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Ngasala B, Chacky F, Mohamed A, Molteni F, Nyinondi S, Kabula B, Mkali H, Thwai K, Popkin-Hall ZR, Mitchell C, Parr JB, Juliano JJ, Lin JT. Evaluation of Malaria Rapid Diagnostic Test Performance and pfhrp2 Deletion in Tanzania School Surveys, 2017. Am J Trop Med Hyg 2024; 110:887-891. [PMID: 38507797 PMCID: PMC11066367 DOI: 10.4269/ajtmh.23-0771] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/02/2024] [Indexed: 03/22/2024] Open
Abstract
As part of malaria nationwide monitoring and evaluation initiatives, there is an increasing trend of incorporating malaria rapid diagnostic tests (mRDTs) in surveys conducted within primary schools to detect malaria parasites. However, mRDTs based on the detection of histidine-rich protein 2 (HRP2) are known to yield false-positive results due to persistent antigenemia, and false-negative results may result from low parasitemia or Plasmodium falciparum hrp2/3 gene deletion. We evaluated diagnostic performance of an HRP2 and pan-parasite lactate dehydrogenase (HRP2/pLDH) mRDT against polymerase chain reaction (PCR) for detection of P. falciparum among 17,051 primary school-age children from eight regions of Tanzania in 2017. According to PCR, the prevalence of P. falciparum was 19.2% (95% CI: 18.6-19.8). Using PCR as reference, the sensitivity and specificity of mRDT was 76.2% (95% CI: 74.7-77.7) and 93.9% (95% CI: 93.5-94.3), respectively. Test agreement was lowest in low transmission areas, where true-positive mRDTs were outnumbered by false-negatives due to low parasitemia. Discordant samples (mRDT-negative but PCR-positive) were screened for pfhrp2/3 deletion by real-time PCR. Among those with a parasite density sufficient for analysis, pfhrp2 deletion was confirmed in 60 samples, whereas pfhrp3 deletion was confirmed in two samples; one sample had both pfhrp2 and pfhrp3 deletions. The majority of samples with gene deletions were detected in the high-transmission Kagera region. Compared with mRDTs, PCR and other molecular methods offer increased sensitivity and are not affected by pfhrp2/3 deletions, making them a useful supplement to mRDTs in schools and other epidemiological surveys.
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Affiliation(s)
- Billy Ngasala
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Frank Chacky
- National Malaria Control Programme, Dodoma, Tanzania
| | - Ally Mohamed
- National Malaria Control Programme, Dodoma, Tanzania
| | | | | | | | | | - Kyaw Thwai
- Institute for Global health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
| | - Zachary R. Popkin-Hall
- Institute for Global health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
| | - Cedar Mitchell
- Institute for Global health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
| | - Jonathan B. Parr
- Institute for Global health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
- Curriculum in Genetics and Molecular Biology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Jonathan J. Juliano
- Institute for Global health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
- Curriculum in Genetics and Molecular Biology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Jessica T. Lin
- Institute for Global health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
- Department of Microbiology and Immunology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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Assefa A, Wamae K, Hennelly CM, Ngasala B, Muller M, Kalonji A, Phanzu F, Cunningham CH, Lin JT, Parr JB. Detection of P. malariae using a new rapid isothermal amplification lateral flow assay. Malar J 2024; 23:104. [PMID: 38609964 PMCID: PMC11015614 DOI: 10.1186/s12936-024-04928-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND While Plasmodium falciparum and Plasmodium vivax cause the majority of malaria cases and deaths, infection by Plasmodium malariae and other Plasmodium species also causes morbidity and mortality. Current understanding of these infections is limited in part by existing point-of-care diagnostics that fail to differentiate them and have poor sensitivity for low-density infections. Accurate diagnosis currently requires molecular assays performed in well-resourced laboratories. This report describes the development of a P. malariae diagnostic assay that uses rapid, isothermal recombinase polymerase amplification (RPA) and lateral-flow-strip detection. METHODS Multiple combinations of custom RPA primers and probes were designed using publicly available P. malariae genomic sequences, and by modifying published primer sets. Based on manufacturer RPA reaction conditions (TwistDx nfo kit), an isothermal assay was optimized targeting the multicopy P. malariae 18S rRNA gene with 39 °C incubation and 30-min run time. RPA product was visualized using lateral strips (FAM-labeled, biotinylated amplicon detected by a sandwich immunoassay, visualized using gold nanoparticles). Analytical sensitivity was evaluated using 18S rRNA plasmid DNA, and clinical sensitivity determined using qPCR-confirmed samples collected from Tanzania, Ethiopia, and the Democratic Republic of the Congo. RESULTS Using 18S rRNA plasmid DNA, the assay demonstrates a detection limit of 10 copies/µL (~ 1.7 genome equivalents) and 100% analytical specificity. Testing in field samples showed 95% clinical sensitivity and 88% specificity compared to qPCR. Total assay time was less than 40 min. CONCLUSION Combined with simplified DNA extraction methods, the assay has potential for future field-deployable, point-of-care use to detect P. malariae infection, which remains largely undiagnosed but a neglected cause of chronic malaria. The assay provides a rapid, simple readout on a lateral flow strip without the need for expensive laboratory equipment.
