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Scott JL, Mayfield HJ, Sinclair JE, Martin BM, Howlett M, Muttucumaru R, Won KY, Thomsen R, Viali S, Tofaeono-Pifeleti R, Graves PM, Lau CL. Field laboratory comparison of STANDARD Q Filariasis Antigen Test (QFAT) with Bioline Filariasis Test Strip (FTS) for the detection of Lymphatic Filariasis in Samoa, 2023. PLoS Negl Trop Dis 2024; 18:e0012386. [PMID: 39102429 PMCID: PMC11326698 DOI: 10.1371/journal.pntd.0012386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 08/15/2024] [Accepted: 07/18/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND To monitor the progress of lymphatic filariasis (LF) elimination programmes, field surveys to assess filarial antigen (Ag) prevalence require access to reliable, user-friendly rapid diagnostic tests. We aimed to evaluate the performance of the new Q Filariasis Antigen Test (QFAT) with the currently recommended Filariasis Test Strip (FTS) for detecting the Ag of Wuchereria bancrofti, the causative agent of LF, under field laboratory conditions. METHODOLOGY/PRINCIPAL FINDINGS During an LF survey in Samoa, 344 finger-prick blood samples were tested using FTS and QFAT. Microfilariae (Mf) status was determined from blood slides prepared from any sample that reported Ag-positive by either Ag-test. Each test was re-read at 1 hour and the next day to determine the stability of results over time. Overall Ag-positivity by FTS was 29.0% and 30.2% by QFAT. Concordance between the two tests was 93.6% (kappa = 0.85). Of the 101 Mf slides available, 39.6% were Mf-positive, and all were Ag-positive by both tests. Darker test line intensities from Ag-positive FTS were found to predict Mf-positivity (compared to same/lighter line intensities). QFAT had significantly higher reported test result changes than FTS, mostly reported the next day, but fewer changes were reported between 10 minutes to 1hour. The field laboratory team preferred QFAT over FTS due to the smaller blood volume required, better usability, and easier readability. CONCLUSION/SIGNIFICANCE QFAT could be a suitable and user-friendly diagnostic alternative for use in the monitoring and surveillance of LF in field surveys based on its similar performance to FTS under field laboratory conditions.
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Affiliation(s)
- Jessica L Scott
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, Queensland, Australia
| | - Helen J Mayfield
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jane E Sinclair
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Beatris Mario Martin
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Maddison Howlett
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ramona Muttucumaru
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kimberly Y Won
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Satupaitea Viali
- School of Medicine, National University of Samoa, Apia, Samoa
- Oceania University of Medicine Samoa, Apia, Samoa
| | | | - Patricia M Graves
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, Queensland, Australia
| | - Colleen L Lau
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Djune-Yemeli L, Hertz M, Nana-Djeunga HC, Rush A, Erdmann-Gilmore P, Sprung R, Bopda JG, Townsend R, Netongo PM, Kamgno J, Budge PJ. Longitudinal study of cross-reactive antigenemia in individuals with high Loa loa microfilarial density reveals promising biomarkers for distinguishing lymphatic filariasis from loiasis. FRONTIERS IN PARASITOLOGY 2023; 2:1292837. [PMID: 39176078 PMCID: PMC11340908 DOI: 10.3389/fpara.2023.1292837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
Background and methods Circulating Loa loa antigens are often detected in individuals with heavy L. loa infections by diagnostic tests for lymphatic filariasis (LF) caused by Wuchereria bancrofti. This is a major challenge to LF mapping and elimination efforts in loiasis co-endemic areas. However, it also provides an opportunity to identify antigen biomarkers for loiasis. To determine which L. loa antigens might be promising biomarkers for distinguishing true LF from loiasis, we screened for L. loa antigens in a group of individuals with heavy L. loa infections living in the Okola Health District of Cameroon. In this longitudinal study, participants were tested for cross-reactive antigenemia by filariasis test strip (FTS), ELISA, and western blot, and were monitored for FTS status at 6, 9, 12, and 15 months post-enrollment. We then identified specific circulating L. loa antigens by liquid chromatography-tandem mass spectrometry (LC-MS/MS) from baseline and 15-month plasma samples. Principal findings and conclusions Among 73 FTS-positive (FTS+) and 13 FTS-negative (FTS-) participants with high L. loa microfilarial loads, 83% maintained their FTS status over the course of the study, while 17% experienced at least one FTS conversion event (from FTS+ to FTS- or vice versa). Cross-reactive antigens were detected in both FTS+ and FTS- sera by western blot, and there was poor agreement in antigen detection by FTS, western blot, and ELISA methods. One protein family, a group of Nas-14 metalloproteases, was detected by LC MS/MS in >80% of tested samples, including FTS- samples. These data identify Nas-14 as a promising loiasis biomarker potentially capable of distinguishing loiasis from lymphatic filariasis.
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Affiliation(s)
- Linda Djune-Yemeli
- Higher Institute of Scientific and Medical Research (ISM), Yaoundé, Cameroon
- Molecular Diagnostics Research Group, Biotechnology Centre-University of Yaoundé I (BTC-UY-I), Yaoundé, Cameroon
| | - Marla Hertz
- Office of Scholarly Communication, University of Alabama at Birmingham Libraries, Birmingham, AL, United States
| | | | - Amy Rush
- Infectious Disease Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Petra Erdmann-Gilmore
- Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Robert Sprung
- Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Jean Gabin Bopda
- Higher Institute of Scientific and Medical Research (ISM), Yaoundé, Cameroon
| | - Reid Townsend
- Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Palmer Masumbe Netongo
- Molecular Diagnostics Research Group, Biotechnology Centre-University of Yaoundé I (BTC-UY-I), Yaoundé, Cameroon
- Departement of Biochemistry, Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Joseph Kamgno
- Higher Institute of Scientific and Medical Research (ISM), Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Philip J. Budge
- Infectious Disease Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, United States
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3
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Greene SE, Huang Y, Kim W, Liebeskind MJ, Chandrasekaran V, Liu Z, Deepak P, Paley MA, Lew D, Yang M, Matloubian M, Gensler LS, Nakamura MC, O'Hallaran JA, Presti RM, Whelan SPJ, Buchser WJ, Kim AHJ, Weil GJ. A simple point-of-care assay accurately detects anti-spike antibodies after SARS-CoV-2 vaccination. JOURNAL OF CLINICAL VIROLOGY PLUS 2023; 3:100135. [PMID: 36644774 PMCID: PMC9831968 DOI: 10.1016/j.jcvp.2023.100135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
Objective Lateral flow assays (LFA) are sensitive for detecting antibodies to SARS-CoV-2 proteins within weeks after infection. This study tested samples from immunocompetent adults, and those receiving treatments for chronic inflammatory diseases (CID), before and after mRNA SARS-CoV-2 vaccination. Methods We compared results obtained with the COVIBLOCK Covid-19 LFA to those obtained by anti-spike (S) ELISA. Results The LFA detected anti-S antibodies in 29 of 29 (100%) of the immunocompetent and 110 of 126 (87.3%) of the CID participants after vaccination. Semiquantitative LFA scores were statistically significantly lower in samples from immunosuppressed participants, and were significantly correlated with anti-S antibody levels measured by ELISA. Conclusions This simple LFA test is a practical alternative to laboratory-based assays for detecting anti-S antibodies after infection or vaccination. This type of test may be most useful for testing people in outpatient or resource-limited settings.
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Affiliation(s)
- Sarah E Greene
- Division of Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, 4444 Forest Park Avenue, Rm 4184 , St. Louis, MO 63110, United States
| | - Yuefang Huang
- Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, MO, United States
| | - Wooseob Kim
- Division of Immunobiology, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Mariel J Liebeskind
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, United States
| | - Vinay Chandrasekaran
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, United States
| | - Zhuoming Liu
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Parakkal Deepak
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Michael A Paley
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Daphne Lew
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, United States
| | - Monica Yang
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Mehrdad Matloubian
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Lianne S Gensler
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States.,San Francisco VA Health Care System, San Francisco, CA, United States
| | - Mary C Nakamura
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, United States.,San Francisco VA Health Care System, San Francisco, CA, United States
| | - Jane A O'Hallaran
- Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, MO, United States
| | - Rachel M Presti
- Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, MO, United States
| | - Sean P J Whelan
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, United States
| | - William J Buchser
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, United States
| | - Alfred H J Kim
- Division of Immunobiology, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States.,Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Gary J Weil
- Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, MO, United States
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Laman M, Tavul L, Karl S, Kotty B, Kerry Z, Kumai S, Samuel A, Lorry L, Timinao L, Howard SC, Makita L, John L, Bieb S, Wangi J, Albert JM, Payne M, Weil GJ, Tisch DJ, Bjerum CM, Robinson LJ, King CL. Mass drug administration of ivermectin, diethylcarbamazine, plus albendazole compared with diethylcarbamazine plus albendazole for reduction of lymphatic filariasis endemicity in Papua New Guinea: a cluster-randomised trial. THE LANCET INFECTIOUS DISEASES 2022; 22:1200-1209. [PMID: 35533701 PMCID: PMC9300473 DOI: 10.1016/s1473-3099(22)00026-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 11/28/2021] [Accepted: 01/10/2022] [Indexed: 11/15/2022]
Abstract
Background Methods Findings Interpretation Funding
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Affiliation(s)
- Moses Laman
- Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea
| | - Livingstone Tavul
- Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea
| | - Stephan Karl
- Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea; Australian Institute of Tropical Health and Medicine, James Cook University, Smithfield, QLD, Australia
| | - Bethuel Kotty
- Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea
| | - Zebede Kerry
- Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea
| | - Stephen Kumai
- Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea
| | - Anna Samuel
- Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea
| | - Lina Lorry
- Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea
| | - Lincoln Timinao
- Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea
| | - S Cade Howard
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
| | - Leo Makita
- National Department of Health, Waigani, Papua New Guinea
| | - Lucy John
- National Department of Health, Waigani, Papua New Guinea
| | - Sibauk Bieb
- National Department of Health, Waigani, Papua New Guinea
| | - James Wangi
- WHO Papua New Guinea, NTD Program, Waigani, Papua New Guinea
| | - Jeffrey M Albert
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Michael Payne
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
| | - Gary J Weil
- Department of Medicine, Washington University, St Louis, MO, USA
| | - Daniel J Tisch
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA; Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Catherine M Bjerum
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
| | - Leanne J Robinson
- Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea; Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Christopher L King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA; Veterans Affairs Research Administration, Cleveland, OH, USA.
