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Kassa HL, Singh S, Douglas-Jones M, Schermbrucker G, De Lange J, Phoya F, Butters C, Hlela C, Coetzee A, Banderker E, Webb K. Scurvy masquerading as IgA vasculitis. Pediatr Rheumatol Online J 2024; 22:56. [PMID: 38760753 DOI: 10.1186/s12969-024-00992-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Vitamin C deficiency, or scurvy, is rare but poses risks for children with poor diets, limited resources, or malabsorption issues. It may also be common in children with restrictive or selective dietary habits in children with global developmental delay, autism spectrum disorder, and physical disabilities. Symptoms include fatigue, irritability, joint and muscle pain, joint swellings, edema, swollen gums, easy bruising, and delayed wound healing. Early recognition and prompt intervention are essential to prevent the progression of symptomatic vitamin C deficiency in children. CASE PRESENTATION We present a case of a 13-year-old boy with developmental delay secondary to Lennox Gastaut syndrome referred for suspected recurrent, severe, and atypical IgA vasculitis. He presented with irritability, loss of appetite, petechial and ecchymotic lower limb lesions, unilateral gum swelling, severe arthritis, peripheral oedema, severe weight loss, anaemia, and raised inflammatory markers. Multiple investigations were performed before the diagnosis of scurvy was made. A surgical finding of friable gingival tissue with multiple loose teeth, a skin biopsy with follicular hyperkeratosis and extravasated perifollicular red blood cells, and a typical X-ray finding led to the diagnosis of scurvy. CONCLUSION Scurvy should be given careful consideration as a differential diagnosis in patients presenting with musculoskeletal issues, mucocutaneous complaints, and constitutional symptoms such as malaise, asthenia, irritability, and loss of appetite. A focused and detailed dietary history looking for a lack of good sources of vitamin C can be an easy indicator of this differential. Imaging studies revealing the typical features can also help make the diagnosis. Pathology of the skin revealing pathognomonic features can add to the certainty of the diagnosis. In the absence of all else, the rapid response to treatment with an appropriate dose of vitamin C has a diagnostic and therapeutic role.
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Affiliation(s)
- Hanna L Kassa
- Department of Pediatric Rheumatology, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa.
| | - S Singh
- National Health Laboratory Service, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - M Douglas-Jones
- Department of Maxillofacial and Oral Surgery, Groote Schuur and Red Cross Children's Hospital, University of the Western Cape, Cape Town, South Africa
| | | | - J De Lange
- Department of Maxillofacial and Oral Surgery, Groote Schuur and Red Cross Children's Hospital, University of the Western Cape, Cape Town, South Africa
| | - Frank Phoya
- Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Claire Butters
- Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Carol Hlela
- Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Ashton Coetzee
- Department of Paediatric Nephrology, Red Cross Childrens Hospital, University of Cape Town, Cape Town, South Africa
| | - Ebrahim Banderker
- Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Kate Webb
- Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
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2
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Lunjani N, Kerbelker T, Mdletshe FB, Hlela C, O’Mahony L. Phenotypes, endotypes and genotypes of atopic dermatitis and allergy in populations of African ancestry on the continent and diaspora. Front Allergy 2024; 4:1203304. [PMID: 38327736 PMCID: PMC10847302 DOI: 10.3389/falgy.2023.1203304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 12/11/2023] [Indexed: 02/09/2024] Open
Abstract
Atopic dermatitis is a complex inflammatory condition characterized by synergist interactions between epidermal and immune related genotypes, skin barrier defects and immune dysregulation as well as microbial dysbiosis. Ethnicity-specific variations in clinical presentation, immune endotypes and genetic susceptibility have been described in diverse populations. We summarize available data with specific consideration of AD in populations of African ancestry. Some highlights include the observation of AD lesions on extensor surfaces, lichen planus-like AD, prurigo type AD and follicular AD in African populations. In addition, a consistent absence of dominant filaggrin gene defects has been reported. The detection of normal filaggrin protein content in AD skin implicates the contribution of alternative mechanisms in the pathogenesis of AD in African patients. Markedly high IgE has been described in paediatric and adult African AD. While Th2, Th22 and Th17 activation in African AD skin shares the same direction as with other populations, it has been noted that the magnitude of activation is dissimilar. Reduced Th17 cytokines have been observed in the circulation of moderate to severe paediatric AD.
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Affiliation(s)
- N. Lunjani
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Division of Dermatology, University of Cape Town, Cape Town, South Africa
| | - T. Kerbelker
- Department of Peadiatrics, University of Cape Town, Cape Town, South Africa
| | - F. B. Mdletshe
- Division of Otorhinolaryngology, University of Witwatersrand, Johannesburg, South Africa
| | - C. Hlela
- Division of Dermatology, University of Cape Town, Cape Town, South Africa
| | - L. O’Mahony
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Medicine, University College Cork, Cork, Ireland
- School of Microbiology, University College Cork, Cork, Ireland
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3
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Lunjani N, Ambikan AT, Hlela C, Levin M, Mankahla A, Heldstab‐Kast JI, Boonpiyathad T, Tan G, Altunbulakli C, Gray C, Nadeau KC, Neogi U, Akdis CA, O'Mahony L. Rural and urban exposures shape early life immune development in South African children with atopic dermatitis and nonallergic children. Allergy 2024; 79:65-79. [PMID: 37534631 PMCID: PMC10952395 DOI: 10.1111/all.15832] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Immunological traits and functions have been consistently associated with environmental exposures and are thought to shape allergic disease susceptibility and protection. In particular, specific exposures in early life may have more significant effects on the developing immune system, with potentially long-term impacts. METHODS We performed RNA-Seq on peripheral blood mononuclear cells (PBMCs) from 150 children with atopic dermatitis and healthy nonallergic children in rural and urban settings from the same ethnolinguistic AmaXhosa background in South Africa. We measured environmental exposures using questionnaires. RESULTS A distinct PBMC gene expression pattern was observed in those children with atopic dermatitis (132 differentially expressed genes [DEGs]). However, the predominant influences on the immune cell transcriptome were related to early life exposures including animals, time outdoors, and types of cooking and heating fuels. Sample clustering revealed two rural groups (Rural_1 and Rural_2) that separated from the urban group (3413 and 2647 DEGs, respectively). The most significantly regulated pathways in Rural_1 children were related to innate activation of the immune system (e.g., TLR and cytokine signaling), changes in lymphocyte polarization (e.g., TH17 cells), and immune cell metabolism (i.e., oxidative phosphorylation). The Rural_2 group displayed evidence for ongoing lymphocyte activation (e.g., T cell receptor signaling), with changes in immune cell survival and proliferation (e.g., mTOR signaling, insulin signaling). CONCLUSIONS This study highlights the importance of the exposome on immune development in early life and identifies potentially protective (e.g., animal) exposures and potentially detrimental (e.g., pollutant) exposures that impact key immunological pathways.