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Affiliation(s)
- Ashenafi Assefa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Kevin Wamae
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Christopher M Hennelly
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Billy Ngasala
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Meredith Muller
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | | | - Clark H Cunningham
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jessica T Lin
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jonathan B Parr
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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Zeno EE, Obala AA, Pence B, Freedman E, Mangeni JN, Lin JT, Abel L, Edwards JK, Gower EW, Taylor SM. Risk of Malaria Following Untreated Subpatent Plasmodium falciparum Infections: Results Over 4 Years From a Cohort in a High-Transmission Area in Western Kenya. J Infect Dis 2024; 229:969-978. [PMID: 37713614 PMCID: PMC11011184 DOI: 10.1093/infdis/jiad398] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/30/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND People with suspected malaria may harbor Plasmodium falciparum undetected by rapid diagnostic test (RDT). The impact of these subpatent infections on the risk of developing clinical malaria is not fully understood. METHODS We analyzed subpatent P. falciparum infections using a longitudinal cohort in a high-transmission site in Kenya. Weighted Kaplan-Meier models estimated the risk difference (RD) for clinical malaria during the 60 days following a symptomatic subpatent infection. Stratum-specific estimates by age and transmission season assessed modification. RESULTS Over 54 months, we observed 1128 symptomatic RDT-negative suspected malaria episodes, of which 400 (35.5%) harbored subpatent P. falciparum. Overall, the 60-day risk of developing clinical malaria was low following all episodes (8.6% [95% confidence interval, 6.7%-10.4%]). In the low-transmission season, the risk of clinical malaria was slightly higher in those with subpatent infection, whereas the opposite was true in the high-transmission season (low-transmission season RD, 2.3% [95% confidence interval, .4%-4.2%]; high-transmission season RD, -4.8% [-9.5% to -.05%]). CONCLUSIONS The risk of developing clinical malaria among people with undetected subpatent infections is low. A slightly elevated risk in the low-transmission season may merit alternate management, but RDTs identify clinically relevant infections in the high-transmission season.