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Safety and efficacy of mass drug administration with a single-dose triple-drug regimen of albendazole + diethylcarbamazine + ivermectin for lymphatic filariasis in Papua New Guinea: An open-label, cluster-randomised trial. PLoS Negl Trop Dis 2022; 16:e0010096. [PMID: 35139070 PMCID: PMC8863226 DOI: 10.1371/journal.pntd.0010096] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 02/22/2022] [Accepted: 12/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background Papua New Guinea (PNG) has a high burden of lymphatic filariasis (LF) caused by Wuchereria bancrofti, with an estimated 4.2 million people at risk of infection. A single co-administered dose of ivermectin, diethylcarbamazine and albendazole (IDA) has been shown to have superior efficacy in sustained clearance of microfilariae compared to diethylcarbamazine and albendazole (DA) in small clinical trials. A community-based cluster-randomised trial of DA versus IDA was conducted to compare the safety and efficacy of IDA and DA for LF in a moderately endemic, treatment-naive area in PNG. Methodology All consenting, eligible residents of 24 villages in Bogia district, Madang Province, PNG were enrolled, screened for W. bancrofti antigenemia and microfilaria (Mf) and randomised to receive IDA (N = 2382) or DA (N = 2181) according to their village of residence. Adverse events (AE) were assessed by active follow-up for 2 days and passive follow-up for an additional 5 days. Antigen-positive participants were re-tested one year after MDA to assess treatment efficacy. Principal findings Of the 4,563 participants enrolled, 96% were assessed for AEs within 2 days after treatment. The overall frequency of AEs were similar after either DA (18%) or IDA (20%) treatment. For those individuals with AEs, 87% were mild (Grade 1), 13% were moderate (Grade 2) and there were no Grade 3, Grade 4, or serious AEs (SAEs). The frequency of AEs was greater in Mf-positive than Mf-negative individuals receiving IDA (39% vs 20% p<0.001) and in Mf-positive participants treated with IDA (39%), compared to those treated with DA (24%, p = 0.023). One year after treatment, 64% (645/1013) of participants who were antigen-positive at baseline were re-screened and 74% of these participants (475/645) remained antigen positive. Clearance of Mf was achieved in 96% (52/54) of infected individuals in the IDA arm versus 84% (56/67) of infected individuals in the DA arm (relative risk (RR) 1.15; 95% CI, 1.02 to 1.30; p = 0.019). Participants receiving DA treatment had a 4-fold higher likelihood of failing to clear Mf (RR 4.67 (95% CI: 1.05 to 20.67; p = 0.043). In the DA arm, a significant predictor of failure to clear was baseline Mf density (RR 1.54; 95% CI, 1.09 to 2.88; p = 0.007). Conclusion IDA was well tolerated and more effective than DA for clearing Mf. Widespread use of this regimen could accelerate LF elimination in PNG. Trial registration Registration number NCT02899936; https://clinicaltrials.gov/ct2/show/NCT02899936. Lymphatic filariasis (LF) is a mosquito-transmitted parasitic nematode that can live in human hosts for up to 6–8 years, disrupting the normal functions of the lymphatic system leading to the abnormal enlargement of body parts, causing pain, severe disability, and social stigma. Lymphatic filariasis can be eliminated by stopping the spread of infection through preventive chemotherapy with safe medicine combinations repeated annually. Several small-scale trials demonstrated that a single dose of a triple-drug regimen (ivermectin, diethylcarbamazine, and albendazole or IDA) was more effective at clearing infection than the standard two-drug regimen (diethylcarbamazine and albendazole or DA). This study was conducted to investigate the safety and efficacy of IDA in a large community-randomised trial in a moderate transmission setting. IDA was shown to be as safe as the standard two-drug DA treatment and more effective for clearing microfilariae compared to DA. These results show that IDA is well tolerated in PNG and has the potential to accelerate LF elimination.
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Nadeem R, Barakat AB, Bahgat MM. Cross-reaction between mouse and rat immunoglobulin G: does it matter in sandwich ELISA? J Genet Eng Biotechnol 2021; 19:119. [PMID: 34403025 PMCID: PMC8369443 DOI: 10.1186/s43141-021-00222-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/02/2021] [Indexed: 11/21/2022]
Abstract
Background Sandwich ELISA is an ideal antigen detection and quantification assay. Recently, it was used as the basic concept for high technology diagnostics. The specificity of the assay depends on the exclusion of detection cross-reactivity which arises from using two antibodies developed in different species. Since mice and rats are the common laboratory animals used to develop antigen specific antibodies. Therefore, the questions we addressed here were (1) can one use antigen-specific antibodies raised in mice and rats in the same assay to specifically detect/quantify antigens? and (2) which antibodies of the two rodents should be placed for capturing and for detection in the antigen-detection sandwich? Results Direct ELISA assay was used to assess for the specific reaction of the HRP-conjugated antibody to the target serum. First reaction was to compare between either conjugate anti-rat IgG (homologous) or anti-mouse IgG (heterologous) for the detection of rat sera IgG. Following the dilution factor optimization, the O.D. were 0.744±0.051 and 0.604±0.05, respectively (p= .004). The difference in mean O.D. of 0.14 reflected an unaccepted non-specific reaction. The second reaction was to compare between either conjugate anti-mouse IgG (homologous) and anti-rat IgG (heterologous) for the detection of mouse sera IgG. The recorded O.D. were 0.9414±0.14 and 0.317 ±0.141, respectively (p= .0002). The improved difference in mean O.D. of 0.624 reflecting a minimized cross-reaction. Conclusions Our results suggest that it is possible to use both Swiss albino mice and albino rats in a single sandwich ELISA, given that the captured antibody species to be from the Swiss albino mice and the detection antibody to be from the albino rat. The described working details are limited to the source of the antibodies used in the study. However, the approach stresses on the importance of such optimization steps before making any interpretations based on the antigen detection. To our knowledge, this study is the first to cover the optimal order of the capturing and the detection antibodies in a sandwich ELISA assay. In addition to addressing the possible interfering cross-reactivity that result from using mouse and rat serum antibodies in a single assay. Graphical abstract ![]()
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Affiliation(s)
- Rola Nadeem
- Department of Therapeutic Chemistry, Division of Pharmaceutical and Drug Industries Research, the National Research Center, Cairo, Egypt.,Research Group Immune- and Bio-markers for Infection, The Center of Excellence for Advanced Sciences, the National Research Center, El Buhooth Street (Formerly El Tahrir), Dokki, Cairo, 12622, Egypt
| | - Ahmed B Barakat
- Department of Microbiology, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Mahmoud M Bahgat
- Department of Therapeutic Chemistry, Division of Pharmaceutical and Drug Industries Research, the National Research Center, Cairo, Egypt. .,Research Group Immune- and Bio-markers for Infection, The Center of Excellence for Advanced Sciences, the National Research Center, El Buhooth Street (Formerly El Tahrir), Dokki, Cairo, 12622, Egypt.
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Campillo JT, Awaca-Uvon NP, Missamou F, Tambwe JP, Kuyangisa-Simuna G, Weil GJ, Louya F, Boussinesq M, Pion SDS, Chesnais CB. Results From 2 Cohort Studies in Central Africa Show That Clearance of Wuchereria bancrofti Infection After Repeated Rounds of Mass Drug Administration With Albendazole Alone Is Closely Linked to Individual Adherence. Clin Infect Dis 2021; 73:e176-e183. [PMID: 32856050 PMCID: PMC8246789 DOI: 10.1093/cid/ciaa1232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background Two community trials conducted from 2012 to 2018 in the Republic of Congo and the Democratic Republic of the Congo demonstrated the efficacy of semiannual mass drug administration (MDA) with albendazole (ALB) alone on lymphatic filariasis (LF). However, a high interindividual heterogeneity in the clearance of infection was observed. Methods We analyzed trial data to assess the effect of individual adherence to ALB MDA on clearance of circulating filarial antigenemia (CFA) and microfilaremia. Community residents were offered a single dose of ALB every 6 months and tested for LF with a rapid test for CFA at baseline and then annually. CFA test results were scored on a semiquantitative scale. At each round, microfilaremia was assessed in CFA-positive individuals. All CFA-positive individuals for whom at least 1 follow-up measure was available were included in the analyses. Parametric survival models were used to assess the influence of treatment adherence on LF infection indicators. Results Of 2658 individuals enrolled in the trials, 394 and 129 were eligible for analysis of CFA and microfilaremia clearance, respectively. After adjusting for age, sex, and initial CFA score, the predicted mean time for clearing CFA was shorter in persons who had taken 2 doses of ALB per year (3.9 years) than in persons who had taken 1 or 0 dose (4.4 and 5.3 years; P < .001 for both). A similar pattern was observed for microfilaremia clearance. Conclusions These results demonstrate a clear dose-response relationship for the effect of ALB on clearance of CFA and microfilaremia.