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Affiliation(s)
- Nonhlanhla Lunjani
- Division of DermatologyUniversity of Cape TownCape TownSouth Africa
- APC Microbiome IrelandUniversity College CorkCorkIreland
| | - Anoop T. Ambikan
- The Systems Virology Lab, Division of Clinical Microbiology, Department of Laboratory MedicineKarolinska Institute, ANA FuturaStockholmSweden
| | - Carol Hlela
- Division of DermatologyUniversity of Cape TownCape TownSouth Africa
| | - Michael Levin
- Division of Paediatric Allergy, Department of Paediatrics and Child HealthUniversity of Cape TownCape TownSouth Africa
| | - Avumile Mankahla
- The Division of Dermatology, Department of Medicine and PharmacologyWalter Sisulu UniversityMthathaEastern CapeSouth Africa
| | | | - Tadech Boonpiyathad
- Swiss Institute of Allergy and Asthma Research (SIAF), University of ZurichDavosSwitzerland
| | - Ge Tan
- Swiss Institute of Allergy and Asthma Research (SIAF), University of ZurichDavosSwitzerland
| | - Can Altunbulakli
- Swiss Institute of Allergy and Asthma Research (SIAF), University of ZurichDavosSwitzerland
| | - Clive Gray
- Division of ImmunologyUniversity of Cape TownCape TownSouth Africa
| | - Kari C. Nadeau
- Department of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Ujjwal Neogi
- The Systems Virology Lab, Division of Clinical Microbiology, Department of Laboratory MedicineKarolinska Institute, ANA FuturaStockholmSweden
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of ZurichDavosSwitzerland
- Christine Kühne‐Center for Allergy Research and EducationDavosSwitzerland
| | - Liam O'Mahony
- APC Microbiome IrelandUniversity College CorkCorkIreland
- Department of MedicineUniversity College CorkCorkIreland
- School of MicrobiologyUniversity College CorkCorkIreland
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4
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Knight. LK, McGrath J, Ozoemena L, Roberts R, Hlela C. A new heterozygous frameshift variant in keratin 10 resulting in ichthyosis hystrix in a father and daughter. JAAD Case Rep 2023; 35:22-24. [PMID: 37089757 PMCID: PMC10114500 DOI: 10.1016/j.jdcr.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
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5
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Tootla HD, Eley BS, Enslin JMN, Frean JA, Hlela C, Kilborn TN, Moodley B, Peer S, Singh S, Nuttall JJC. Balamuthia mandrillaris Granulomatous Amoebic Encephalitis: The First African Experience. J Pediatric Infect Dis Soc 2022; 11:578-581. [PMID: 36041049 DOI: 10.1093/jpids/piac096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 08/24/2022] [Indexed: 01/05/2023]
Abstract
We report the first case of Balamuthia mandrillaris granulomatous amoebic encephalitis definitively acquired in Africa. Our case emphasizes initial nonspecific dermatological features, delays in confirmation of the diagnosis, difficulties accessing recommended medication, and uncertainty about optimal treatment of a disease with a frequently fatal outcome.
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Affiliation(s)
- Hafsah D Tootla
- Division of Medical Microbiology, National Health Laboratory Service (Red Cross War Memorial Children's Hospital) and University of Cape Town, Cape Town, South Africa
| | - Brian S Eley
- Paediatric Infectious Diseases Unit, Department of Paediatrics and Child Health, University of Cape Town and Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Johannes M N Enslin
- Division of Neurosurgery, Department of Surgery, University of Cape Town & Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - John A Frean
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases (Division of the National Health Laboratory Service), Johannesburg, South Africa.,Wits Research Institute for Malaria, University of the Witwatersrand, Johannesburg, South Africa
| | - Carol Hlela
- Paediatric Dermatology Unit, Department of Paediatrics and Child Health, University of Cape Town and Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Tracy N Kilborn
- Division of Paediatric Radiology, Department of Radiology, University of Cape Town and Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Bhavani Moodley
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases (Division of the National Health Laboratory Service), Johannesburg, South Africa
| | - Shazia Peer
- Division of Otolaryngology, Department of Surgery, University of Cape Town & Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Shivani Singh
- Division of Anatomical Pathology, National Health Laboratory Service (Red Cross War Memorial Children's Hospital) and University of Cape Town, Cape Town, South Africa
| | - James J C Nuttall
- Paediatric Infectious Diseases Unit, Department of Paediatrics and Child Health, University of Cape Town and Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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6
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Ndhlovu GON, Dube FS, Moonsamy RT, Mankahla A, Hlela C, Levin ME, Lunjani N, Shittu AO, Abdulgader SM. Skin and nasal colonization of coagulase-negative staphylococci are associated with atopic dermatitis among South African toddlers. PLoS One 2022; 17:e0265326. [PMID: 35298533 PMCID: PMC8929619 DOI: 10.1371/journal.pone.0265326] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 02/28/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Skin colonization with coagulase-negative staphylococci (CoNS) is generally beneficial, but recent investigations suggest its association with flares and atopic dermatitis (AD) severity. However, this relationship remains unclear.
Objective
To assess patterns of staphylococcal colonization and biofilm formation in toddlers with and without AD from rural and urban South African settings.
Methods
We conducted a cross-sectional study of AD-affected and non-atopic AmaXhosa toddlers from rural Umtata and urban Cape Town, South Africa. CoNS isolates were recovered from lesional, nonlesional skin samples and the anterior nares of participants. Identification of the staphylococci was achieved by MALDI-TOF mass spectrometry. The microtiter plate assay assessed in-vitro biofilm formation.
Results
CoNS and S. aureus commonly co-colonized nonlesional skin among cases (urban: 24% vs. 3%, p = 0.037 and rural 21% vs. 6%, p<0.001), and anterior nares in urban cases (24% vs. 0%, p = 0.002) than the control group. S. capitis colonization on nonlesional skin and anterior nares was positively associated with more severe disease in rural (48.3±10.8 vs. 39.7±11.5, P = 0.045) and urban cases (74.9±10.3 vs. 38.4±13, P = 0.004), respectively. Biofilm formation was similar between cases and controls, independent of rural-urban living.
Conclusion
CoNS colonization is associated with AD and disease severity and may be implicated in AD exacerbations. Studies are needed to understand their underlying pathological contribution in AD pathogenesis.
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Affiliation(s)
- Gillian O. N. Ndhlovu
- Department of Molecular and Cell Biology, Faculty of Science, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Felix S. Dube
- Department of Molecular and Cell Biology, Faculty of Science, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Rasalika T. Moonsamy
- Department of Molecular and Cell Biology, Faculty of Science, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Avumile Mankahla
- Department of Medicine and Pharmacology, Division of Dermatology, Walter Sisulu University, Umtata, South Africa
| | - Carol Hlela
- Department of Paediatric, Division of Paediatric Allergy, University of Cape Town, Cape Town, South Africa
| | - Michael E. Levin
- Department of Paediatric, Division of Paediatric Allergy, University of Cape Town, Cape Town, South Africa
| | - Nonhlanhla Lunjani
- Department of Paediatric, Division of Paediatric Allergy, University of Cape Town, Cape Town, South Africa
| | - Adebayo O. Shittu
- Department of Microbiology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Shima M. Abdulgader
- Department of Biomedical Sciences, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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7
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Lunjani N, Tan G, Dreher A, Sokolowska M, Groeger D, Warwyzniak M, Altunbulakli C, Westermann P, Basera W, Hobane L, Botha M, Gray C, Mankahla A, Gray C, Nadeau KC, Hlela C, Levin M, O'Mahony L, Akdis CA. Environment-dependent alterations of immune mediators in urban and rural South African children with atopic dermatitis. Allergy 2022; 77:569-581. [PMID: 34086351 DOI: 10.1111/all.14974] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/09/2021] [Accepted: 05/31/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND In order to improve targeted therapeutic approaches for children with atopic dermatitis (AD), novel insights into the molecular mechanisms and environmental exposures that differentially contribute to disease phenotypes are required. We wished to identify AD immunological endotypes in South African children from rural and urban environments. METHODS We measured immunological, socio-economic and environmental factors in healthy children (n = 74) and children with AD (n = 78), in rural and urban settings from the same ethno-linguistic AmaXhosa background in South Africa. RESULTS Circulating eosinophils, monocytes, TARC, MCP-4, IL-16 and allergen-specific IgE levels were elevated, while IL-17A and IL-23 levels were reduced, in children with AD regardless of their location. Independent of AD, children living in a rural environment had the highest levels of TNFα, TNFβ, IL-1α, IL-6, IL-8, IL-21, MCP-1, MIP-1α, MIP-1β, MDC, sICAM1, sVCAM1, VEGFA, VEGFD and Tie2, suggesting a generalized microinflammation or a pattern of trained immunity without any specific TH polarization. In contrast, IL-15, IL-22, Flt1, PIGF and βFGF were highest in urban children. Rural healthy children had the lowest levels of food allergen-specific IgG4. Early life nutritional factors, medications, animal exposures, indoor environment, sunlight exposure, household size, household income and parental education levels were associated with differences in circulating cytokine levels. CONCLUSIONS This study highlights the immunological impact of environmental exposures and socio-economic status in the manifestation of immune endotypes in children with AD living in urban and rural areas, which are important in selecting appropriately matched immunological therapies for treatment of AD.