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Affiliation(s)
- Erica E Zeno
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Andrew A Obala
- School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Brian Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| | - Elizabeth Freedman
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Judith N Mangeni
- School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Jessica T Lin
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, USA
| | - Lucy Abel
- Academic Model Providing Access to Healthcare, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Jessie K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| | - Emily W Gower
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| | - Steve M Taylor
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Lyu HH, Lin JT, Wen YH. [Research progress of sinonasal malignant tumors based on SEER database]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2024; 59:392-398. [PMID: 38622025 DOI: 10.3760/cma.j.cn115330-20231031-00181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- H H Lyu
- Department of Otorhinolaryngology, the First Affiliated Hospital of Sun Yat-Sen University, Otorhinolaryngology Institute, Sun Yat-Sen University, Key Otorhinolaryngology Laboratory of Guangzhou, Guangzhou 510080, China
| | - J T Lin
- Department of Otorhinolaryngology, the First Affiliated Hospital of Sun Yat-Sen University, Otorhinolaryngology Institute, Sun Yat-Sen University, Key Otorhinolaryngology Laboratory of Guangzhou, Guangzhou 510080, China
| | - Y H Wen
- Department of Otorhinolaryngology, the First Affiliated Hospital of Sun Yat-Sen University, Otorhinolaryngology Institute, Sun Yat-Sen University, Key Otorhinolaryngology Laboratory of Guangzhou, Guangzhou 510080, China
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Connelly SV, Brazeau NF, Msellem M, Ngasala BE, Aydemir Ö, Goel V, Niaré K, Giesbrecht DJ, Popkin-Hall ZR, Hennelly CM, Park Z, Moormann AM, Ong'echa JM, Verity R, Mohammed S, Shija SJ, Mhamilawa LE, Morris U, Mårtensson A, Lin JT, Björkman A, Juliano JJ, Bailey JA. Strong isolation by distance and evidence of population microstructure reflect ongoing Plasmodium falciparum transmission in Zanzibar. medRxiv 2024:2023.02.15.23285960. [PMID: 36865135 PMCID: PMC9980253 DOI: 10.1101/2023.02.15.23285960] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The Zanzibar archipelago of Tanzania has become a low-transmission area for Plasmodium falciparum. Despite being considered an area of pre-elimination for years, achieving elimination has been difficult, likely due to a combination of imported infections from mainland Tanzania, and continued local transmission. To shed light on these sources of transmission, we applied highly multiplexed genotyping utilizing molecular inversion probes to characterize the genetic relatedness of 282 P. falciparum isolates collected across Zanzibar and in Bagamoyo District on the coastal mainland from 2016-2018. Overall, parasite populations on the coastal mainland and Zanzibar archipelago remain highly related. However, parasite isolates from Zanzibar exhibit population microstructure due to rapid decay of parasite relatedness over very short distances. This, along with highly related pairs within shehias, suggests ongoing low level local transmission. We also identified highly related parasites across shehias that reflect human mobility on the main island of Unguja and identified a cluster of highly related parasites, suggestive of an outbreak, in the Micheweni district on Pemba island. Parasites in asymptomatic infections demonstrated higher complexity of infection than those in symptomatic infections, but have similar core genomes. Our data support importation as a main source of genetic diversity and contribution to the parasite population on Zanzibar, but they also show local outbreak clusters where targeted interventions are essential to block local transmission. These results highlight the need for preventive measures against imported malaria and enhanced control measures in areas that remain receptive for malaria reemergence due to susceptible hosts and competent vectors.
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Affiliation(s)
- Sean V Connelly
- MD-PhD Program, University of North Carolina, Chapel Hill, NC 27599
| | | | - Mwinyi Msellem
- Research Division, Ministry of Health, Zanzibar, Tanzania
| | - Billy E Ngasala
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Global Health and Migration Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Özkan Aydemir
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA
| | - Varun Goel
- Carolina Population Center, University of North Carolina, Chapel Hill, NC 27599
| | - Karamoko Niaré
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI, 02912 USA
| | - David J Giesbrecht
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI, 02912 USA
| | - Zachary R Popkin-Hall
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599 USA
| | - Christopher M Hennelly
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599 USA
| | - Zackary Park
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599 USA
| | - Ann M Moormann
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA
| | | | - Robert Verity
- MRC Centre for Global Infectious Disease Analysis, Imperial College, London
| | - Safia Mohammed
- Zanzibar Malaria Elimination Program (ZAMEP), Zanzibar, Tanzania
| | - Shija J Shija
- Zanzibar Malaria Elimination Program (ZAMEP), Zanzibar, Tanzania
| | - Lwidiko E Mhamilawa
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Global Health and Migration Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ulrika Morris
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Andreas Mårtensson
- Global Health and Migration Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Jessica T Lin
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599 USA
| | - Anders Björkman
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 17177 Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Jonathan J Juliano
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599 USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, 27599 USA
- Curriculum in Genetics and Molecular Biology, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Jeffrey A Bailey