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Affiliation(s)
- Jérémy T Campillo
- UMI 233, Institut de Recherche pour le Développement, Montpellier, France.,Université de Montpellier, Montpellier, France.,INSERM Unité 1175, Montpellier, France
| | - Naomi P Awaca-Uvon
- Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo
| | - Francois Missamou
- Programme National de Lutte contre l'Onchocercose, Direction de l'Epidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo
| | - Jean-Paul Tambwe
- Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo
| | | | - Gary J Weil
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Frédéric Louya
- Programme National de Lutte contre l'Onchocercose, Direction de l'Epidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo
| | - Michel Boussinesq
- UMI 233, Institut de Recherche pour le Développement, Montpellier, France.,Université de Montpellier, Montpellier, France.,INSERM Unité 1175, Montpellier, France
| | - Sébastien D S Pion
- UMI 233, Institut de Recherche pour le Développement, Montpellier, France.,Université de Montpellier, Montpellier, France.,INSERM Unité 1175, Montpellier, France
| | - Cédric B Chesnais
- UMI 233, Institut de Recherche pour le Développement, Montpellier, France.,Université de Montpellier, Montpellier, France.,INSERM Unité 1175, Montpellier, France
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8
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Bjerum CM, Ouattara AF, Aboulaye M, Kouadio O, Marius VK, Andersen BJ, Weil GJ, Koudou BG, King CL. Efficacy and Safety of a Single Dose of Ivermectin, Diethylcarbamazine, and Albendazole for Treatment of Lymphatic Filariasis in Côte d'Ivoire: An Open-label Randomized Controlled Trial. Clin Infect Dis 2021; 71:e68-e75. [PMID: 31641754 PMCID: PMC7583415 DOI: 10.1093/cid/ciz1050] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/21/2019] [Indexed: 12/30/2022] Open
Abstract
Background Improved drug regimens are needed to accelerate elimination of lymphatic filariasis in Africa. This study determined whether a single co-administered dose of ivermectin plus diethylcarbamazine plus albendazole [IDA] is noninferior to standard 3 annual doses of ivermectin plus albendazole (IA) used in many LF-endemic areas of Africa. Methods Treatment-naive adults with Wuchereria bancrofti microfilaremia in Côte d’Ivoire were randomized to receive a single dose of IDA (n = 43) or 3 annual doses of IA (n = 52) in an open-label, single-blinded trial. The primary endpoint was the proportion of participants who were microfilaria (Mf) negative at 36 months. Secondary endpoints were Mf clearance at 6, 12, and 24 months; inactivation of adult worm nests; and safety. Results At 36 months posttreatment with IDA, 18/33 (55%; 95% CI, 38–72%) cleared Mf versus 33/42 (79%; 67–91%) with IA (P = .045). At 6 and 12 months IDA was superior to IA in clearing Mf (89% [77–99%] and 71% [56–85%]), respectively, versus 34% (20–48%) and 26% (14–42%) (P < .001). IDA was equivalent to IA at 24 months (61% [45–77%] vs 54% [38–72%]; P = .53). IDA was superior to IA for inactivating adult worms at all time points. Both treatments were well tolerated, and there were no serious adverse events. Conclusions A single dose of IDA was superior to 2 doses of IA in reducing the overall Mf burden by 24 months. Reinfection may have contributed to the lack of sustained clearance of Mf with IDA. Clinical Trials Registration NCT02974049.
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Affiliation(s)
- Catherine M Bjerum
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Allassane F Ouattara
- Centre Suisse de Recherche Scientifique en Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Université Nangui Abrogoua, Abidjan, Côte d'Ivoire
| | - Méité Aboulaye
- Programme National de la Lutte Contre la Schistosomiase, Les Geohelminthiases et la Filariose Lymphatique, Abidjan, Côte d'Ivoire
| | - Olivier Kouadio
- Centre Suisse de Recherche Scientifique en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Vanga K Marius
- Universite Alassane Ouattara Centre Hospitalier Universitaire de Bouake, Bouaké, Côte d'Ivoire
| | - Britt J Andersen
- Infectious Diseases Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Gary J Weil
- Infectious Diseases Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Benjamin G Koudou
- Centre Suisse de Recherche Scientifique en Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Université Nangui Abrogoua, Abidjan, Côte d'Ivoire
| | - Christopher L King
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Veterans Affairs Research Service, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA
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Ouattara AF, Bjerum CM, Aboulaye M, Kouadio O, Marius VK, Andersen B, Lew D, Goss CW, Weil GJ, Koudou BG, King CL. Semiannual Treatment of Albendazole Alone is Efficacious for Treatment of Lymphatic Filariasis: A Randomized Open-label Trial in Cote d'Ivoire. Clin Infect Dis 2021; 74:2200-2208. [PMID: 33674871 DOI: 10.1093/cid/ciab194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Ivermectin (IVM) plus albendazole (ALB), or IA, is widely used in mass drug administration (MDA) programs that aim to eliminate lymphatic filariasis (LF) in Africa. However, IVM can cause severe adverse events in persons with heavy Loa loa infections that are common in Central Africa. ALB is safe in loiasis, but more information is needed on its efficacy for LF. This study compared the efficacy and safety of three years of semiannual treatment with ALB to annual IA in persons with bancroftian filariasis. METHODS Adults with Wuchereria bancrofti microfilaremia (Mf) were randomized to receive either three annual doses of IA (N=52), six semiannual doses of ALB 400mg (N=45), or six semiannual doses of ALB 800mg (N=47). The primary outcome amicrofilaremia at 36 months. FINDINGS IA was more effective for completely clearing Mf than ALB 400mg or ALB 800mg (79%, CI 67-91; vs. 48%, CI 32-66 and 57%, CI 41-73, respectively). Mean % reductions in Mf counts at 36 months relative to baseline tended to be greater after IA (98%, CI 88-100) than after ALB 400mg (88%, CI 78-98) and ALB 800mg (89%, CI 79-99) (P=0.07 and P=0.06, respectively). Adult worm nest numbers (assessed by ultrasound) were reduced in all treatment groups. Treatments were well tolerated. INTERPRETATION Repeated semiannual treatment with ALB is macrofilaricidal for W. bancrofti and leads to sustained reductions in Mf counts. This is a safe and effective regimen that could be used as MDA to eliminate LF in areas ivermectin cannot be used.
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Affiliation(s)
- Allassane F Ouattara
- Centre Suisse de Recherche Scientifique en Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Université Nangui Abrogoua, Abidjan, Côte d'Ivoire
| | - Catherine M Bjerum
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Méité Aboulaye
- Programme National de la Lutte Contre la Schistosomiase, les Geohelminthiases et la Filariose Lymphatique, Abidjan, Côte d'Ivoire
| | - Olivier Kouadio
- Centre Suisse de Recherche Scientifique en Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Université Nangui Abrogoua, Abidjan, Côte d'Ivoire
| | - Vanga K Marius
- Université Alassane Ouattara Centre Hôspitalier Universitaire de Bouake, Bouaké, Côte d'Ivoire
| | - Britt Andersen
- Infectious Diseases Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Daphne Lew
- Division of Biostatistics, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Charles W Goss
- Division of Biostatistics, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Gary J Weil
- Infectious Diseases Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Benjamin G Koudou
- Centre Suisse de Recherche Scientifique en Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Université Nangui Abrogoua, Abidjan, Côte d'Ivoire
| | - Christopher L King
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Veterans Affairs Research Service, Cleveland Veterans Affairs Medical Center, USA
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Jambulingam P, Kuttiatt VS, Krishnamoorthy K, Subramanian S, Srividya A, Raju HKK, Rahi M, Somani RK, Suryaprakash MK, Dwivedi GP, Weil GJ. An open label, block randomized, community study of the safety and efficacy of co-administered ivermectin, diethylcarbamazine plus albendazole vs. diethylcarbamazine plus albendazole for lymphatic filariasis in India. PLoS Negl Trop Dis 2021; 15:e0009069. [PMID: 33591979 PMCID: PMC7909694 DOI: 10.1371/journal.pntd.0009069] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 02/26/2021] [Accepted: 12/12/2020] [Indexed: 12/16/2022] Open
Abstract
Background Better drug regimens for mass drug administration (MDA) could accelerate the Global Programme to Eliminate Lymphatic Filariasis (LF). This community study was designed to compare the safety and efficacy of MDA with IDA (ivermectin, diethylcarbamazine and albendazole) or DA (diethylcarbamazine and albendazole) in India. Methodology/Principal findings This two-armed, open-labelled, block randomised, community study was conducted in LF endemic villages in Yadgir district, Karnataka, India. Consenting participants ≥5 years of age were tested for circulating filarial antigenemia (CFA) and microfilaremia (Mf) before treatment with a single oral dose of IDA or DA. Adverse events (AEs) were monitored actively for two days and passively for five more days. Persons with positive CFA or Mf tests at baseline were retested 12-months post-treatment to assess treatment efficacy. Baseline CFA and Mf-rates were 26.4% and 6.9% in IDA and 24.5% and 6.4% in DA villages respectively. 4758 and 4160 participants received IDA and DA. Most AEs were mild after both treatments; fewer than 0.1% of participants experienced AEs with severity > grade 1. No serious AEs were observed. Fever, headache and dizziness were the most common AEs. AE rates were slightly higher after IDA than DA (8.3% vs. 6.4%, P<0.01). AEs were more frequent in females and Mf-positives after either treatment, but significantly more frequent after IDA (40.5% vs 20.2%, P < 0.001). IDA was more effective for clearing Mf than DA (84% vs. 61.8%, P < 0.001). Geometric mean Mf counts per 60μl in retested Mf-positives decreased by 96.4% from 11.8 after IDA and by 90.0% from 9.5 after DA. Neither treatment was effective for clearing CFA. Conclusions/Significance IDA had an acceptable safety profile and was more effective for clearing Mf than DA. With adequate compliance and medical support to manage AEs, IDA has the potential to accelerate LF elimination in India. Trial registration Clinical Trial Registry of India (CTRI No/2016/10/007399) Lymphatic filariasis (LF) is a major neglected tropical disease that is caused by filarial nematode worms. The strategies of the Global Programme to Eliminate Lymphatic Filariasis, launched in 2000, are mass drug administration (MDA) of antifilarial medications to kill the parasites and reduce transmission and morbidity management and disability prevention for those who are already affected by the disease. Recent clinical trials have shown that a single co-administered dose of ivermectin, diethylcarbamazine and albendazole (IDA) is more effective for clearing microfilariae (Mf) from the blood than the traditional two-drug regimen (DA). That is important, because blood Mf are essential for mosquitoes to transmit the parasite. As part of a large multicenter study, we assessed the safety of IDA and compared the efficacy of IDA and DA for clearing parasites from the blood. We treated almost 9,000 people in Wuchereria bancrofti endemic villages with either IDA or DA. Adverse events (AE) were monitored actively for two days and passively for another five days. AE rates were slightly higher after IDA than DA, but AEs were mild and self-limited. Infected persons, adults and females had higher AE rates in both treatment areas. We retested infected persons one year after treatment. IDA was significantly more effective for clearing Mf and reducing blood Mf counts than DA. Neither treatment was effective for clearing circulating filarial antigenemia. Our large study showed that IDA was well tolerated and more effective than DA. This new treatment has the potential to hasten LF elimination in India and many other countries.