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Affiliation(s)
- Nonhlanhla Lunjani
- Swiss Institute of Allergy and Asthma Research (SIAF, University of Zurich, Davos, Switzerland.,Department of Dermatology, University of Cape Town, Cape Town, South Africa.,APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Ge Tan
- Swiss Institute of Allergy and Asthma Research (SIAF, University of Zurich, Davos, Switzerland.,Functional Genomics Center, University of Zurich, Zurich, Switzerland
| | - Anita Dreher
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF, University of Zurich, Davos, Switzerland
| | - David Groeger
- Swiss Institute of Allergy and Asthma Research (SIAF, University of Zurich, Davos, Switzerland.,PrecisionBiotics Ltd, Cork, Ireland
| | - Marcin Warwyzniak
- Swiss Institute of Allergy and Asthma Research (SIAF, University of Zurich, Davos, Switzerland
| | - Can Altunbulakli
- Swiss Institute of Allergy and Asthma Research (SIAF, University of Zurich, Davos, Switzerland
| | - Patrick Westermann
- Swiss Institute of Allergy and Asthma Research (SIAF, University of Zurich, Davos, Switzerland
| | - Wisdom Basera
- Division of Paediatric Allergy, Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Lelani Hobane
- Division of Paediatric Allergy, Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Maresa Botha
- Division of Paediatric Allergy, Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Claudia Gray
- Division of Paediatric Allergy, Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Avumile Mankahla
- The Division of Dermatology, Department of Medicine and Pharmacology, Walter Sisulu University, Eastern Cape, South Africa
| | - Clive Gray
- Division of Immunology, University of Cape Town, Cape Town, South Africa
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, CA, USA
| | - Carol Hlela
- Department of Dermatology, University of Cape Town, Cape Town, South Africa
| | - Michael Levin
- Division of Paediatric Allergy, Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Liam O'Mahony
- APC Microbiome Ireland, University College Cork, Cork, Ireland.,Department of Medicine, University College Cork, Cork, Ireland.,School of Microbiology, University College Cork, Cork, Ireland
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF, University of Zurich, Davos, Switzerland.,Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
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8
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Jungles K, Tran TDB, Botha M, Rasmussen HE, Teixeira-Reis V, Sodergren E, Gray C, Lunjani N, Hlela C, Basera W, Hobane L, Watkins A, Engen P, Mankahla A, Gaunt B, Facey-Thomas H, Landay A, Weinstock GM, Keshavarzian A, Levin ME, Mahdavinia M. Association of gut microbiota and environment in children with AD, comparison of three cohorts of children. Clin Exp Allergy 2021; 52:447-450. [PMID: 34786779 DOI: 10.1111/cea.14052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/05/2021] [Accepted: 11/11/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Kylie Jungles
- Allergy and Immunology Division, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA.,Rush Medical College, Chicago, Illinois, USA
| | - Thi Dong Binh Tran
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA
| | - Maresa Botha
- Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Rondebosch, South Africa.,InVivo planetary health network, Rondebosch, South Africa
| | - Heather E Rasmussen
- Department of Nutrition and Health Sciences, University of Nebraska, Lincoln, Nebraska, USA
| | - Victoria Teixeira-Reis
- Department of Nutrition and Health Sciences, University of Nebraska, Lincoln, Nebraska, USA
| | - Erica Sodergren
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA
| | - Claudia Gray
- Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Rondebosch, South Africa.,Department of Dermatology, University of Cape Town, Rondebosch, South Africa
| | - Nonhlanhla Lunjani
- Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Rondebosch, South Africa
| | - Carol Hlela
- Department of Dermatology, University of Cape Town, Rondebosch, South Africa
| | - Wisdom Basera
- School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa.,Burden of Disease Research Unit, South African Medical Research Council, Rondebosch, South Africa
| | - Lelani Hobane
- Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Rondebosch, South Africa
| | - Alexandra Watkins
- Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Rondebosch, South Africa
| | - Phillip Engen
- Center for Integrated Microbiome and Chronolbiology research, Rush University Medical Center, Chicago, Illinois, USA
| | - Avumile Mankahla
- Eastern Cape Department of Health, Zithulele Hospital, Pretoria, South Africa
| | - Ben Gaunt
- Division of Dermatology, Department of Medicine and Pharmacology, Walter Sisulu University, Mthatha, South Africa
| | - Heidi Facey-Thomas
- Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Rondebosch, South Africa
| | - Alan Landay
- Geriatrics Division, Department of Internal Medicine, Rush University Medical Center Chicago, Chicago, Illinois, USA
| | - George M Weinstock
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA
| | - Ali Keshavarzian
- Center for Integrated Microbiome and Chronolbiology research, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael E Levin
- Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Rondebosch, South Africa.,InVivo planetary health network, Rondebosch, South Africa
| | - Mahboobeh Mahdavinia
- Allergy and Immunology Division, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
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9
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Lunjani N, Ahearn-Ford S, Dube FS, Hlela C, O'Mahony L. Mechanisms of microbe-immune system dialogue within the skin. Genes Immun 2021; 22:276-288. [PMID: 33993202 PMCID: PMC8497273 DOI: 10.1038/s41435-021-00133-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/09/2021] [Accepted: 04/26/2021] [Indexed: 02/01/2023]
Abstract
The prevalence and severity of dermatological conditions such as atopic dermatitis have increased dramatically during recent decades. Many of the factors associated with an altered risk of developing inflammatory skin disorders have also been shown to alter the composition and diversity of non-pathogenic microbial communities that inhabit the human host. While the most densely microbial populated organ is the gut, culture and non-culture-based technologies have revealed a dynamic community of bacteria, fungi, viruses and mites that exist on healthy human skin, which change during disease. In this review, we highlight some of the recent findings on the mechanisms through which microbes interact with each other on the skin and the signalling systems that mediate communication between the immune system and skin-associated microbes. In addition, we summarize the ongoing clinical studies that are targeting the microbiome in patients with skin disorders. While significant efforts are still required to decipher the mechanisms underpinning host-microbe communication relevant to skin health, it is likely that disease-related microbial communities, or Dermatypes, will help identify personalized treatments and appropriate microbial reconstitution strategies.
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Affiliation(s)
- Nonhlanhla Lunjani
- Department of Dermatology, University of Cape Town, Cape Town, South Africa
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | | | - Felix S Dube
- Department of Molecular and Cell Biology, Faculty of Science, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Carol Hlela
- Department of Dermatology, University of Cape Town, Cape Town, South Africa
| | - Liam O'Mahony
- APC Microbiome Ireland, University College Cork, Cork, Ireland.
- Department of Medicine, University College Cork, Cork, Ireland.
- School of Microbiology, University College Cork, Cork, Ireland.