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI, 02912 USA
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Potlapalli VR, Muller MS, Ngasala B, Ali IM, Na YB, Williams DR, Kharabora O, Chhetri S, Liu MS, Carey-Ewend K, Lin FC, Mathias D, Tarimo BB, Juliano JJ, Parr JB, Lin JT. Real-time PCR detection of mixed Plasmodium ovale curtisi and wallikeri infections in human and mosquito hosts. PLoS Negl Trop Dis 2023; 17:e0011274. [PMID: 38064489 PMCID: PMC10732364 DOI: 10.1371/journal.pntd.0011274] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 12/20/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023] Open
Abstract
Plasmodium ovale curtisi (Poc) and Plasmodium ovale wallikeri (Pow) represent distinct non-recombining Plasmodium species that are increasing in prevalence in sub-Saharan Africa. Though they circulate sympatrically, co-infection within human and mosquito hosts has rarely been described. Separate 18S rRNA real-time PCR assays that detect Poc and Pow were modified to allow species determination in parallel under identical cycling conditions. The lower limit of detection was 0.6 plasmid copies/μL (95% CI 0.4-1.6) for Poc and 4.5 plasmid copies/μL (95% CI 2.7-18) for Pow, or 0.1 and 0.8 parasites/μL, respectively, assuming 6 copies of 18s rRNA per genome. However, the assays showed cross-reactivity at concentrations greater than 103 plasmid copies/μL (roughly 200 parasites/μL). Mock mixtures were used to establish criteria for classifying mixed Poc/Pow infections that prevented false-positive detection while maintaining sensitive detection of the minority ovale species down to 100 copies/μL (<1 parasite/μL). When the modified real-time PCR assays were applied to field-collected blood samples from Tanzania and Cameroon, species identification by real-time PCR was concordant with nested PCR in 19 samples, but additionally detected two mixed Poc/Pow infections where nested PCR detected a single Po species. When real-time PCR was applied to oocyst-positive Anopheles midguts saved from mosquitoes fed on P. ovale-infected persons, mixed Poc/Pow infections were detected in 11/14 (79%). Based on these results, 8/9 P. ovale carriers transmitted both P. ovale species to mosquitoes, though both Po species could only be detected in the blood of two carriers. The described real-time PCR approach can be used to identify the natural occurrence of mixed Poc/Pow infections in human and mosquito hosts and reveals that such co-infections and co-transmission are likely more common than appreciated.
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Affiliation(s)
- Varun R. Potlapalli
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Meredith S. Muller
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Billy Ngasala
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Innocent Mbulli Ali
- Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Yu Bin Na
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Danielle R. Williams
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Oksana Kharabora
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Srijana Chhetri
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Mei S. Liu
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Kelly Carey-Ewend
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Feng-Chang Lin
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Derrick Mathias
- Florida Medical Entomology Laboratory, Institute of Food & Agricultural Sciences, University of Florida, Vero Beach, Florida United States of America
| | - Brian B. Tarimo
- Vector Immunity and Transmission Biology Unit, Department of Environmental Health and Ecological Sciences, Ifakara Health Institute-Bagamoyo Office, Bagamoyo, Tanzania
| | - Jonathan J. Juliano
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Jonathan B. Parr
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Jessica T. Lin
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
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He W, Sendor R, Potlapalli VR, Kashamuka MM, Tshefu AK, Phanzu F, Kalonji A, Ngasala B, Thwai KL, Juliano JJ, Lin JT, Parr JB. A novel duplex qualitative real-time PCR assay for the detection and differentiation of Plasmodium ovale curtisi and Plasmodium ovale wallikeri malaria. medRxiv 2023:2023.10.31.23297819. [PMID: 37961397 PMCID: PMC10635243 DOI: 10.1101/2023.10.31.23297819] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background P. ovale spp. infections are endemic across multiple African countries and are caused by two distinct non-recombining species, P. ovale curtisi (Poc) and P. ovale wallikeri (Pow). These species are thought to differ in clinical symptomatology and latency, but existing diagnostic assays have limited ability to detect and distinguish them. In this study, we developed a new duplex assay for the detection and differentiation of Poc and Pow that can be used to improve our understanding of these parasites. Methods Repetitive sequence motifs were identified in available Poc and Pow genomes and used for assay development and validation. We evaluated the analytical sensitivity and specificity of the best-performing assay using a panel of samples from Tanzania and the Democratic Republic of the Congo (DRC), then validated its performance using 55 P. ovale spp. samples and 40 non-ovale Plasmodium samples from the DRC. Poc and Pow prevalence among symptomatic individuals sampled across three provinces of the DRC were estimated. Results The best-performing Poc and Pow targets had 9 and 8 copies within the reference genomes, respectively. Our duplex assay had 100% specificity and 95% confidence lower limits of detection of 4.2 and 41.2 parasite genome equivalents/μl for Poc and Pow, respectively. Species was determined in 80% of all P. ovale spp.-positive field samples and 100% of those with >10 parasites/μl. Most P. ovale spp. field samples from the DRC were found to be Poc infections. Conclusions We identified promising multi-copy targets for molecular detection and differentiation of Poc and Pow and used them to develop a new duplex real-time PCR assay that performed well when applied to diverse field samples. Though low-density Pow infections are not reliably detected, the assay is highly specific and can be used for high-throughput studies of P. ovale spp. epidemiology among symptomatic cases in malaria-endemic countries like the DRC.