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Affiliation(s)
| | | | | | | | | | | | - Manju Rahi
- Indian Council of Medical Research, New Delhi, India
| | - Roopali K. Somani
- Department of Clinical Pharmacology & Therapeutics, Nizams Institute of Medical Sciences, Hyderabad, India
| | | | | | - Gary J. Weil
- Washington University School of Medicine, St. Louis, Missouri, United States of America
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11
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K KN, Wahab S, Djawad K, Wospodo NN, Mulawardi. Lymphedema resulting from filariasis successfully treated by surgery. J Public Health Afr 2020; 11:1059. [PMID: 33209229 PMCID: PMC7656181 DOI: 10.4081/jphia.2020.1059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 08/19/2019] [Indexed: 11/23/2022] Open
Abstract
Filariasis is an infectious disease caused by a filarial worm infection transmitted by mosquito bites. The disease can result in reduced work productivity, disability and social stigma. This disease transmission process begins when a mosquito bite and suck the blood containing the microfilaria. Filarial infections have been grouped into three categories based on their location diseases of the disease: (1) lymphatics, (2) skin, and (3) body cavities. Morbidity is almost entirely due to the species that cause lymphatic diseases, and skin diseases to a lesser degree. A 28-year-old male came with a chief complaint of swollen right leg since four years ago which worsened in the last three months. Upon physical examination, edema, fibrosis, and hyper-pigmented plaques were present on the right lower extremity. The blood microfilariae examination was positive for Wuchereria bancrofti. The lymphedema did not resolve despite of antifilarial treatment and surgery was eventually performed to resect the fibrous tissue and subcutaneous edema. The patient responded well to the treatment with a significant reduction in the edema. No complication was present until two years after surgery.
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Affiliation(s)
| | | | | | | | - Mulawardi
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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12
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Pion SDS, Chesnais CB, Awaca-Uvon NP, Vlaminck J, Abdou A, Kunyu-Shako B, Kuyangisa Simuna G, Tambwe JP, Weil GJ, Boussinesq M. The impact of four years of semiannual treatments with albendazole alone on lymphatic filariasis and soil-transmitted helminth infections: A community-based study in the Democratic Republic of the Congo. PLoS Negl Trop Dis 2020; 14:e0008322. [PMID: 32574160 PMCID: PMC7337406 DOI: 10.1371/journal.pntd.0008322] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 07/06/2020] [Accepted: 04/24/2020] [Indexed: 02/03/2023] Open
Abstract
Background The World Health Organization now recommends semiannual mass drug administration (MDA) of albendazole with integrated vector management as an option for eliminating lymphatic filariasis (LF) in areas of loiasis-endemic countries where it may not be safe to use diethylcarbamazine or ivermectin in MDA programs. However, the published evidence base to support this policy is thin, and uptake by national programs has been slow. Methodology/Principal findings We conducted a community trial to assess the impact of semiannual MDA on lymphatic filariasis and soil-transmitted helminth infections (STH) in two villages in the Bandundu province of the Democratic Republic of the Congo with moderately high prevalences for LF and hookworm infections. MDA with albendazole was provided every six months from June 2014 to December 2017 with treatment coverages of the eligible population (all ≥ 2 year of age) that ranged between 56% and 88%. No adverse effects were reported during the trial. Evaluation at 48 months, (i.e. 6 months after the 8th round of MDA), showed that W. bancrofti microfilaremia (Mf) prevalence in the study communities had decreased between 2014 to 2018 from 12% to 0.9% (p<0.001). The prevalence of W. bancrofti antigenemia was also significantly reduced from 31.6% to 8.5% (p<0.001). MDA with albendazole also reduced hookworm, Ascaris lumbricoides and Trichuris trichiura infection prevalences in the community from 58.6% to 21.2% (p<0.001), from 14.0% to 1.6% and 4.1% to 2.9%, respectively. Hookworm and Ascaris infection intensities were reduced by 93% (p = 0.02) and 57% (p = 0.03), respectively. In contrast, Trichuris infection intensity was not significantly reduced by MDA (p = 0.61) over this time period. Conclusion/Significance These results provide strong evidence that semiannual MDA with albendazole alone is a safe and effective strategy for LF elimination in Central Africa. Community MDA also had a major impact on STH infections. In low-income rural settings of Africa, populations are commonly affected by multiple parasitic diseases. Some of these diseases have been targeted for elimination through dedicated national or international programs. In 2012, the World Health Organization (WHO) defined a specific strategy to eliminate lymphatic filariasis, the disease responsible for elephantiasis, in central Africa. This strategy consists in treating the whole population living in endemic areas every six months with a single donated drug—albendazole. Together with the use of the night bed nets distributed as part of malaria programs, it was expected that this strategy could interrupt the transmission and eliminate lymphatic filariasis locally within period of 4 to 7 years. Here, we evaluated this strategy in two endemic communities near Bandundu in the Democratic Republic of the Congo. We also assessed the impact of the semiannual community treatments on three species of gastrointestinal parasitic worms. Our results suggest that semiannual MDA with albendazole is effective for LF elimination in Central Africa, but they also indicate that drug-based only intervention is not enough to eliminate gastrointestinal worm infections in areas with high transmission.
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Affiliation(s)
- Sébastien D. S. Pion
- French National Research Institute for Sustainable Development, Montpellier, France
- * E-mail:
| | - Cédric B. Chesnais
- French National Research Institute for Sustainable Development, Montpellier, France
| | | | - Johnny Vlaminck
- Ministry of health, Kinshasa, Democratic Republic of the Congo
- Ghent University, Merelbeke, Belgium
| | - Anlimou Abdou
- French National Research Institute for Sustainable Development, Montpellier, France
| | - Billy Kunyu-Shako
- National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | | | | | - Gary J. Weil
- Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Michel Boussinesq
- French National Research Institute for Sustainable Development, Montpellier, France
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Safety and efficacy of co-administered diethylcarbamazine, albendazole and ivermectin during mass drug administration for lymphatic filariasis in Haiti: Results from a two-armed, open-label, cluster-randomized, community study. PLoS Negl Trop Dis 2020; 14:e0008298. [PMID: 32511226 PMCID: PMC7302858 DOI: 10.1371/journal.pntd.0008298] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/18/2020] [Accepted: 04/15/2020] [Indexed: 12/12/2022] Open
Abstract
In Haiti, 22 communes still require mass drug administration (MDA) to eliminate lymphatic filariasis (LF) as a public health problem. Several clinical trials have shown that a single oral dose of ivermectin (IVM), diethylcarbamazine (DEC) and albendazole (ALB) (IDA) is more effective than DEC plus ALB (DA) for clearing Wuchereria bancrofti microfilariae (Mf). We performed a cluster-randomized community study to compare the safety and efficacy of IDA and DA in an LF-endemic area in northern Haiti. Ten localities were randomized to receive either DA or IDA. Participants were monitored for adverse events (AE), parasite antigenemia, and microfilaremia. Antigen-positive participants were retested one year after MDA to assess treatment efficacy. Fewer participants (11.0%, 321/2917) experienced at least one AE after IDA compared to DA (17.3%, 491/2844, P<0.001). Most AEs were mild, and the three most common AEs reported were headaches, dizziness and abdominal pain. Serious AEs developed in three participants who received DA. Baseline prevalence for filarial antigenemia was 8.0% (239/3004) in IDA localities and 11.5% (344/2994) in DA localities (<0.001). Of those with positive antigenemia, 17.6% (42/239) in IDA localities and 20.9% (72/344, P = 0.25) in DA localities were microfilaremic. One year after treatment, 84% percent of persons with positive filarial antigen tests at baseline could be retested. Clearance rates for filarial antigenemia were 20.5% (41/200) after IDA versus 25.4% (74/289) after DA (P = 0.3). However, 94.4% (34/36) of IDA recipients and 75.9% (44/58) of DA recipients with baseline microfilaremia were Mf negative at the time of retest (P = 0.02). Thus, MDA with IDA was at least as well tolerated and significantly more effective for clearing Mf compared to the standard DA regimen in this study. Effective MDA coverage with IDA could accelerate the elimination of LF as a public health problem in the 22 communes that still require MDA in Haiti.
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Dietrich CF, Chaubal N, Hoerauf A, Kling K, Piontek MS, Steffgen L, Mand S, Dong Y. Review of Dancing Parasites in Lymphatic Filariasis. Ultrasound Int Open 2019; 5:E65-E74. [PMID: 31312785 PMCID: PMC6629997 DOI: 10.1055/a-0918-3678] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/04/2019] [Accepted: 05/01/2019] [Indexed: 02/07/2023] Open
Abstract
Lymphatic filariasis is an infection transmitted by blood-sucking mosquitoes with filarial nematodes of the species Wuchereria bancrofti, Brugia malayi und B. timori . It is prevalent in tropical countries throughout the world, with more than 60 million people infected and more than 1 billion living in areas with the risk of transmission. Worm larvae with a length of less than 1 mm are transmitted by mosquitoes, develop in human lymphatic tissue to adult worms with a length of 7-10 cm, live in the human body for up to 10 years and produce millions of microfilariae, which can be transmitted further by mosquitoes. The adult worms can be easily observed by ultrasonography because of their size and fast movements (the so-called "filarial dance sign"), which can be differentiated from other movements (e. g., blood in venous vessels) by their characteristic movement profile in pulsed-wave Doppler mode. Therapeutic options include (combinations of) ivermectin, albendazole, diethylcarbamazine and doxycycline. The latter depletes endosymbiotic Wolbachia bacteria from the worms and thus sterilizes and later kills the adult worms (macrofilaricidal or adulticidal effect).
