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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.
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Rob F, Jilich D, Lásiková Š, Křížková V, Hercogová J. First reported case of chancroid in the Czech Republic. Int J STD AIDS 2018; 29:1127-1129. [PMID: 29749871 DOI: 10.1177/0956462418774700] [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] [Indexed: 11/16/2022]
Abstract
We describe the first case of chancroid seen in the Czech Republic, diagnosed in a 40-year-old heterosexual HIV-positive man. Despite genital localization of the ulcer, the transmission of Haemophilus ducreyi infection in our patient remains unclear, as he denied having sexual intercourse and he did not travel outside the Czech Republic for several months before the ulcer appeared. The correct diagnosis has been revealed by a multiplex nucleic acid amplification test. Physicians in countries in the eastern and central Europe region should be aware that chancroid can occur in their patients.
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Affiliation(s)
- Filip Rob
- 1 Department of Dermatovenerology, Second Faculty of Medicine, Charles University, Na Bulovce Hospital, Prague, Czech Republic
| | - David Jilich
- 2 Department of Infectious and Tropical Diseases, First Faculty of Medicine, Charles University, Na Bulovce Hospital, Prague, Czech Republic
| | - Šárka Lásiková
- 3 Department of Microbiology, Na Bulovce Hospital, Prague, Czech Republic
| | - Veronika Křížková
- 1 Department of Dermatovenerology, Second Faculty of Medicine, Charles University, Na Bulovce Hospital, Prague, Czech Republic
| | - Jana Hercogová
- 1 Department of Dermatovenerology, Second Faculty of Medicine, Charles University, Na Bulovce Hospital, Prague, Czech Republic
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Houinei W, Godornes C, Kapa A, Knauf S, Mooring EQ, González-Beiras C, Watup R, Paru R, Advent P, Bieb S, Sanz S, Bassat Q, Spinola SM, Lukehart SA, Mitjà O. Haemophilus ducreyi DNA is detectable on the skin of asymptomatic children, flies and fomites in villages of Papua New Guinea. PLoS Negl Trop Dis 2017; 11:e0004958. [PMID: 28489855 PMCID: PMC5425006 DOI: 10.1371/journal.pntd.0004958] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 08/08/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Haemophilus ducreyi and Treponema pallidum subsp. pertenue are major causes of leg ulcers in children in Africa and the Pacific Region. We investigated the presence of DNA (PCR positivity) from these bacteria on asymptomatic people, flies, and household linens in an endemic setting. METHODOLOGY/PRINCIPAL FINDINGS We performed a cross-sectional study in rural villages of Lihir Island, Papua New Guinea during a yaws elimination campaign. Participants were asymptomatic subjects recruited from households with cases of leg ulcers, and from households without cases of leg ulcers. We rubbed swabs on the intact skin of the leg of asymptomatic individuals, and collected flies and swabs of environmental surfaces. All specimens were tested by PCR for H. ducreyi and T. p. pertenue DNA. Of 78 asymptomatic participants that had an adequate specimen for DNA detection, H. ducreyi-PCR positivity was identified in 16 (21%) and T. p. pertenue-PCR positivity in 1 (1%). In subgroup analyses, H. ducreyi-PCR positivity did not differ in participants exposed or not exposed to a case of H. ducreyi ulcer in the household (24% vs 18%; p = 0.76). Of 17 cultures obtained from asymptomatic participants, 2 (12%) yielded a definitive diagnosis of H. ducreyi, proving skin colonization. Of 10 flies tested, 9 (90%) had H. ducreyi DNA and 5 (50%) had T. p. pertenue DNA. Of 6 bed sheets sampled, 2 (33%) had H. ducreyi DNA and 1 (17%) had T. p. pertenue DNA. CONCLUSIONS/SIGNIFICANCE This is the first time that H. ducreyi DNA and colonization has been demonstrated on the skin of asymptomatic children and that H. ducreyi DNA and T. p. pertenue DNA has been identified in flies and on fomites. The ubiquity of H. ducreyi in the environment is a contributing factor to the spread of the organism.