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Affiliation(s)
- Wenqiao He
- Division of Infectious Diseases and Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Epidemiology, School of Public Health, Guangdong Provincial Key Laboratory of Tropical Disease Research, Southern Medical University, Guangzhou, China
| | - Rachel Sendor
- Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, NC, United States
| | - Varun R. Potlapalli
- Division of Infectious Diseases and Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | | | | | | | - Billy Ngasala
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Kyaw Lay Thwai
- Division of Infectious Diseases and Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jonathan J. Juliano
- Division of Infectious Diseases and Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, NC, United States
| | - Jessica T. Lin
- Division of Infectious Diseases and Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jonathan B. Parr
- Division of Infectious Diseases and Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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8
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Sendor R, Banek K, Kashamuka MM, Mvuama N, Bala JA, Nkalani M, Kihuma G, Atibu J, Thwai KL, Svec WM, Goel V, Nseka T, Lin JT, Bailey JA, Emch M, Carrel M, Juliano JJ, Tshefu A, Parr JB. Epidemiology of Plasmodium malariae and Plasmodium ovale spp. in Kinshasa Province, Democratic Republic of Congo. Nat Commun 2023; 14:6618. [PMID: 37857597 PMCID: PMC10587068 DOI: 10.1038/s41467-023-42190-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
Reports suggest non-falciparum species are an underappreciated cause of malaria in sub-Saharan Africa but their epidemiology is ill-defined, particularly in highly malaria-endemic regions. We estimated incidence and prevalence of PCR-confirmed non-falciparum and Plasmodium falciparum malaria infections within a longitudinal study conducted in Kinshasa, Democratic Republic of Congo (DRC) between 2015-2017. Children and adults were sampled at biannual household surveys and routine clinic visits. Among 9,089 samples from 1,565 participants, incidences of P. malariae, P. ovale spp., and P. falciparum infections by 1-year were 7.8% (95% CI: 6.4%-9.1%), 4.8% (95% CI: 3.7%-5.9%) and 57.5% (95% CI: 54.4%-60.5%), respectively. Non-falciparum prevalences were higher in school-age children, rural and peri-urban sites, and P. falciparum co-infections. P. falciparum remains the primary driver of malaria in the DRC, though non-falciparum species also pose an infection risk. As P. falciparum interventions gain traction in high-burden settings, continued surveillance and improved understanding of non-falciparum infections are warranted.