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Affiliation(s)
| | - Nitin Chaubal
- Thane Ultrasound Centre, Thane Ultrasound Centre, Thane, India
| | - Achim Hoerauf
- Institut für Med. Mikrobiologie, Immunologie und Parasitologie (IMMIP), Universität Bonn, Bonn, Germany
| | - Kerstin Kling
- Department of Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | - Markus Schindler Piontek
- Caritas Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Medical Clinic 2, Bad Mergentheim, Germany
| | - Ludwig Steffgen
- Trainings-Zentrum Ultraschall-Diagnostik LS GmbH, Ultrasound, Mainleus, Germany
| | - Sabine Mand
- Institut für Med. Mikrobiologie, Immunologie und Parasitologie (IMMIP), Universität Bonn, Bonn, Germany
| | - Yi Dong
- Zhongshan Hospital, Ultrasound, Shanghai, China
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Silva E, Xavier A, Silva E, Barbosa Júnior W, Rocha A, Freitas V, Oliveira P, Aguiar-Santos AM, Bonfim C, Medeiros Z. Evaluation of lymphatic filariasis in endemic area of Brazil where mass drug administration is not required. Pathog Glob Health 2019; 113:143-148. [PMID: 31138026 DOI: 10.1080/20477724.2019.1623546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Mass drug administration (MDA) is the main counter-transmission strategy of the Global Programme to Eliminate Lymphatic Filariasis. In endemic countries, there are areas where MDA is not required. However, there is no standard approach in these areas, and studies are important to evaluate the epidemiological status. This study aimed to investigate lymphatic filariasis and strategies developed for its control in an area where MDA is not required. Together with the 2018 morbidity evaluation, a survey was conducted using point-of-care immunochromatographic test-AD12 tests for diagnostic screening in an area where MDA is not required. The methodology also included desk research based on Health Department reports of the control activities for lymphatic filariasis during 2003-2016. Among the 934 cases investigated in 2018, there was a 0.64% prevalence of circulating filarial antigen positive, comprising five adults and one 2-year-old child. Six patients aged 39-63 years had filarial disease. Fourteen surveys have already been conducted as control activities, and since 2009, there have been no positive cases. This study showed that the prevalence of antigenemia decreased from 2.97% in 2003 to 0.64% in 2018. Moreover, the transmission of filariasis infection was under control in this area. Our study provides insights into the surveillance phase by identifying areas of low transmission and where MDA is not required. Although we have not identified cases of filarial infection, there is a need to provide services that will provide assist those already affected with morbidity and help reduce and prevent disability.
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Affiliation(s)
- Ellyda Silva
- a Programa de Pós-graduação em Biociências e Biotecnologia em Saúde , Instituto Aggeu Magalhães (IAM), Fundação Oswaldo Cruz (FIOCRUZ) , Recife , Pernambuco , Brasil
| | - Amanda Xavier
- b Programa de Pós-graduação em Ciências da Saúde , Universidade de Pernambuco (UPE) , Recife , Pernambuco , Brasil
| | - Elis Silva
- a Programa de Pós-graduação em Biociências e Biotecnologia em Saúde , Instituto Aggeu Magalhães (IAM), Fundação Oswaldo Cruz (FIOCRUZ) , Recife , Pernambuco , Brasil
| | - Walter Barbosa Júnior
- a Programa de Pós-graduação em Biociências e Biotecnologia em Saúde , Instituto Aggeu Magalhães (IAM), Fundação Oswaldo Cruz (FIOCRUZ) , Recife , Pernambuco , Brasil
| | - Abraham Rocha
- c Serviço de Referencia Nacional em Filarioses, Departamento de Parasitologia , Instituto Aggeu Magalhães, Fundação Oswaldo Cruz (FIOCRUZ) , Recife , Pernambuco , Brasil.,d Secretaria de Saúde do Estado de Pernambuco , Laboratório do Hospital Otávio de Freitas , Recife , Pernambuco , Brazil
| | - Vania Freitas
- e Secretária Municipal de Saúde de Jaboatão dos Guararapes , Diretoria de Vigilância em Saúde , Jaboatão dos Guararapes , Pernambuco , Brazil
| | - Paula Oliveira
- c Serviço de Referencia Nacional em Filarioses, Departamento de Parasitologia , Instituto Aggeu Magalhães, Fundação Oswaldo Cruz (FIOCRUZ) , Recife , Pernambuco , Brasil
| | - Ana Maria Aguiar-Santos
- c Serviço de Referencia Nacional em Filarioses, Departamento de Parasitologia , Instituto Aggeu Magalhães, Fundação Oswaldo Cruz (FIOCRUZ) , Recife , Pernambuco , Brasil
| | - Cristine Bonfim
- f Diretoria de Pesquisas Sociais, Núcleo de Estudos em Estatísticas Sociais , Fundação Joaquim Nabuco (FUNDAJ) , Recife , Pernambuco , Brasil.,g Programa de Pós-graduação em Saúde Coletiva , Universidade Federal de Pernambuco (UFPE) , Recife , Pernambuco , Brasil
| | - Zulma Medeiros
- a Programa de Pós-graduação em Biociências e Biotecnologia em Saúde , Instituto Aggeu Magalhães (IAM), Fundação Oswaldo Cruz (FIOCRUZ) , Recife , Pernambuco , Brasil.,b Programa de Pós-graduação em Ciências da Saúde , Universidade de Pernambuco (UPE) , Recife , Pernambuco , Brasil.,c Serviço de Referencia Nacional em Filarioses, Departamento de Parasitologia , Instituto Aggeu Magalhães, Fundação Oswaldo Cruz (FIOCRUZ) , Recife , Pernambuco , Brasil
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King CL, Suamani J, Sanuku N, Cheng YC, Satofan S, Mancuso B, Goss CW, Robinson LJ, Siba PM, Weil GJ, Kazura JW. A Trial of a Triple-Drug Treatment for Lymphatic Filariasis. N Engl J Med 2018; 379:1801-1810. [PMID: 30403937 PMCID: PMC6194477 DOI: 10.1056/nejmoa1706854] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The World Health Organization has targeted lymphatic filariasis for global elimination by 2020 with a strategy of mass drug administration. This trial tested whether a single dose of a three-drug regimen of ivermectin plus diethylcarbamazine plus albendazole results in a greater sustained clearance of microfilariae than a single dose of a two-drug regimen of diethylcarbamazine plus albendazole and is noninferior to the two-drug regimen administered once a year for 3 years. METHODS In a randomized, controlled trial involving adults from Papua New Guinea with Wuchereria bancrofti microfilaremia, we assigned 182 participants to receive a single dose of the three-drug regimen (60 participants), a single dose of the two-drug regimen (61 participants), or the two-drug regimen once a year for 3 years (61 participants). Clearance of microfilariae from the blood was measured at 12, 24, and 36 months after trial initiation. RESULTS The three-drug regimen cleared microfilaremia in 55 of 57 participants (96%) at 12 months, in 52 of 54 participants (96%) at 24 months, and in 55 of 57 participants (96%) at 36 months. A single dose of the two-drug regimen cleared microfilaremia in 18 of 56 participants (32%) at 12 months, in 31 of 55 participants (56%) at 24 months, and in 43 of 52 participants (83%) at 36 months (P=0.02 for the three-drug regimen vs. a single dose of the two-drug regimen at 36 months). The two-drug regimen administered once a year for 3 years cleared microfilaremia in 20 of 59 participants (34%) at 12 months, in 42 of 56 participants (75%) at 24 months, and in 51 of 52 participants (98%) at 36 months (P=0.004 for noninferiority of the three-drug regimen vs. the two-drug regimen administered once a year for 3 years at 36 months). Moderate adverse events were more common in the group that received the three-drug regimen than in the combined two-drug-regimen groups (27% vs. 5%, P<0.001). There were no serious adverse events. CONCLUSIONS The three-drug regimen induced clearance of microfilariae from the blood for 3 years in almost all participants who received the treatment and was superior to the two-drug regimen administered once and noninferior to the two-drug regimen administered once a year for 3 years. (Funded by the Bill and Melinda Gates Foundation; ClinicalTrials.gov number, NCT01975441 .).