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10
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Mahdavinia M, Greenfield LR, Moore D, Botha M, Engen P, Gray C, Lunjani N, Hlela C, Basera W, Hobane L, Watkins A, Mankahla A, Gaunt B, Facey-Thomas H, Landay A, Keshavarzian A, Levin ME. House dust microbiota and atopic dermatitis; effect of urbanization. Pediatr Allergy Immunol 2021; 32:1006-1012. [PMID: 33570236 DOI: 10.1111/pai.13471] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Previous studies have shown that a child's risk of developing atopic disease is impacted by both genetic and environmental factors. Because small children spend the majority of their time in their homes, exposure to microbial factors in their home environment may be protective or risk factors for development of atopic diseases, such as atopic dermatitis. METHODS Dust samples from the homes of 86 Black South African children 12 to 36 months old were collected for analysis of the bacterial microbiome. This case-control study design included children with and without atopic dermatitis from rural and urban environments. RESULTS Significant differences in bacterial composition and diversity were found when comparing children with and without atopic dermatitis. Furthermore, house dust microbiota was significantly different in rural and urban areas. Differences were best accounted for by higher relative abundance of Ruminococcaceae, Lachnospiraceae, and Bacteroidaceae families in rural compared with urban houses. Levels of Ruminococcaceae were also found to be significantly depleted in the house dust of rural children with atopic dermatitis as compared to control children. CONCLUSIONS House dust composition may be an important risk factor for the development of atopic disease, and this association may be driven in part by the gut microbiome. Low levels of the Ruminococcaceae family from Clostridia class in particular may explain the association between urban living and atopy. However, further research is needed to elucidate these links.
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Affiliation(s)
- Mahboobeh Mahdavinia
- Department of Internal Medicine, Allergy and Immunology Division, Rush University Medical Center, Chicago, IL, USA.,InVivo Planetary Health Network, Chicago, IL, USA
| | - Leah R Greenfield
- Department of Internal Medicine, Allergy and Immunology Division, Rush University Medical Center, Chicago, IL, USA.,Rush Medical College, Chicago, IL, USA
| | - Donyea Moore
- Department of Internal Medicine, Allergy and Immunology Division, Rush University Medical Center, Chicago, IL, USA
| | - Maresa Botha
- InVivo Planetary Health Network, Chicago, IL, USA.,Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | | | - Claudia Gray
- Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,Department of Dermatology, University of Cape Town, Cape Town, South Africa
| | - Nonhlanhla Lunjani
- Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Carol Hlela
- Department of Dermatology, University of Cape Town, Cape Town, South Africa
| | - Wisdom Basera
- Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Lelani Hobane
- Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Alexandra Watkins
- Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Avumile Mankahla
- Eastern Cape Department of Health, Zithulele Hospital, Mqanduli, South Africa
| | - Ben Gaunt
- Division of Dermatology, Department of Medicine and Pharmacology, Walter Sisulu University, Mthatha, South Africa
| | - Heidi Facey-Thomas
- Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Alan Landay
- Geriatrics Division, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Ali Keshavarzian
- Department of Internal Medicine, Division of Gastroenterology, Rush University Medical Center, Chicago, IL, USA
| | - Michael E Levin
- InVivo Planetary Health Network, Chicago, IL, USA.,Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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11
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Trikamjee T, Basera W, Botha M, Facey-Thomas HE, Gaunt B, Genuneit J, Gray CL, Hadebe S, Hlela C, Kirstein F, Lunjani N, Mankahla A, Ramjith J, Levin M. Associations between Environmental dust composition and Atopic Dermatitis in urban and rural settings. Pediatr Allergy Immunol 2021; 32:1013-1021. [PMID: 33595127 DOI: 10.1111/pai.13476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Environmental exposures are involved in the pathogenesis of the allergic phenotype and in determining which individual triggers a person becomes sensitized to. Atopic dermatitis (AD) may modulate these effects through increased penetration through the skin modifying the immune system and AD may be triggered or intensified by environmental exposures. These exposures and immune-modulating factors may differ in urban and rural environments. OBJECTIVES To compare house dust composition in urban and rural settings and correlate them with AD outcomes. METHODS Dust samples were collected from the beds of 156 children aged 6 months to 3 years. 42% of participants had atopic dermatitis. Samples were analyzed for bacterial endotoxin, fungal (β-1,3-glucan) levels, and house dust mite, cockroach, dog, cat, mouse, and peanut allergen. Exposures were compared in urban and rural environments and in participants with and without AD. RESULTS Endotoxin but not fungal β-glucan exposure is higher in the environment of healthy controls than children with AD in both urban and rural settings. House dust mite allergen exposure is high in urban and rural settings with Dermatophagoides detected in 100% of samples. Cat and dog allergen exposure mirrors pet ownership patterns which differ slightly between groups and environments. Mouse allergen exposure is higher in urban homes. CONCLUSION Environmental endotoxin may be protective against AD in both urban and rural settings. There are marked differences in allergen exposure in urban and rural settings, but these are unlikely to be important protective or risk factors.
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Affiliation(s)
- Thulja Trikamjee
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Wisdom Basera
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Burden of Disease Research Unit, South African Medical Research Council, South Africa
| | - Maresa Botha
- Division of Paediatric Allergy, Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Heidi E Facey-Thomas
- Division of Paediatric Allergy, Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ben Gaunt
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Eastern Cape Department of Health, Zithulele Hospital, Mqanduli, South Africa
| | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Claudia L Gray
- Division of Paediatric Allergy, Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sabelo Hadebe
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Carol Hlela
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Frank Kirstein
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nonhlanhla Lunjani
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.,Department of Dermatology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Avumile Mankahla
- Division of Dermatology, Department of Medicine and Pharmacology, Walter Sisulu University, Mthatha, South Africa
| | - Jordache Ramjith
- Department for Health Evidence, Biostatistics Research Group, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Michael Levin
- Division of Paediatric Allergy, Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,inVIVO Planetary Health, Group of Worldwide Universities Network (WUN)
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12
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Ndhlovu GON, Abotsi RE, Shittu AO, Abdulgader SM, Jamrozy D, Dupont CL, Mankahla A, Nicol MP, Hlela C, Levin ME, Lunjani N, Dube FS. Molecular epidemiology of Staphylococcus aureus in African children from rural and urban communities with atopic dermatitis. BMC Infect Dis 2021; 21:348. [PMID: 33849482 PMCID: PMC8045247 DOI: 10.1186/s12879-021-06044-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/05/2021] [Indexed: 12/22/2022] Open
Abstract
Background Staphylococcus aureus has been associated with the exacerbation and severity of atopic dermatitis (AD). Studies have not investigated the colonisation dynamics of S. aureus lineages in African toddlers with AD. We determined the prevalence and population structure of S. aureus in toddlers with and without AD from rural and urban South African settings. Methods We conducted a study of AD-affected and non-atopic AmaXhosa toddlers from rural Umtata and urban Cape Town, South Africa. S. aureus was screened from skin and nasal specimens using established microbiological methods and clonal lineages were determined by spa typing. Logistic regression analyses were employed to assess risk factors associated with S. aureus colonisation. Results S. aureus colonisation was higher in cases compared to controls independent of geographic location (54% vs. 13%, p < 0.001 and 70% vs. 35%, p = 0.005 in Umtata [rural] and Cape Town [urban], respectively). Severe AD was associated with higher colonisation compared with moderate AD (86% vs. 52%, p = 0.015) among urban cases. Having AD was associated with colonisation in both rural (odds ratio [OR] 7.54, 95% CI 2.92–19.47) and urban (OR 4.2, 95% CI 1.57–11.2) toddlers. In rural toddlers, living in an electrified house that uses gas (OR 4.08, 95% CI 1.59–10.44) or utilises kerosene and paraffin (OR 2.88, 95% CI 1.22–6.77) for heating and cooking were associated with increased S. aureus colonisation. However, exposure to farm animals (OR 0.3, 95% CI 0.11–0.83) as well as living in a house that uses wood and coal (OR 0.14, 95% CI 0.04–0.49) or outdoor fire (OR 0.31, 95% CI 0.13–0.73) were protective. Spa types t174 and t1476, and t272 and t1476 were dominant among urban and rural cases, respectively, but no main spa type was observed among controls, independent of geographic location. In urban cases, spa type t002 and t442 isolates were only identified in severe AD, t174 was more frequent in moderate AD, and t1476 in severe AD. Conclusion The strain genotype of S. aureus differed by AD phenotypes and rural-urban settings. Continued surveillance of colonising S. aureus lineages is key in understanding alterations in skin microbial composition associated with AD pathogenesis and exacerbation. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06044-4.