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Affiliation(s)
- Rachel Sendor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Kristin Banek
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melchior M Kashamuka
- Ecole de Santé Publique, Faculté de Médecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Nono Mvuama
- Ecole de Santé Publique, Faculté de Médecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Joseph A Bala
- Ecole de Santé Publique, Faculté de Médecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Marthe Nkalani
- Ecole de Santé Publique, Faculté de Médecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Georges Kihuma
- Ecole de Santé Publique, Faculté de Médecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Joseph Atibu
- Ecole de Santé Publique, Faculté de Médecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Kyaw L Thwai
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - W Matthew Svec
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Varun Goel
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tommy Nseka
- Ecole de Santé Publique, Faculté de Médecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jessica T Lin
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeffrey A Bailey
- Department of Pathology and Laboratory Medicine and Center for Computational Molecular Biology, Brown University, Providence, RI, USA
| | - Michael Emch
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Margaret Carrel
- Department of Geographical and Sustainability Sciences, University of Iowa, Iowa City, IA, USA
| | - Jonathan J Juliano
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Antoinette Tshefu
- Ecole de Santé Publique, Faculté de Médecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jonathan B Parr
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Rapp T, Amagai K, Sinai C, Basham C, Loya M, Ngasala S, Said H, Muller MS, Chhetri SB, Yang G, François R, Odas M, Mathias D, Juliano JJ, Lin FC, Ngasala B, Lin JT. Micro-heterogeneity of transmission shapes the submicroscopic malaria reservoir in coastal Tanzania. medRxiv 2023:2023.09.06.23295089. [PMID: 37732257 PMCID: PMC10508794 DOI: 10.1101/2023.09.06.23295089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Background Asymptomatic malaria may be patent (visible by microscopy) and detectable by rapid malaria diagnostic tests (RDTs), or it may be submicroscopic and only detectable by polymerase chain reaction (PCR). Methods To characterize the submicroscopic reservoir in an area of declining malaria transmission, asymptomatic persons >5 years of age in Bagamoyo District, Tanzania, were screened using RDT, microscopy, and PCR. We investigated the size of the submicroscopic reservoir across villages, determined factors associated with submicroscopic parasitemia, and assessed the natural history of submicroscopic malaria over four weeks. Results Among 6,076 participants, Plasmodium falciparum prevalence by RDT, microscopy, and PCR was 9%, 9%, and 28%, respectively, with roughly two-thirds of PCR-positive individuals harboring submicroscopic infection. Adult status, female gender, dry season months, screened windows, and bednet use were associated with submicroscopic carriage. Among 15 villages encompassing 80% of participants, the proportion of submicroscopic carriers increased with decreasing village-level malaria prevalence. Over four weeks, 23% (61/266) of submicroscopic carriers became RDT-positive and were treated, with half exhibiting symptoms. This occurred more frequently in villages with higher malaria prevalence. Conclusions Micro-heterogeneity in transmission impacts the size of the submicroscopic reservoir and the likelihood of submicroscopic carriers developing patent malaria in coastal Tanzania.
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Affiliation(s)
- Tyler Rapp
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Kano Amagai
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
| | - Cyrus Sinai
- Department of Geography, University of North Carolina, Chapel Hill, NC USA
| | - Christopher Basham
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Mwajabu Loya
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sifa Ngasala
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Hamza Said
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Meredith S Muller
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Srijana B Chhetri
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Guozheng Yang
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Ruthly François
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
| | - Melic Odas
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Derrick Mathias
- Florida Medical Entomology Laboratory, Institute of Food & Agricultural Sciences, University of Florida, Vero Beach, FL USA
| | - Jonathan J Juliano
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Feng-Chang Lin
- Department of Geography, University of North Carolina, Chapel Hill, NC USA
| | - Billy Ngasala
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jessica T Lin
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
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10
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Fan JY, Dama G, Liu YL, Guo WY, Lin JT. [Combinational Overexpression of Foxa3 and Hnf4α Enhance the Proliferation and Prolong the Functional Maintenance of Primary Hepatocytes]. Mol Biol (Mosk) 2023; 57:668-670. [PMID: 37528786 DOI: 10.31857/s0026898423040031, edn: qkqquw] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/06/2022] [Indexed: 08/03/2023]
Abstract
In an in vitro culture system, primary hepatocytes usually display a low proliferation capacity, accompanied with a decrease of viability and a loss of hepatocyte-specific functions. Previous studies have demonstrated that the combination introductions of certain hepatocyte-specific transcription factors are able to convert fibroblasts into functional hepatocyte-like cells. However, such combinational usage of transcription factors in primary hepatocytes culture has not yet sufficiently studied. The forkhead box protein A3 (FoxA3) and hepatocyte nuclear factor 4α (Hnf4α) are liver-enriched transcription factors that play vital roles in the differentiation, and maintenance of hepatocytes. Thus, we simultaneously overexpressed the two genes, Foxa3 and Hnf4α, in rat hepatocytes and observed that the combinational augmentation of these two transcription factors have enhanced the proliferation and stabilized the hepatocyte-specific functions of primary hepatocytes over a long-term culture period.