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Affiliation(s)
- Christopher L King
- From the Center for Global Health and Diseases, Case Western Reserve University School of Medicine (C.L.K., Y.-C.C., B.M., J.W.K.), and the Veterans Affairs Medical Center (C.L.K.), Cleveland; Papua New Guinea Institute of Medical Research, Goroka (J.S., N.S., S.S., L.J.R., P.M.S.); and the Division of Biostatistics (C.W.G.) and Department of Medicine, Infectious Diseases Division (G.J.W.), Washington University School of Medicine, St. Louis
| | - James Suamani
- From the Center for Global Health and Diseases, Case Western Reserve University School of Medicine (C.L.K., Y.-C.C., B.M., J.W.K.), and the Veterans Affairs Medical Center (C.L.K.), Cleveland; Papua New Guinea Institute of Medical Research, Goroka (J.S., N.S., S.S., L.J.R., P.M.S.); and the Division of Biostatistics (C.W.G.) and Department of Medicine, Infectious Diseases Division (G.J.W.), Washington University School of Medicine, St. Louis
| | - Nelly Sanuku
- From the Center for Global Health and Diseases, Case Western Reserve University School of Medicine (C.L.K., Y.-C.C., B.M., J.W.K.), and the Veterans Affairs Medical Center (C.L.K.), Cleveland; Papua New Guinea Institute of Medical Research, Goroka (J.S., N.S., S.S., L.J.R., P.M.S.); and the Division of Biostatistics (C.W.G.) and Department of Medicine, Infectious Diseases Division (G.J.W.), Washington University School of Medicine, St. Louis
| | - Yao-Chieh Cheng
- From the Center for Global Health and Diseases, Case Western Reserve University School of Medicine (C.L.K., Y.-C.C., B.M., J.W.K.), and the Veterans Affairs Medical Center (C.L.K.), Cleveland; Papua New Guinea Institute of Medical Research, Goroka (J.S., N.S., S.S., L.J.R., P.M.S.); and the Division of Biostatistics (C.W.G.) and Department of Medicine, Infectious Diseases Division (G.J.W.), Washington University School of Medicine, St. Louis
| | - Samson Satofan
- From the Center for Global Health and Diseases, Case Western Reserve University School of Medicine (C.L.K., Y.-C.C., B.M., J.W.K.), and the Veterans Affairs Medical Center (C.L.K.), Cleveland; Papua New Guinea Institute of Medical Research, Goroka (J.S., N.S., S.S., L.J.R., P.M.S.); and the Division of Biostatistics (C.W.G.) and Department of Medicine, Infectious Diseases Division (G.J.W.), Washington University School of Medicine, St. Louis
| | - Brooke Mancuso
- From the Center for Global Health and Diseases, Case Western Reserve University School of Medicine (C.L.K., Y.-C.C., B.M., J.W.K.), and the Veterans Affairs Medical Center (C.L.K.), Cleveland; Papua New Guinea Institute of Medical Research, Goroka (J.S., N.S., S.S., L.J.R., P.M.S.); and the Division of Biostatistics (C.W.G.) and Department of Medicine, Infectious Diseases Division (G.J.W.), Washington University School of Medicine, St. Louis
| | - Charles W Goss
- From the Center for Global Health and Diseases, Case Western Reserve University School of Medicine (C.L.K., Y.-C.C., B.M., J.W.K.), and the Veterans Affairs Medical Center (C.L.K.), Cleveland; Papua New Guinea Institute of Medical Research, Goroka (J.S., N.S., S.S., L.J.R., P.M.S.); and the Division of Biostatistics (C.W.G.) and Department of Medicine, Infectious Diseases Division (G.J.W.), Washington University School of Medicine, St. Louis
| | - Leanne J Robinson
- From the Center for Global Health and Diseases, Case Western Reserve University School of Medicine (C.L.K., Y.-C.C., B.M., J.W.K.), and the Veterans Affairs Medical Center (C.L.K.), Cleveland; Papua New Guinea Institute of Medical Research, Goroka (J.S., N.S., S.S., L.J.R., P.M.S.); and the Division of Biostatistics (C.W.G.) and Department of Medicine, Infectious Diseases Division (G.J.W.), Washington University School of Medicine, St. Louis
| | - Peter M Siba
- From the Center for Global Health and Diseases, Case Western Reserve University School of Medicine (C.L.K., Y.-C.C., B.M., J.W.K.), and the Veterans Affairs Medical Center (C.L.K.), Cleveland; Papua New Guinea Institute of Medical Research, Goroka (J.S., N.S., S.S., L.J.R., P.M.S.); and the Division of Biostatistics (C.W.G.) and Department of Medicine, Infectious Diseases Division (G.J.W.), Washington University School of Medicine, St. Louis
| | - Gary J Weil
- From the Center for Global Health and Diseases, Case Western Reserve University School of Medicine (C.L.K., Y.-C.C., B.M., J.W.K.), and the Veterans Affairs Medical Center (C.L.K.), Cleveland; Papua New Guinea Institute of Medical Research, Goroka (J.S., N.S., S.S., L.J.R., P.M.S.); and the Division of Biostatistics (C.W.G.) and Department of Medicine, Infectious Diseases Division (G.J.W.), Washington University School of Medicine, St. Louis
| | - James W Kazura
- From the Center for Global Health and Diseases, Case Western Reserve University School of Medicine (C.L.K., Y.-C.C., B.M., J.W.K.), and the Veterans Affairs Medical Center (C.L.K.), Cleveland; Papua New Guinea Institute of Medical Research, Goroka (J.S., N.S., S.S., L.J.R., P.M.S.); and the Division of Biostatistics (C.W.G.) and Department of Medicine, Infectious Diseases Division (G.J.W.), Washington University School of Medicine, St. Louis
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Agbozo EY, Dumashie E, Boakye DA, de Souza DK. Effects of lyophilization and storage temperature on Wuchereria bancrofti antigen sensitivity and stability. BMC Res Notes 2018; 11:454. [PMID: 29996898 PMCID: PMC6042357 DOI: 10.1186/s13104-018-3586-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/07/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Antigen-based rapid diagnostic tests for Lymphatic filariasis (LF) do not come with external quality control (QC) materials, and research and disease control programmes rely on stored positive samples. This study was undertaken to evaluate the use of lyophilized Wuchereria bancrofti antigen positive plasma samples to serve as QC materials for LF diagnostic tests. 10 well characterized W. bancrofti positive samples were lyophilized and stored at 4, 28 and 40 °C. The samples were evaluated using the Alere Filariasis Test Strips before lyophilization, and after 1 and 3 months of storage. The sensitivity and stability of the lyophilized samples were evaluated. RESULTS The results revealed a loss of sensitivity and stability with increasing temperature and duration of storage. The results are further discussed in terms of the use of dried blood spot (DBS) in diagnostic studies on LF, and the need for thoughtful DBS preparation and storage.
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Affiliation(s)
- Edem Y. Agbozo
- Accra Technical University, Accra, Ghana
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Edward Dumashie
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Daniel A. Boakye
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Dziedzom K. de Souza
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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de Araújo PSR, de Souza Junior VR, de Souza A, de Barros Correia Fontes L, Brandao E, Rocha A. Chiluria in a lymphatic filariasis endemic area. BMC Res Notes 2018; 11:269. [PMID: 29720217 PMCID: PMC5932810 DOI: 10.1186/s13104-018-3357-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/18/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To establish clinical and laboratory data of individuals presenting chyluria in endemic areas. RESULTS 75 individuals were studied. The majority were females with an average age of 45 years residing in the Metropolitan Region of Recife. The mean time between the beginning of the presentation of chyluria and the first care service in the Serviço de Referencia Nacional em Filarioses was approximately 5 years. The most frequent urinalysis changes were hematuria (27.6%), leukocytes (21.9%) and proteinuria (10.5%). The Addis test showed mean values of 155.43 E/min/mL of cylinders, 52,892 E/min/mL of erythrocytes and 291,660 E/min/mL of leukocytes. Among recorded cases, proteinuria had a mean value of 1372.80 mg/dL in 24 h, and the presence of lymphocytes in the urine was positive in 68.3%. Among lymphatic filariasis tests, immunochromatography was positive in 16.7%, there was circulating filarial antigen determined by detection of OG4C3 antibodies in 7.7% and microfilaremia in only 1/55.
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Affiliation(s)
- Paulo Sérgio Ramos de Araújo
- Federal University of Pernambuco, Av. Prof. Moraes Rego 1235, Recife, Pernambuco 50670-901 Brazil
- Instituto Aggeu Magalhaes, FIOCRUZ, Av. Prof. Moraes Rego 1235, Recife, 50670-901 Brazil
| | | | - Anderson de Souza
- Federal University of Pernambuco, Av. Prof. Moraes Rego 1235, Recife, Pernambuco 50670-901 Brazil
| | | | - Eduardo Brandao
- Instituto Aggeu Magalhaes, FIOCRUZ, Av. Prof. Moraes Rego 1235, Recife, 50670-901 Brazil
| | - Abraham Rocha
- Instituto Aggeu Magalhaes, FIOCRUZ, Av. Prof. Moraes Rego 1235, Recife, 50670-901 Brazil
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A multi-center field study of two point-of-care tests for circulating Wuchereria bancrofti antigenemia in Africa. PLoS Negl Trop Dis 2017; 11:e0005703. [PMID: 28892473 PMCID: PMC5608416 DOI: 10.1371/journal.pntd.0005703] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/21/2017] [Accepted: 06/11/2017] [Indexed: 11/19/2022] Open
Abstract
Background The Global Programme to Eliminate Lymphatic Filariasis uses point-of-care tests for circulating filarial antigenemia (CFA) to map endemic areas and for monitoring and evaluating the success of mass drug administration (MDA) programs. We compared the performance of the reference BinaxNOW Filariasis card test (ICT, introduced in 1997) with the Alere Filariasis Test Strip (FTS, introduced in 2013) in 5 endemic study sites in Africa. Methodology The tests were compared prior to MDA in two study sites (Congo and Côte d'Ivoire) and in three sites that had received MDA (DRC and 2 sites in Liberia). Data were analyzed with regard to % positivity, % agreement, and heterogeneity. Models evaluated potential effects of age, gender, and blood microfilaria (Mf) counts in individuals and effects of endemicity and history of MDA at the village level as potential factors linked to higher sensitivity of the FTS. Lastly, we assessed relationships between CFA scores and Mf in pre- and post-MDA settings. Principal findings Paired test results were available for 3,682 individuals. Antigenemia rates were 8% and 22% higher by FTS than by ICT in pre-MDA and in post-MDA sites, respectively. FTS/ICT ratios were higher in areas with low infection rates. The probability of having microfilaremia was much higher in persons with CFA scores >1 in untreated areas. However, this was not true in post-MDA settings. Conclusions/Significance This study has provided extensive new information on the performance of the FTS compared to ICT in Africa and it has confirmed the increased sensitivity of FTS reported in prior studies. Variability in FTS/ICT was related in part to endemicity level, history of MDA, and perhaps to the medications used for MDA. These results suggest that FTS should be superior to ICT for mapping, for transmission assessment surveys, and for post-MDA surveillance. The Global Programme to Eliminate Lymphatic Filariasis (LF) uses point-of-care tests for circulating filarial antigenemia to map endemic areas and for monitoring and evaluating the success of mass drug administration (MDA) programs. We compared the performance of the reference BinaxNOW Filariasis card test (ICT) with the Alere Filariasis Test Strip (FTS, introduced in 2013) in 3,682 people in 5 endemic study sites in Africa. Our study confirmed the increased sensitivity of FTS reported in prior studies. FTS/ICT ratios tended to be higher in areas with low residual endemicity after MDA. However, FTS rates were only slightly higher than ICT rates in young children. These results suggest that FTS should be superior to ICT as a tool for mapping and for monitoring and evaluating LF elimination programmes.