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Affiliation(s)
- Wendy Houinei
- Disease Control Branch, National Department of Health, Port Moresby, Papua New Guinea
| | - Charmie Godornes
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - August Kapa
- Lihir Medical Centre– International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
| | - Sascha Knauf
- German Primate Center, Leibniz-Institute for Primate Research, Pathology Unit, Working Group Neglected Tropical Diseases, Göttingen, Germany
| | - Eric Q. Mooring
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Ronald Watup
- 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
| | - Paul Advent
- Lihir Medical Centre– International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
| | - Sivauk Bieb
- Disease Control Branch, National Department of Health, Port Moresby, Papua New Guinea
| | - Sergi Sanz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona, Barcelona, Spain
| | - Quique Bassat
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Stanley M. Spinola
- Departments of Microbiology and Immunology, Medicine, and Pathology and Laboratory Medicine Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - 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
| | - 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
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Abstract
The global epidemiology of Haemophilus ducreyi infections is poorly documented because of difficulties in confirming microbiological diagnoses. We evaluated published data on the proportion of genital and nongenital skin ulcers caused by H. ducreyi before and after introduction of syndromic management for genital ulcer disease (GUD). Before 2000, the proportion of GUD caused by H. ducreyi ranged from 0.0% to 69.0% (35 studies in 25 countries). After 2000, the proportion ranged from 0.0% to 15.0% (14 studies in 13 countries). In contrast, H. ducreyi has been recently identified as a causative agent of skin ulcers in children in the tropical regions; proportions ranged from 9.0% to 60.0% (6 studies in 4 countries). We conclude that, although there has been a sustained reduction in the proportion of GUD caused by H. ducreyi, this bacterium is increasingly recognized as a major cause of nongenital cutaneous ulcers.
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Haemophilus ducreyi Cutaneous Ulcer Strains Are Nearly Identical to Class I Genital Ulcer Strains. PLoS Negl Trop Dis 2015; 9:e0003918. [PMID: 26147869 PMCID: PMC4492979 DOI: 10.1371/journal.pntd.0003918] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 06/16/2015] [Indexed: 12/20/2022] Open
Abstract
Background Although cutaneous ulcers (CU) in the tropics is frequently attributed to Treponema pallidum subspecies pertenue, the causative agent of yaws, Haemophilus ducreyi has emerged as a major cause of CU in yaws-endemic regions of the South Pacific islands and Africa. H. ducreyi is generally susceptible to macrolides, but CU strains persist after mass drug administration of azithromycin for yaws or trachoma. H. ducreyi also causes genital ulcers (GU) and was thought to be exclusively transmitted by microabrasions that occur during sex. In human volunteers, the GU strain 35000HP does not infect intact skin; wounds are required to initiate infection. These data led to several questions: Are CU strains a new variant of H. ducreyi or did they evolve from GU strains? Do CU strains contain additional genes that could allow them to infect intact skin? Are CU strains susceptible to azithromycin? Methodology/Principal Findings To address these questions, we performed whole-genome sequencing and antibiotic susceptibility testing of 5 CU strains obtained from Samoa and Vanuatu and 9 archived class I and class II GU strains. Except for single nucleotide polymorphisms, the CU strains were genetically almost identical to the class I strain 35000HP and had no additional genetic content. Phylogenetic analysis showed that class I and class II strains formed two separate clusters and CU strains evolved from class I strains. Class I strains diverged from class II strains ~1.95 million years ago (mya) and CU strains diverged from the class I strain 35000HP ~0.18 mya. CU and GU strains evolved under similar selection pressures. Like 35000HP, the CU strains were highly susceptible to antibiotics, including azithromycin. Conclusions/Significance These data suggest that CU strains are derivatives of class I strains that were not recognized until recently. These findings require confirmation by analysis of CU strains from other regions. Cutaneous ulcers (CU) in children living in equatorial Africa and the South Pacific islands have long been attributed to yaws, which is caused by Treponema pallidum subsp. pertenue. However, PCR-based cross sectional surveys done in yaws-endemic regions show that Haemophilus ducreyi is the leading cause of CU in these regions. H. ducreyi classically causes the genital ulcer (GU) disease chancroid and was once thought to be exclusively sexually transmitted. We show that CU strains obtained from Samoa and Vanuatu are genetically nearly identical to class 1 GU strains and contain no additional genetic content. The CU strains are highly susceptible to antibiotics, including azithromycin. The data suggest an urgent need to obtain and analyze CU isolates from Africa and other countries in the South Pacific and to search for environmental sources of the organism.