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Affiliation(s)
- Gillian O N Ndhlovu
- Department of Molecular and Cell Biology, Faculty of Science, University of Cape Town, Cape Town, South Africa
| | - Regina E Abotsi
- Department of Molecular and Cell Biology, Faculty of Science, University of Cape Town, Cape Town, South Africa.,Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Department of Pharmaceutical Microbiology, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| | - Adebayo O Shittu
- Department of Microbiology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.,Institute of Medical Microbiology, University Hospital Münster, Münster, West Germany
| | - Shima M Abdulgader
- Department of Pathology, Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Dorota Jamrozy
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, UK
| | | | - Avumile Mankahla
- Department of Medicine and Pharmacology, Division of Dermatology, Walter Sisulu University, Umtata, South Africa
| | - Mark P Nicol
- Division of Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - Carol Hlela
- Department of Paediatrics, Division of Paediatric Allergy, University of Cape Town, Cape Town, South Africa
| | - Michael E Levin
- Department of Paediatrics, Division of Paediatric Allergy, University of Cape Town, Cape Town, South Africa
| | - Nonhlanhla Lunjani
- Department of Paediatrics, Division of Paediatric Allergy, University of Cape Town, Cape Town, South Africa
| | - Felix S Dube
- Department of Molecular and Cell Biology, Faculty of Science, University of Cape Town, Cape Town, South Africa. .,Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa.
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13
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Mittermann I, Dzoro S, Gattinger P, Botha M, Basera W, Facey-Thomas HE, Gaunt B, Genuneit J, Gray CL, Hlela C, Flicker S, Lunjani N, Mankahla A, Ramjith J, Valenta R, Levin ME. Molecular IgE sensitization profiles of urban and rural children in South Africa. Pediatr Allergy Immunol 2021; 32:234-241. [PMID: 32969537 DOI: 10.1111/pai.13377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Allergens can act as disease-triggering factors in atopic dermatitis (AD) patients. The aim of the study was to elucidate the molecular IgE sensitization profile in children with and without AD living in urban and rural areas of South Africa. METHODS Specific IgE reactivity was assessed in 166 Black South African children aged 9-38 months using a comprehensive panel of microarrayed allergens. According to clinical characterization children fell in four groups, urban AD cases (n = 32), urban controls (non-AD, n = 40), rural cases (n = 49) and rural controls (non-AD, n = 45). RESULTS IgE reactivity to at least one of the allergens was detected in 94% of urban and 86% of rural AD children. House dust mite (HDM; 81% urban, 74% rural AD) and animal-derived allergens (50% urban, 31% rural AD) were the most frequently recognized respiratory allergens, whereas IgE to pollen allergens was almost absent. Urban AD children showed significantly higher frequency of IgE reactivity (50%) to mouse lipocalin, Mus m 1, than rural AD children (12%). The most frequently recognized food allergens were from egg (63% urban, 43% rural AD), peanut (31% vs 41%), and soybean (22% vs 27%), whereas milk sensitization was rare. α-gal-specific IgE almost exclusively occurred in rural children (AD: 14%, non-AD: 49%). CONCLUSION Molecular allergy diagnosis detects frequent IgE sensitization to HDM, animal but not pollen allergens and to egg, peanut, and soy, but not milk allergens in African AD children. Urban AD children reacted more often to Mus m 1, whereas α-gal sensitization is more common in rural children likely due to parasite exposure.
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Affiliation(s)
- Irene Mittermann
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Sheron Dzoro
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Pia Gattinger
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Maresa Botha
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Wisdom Basera
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Heidi E Facey-Thomas
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Ben Gaunt
- Eastern Cape Department of Health, Zithulele Hospital, Mqanduli, South Africa.,Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Claudia L Gray
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Carol Hlela
- Department of Dermatology, University of Cape Town, Cape Town, South Africa
| | - Sabine Flicker
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Nonhlanhla Lunjani
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Avumile Mankahla
- Eastern Cape Department of Health, Zithulele Hospital, Mqanduli, South Africa
| | - Jordache Ramjith
- Department for Health Evidence, Biostatistics Research Group, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.,NRC Institute of Immunology FMBA of Russia, Moscow, Russia.,Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia.,Karl Landsteiner University for Health Sciences, Krems, Austria
| | - Michael E Levin
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa.,INVIVO Planetary Health Network, Research subgroup of the Worldwide Universities Network
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14
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Knight L, Gericke N, Pillay K, Hlela C. Progressively enlarging nodules over the distal interphalangeal joints of a 6-month-old boy. Int J Dermatol 2020; 60:41-43. [PMID: 33047820 DOI: 10.1111/ijd.15245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/02/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Lauren Knight
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Nandi Gericke
- Division of Anatomical Pathology, National Health Laboratory Service, University of Cape Town, Cape Town, South Africa
| | - Komala Pillay
- Division of Anatomical Pathology, National Health Laboratory Service, University of Cape Town, Cape Town, South Africa
| | - Carol Hlela
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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15
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Hlela C, Mancini AJ. Deep forehead lipomas in children-A series and review. Pediatr Dermatol 2020; 37:520-523. [PMID: 32100337 DOI: 10.1111/pde.14116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Deep forehead lipomas are rare in children and may be confused with other more concerning soft tissue masses. We describe four children with deep forehead lipomas, diagnosed between 2 months and 1 year of age, three of them congenital. Notable findings included association with intracranial lipoma and seizures in one patient and the development of marked alopecia overlying the lipoma in another. While deep forehead lipomas may become less visible over time, alopecia and non-syndromic extracutaneous involvement may be important associations.
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Affiliation(s)
- Carol Hlela
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Anthony J Mancini
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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16
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Dame JA, Phillips LA, de Villiers N, Pillay K, Hlela C, Eley B. A novel LYST mutation causing Chédiak Higashi syndrome in a South African child. Pediatric Hematology Oncology Journal 2019. [DOI: 10.1016/j.phoj.2019.08.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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17
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Vermeulen M, Sykes W, Coleman C, Custer B, Jacobs G, Jaza J, Kaidarova Z, Hlela C, Gessain A, Cassar O, Poole C, Ingram C, Murphy EL, Reddy R. The prevalence of human T-lymphotropic virus type 1 & 2 (HTLV-1/2) in South African blood donors. Vox Sang 2019; 114:451-458. [PMID: 30950074 DOI: 10.1111/vox.12778] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/07/2019] [Accepted: 03/12/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Donated blood is not currently screened for human T-cell lymphotropic virus (HTLV) in South Africa. Several small studies have detected HTLV-1 in South Africa, but prevalence by geographic region or population group is unavailable. MATERIALS AND METHODS We performed a large seroprevalence study of South African blood donors during 3 months in 2013. All geographic regions except the Western Cape were included, and Black and Coloured (local term for mixed race) donors were oversampled. Identity-unlinked plasma samples were screened with the Abbott Prism HTLV-1/2 assay, and repeatedly reactive samples were tested by the Inno-LIA HTLV-1/2 Score confirmatory assay. Odds ratios were calculated with multivariable logistic regression. RESULTS Of 46 752 donors tested, 133 (0·28%) were initially reactive, 111 (0·24%) repeatedly reactive and 57 (0·12%) confirmed positive for HTLV-1; none were HTLV-2 positive. Prevalence was 0·062% weighted to annual blood donations but highly concentrated in the Black population group (OR = 20·24 CI: 2·77-147·88); higher in females than males (OR = 1·81 CI: 1·06-3·08); and in donors aged >50 years compared to ages 16-19 (OR = 6·4 CI: 2·95-13·86). After controlling for age, sex and population group, there was no difference in prevalence between new and repeat blood donors or among geographic regions within South Africa. CONCLUSIONS We conclude that HTLV-1 infection is widespread among the Black population of South Africa and its epidemiology is similar to other endemic areas. Because South Africa is increasing its recruitment of Black blood donors, the implications for blood screening require further consideration.