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Amelio P, Portevin D, Reither K, Mhimbira F, Mpina M, Tumbo A, Nickel B, Marti H, Knopp S, Ding S, Penn-Nicholson A, Darboe F, Ohmiti K, Scriba TJ, Pantaleo G, Daubenberger C, Perreau M. Mixed Th1 and Th2 Mycobacterium tuberculosis-specific CD4 T cell responses in patients with active pulmonary tuberculosis from Tanzania. PLoS Negl Trop Dis 2017; 11:e0005817. [PMID: 28759590 PMCID: PMC5552332 DOI: 10.1371/journal.pntd.0005817] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/10/2017] [Accepted: 07/19/2017] [Indexed: 12/22/2022] Open
Abstract
Mycobacterium tuberculosis (Mtb) and helminth infections elicit antagonistic immune effector functions and are co-endemic in several regions of the world. We therefore hypothesized that helminth infection may influence Mtb-specific T-cell immune responses. We evaluated the cytokine profile of Mtb-specific T cells in 72 individuals with pulmonary TB disease recruited from two Sub-Saharan regions with high and moderate helminth burden i.e. 55 from Tanzania (TZ) and 17 from South Africa (SA), respectively. We showed that Mtb-specific CD4 T-cell functional profile of TB patients from Tanzania are primarily composed of polyfunctional Th1 and Th2 cells, associated with increased expression of Gata-3 and reduced expression of T-bet in memory CD4 T cells. In contrast, the cytokine profile of Mtb-specific CD4 T cells of TB patients from SA was dominated by single IFN-γ and dual IFN-γ/TNF-α and associated with TB-induced systemic inflammation and elevated serum levels of type I IFNs. Of note, the proportion of patients with Mtb-specific CD8 T cells was significantly reduced in Mtb/helminth co-infected patients from TZ. It is likely that the underlying helminth infection and possibly genetic and other unknown environmental factors may have caused the induction of mixed Th1/Th2 Mtb-specific CD4 T cell responses in patients from TZ. Taken together, these results indicate that the generation of Mtb-specific CD4 and CD8 T cell responses may be substantially influenced by environmental factors in vivo. These observations may have major impact in the identification of immune biomarkers of disease status and correlates of protection. Mycobacterium tuberculosis (Mtb) and helminth infections are co-endemic in several regions of the world and their immune responses may be mutually antagonistic. We therefore hypothesized that helminth infection would impact and potentially shape Mtb-specific T-cell responses and systemic inflammation in patients suffering from active pulmonary tuberculosis (TB) enrolled from two helminth endemic regions i.e. Tanzania (TZ) and South Africa (SA). In this study, we demonstrate for the first time that TB patients from SA and TZ harbor distinct immune responses to Mtb antigens. Indeed, we showed that Mtb-specific CD4 T-cell responses of TB patients from TZ were composed by a mixed T helper type 1 (Th1) and Th2 responses. In contrast, the cytokine profile of Mtb-specific CD4 T cells of TB patients from SA was dominated by Th1 cells and associated with TB-induced systemic inflammation and elevated serum levels of type I IFN. Taken together, these data indicate that Mtb-specific T-cell responses are diverse in human populations and can be strongly influenced by host and pathogen genetic background, co-infections and yet unknown environmental factors. Identification of correlates of risk and protection from TB disease will help in the rational development of protective T-cell based vaccines against TB, early monitoring TB treatment outcomes and focused follow up of high risk populations.
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Affiliation(s)
- Patrizia Amelio
- Service of Immunology and Allergy, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Damien Portevin
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Klaus Reither
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | | | - Beatrice Nickel
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Hanspeter Marti
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Stefanie Knopp
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Song Ding
- EuroVacc Foundation, Lausanne, Switzerland
| | - Adam Penn-Nicholson
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Fatoumatta Darboe
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Khalid Ohmiti
- Service of Immunology and Allergy, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Thomas J. Scriba
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Giuseppe Pantaleo
- Service of Immunology and Allergy, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- SVRI, Lausanne, Switzerland
| | - Claudia Daubenberger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Matthieu Perreau
- Service of Immunology and Allergy, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- * E-mail:
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Moustafa MA, Salamah MMI, Thabet HS, Tawfik RA, Mehrez MM, Hamdy DM. Molecular xenomonitoring (MX) and transmission assessment survey (TAS) of lymphatic filariasis elimination in two villages, Menoufyia Governorate, Egypt. Eur J Clin Microbiol Infect Dis 2017; 36:1143-1150. [PMID: 28155014 DOI: 10.1007/s10096-017-2901-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/04/2017] [Indexed: 11/30/2022]
Abstract
Lymphatic filariasis (LF) is focally endemic in Egypt where the female mosquito, Culex pipiens, is responsible for its transmission. The aim of the study was to investigate the impact of implementation of the 13th round of MDA in two Egyptian villages in the Menoufyia Governorate area after failing the transmission assessment survey (TAS) in 2005 using two methods, and to decide whether it is safe to stop MDA in these, as well as in similar implementation units (IUs). To achieve this aim, both the immunochromatographic card test (ICT) and molecular xenomonitoring (MX) techniques were employed. A cross-sectional study was carried out in the villages in 2014 with two sections: Section (1): a school-based survey where all the primary school entrants (6-7) years of age were tested by ICT. Section (2): a mosquito-based survey where a total of 152 mosquito pools collected from Samalay and 167 from Kafr El-Tarainah were tested for the presence of the gDNA of Wuchereria bancrofti microfilaria by real-time PCR assays. The results revealed that all primary school children in both villages were 100% negative for antigenemia. Also, all mosquito pools were 100% negative for the microfilarial gDNA.
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Affiliation(s)
- M A Moustafa
- Department of Parasitology, Faculty of Medicine, Ain Shams University, Abbassia, 11566, Cairo, Egypt
| | - M M I Salamah
- Department of Parasitology, Faculty of Medicine, Ain Shams University, Abbassia, 11566, Cairo, Egypt
| | - H S Thabet
- Department of Parasitology, Faculty of Medicine, Ain Shams University, Abbassia, 11566, Cairo, Egypt
| | - R A Tawfik
- Department of Parasitology, Faculty of Medicine, Ain Shams University, Abbassia, 11566, Cairo, Egypt.
| | - M M Mehrez
- General Department for Malaria, Filariasis & Leishmaniasis Control, Endemic Diseases Control Sector, Ministry of Health and Population, Cairo, Egypt
| | - D M Hamdy
- Department of Parasitology, Faculty of Medicine, Ain Shams University, Abbassia, 11566, Cairo, Egypt
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Pion SD, Montavon C, Chesnais CB, Kamgno J, Wanji S, Klion AD, Nutman TB, Boussinesq M. Positivity of Antigen Tests Used for Diagnosis of Lymphatic Filariasis in Individuals Without Wuchereria bancrofti Infection But with High Loa loa Microfilaremia. Am J Trop Med Hyg 2016; 95:1417-1423. [PMID: 27729568 PMCID: PMC5154460 DOI: 10.4269/ajtmh.16-0547] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 08/25/2016] [Indexed: 01/25/2023] Open
Abstract
Since the mid-2000s, the immunochromatographic card test (ICT), a point-of-care test for detecting Wuchereria bancrofti circulating filarial antigens (CFAs), has been the backbone for mapping and monitoring lymphatic filariasis (LF) worldwide. Recently, there have been instances in which CFA positivity has been associated with Loa loa microfilaremia. Here, we examined the association, at both the community and individual levels, between L. loa and CFA using additional diagnostic tools (quantitative polymerase chain reaction [qPCR], Og4C3 enzyme-linked immunosorbent assay, and IgG4 antibodies to Wb123 assays) to demonstrate the relationship between L. loa microfilaremia and ICT positivity. In May 2013, peripheral blood was collected during the day from 1,812 individuals living in southern Cameroon. ICT tests were done on the spot, and positive individuals were resampled at night. Results of qPCR and Wb123 assays concurred proving the absence of W. bancrofti infection. Og4C3 assays indicate a quantitative relationship between the level of L. loa microfilaremia and that of CFA. This was confirmed by epidemiological analyses, which reveal a strong association between L. loa microfilaremia and ICT positivity, with 50% of ICT reacting to L. loa when its microfilarial density exceeds 30,000 microfilariae/mL. At the community level, the proportion of positive ICT would exceed 2% when the prevalence of L. loa microfilaremia in the total population is above 20%. This has significant implications in terms of mapping and control of LF caused by W. bancrofti in Loa-endemic areas. Cross-reactivity of ICT with L. loa has to be considered in the context of both individual and community diagnostics.
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Affiliation(s)
- Sébastien D Pion
- Centre de Recherche sur les Filarioses et autres Maladies Tropicales, Yaoundé, Cameroon.,Unité Mixte Internationale 233, Institut de Recherche pour le Développement, Université de Montpellier, Institut National de la Santé et de la Recherche Médicale, Montpellier, France
| | - Céline Montavon
- Unité Mixte Internationale 233, Institut de Recherche pour le Développement, Université de Montpellier, Institut National de la Santé et de la Recherche Médicale, Montpellier, France
| | - Cédric B Chesnais
- Unité Mixte Internationale 233, Institut de Recherche pour le Développement, Université de Montpellier, Institut National de la Santé et de la Recherche Médicale, Montpellier, France
| | - Joseph Kamgno
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.,Centre de Recherche sur les Filarioses et autres Maladies Tropicales, Yaoundé, Cameroon
| | - Samuel Wanji
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.,Research Foundation for Tropical Diseases and Environment, Buea, Cameroon
| | - Amy D Klion
- National Institutes of Health, Bethesda, Maryland
| | | | - Michel Boussinesq
- Unité Mixte Internationale 233, Institut de Recherche pour le Développement, Université de Montpellier, Institut National de la Santé et de la Recherche Médicale, Montpellier, France
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Chesnais CB, Vlaminck J, Kunyu-Shako B, Pion SD, Awaca-Uvon NP, Weil GJ, Mumba D, Boussinesq M. Measurement of Circulating Filarial Antigen Levels in Human Blood with a Point-of-Care Test Strip and a Portable Spectrodensitometer. Am J Trop Med Hyg 2016; 94:1324-1329. [PMID: 27114288 PMCID: PMC4889752 DOI: 10.4269/ajtmh.15-0916] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/01/2016] [Indexed: 11/21/2022] Open
Abstract
The Alere Filariasis Test Strip (FTS) is a qualitative, point-of-care diagnostic tool that detects Wuchereria bancrofti circulating filarial antigen (CFA) in human blood, serum, or plasma. The Global Program to Eliminate Lymphatic Filariasis employs the FTS for mapping filariasis-endemic areas and assessing the success of elimination efforts. The objective of this study was to explore the relationship between the intensity of positive test lines obtained by FTS with CFA levels as determined by enzyme-linked immunosorbent assay (ELISA) with blood and plasma samples from 188 individuals who live in a filariasis-endemic area. The intensity of the FTS test line was assessed visually to provide a semiquantitative score (visual Filariasis Test Strip [vFTS]), and line intensity was measured with a portable spectrodensitometer (quantitative Filariasis Test Strip [qFTS]). These results were compared with antigen levels measured by ELISA in plasma from the same subjects. qFTS measurements were highly correlated with vFTS scores (ρ = 0.94; P < 0.001) and with plasma CFA levels (ρ = 0.91; P < 0.001). Thus, qFTS assessment is a convenient method for quantifying W. bancrofti CFA levels in human blood, which are correlated with adult worm burdens. This tool may be useful for assessing the impact of treatment on adult filarial worms in individuals and communities.