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Sherwood JA, Grosso A, Decker MR, Peitzmeier S, Papworth E, Diouf D, Drame FM, Ceesay N, Baral S. Sexual violence against female sex workers in The Gambia: a cross-sectional examination of the associations between victimization and reproductive, sexual and mental health. BMC Public Health 2015; 15:270. [PMID: 25886187 PMCID: PMC4375842 DOI: 10.1186/s12889-015-1583-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 02/25/2015] [Indexed: 11/12/2022] Open
Abstract
Background Female sex workers (FSW) are a vulnerable population for sexual violence and poor sexual and reproductive health outcomes. Sexual violence against FSW has not been widely studied in The Gambia. This study will report the prevalence of and evaluate the health issues correlated with forced sex perpetrated by clients against FSW in The Gambia, and will secondly aim to inform future research and efforts to improve health outcomes for survivors of violence. Methods A cross-sectional survey was administered among 251 FSW accrued through a combination of chain referral and venue-based sampling in The Gambia. Eligibility criteria included being over 16 years old and having exchanged sex for money, goods, or favors in the past 12 months. Results There is a high prevalence of sexual violence against FSW in The Gambia, with 29% (n = 70) of participants reporting a client forced them to have sex in their lifetime. Women who reported forced sex by a client were more likely to report symptoms of depression (aOR 2.15, CI: 1.10 – 4.16 p < 0.05), unwanted pregnancy (aOR: 2.69, CI: 1.12 – 6.49 p < 0.05) and report “no”, “difficult” or “somewhat difficult” access to condoms (aOR: 3.31, CI: 1.76 – 6.26 p < .01) compared to women who did not report forced sex. Client-perpetrated forced sex was also negatively associated with receiving any sexually transmitted infection (STI) test in the past 12 months (aOR: 0.49, CI: .26 – .91 p < .05). Conclusion FSW who experience sexual violence by a client are more likely to experience poor sexual, reproductive and mental health outcomes. Responding to sexual violence among FSW, including providing survivors with access to post-exposure prophylaxis, emergency contraception, and mental health services, must be a priority given the prevalence of forced sex and links with poor health outcomes. Efforts to reduce sexual violence against FSW is a vital strategy to improve the health and safety of FSW as well as impact the spread of HIV/STIs in The Gambia.
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Affiliation(s)
- Jennifer A Sherwood
- Johns Hopkins School of Public Health, 615 N Wolfe St. #5041, Baltimore, MD, 21205, USA.
| | - Ashley Grosso
- Johns Hopkins School of Public Health, 615 N Wolfe St. #5041, Baltimore, MD, 21205, USA.
| | - Michele R Decker
- Johns Hopkins School of Public Health, 615 N Wolfe St. #5041, Baltimore, MD, 21205, USA.
| | - Sarah Peitzmeier
- Johns Hopkins School of Public Health, 615 N Wolfe St. #5041, Baltimore, MD, 21205, USA.
| | - Erin Papworth
- Johns Hopkins School of Public Health, 615 N Wolfe St. #5041, Baltimore, MD, 21205, USA.
| | - Daouda Diouf
- Enda Santé Senegal, 56, Comico VDN, BP, 3370, Dakar, Sénégal.
| | | | - Nuha Ceesay
- Lilunga House, Fifth Floor, Somhlolo Street, Mbabane, Swaziland.
| | - Stefan Baral
- Johns Hopkins School of Public Health, 615 N Wolfe St. #5041, Baltimore, MD, 21205, USA.
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Affiliation(s)
- D A Lewis
- Sexually Transmitted Bacteria Reference Laboratory, Health Protection Agency Centre for Infections, Colindale, London, UK
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van der Loeff MFS, Awasana AA, Sarge-Njie R, van der Sande M, Jaye A, Sabally S, Corrah T, McConkey SJ, Whittle HC. Sixteen years of HIV surveillance in a West African research clinic reveals divergent epidemic trends of HIV-1 and HIV-2. Int J Epidemiol 2006; 35:1322-8. [PMID: 16543363 DOI: 10.1093/ije/dyl037] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The HIV-1 epidemic in West Africa is characterized by a slower rise than that in Eastern and Southern Africa. The HIV-2 epidemic in West Africa may be declining, but few long-term data exist. METHODS In a research clinic in The Gambia, HIV-1 and HIV-2 prevalence trends among all new patients being tested for HIV were examined over a 16 year period (1988 till 2003). In newly diagnosed patients a baseline CD4 count was done. RESULTS An HIV test was done in 23 363 patients aged 15 years or older. The prevalence of HIV-1 was 4.2% in 1988-91 and rose to 17.5% in 2001-03 (P < 0.0001, chi(2)-test for trend). The prevalence of HIV-2 was 7.0% in 1988-91 and declined to 4.0% in 2001-03 (P < 0.0001). HIV-1 prevalence increased and HIV-2 prevalence decreased with time in logistic regression models adjusting for age, sex, and indication for test (P < 0.0001). Baseline CD4 counts were available for 65% of patients. The median CD4 count was 215 cells/mm3 [interquartile range (IQR) 72-424] for HIV-1, and 274 (IQR 100-549) for HIV-2 infected patients. There was no marked trend of rise or decline in baseline CD4 count in either HIV-1 or HIV-2 infected patients over the study period. Forty-five per cent of newly diagnosed HIV patients had a CD4 count <200 cells/mm3. CONCLUSIONS These data suggest that HIV-1 prevalence is rising in The Gambia, and that HIV-2 is declining. HIV patients in The Gambia present late and almost half of patients would qualify for anti-retroviral treatment at their first visit.
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