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Affiliation(s)
| | - Wendy Sykes
- South African National Blood Service, Roodepoort, South Africa
| | - Charl Coleman
- South African National Blood Service, Roodepoort, South Africa
| | - Brian Custer
- Vitalant Research Institute, San Francisco, CA, USA.,University of California San Francisco, San Francisco, CA, USA
| | | | - Jabulisile Jaza
- South African National Blood Service, Roodepoort, South Africa
| | | | - Carol Hlela
- Red Cross Children's Hospital, Cape Town, South Africa
| | - Antoine Gessain
- Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Département de Virologie, Institut Pasteur, Paris, France.,CNRS, UMR3569, Paris, France
| | - Olivier Cassar
- Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Département de Virologie, Institut Pasteur, Paris, France.,CNRS, UMR3569, Paris, France
| | - Colwyn Poole
- South African National Blood Service, Roodepoort, South Africa
| | | | - Edward L Murphy
- Vitalant Research Institute, San Francisco, CA, USA.,University of California San Francisco, San Francisco, CA, USA
| | - Ravi Reddy
- South African National Blood Service, Roodepoort, South Africa
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18
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Spengane Z, Hlela C, Pillay K. Neonatal lupus erythematosus or Sweet syndrome? JAAD Case Rep 2018; 4:780-783. [PMID: 30246125 PMCID: PMC6141640 DOI: 10.1016/j.jdcr.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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19
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Mahdavinia M, Rasmussen HE, Engen P, Van den Berg JP, Davis E, Engen K, Green SJ, Naqib A, Botha M, Gray C, Lunjani N, Hlela C, Basera W, Hobane L, Watkins A, Tobin MC, Landay A, Keshavarzian A, Levin ME. Atopic dermatitis and food sensitization in South African toddlers: Role of fiber and gut microbiota. Ann Allergy Asthma Immunol 2017; 118:742-743.e3. [PMID: 28583264 DOI: 10.1016/j.anai.2017.04.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 04/03/2017] [Accepted: 04/16/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Mahboobeh Mahdavinia
- Department of Immunology and Microbiology, Allergy/Immunology Section, Rush University Medical Center, Chicago, Illinois.
| | - Heather E Rasmussen
- Division of Gastroenterology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois; Department of Clinical Nutrition, Rush University Medical Center, Chicago, Illinois
| | - Phillip Engen
- Division of Gastroenterology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Jolice P Van den Berg
- Division of Gastroenterology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Erika Davis
- Division of Gastroenterology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Krista Engen
- Division of Gastroenterology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Stefan J Green
- DNA Services Facility, Research Resources Center, University of Illinois at Chicago, Chicago, Illinois; Department of Biological Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Ankur Naqib
- DNA Services Facility, Research Resources Center, University of Illinois at Chicago, Chicago, Illinois
| | - Maresa Botha
- Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; In-FLAME, the International Inflammation Network World Universities Network (WUN)
| | - Claudia Gray
- Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Nonhlanhla Lunjani
- Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Carol Hlela
- Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Wisdom Basera
- Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Lelani Hobane
- Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Alexandra Watkins
- Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Mary C Tobin
- Department of Immunology and Microbiology, Allergy/Immunology Section, Rush University Medical Center, Chicago, Illinois
| | - Alan Landay
- Department of Immunology and Microbiology, Allergy/Immunology Section, Rush University Medical Center, Chicago, Illinois; In-FLAME, the International Inflammation Network World Universities Network (WUN)
| | - Ali Keshavarzian
- Division of Gastroenterology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Michael E Levin
- Division of Allergy, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; In-FLAME, the International Inflammation Network World Universities Network (WUN)
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Hlela C, Khumalo NP. Comment on "Prevention of flares in children with atopic dermatitis with regular use of an emollient containing glycerol and paraffin: A randomised controlled study". Pediatr Dermatol 2017; 34:743. [PMID: 29144052 DOI: 10.1111/pde.13264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Carol Hlela
- Division of Dermatology, Red Cross Children's Hospital, Rondenbosch, Cape Town, South Africa
| | - Nonhlanhla P Khumalo
- Groote Schuur Hospital, University of Cape Town, Rondenbosch, Cape Town, South Africa
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Abstract
There is a sense that many patients seen at referral centers could be managed at a primary health care level. The objective of the current study was to examine the range of diagnoses among consultations at the Red Cross Children's Hospital in Cape Town, South Africa, to help develop a strategy for targeted education of primary health care personnel. This was a retrospective review of data for children seen at a pediatric dermatology clinic from 2005 to 2010, recorded according to International Classification of Diseases coding and compared with published data from similar clinical settings. There were 13,253 clinic visits, with 4,789 patients seen (median age 4.8 yrs, range 2 days to 18.6 yrs). The top 10 diagnoses accounted for 88.5% of consultations (59.5% atopic eczema [AE], 7.1% seborrheic dermatitis [SD], 4.2% superficial mycoses, 3.1% molluscum contagiosum, 2.8% vitiligo, 2.7% viral warts, 2.4% prurigo or scabies, 2.3% psoriasis, 2.3% hemangioma, 2.1% impetigo). Disease prevalence was somewhat different during the first year of life (AE 43.7%, SD 18.6%, hemangiomas 13.4%). Inflammatory dermatoses (76.6%) were more prevalent than infections and infestations (14.5%). The disease spectrum was similar to that in developed countries, although AE prevalence was higher in this study (followed by London 36%, Greece 35%, and Hong Kong 33%) than in 19 published studies. The top 10 diagnoses accounted for more than 70% of diagnoses in 12 studies. The retrospective nature and setting at a specialist clinic increased bias and limited generalizability. Focused education on the optimal care of common diseases, especially AE, could reduce referrals, improve access, and allow specialists at tertiary centers more time to manage complex and uncommon dermatoses.
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Affiliation(s)
- Betty Kakande
- Division of Dermatology, Red Cross Children's Hospital, Cape Town, South Africa.,Division of Dermatology, Groote Schuur Hospital, Cape Town, South Africa
| | - Freedom Gumedze
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Carol Hlela
- Division of Dermatology, Red Cross Children's Hospital, Cape Town, South Africa.,Division of Dermatology, Groote Schuur Hospital, Cape Town, South Africa
| | - Nonhlanhla P Khumalo
- Division of Dermatology, Red Cross Children's Hospital, Cape Town, South Africa.,Division of Dermatology, Groote Schuur Hospital, Cape Town, South Africa
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Sykes W, Coleman C, Beck G, Mhlanga J, Hlela C, Custer B, Murphy EL, Vermeulen M. Cost-effectiveness analysis of introducing HTLV-1 testing in South Africa. Retrovirology 2015. [PMCID: PMC4578686 DOI: 10.1186/1742-4690-12-s1-p81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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23
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Webb K, Hlela C, Jordaan HF, Suliman S, Scriba T, Lipsker D, Scott C. A Review and Proposed Approach to the Neutrophilic Dermatoses of Childhood. Pediatr Dermatol 2015; 32:437-46. [PMID: 25727235 DOI: 10.1111/pde.12502] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Neutrophilic dermatoses (NDs) are inflammatory skin conditions that are not associated with infection. The classification and clinical approach to these conditions in children is poorly described. This review classifies these conditions into five nosological subtypes: Sweet's syndrome, pyoderma gangrenosum, aseptic pustules, neutrophilic urticarial dermatoses, and Marshall's syndrome. In addition, we review the various secondary diseases that need to be excluded in the clinical management of the NDs of childhood, with a focus on the autoinflammatory conditions that the reader may not be familiar with. We propose a practical clinical approach to these disorders.