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Affiliation(s)
- Cédric B. Chesnais
- *Address correspondence to Cédric B. Chesnais, Institut de Recherche pour le Développement (UMI 233), 911 avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France. E-mail:
| | - Johnny Vlaminck
- Unité Mixte Internationale (UMI) 233, Institut de Recherche pour le Développement (IRD), Montpellier, France; Université Montpellier, Montpellier, France; Institut National de la Santé et de la Recherche Médicale (INSERM) Unité 1175, Montpellier, France; Infectious Diseases Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri; Department of Parasitology, National Institute of Biomedical Research (INRB), Kinshasa, Democratic Republic of the Congo; National Onchocerciasis Control Programme, Ministry of Public Health, Kinshasa, Democratic Republic of the Congo
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Chesnais CB, Sabbagh A, Pion SD, Missamou F, Garcia A, Boussinesq M. Familial Aggregation and Heritability of Wuchereria bancrofti Infection. J Infect Dis 2016; 214:587-94. [PMID: 27230098 DOI: 10.1093/infdis/jiw212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/13/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The familial recurrence risk of lymphatic filariasis (LF) is unknown. This case study aimed to evaluate the familial susceptibility to infection with Wuchereria bancrofti and to microfilaremia in a village of the Republic of Congo. METHODS The heritability and intrafamilial correlation coefficients were assessed for both W. bancrofti infection and microfilaremia by controlling for individual risk factors, environmental influence, and household effects. RESULTS Pedigree charts were constructed for 829 individuals, including 143 individuals with a diagnosis of W. bancrofti circulating filarial antigens (CFAs) and 44 who also had microfilariae (MF). There was no intrafamilial correlation regarding CFA levels. However, the presence of MF (ρ = 0.45) and microfilarial density (ρ = 0.44) were significantly correlated among parent-offspring pairs. Heritability estimates for CFA positivity and intensity were 0.23 and 0.18, respectively. Heritability estimates were high for microfilarial positivity (h(2) = 0.74) and microfilarial density traits (h(2) = 0.81). CONCLUSIONS Our study suggests that the acquisition of LF is mainly driven by environmental factors and habits and that genetic factors are moderately involved in the regulation of infection. By contrast, genetic factors play a major role in both the presence and intensity of microfilaremia.
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Affiliation(s)
- Cédric B Chesnais
- Institut de Recherche pour le Développement, UMI 233 TransVIHMI Institut national de la santé et de la recherche médicale, U1175 Université de Montpellier
| | - Audrey Sabbagh
- Institut de Recherche pour le Développement UMR216, COMUE Sorbonne Paris Cité, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, France
| | - Sébastien D Pion
- Institut de Recherche pour le Développement, UMI 233 TransVIHMI Institut national de la santé et de la recherche médicale, U1175 Université de Montpellier
| | - François Missamou
- Programme National de Lutte contre l'Onchocercose, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo
| | - André Garcia
- Institut de Recherche pour le Développement UMR216, COMUE Sorbonne Paris Cité, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, France
| | - Michel Boussinesq
- Institut de Recherche pour le Développement, UMI 233 TransVIHMI Institut national de la santé et de la recherche médicale, U1175 Université de Montpellier
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Diagnostic Tools for Onchocerciasis Elimination Programs. Trends Parasitol 2015; 31:571-582. [PMID: 26458784 DOI: 10.1016/j.pt.2015.06.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/16/2015] [Accepted: 06/24/2015] [Indexed: 11/24/2022]
Abstract
Onchocerciasis (river blindness) is a major public health problem in sub-Saharan Africa. Major disease-control programs have greatly reduced both disease and infection prevalence by mass distribution of donated ivermectin. Recent studies have shown that local elimination was achieved in some areas following many years of ivermectin. The global health community has recently decided to build on these successes with a new program that aims to eliminate onchocerciasis. Diagnostic tests that were useful for identifying priority areas for disease prevention may not be adequate tools for elimination programs. This paper reviews available and emerging diagnostic tests for onchocerciasis and considers how they might be best employed during different stages of onchocerciasis elimination programs.
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Pion SDS, Chesnais CB, Bopda J, Louya F, Fischer PU, Majewski AC, Weil GJ, Boussinesq M, Missamou F. The impact of two semiannual treatments with albendazole alone on lymphatic filariasis and soil-transmitted helminth infections: a community-based study in the Republic of Congo. Am J Trop Med Hyg 2015; 92:959-66. [PMID: 25758650 DOI: 10.4269/ajtmh.14-0661] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/09/2014] [Indexed: 11/07/2022] Open
Abstract
Implementation of mass drug administration (MDA) with ivermectin plus albendazole (ALB) for lymphatic filariasis (LF) has been delayed in central Africa because of the risk of serious adverse events in subjects with high Loa loa microfilaremia. We conducted a community trial to assess the impact of semiannual MDA with ALB (400 mg) alone on LF and soil-transmitted helminth (STH) infections in the Republic of Congo. Evaluation at 12 months showed that ALB MDA had not significantly reduced Wuchereria bancrofti antigenemia or microfilaria (mf) rates in the community (from 17.3% to 16.6% and from 5.3% to 4.2%, respectively). However, the geometric mean mf count in mf-positive subjects was reduced from 202.2 to 80.9 mf/mL (60% reduction, P = 0.01). The effect of ALB was impressive in 38 subjects who were mf-positive at baseline and retested at 12 months: 37% had total mf clearance, and individual mf densities were reduced by 73.0%. MDA also dramatically reduced the hookworm infection rate in the community from 6.5% to 0.6% (91% reduction), with less impressive effects on Ascaris and Trichuris. These preliminary results suggest that semiannual community MDA with ALB is a promising strategy for controlling LF and STH in areas with coendemic loiasis.
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Affiliation(s)
- Sébastien D S Pion
- Unité Mixte Internationale 233, Institut de Recherche pour le Développement and University of Montpellier 1, Montpellier, France; Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), Yaoundé, Cameroon; Programme National de Lutte contre l'Onchocercose, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo; Infectious Diseases Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Cédric B Chesnais
- Unité Mixte Internationale 233, Institut de Recherche pour le Développement and University of Montpellier 1, Montpellier, France; Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), Yaoundé, Cameroon; Programme National de Lutte contre l'Onchocercose, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo; Infectious Diseases Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Jean Bopda
- Unité Mixte Internationale 233, Institut de Recherche pour le Développement and University of Montpellier 1, Montpellier, France; Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), Yaoundé, Cameroon; Programme National de Lutte contre l'Onchocercose, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo; Infectious Diseases Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Frédéric Louya
- Unité Mixte Internationale 233, Institut de Recherche pour le Développement and University of Montpellier 1, Montpellier, France; Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), Yaoundé, Cameroon; Programme National de Lutte contre l'Onchocercose, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo; Infectious Diseases Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Peter U Fischer
- Unité Mixte Internationale 233, Institut de Recherche pour le Développement and University of Montpellier 1, Montpellier, France; Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), Yaoundé, Cameroon; Programme National de Lutte contre l'Onchocercose, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo; Infectious Diseases Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Andrew C Majewski
- Unité Mixte Internationale 233, Institut de Recherche pour le Développement and University of Montpellier 1, Montpellier, France; Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), Yaoundé, Cameroon; Programme National de Lutte contre l'Onchocercose, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo; Infectious Diseases Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Gary J Weil
- Unité Mixte Internationale 233, Institut de Recherche pour le Développement and University of Montpellier 1, Montpellier, France; Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), Yaoundé, Cameroon; Programme National de Lutte contre l'Onchocercose, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo; Infectious Diseases Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Michel Boussinesq
- Unité Mixte Internationale 233, Institut de Recherche pour le Développement and University of Montpellier 1, Montpellier, France; Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), Yaoundé, Cameroon; Programme National de Lutte contre l'Onchocercose, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo; Infectious Diseases Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - François Missamou
- Unité Mixte Internationale 233, Institut de Recherche pour le Développement and University of Montpellier 1, Montpellier, France; Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), Yaoundé, Cameroon; Programme National de Lutte contre l'Onchocercose, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo; Infectious Diseases Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
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Shrinking the lymphatic filariasis map: update on diagnostic tools for mapping and transmission monitoring. Parasitology 2014; 141:1912-7. [PMID: 25225828 DOI: 10.1017/s0031182014001231] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lymphatic filariasis (LF), which is highly endemic in 73 countries worldwide, is targeted for elimination by 2020. The strategy for achieving this goal is based on 4 sequential programmatic steps: mapping, Mass drug administration (MDA) implementation, post-MDA surveillance and verification of LF elimination. All 4 stages of the implementation process are dependent on the availability of user friendly and highly sensitive rapid diagnostic tools. By the end of 2012, 59 countries had completed mapping for LF and Eritrea was the only country yet to start the process. Rolling out new diagnostic tools to facilitate the mapping process will enable an accelerated shrinking of the LF map to zero endemic countries by 2020. When the Global Programme to Eliminate Lymphatic Filariasis was launched in 2000, diagnostic tools for LF were limited to clinical examination, detection of microfilaria (MF) by microscopy in night blood samples and detection of antibodies to native-antigen preparations. There has been a significant improvement in the traditional LF diagnostic methods in recent years and some new tools are now available. This paper provides an update on the human diagnostic tests available for LF and their current applications as tools in mapping and transmission monitoring. The values of entomological indicators and parasite detection and speciation methods applied to vector populations are also discussed.
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