infants from Malawi, Zambia, and Tanzania. Pediatr Infect Dis J 2008; 27:808-14. [PMID: 18679152 PMCID: PMC2739309 DOI: 10.1097/inf.0b013e31817109a4] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Morbidity and mortality patterns among pregnant women and their infants (before antiretroviral therapy was widely available) determines HIV-1 diagnostic, monitoring, and care interventions. METHODS Data from mothers and their infants enrolled in a trial of antibiotics to reduce mother-to-child-transmission of HIV-1 at 4 sub-Saharan African sites were analyzed. Women were enrolled during pregnancy and follow-up continued until the infants reached 12 months of age. We describe maternal and infant morbidity and mortality in a cohort of HIV-1-infected and HIV-1-uninfected mothers. Maternal and infant factors associated with mortality risk in the infants were assessed using Cox proportional hazard modeling. RESULTS Among 2292 HIV-1-infected mothers, 166 (7.2%) had a serious adverse event (SAE) and 42 (1.8%) died, whereas no deaths occurred among the 331 HIV-1 uninfected mothers. Four hundred twenty-four (17.8%) of 2383 infants had an SAE and 349 (16.4%) died before the end of follow-up. Infants with early HIV-1 infection (birth to 4-6 weeks) had the highest mortality. Among infants born to HIV-1-infected women, maternal morbidity and mortality (P = 0.0001), baseline CD4 count (P = 0.0002), and baseline plasma HIV-1 RNA concentration (P < 0.0001) were significant predictors of infant mortality in multivariate analyses. CONCLUSIONS The high mortality among infants with early HIV-1 infection supports access to HIV-1 diagnostics and appropriate early treatment for all infants of HIV-1-infected mothers. The significant association between stage of maternal HIV-1 infection and infant mortality supports routine CD4 counts at the time of prenatal HIV-1 testing.
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Little KE, Bland RM, Newell ML. Vertically acquired paediatric HIV infection: the challenges of providing comprehensive packages of care in resource-limited settings. Trop Med Int Health 2008; 13:1098-110. [PMID: 18664240 DOI: 10.1111/j.1365-3156.2008.02130.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The successes achieved in paediatric disease management in well-resourced countries in recent years highlight the vast divide between the care options, and ultimately survival, between developed and developing areas of the world. Using an extensive literature review, we quantify recent achievements in terms of improved survival and quality of life, and examine current evidence of the effects of treatment on the survival and morbidity of HIV-infected children in developing countries. When provided with the same care as their counterparts in developed countries, children in developing countries show similar improvements in survival and general health, with 1-year survival rates exceeding 90% in many African settings. Despite the challenges of providing comprehensive packages of care in resource-limited settings, there is an urgent need to scale up prevention and treatment of HIV infections in children, focussing on strengthening Prevention of Mother-to-Child Transmission programmes in order to reduce the numbers of infants who are infected in addition to reducing morbidity and mortality among their mothers.
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Affiliation(s)
- K E Little
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, UCL, London, UK
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35
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Lee H, Sun E, Ham D, Weissleder R. Chip-NMR biosensor for detection and molecular analysis of cells. Nat Med 2008; 14:869-74. [PMID: 18607350 DOI: 10.1038/nm.1711] [Citation(s) in RCA: 374] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Accepted: 01/04/2008] [Indexed: 01/12/2023]
Abstract
Rapid and accurate measurement of biomarkers in tissue and fluid samples is a major challenge in medicine. Here we report the development of a new, miniaturized diagnostic magnetic resonance (DMR) system for multiplexed, quantitative and rapid analysis. By using magnetic particles as a proximity sensor to amplify molecular interactions, the handheld DMR system can perform measurements on unprocessed biological samples. We show the capability of the DMR system by using it to detect bacteria with high sensitivity, identify small numbers of cells and analyze them on a molecular level in real time, and measure a series of protein biomarkers in parallel. The DMR technology shows promise as a robust and portable diagnostic device.
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Affiliation(s)
- Hakho Lee
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, Boston, Massachusetts 02114, USA
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MILLER M, SENTZ J, RABAA M, MINTZ E. Global epidemiology of infections due to Shigella, Salmonella serotype Typhi, and enterotoxigenic Escherichia coli. Epidemiol Infect 2008; 136:433-5. [PMID: 18461719 PMCID: PMC2870845 DOI: 10.1017/s095026880800040x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2008] [Indexed: 11/06/2022] Open
Affiliation(s)
- M. A. MILLER
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - J. SENTZ
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - M. A. RABAA
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - E. D. MINTZ
- Enteric Diseases Epidemiology Branch, National Center for Zoonotic, Vectorborne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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George E, Beauharnais CA, Brignoli E, Noel F, Bois G, De Matteis Rouzier P, Altenor M, Lauture D, Hosty M, Mehta S, Wright PF, Pape JW. Potential of a simplified p24 assay for early diagnosis of infant human immunodeficiency virus type 1 infection in Haiti. J Clin Microbiol 2007; 45:3416-8. [PMID: 17670933 PMCID: PMC2045325 DOI: 10.1128/jcm.01314-07] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
With global efforts to scale up the prevention of mother-to-child transmission services and pediatric antiretroviral therapy, there is an urgent need to introduce a simple, low-cost infant human immunodeficiency virus test in the field. We postulated that the p24 antigen capture enzyme-linked immunosorbent assay could be simplified by eliminating signal amplification without compromising diagnostic accuracy.
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Affiliation(s)
- Erik George
- Department of Medicine, Weill Medical College, Cornell University, New York, NY, USA.
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