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Affiliation(s)
- Kate Webb
- Department of Rheumatology, University of Cape Town, Cape Town, South Africa.,Department of Dermatology, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Carol Hlela
- Department of Rheumatology, University of Cape Town, Cape Town, South Africa.,Department of Dermatology, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - H Francois Jordaan
- Division of Dermatology, Department of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch, Stellenbosch, South Africa
| | - Sara Suliman
- South African TB Vaccine Initiative, University of Cape Town, Cape Town, South Africa
| | - Thomas Scriba
- South African TB Vaccine Initiative, University of Cape Town, Cape Town, South Africa
| | - Dan Lipsker
- Faculté de Médecine, Université de Strasbourg and Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Chris Scott
- Department of Rheumatology, University of Cape Town, Cape Town, South Africa
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24
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Basera W, Botha M, Gray CL, Lunjani N, Watkins ASM, Venter C, Allen KJ, Hlela C, Zar HJ, Levin ME. The South African Food Sensitisation and Food Allergy population-based study of IgE-mediated food allergy: validity, safety, and acceptability. Ann Allergy Asthma Immunol 2015; 115:113-9. [PMID: 26105048 DOI: 10.1016/j.anai.2015.06.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/25/2015] [Accepted: 06/03/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Few studies exist on food sensitization and challenge-proven food allergy in low- and middle-income countries. OBJECTIVE To describe the study design and methodology to recruit infants from an African population for skin prick testing and oral food challenges and the use of preliminary data to investigate the extent to which the study sample is representative of the target population. METHODS Children 12 to 36 months old were recruited from childcare education facilities in Cape Town. Children underwent skin prick testing to foods. Those with a reactive wheal of at least 1 mm larger than the negative control and not clearly tolerant according to history to a full age-appropriate portion to at least 1 food underwent oral food challenges. Parents who chose not to participate completed a nonparticipant questionnaire. Interim analysis of at least 500 respondents was performed. Demographic features of participating children were compared with those of nonparticipants and the population demographics of the most recent Cape Town census data. RESULTS The response rate was 60.1%, with high participation and completion rates of 96.5% and 97.5%, respectively. Demographics of the completed participant sample were similar to those of the Cape Town census. Use of a nonrespondent questionnaire indicated no selection bias in favor of increased participation of participants with allergy. No ethnic differences in sensitization or food allergy were evident. CONCLUSION The study was safe and feasible and the recruitment was effective and representative of the target population. Future studies will aim to increase the precision of the prevalence of food sensitization and allergy, describe environmental risk factors, and include a rural black African cohort.
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Affiliation(s)
- Wisdom Basera
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Maresa Botha
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Claudia L Gray
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Nonhlanhla Lunjani
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Alexandra S M Watkins
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; University of Southampton, Southampton, United Kingdom
| | - Carina Venter
- The David Hide Asthma and Allergy Research Centre, Newport, Isle of Wight, United Kingdom; University of Portsmouth, Portsmouth, United Kingdom
| | - Katrina J Allen
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia; University of Manchester, Manchester, United Kingdom
| | - Carol Hlela
- Department of Dermatology, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; MRC Unit of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Michael E Levin
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
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Hlela C, Bittencourt A. Infective dermatitis associated with HTLV-1 mimics common eczemas in children and may be a prelude to severe systemic diseases. Dermatol Clin 2014; 32:237-48. [PMID: 24680009 DOI: 10.1016/j.det.2013.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Infective dermatitis associated with human T-cell lymphotropic virus type 1 (HTLV-1) (IDH) is a chronic dermatitis that has been observed in a variable proportion of HTLV-1-infected children. IDH may serve as an early clinical marker for HTLV-1 infection and an indicator of increased risk for developing other HTLV-1-associated conditions. Factors that lead only some infected children to develop IDH are poorly understood. The variable clinical presentation of IDH, in particular its chronicity, the morphology and distribution of the lesions, and its clinical resemblance to other cutaneous inflammatory conditions, make it necessary to distinguish it from other common dermatoses.
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Affiliation(s)
- Carol Hlela
- Division of Dermatology, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, Western Cape 7700, South Africa.
| | - Achiléa Bittencourt
- Laboratory Service, Complexo Hospitalar Universita'rio Prof Edgars Santos, University of Bahia, Rua Augusto Viana, s/n-Canela-40110-160 Salvador, Bahia, Brazil
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26
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Webb K, Hlela C, Scott C. PW03-022 – Neutrophilic skin disease and inflammation. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952516 DOI: 10.1186/1546-0096-11-s1-a248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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27
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Hlela C, Graham N, Bhigjee AI, Taylor GP, Khumalo NP, Mosam A. Human T cell lymphotropic virus type 1- associated infective dermatitis in KwaZulu Natal, South Africa. BMC Dermatol 2013; 13:11. [PMID: 24152710 PMCID: PMC4015614 DOI: 10.1186/1471-5945-13-11] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 10/11/2013] [Indexed: 11/30/2022]
Abstract
Background The Human T cell lymphotropic virus type 1 (HTLV-1)-associated infective dermatitis (IDH), is a chronic relapsing dermatitis which usually presents in children older than 2 years. A total of 300 cases have been reported worldwide (Latin America, the Caribbean and only 5 from Senegal). Neither IDH, nor its complications have been reported from the rest of Africa. We aimed to examine the clinical and aetiological characteristics of IDH in a cohort of South African children. Methods Attendees at the dermatology clinic at King Edward VIII Hospital, Durban underwent clinical examination. After obtaining consent those suspected of IDH had specimens taken for blood counts, immunoglobulins, serum protein electrophoresis, viral studies (including genotyping), skin swabs and stool examinations. Results Nineteen of 60 suspected cases recruited over 3 years met the diagnostic criteria for IDH. The male-to-female ratio was 1:2; mean age 8 years (range 0.7 to 15). Dermatitis mostly affected the scalp (78.9%) and axilla (73.7%); fewer children had nasal crusting (47.4%). Mean Ig A, IgG and IgM were raised, at 3.52 g/l, 22.6 g/l and 1.38 g/l, respectively. The median CD4 cell count was 1958 cells/mm3. Viral genotyping of all tested samples were positive for the Cosmopolitan, Subtype A (HTLV-1a). Conclusions IDH is a distinct entity which also affects South Africans. Our patients were older at presentation and the majority did not present with nasal crusting as has been described in other countries.
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Affiliation(s)
- Carol Hlela
- Division of Dermatology; Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa.
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28
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Gillet NA, Cook L, Laydon DJ, Hlela C, Verdonck K, Alvarez C, Gotuzzo E, Clark D, Farré L, Bittencourt A, Asquith B, Taylor GP, Bangham CRM. Strongyloidiasis and infective dermatitis alter human T lymphotropic virus-1 clonality in vivo. PLoS Pathog 2013; 9:e1003263. [PMID: 23592987 PMCID: PMC3617147 DOI: 10.1371/journal.ppat.1003263] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 02/05/2013] [Indexed: 01/03/2023] Open
Abstract
Human T-lymphotropic Virus-1 (HTLV-1) is a retrovirus that persists lifelong by driving clonal proliferation of infected T-cells. HTLV-1 causes a neuroinflammatory disease and adult T-cell leukemia/lymphoma. Strongyloidiasis, a gastrointestinal infection by the helminth Strongyloides stercoralis, and Infective Dermatitis associated with HTLV-1 (IDH), appear to be risk factors for the development of HTLV-1 related diseases. We used high-throughput sequencing to map and quantify the insertion sites of the provirus in order to monitor the clonality of the HTLV-1-infected T-cell population (i.e. the number of distinct clones and abundance of each clone). A newly developed biodiversity estimator called “DivE” was used to estimate the total number of clones in the blood. We found that the major determinant of proviral load in all subjects without leukemia/lymphoma was the total number of HTLV-1-infected clones. Nevertheless, the significantly higher proviral load in patients with strongyloidiasis or IDH was due to an increase in the mean clone abundance, not to an increase in the number of infected clones. These patients appear to be less capable of restricting clone abundance than those with HTLV-1 alone. In patients co-infected with Strongyloides there was an increased degree of oligoclonal expansion and a higher rate of turnover (i.e. appearance and disappearance) of HTLV-1-infected clones. In Strongyloides co-infected patients and those with IDH, proliferation of the most abundant HTLV-1+ T-cell clones is independent of the genomic environment of the provirus, in sharp contrast to patients with HTLV-1 infection alone. This implies that new selection forces are driving oligoclonal proliferation in Strongyloides co-infection and IDH. We conclude that strongyloidiasis and IDH increase the risk of development of HTLV-1-associated diseases by increasing the rate of infection of new clones and the abundance of existing HTLV-1+ clones. HTLV-1 is a human retrovirus estimated to infect 20 million people world-wide and is causing in a small proportion of the infected individuals an inflammatory disease or a leukemia/lymphoma. HTLV-1 persists lifelong by driving clonal proliferation of infected T-cells. Strongyloidiasis, a gastrointestinal infection by an helminth (Strongyloides stercoralis) and Infective Dermatitis associated with HTLV-1 (IDH), a skin inflammation with bacterial infection, appear to increase the risk of developing HTLV-1-related diseases. It is well known that the chance of developing HTLV-1-related diseases increases with the number of cells infected by the virus (also called proviral load). It is also known that HTLV-1-infected individuals co-infected by Strongyloides or affected by IDH have a higher proviral load, but the mechanism is still unclear. Consequently, the aim of this study was to test if co-infection increases the total number and/or the abundance (or size) of HTLV-1-infected T-cell clones. We have shown that the significantly increased proviral load in HTLV-1-infected individuals with IDH or strongyloidiasis is due to an increase in the mean clone abundance (bigger clones), not to an increase in the number of infected clones. These patients appear to be less capable of restricting clone abundance than those with HTLV-1 alone.
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Affiliation(s)
- Nicolas A. Gillet
- Section of Immunology, Wright-Fleming Institute, Imperial College London, London, United Kingdom
- Molecular and Cellular Epigenetics, Interdisciplinary Cluster for Applied Genoproteomics (GIGA) of University of Liège (ULg), Liège, Belgium
- * E-mail: (NAG); (CRMB)
| | - Lucy Cook
- Section of Immunology, Wright-Fleming Institute, Imperial College London, London, United Kingdom
| | - Daniel J. Laydon
- Section of Immunology, Wright-Fleming Institute, Imperial College London, London, United Kingdom
| | - Carol Hlela
- Section of Immunology, Wright-Fleming Institute, Imperial College London, London, United Kingdom
| | - Kristien Verdonck
- Instituto de Medicina Tropical Alexander von Humboldt and Hospital Nacional Cayetano Heredia, Universidad Peruana Cayetano Heredia, Lima, Peru
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Carolina Alvarez
- Instituto de Medicina Tropical Alexander von Humboldt and Hospital Nacional Cayetano Heredia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eduardo Gotuzzo
- Instituto de Medicina Tropical Alexander von Humboldt and Hospital Nacional Cayetano Heredia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Daniel Clark
- Instituto de Medicina Tropical Alexander von Humboldt and Hospital Nacional Cayetano Heredia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lourdes Farré
- Laboratory of Experimental Pathology, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Achiléa Bittencourt
- Complexo Hospitalar Universitário Prof. Edgard Santos, Department of Pathology, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Becca Asquith
- Section of Immunology, Wright-Fleming Institute, Imperial College London, London, United Kingdom
| | - Graham P. Taylor
- Section of Infectious Diseases, Wright-Fleming Institute, Imperial College London, London, United Kingdom
| | - Charles R. M. Bangham
- Section of Immunology, Wright-Fleming Institute, Imperial College London, London, United Kingdom
- * E-mail: (NAG); (CRMB)
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Lehloenya RJ, Todd G, Mogotlane L, Gantsho N, Hlela C, Dheda K. Lichenoid drug reaction to antituberculosis drugs treated through with topical steroids and phototherapy. J Antimicrob Chemother 2012; 67:2535-7. [PMID: 22687890 DOI: 10.1093/jac/dks225] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gillet NA, Hlela C, Verdonck T, Gotuzzo E, Clark D, Rodriguez S, Malani N, Melamed A, Gormley N, Carter R, Bentley D, Berry C, Bushman FD, Taylor GP, Willems L, Bangham CRM. HTLV-1 clonality during chronic infection and BLV clonality during primary infection. Retrovirology 2011. [PMCID: PMC3112659 DOI: 10.1186/1742-4690-8-s1-a185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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31
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Hlela C, Gillet N, Bangham C, Marafioti T, Ogg G. Human T-lymphotropic virus type 1(HTLV-1) integration, HTLV-1-associated infective dermatitis (IDH) and the risk of Adult T cell leukaemia/lymphoma (ATLL). Retrovirology 2011. [PMCID: PMC3112764 DOI: 10.1186/1742-4690-8-s1-a50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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32
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Hlela C, Shepperd S, Khumalo NP, Taylor GP. The prevalence of human T-cell lymphotropic virus type 1 in the general population is unknown. AIDS Rev 2009; 11:205-214. [PMID: 19940947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Human T-cell lymphotropic virus type 1 prevalence estimates are usually based on serological screening of blood donors, pregnant women, and other selected population groups. Previously, data on the global epidemiology of human T-cell lymphotropic virus type 1 infection have been summarized unsystematically and without a focus on general populations. To assess the implications of the virus for healthcare systems it is essential to know its past and present prevalence. The widely cited estimate that 10-20 million people are infected with human T-cell lymphotropic virus type 1 worldwide was calculated from data that are now 25 years old. This estimate may therefore no longer reflect the global epidemiology. The objective of this study was to collate published data that are truly representative of the general population through a systematic review of the literature. Fifty-nine relevant studies were identified and the 17 that met the inclusion criteria were all cross-sectional designs; none reported incidence. The prevalence of human T-cell lymphotropic virus type 1 was highest in the two studies of Japanese islands (36.4%; 95% CI: 29.9-42.8) and lowest in studies from Mongolia, Malaysia and India. In Haiti the prevalence was 3.8% (95% CI: 1.78-5.86); in Africa between 6.6% (95% CI: 4.0-9.9) and 8.5% (95% CI: 6.99-10.10) in Gabon, and 1.05% (95% CI: 0.63-1.47) in Guinea. Only three studies were from West Africa and none were from the South; the only study from India was from the north of the country. We conclude that there is a paucity of general population data from countries in which human T-cell lymphotropic virus type 1 is endemic, and that new studies are required to reevaluate the global burden of infection.
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Affiliation(s)
- Carol Hlela
- Weatherall Institute of Molecular Medicine, Human Immunology Unit, University of Oxford, Oxford, UK.
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Alcantara LCJ, de Oliveira T, Gordon M, Pybus O, Mascarenhas RE, Seixas MO, Gonçalves M, Hlela C, Cassol S, Galvão-Castro B. Tracing the origin of Brazilian HTLV-1 as determined by analysis of host and viral genes. AIDS 2006; 20:780-2. [PMID: 16514313 DOI: 10.1097/01.aids.0000216383.14808.13] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We compared the genetic diversity of the Brazilian human T-cell lymphotropic virus type 1 isolates with those found in KwaZulu-Natal (KZN), South Africa, and with the genetic background of the hosts. The seroprevalence rate in KZN was 1.7%. All sequences belonged to the A subgroup. The presence of South African sequences in two different clusters from Brazil, and the finding of the beta-globin haplotype in infected hosts are consistent with the transmission of this virus from southern Africa to Brazil.
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Affiliation(s)
- Luiz C J Alcantara
- Public Health Advanced Laboratory, Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
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