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Affiliation(s)
- J Y Fan
- Stem Cell and Biotherapy Engineering Research Center of Henan, Henan Joint International Research Laboratory of Stem Cell Medicine, Xinxiang Medical University, Xinxiang, 453003 China
- College of Life Science and Technology, Xinxiang Medical University, Henan, Xinxiang, 453003 China
- Shandong Tianchuan Precision Medical Technology Co. Ltd., Dezhou, 253084 China
| | - G Dama
- Stem Cell and Biotherapy Engineering Research Center of Henan, Henan Joint International Research Laboratory of Stem Cell Medicine, Xinxiang Medical University, Xinxiang, 453003 China
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, 13200 Malaysia
| | - Y L Liu
- Stem Cell and Biotherapy Engineering Research Center of Henan, Henan Joint International Research Laboratory of Stem Cell Medicine, Xinxiang Medical University, Xinxiang, 453003 China
- College of Life Science and Technology, Xinxiang Medical University, Henan, Xinxiang, 453003 China
| | - W Y Guo
- College of Life Science and Technology, Xinxiang Medical University, Henan, Xinxiang, 453003 China
| | - J T Lin
- Stem Cell and Biotherapy Engineering Research Center of Henan, Henan Joint International Research Laboratory of Stem Cell Medicine, Xinxiang Medical University, Xinxiang, 453003 China
- College of Life Science and Technology, Xinxiang Medical University, Henan, Xinxiang, 453003 China
- College of Biomedical Engineering, Xinxiang Medical University, Henan, Xinxiang, 453003 China
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11
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Rubinstein RJ, Mei W, Cassidy CA, Streeter G, Basham C, Cerami C, Lin FC, Lin JT, Mollan KR. Transmission prevention behaviors in US households with SARS-CoV-2 cases in 2020. Front Epidemiol 2023; 3:1160214. [PMID: 38406213 PMCID: PMC10888502 DOI: 10.3389/fepid.2023.1160214] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Introduction Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) transmission frequently occurs within households, yet few studies describe which household contacts and household units are most likely to engage in transmission-interrupting behaviors. Methods We analyzed a COVID-19 prospective household transmission cohort in North Carolina (April to October 2020) to quantify changes in physical distancing behaviors among household contacts over 14 days. We evaluated which household contacts were most likely to ever mask at home and to ever share a bedroom with the index case between days 7-14. Results In the presence of a household COVID-19 infection, 24% of household contacts reported ever masking at home during the week before study entry. Masking in the home between days 7-14 was reported by 26% of household contacts and was more likely for participants who observed their household index case wearing a mask. Participants of color and participants in high-density households were more likely to mask at home. After adjusting for race/ethnicity, living density was not as clearly associated with masking. Symptomatic household contacts were more likely to share a bedroom with the index case. Working individuals and those with comorbidities avoided sharing a bedroom with the index case. Discussion In-home masking during household exposure to COVID-19 was infrequent in 2020. In light of the ongoing transmission of SARS-CoV-2, these findings underscore a need for health campaigns to increase the feasibility and social desirability of in-home masking among exposed household members. Joint messaging on social responsibility and prevention of breakthrough infections, reinfections, and long COVID-19 may help motivate transmission-interruption behaviors.
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Affiliation(s)
- Rebecca J. Rubinstein
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Wenwen Mei
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Caitlin A. Cassidy
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Gabrielle Streeter
- College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Christopher Basham
- Institute of Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Carla Cerami
- Institute of Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Medical Research Council Unit, The Gambia, London School of Hygiene & Tropical Medicine, Banjul, Gambia
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jessica T. Lin
- Institute of Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Katie R. Mollan
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Center for AIDS Research, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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12
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Sendor R, Mitchell CL, Chacky F, Mohamed A, Mhamilawa LE, Molteni F, Nyinondi S, Kabula B, Mkali H, Reaves EJ, Serbantez N, Kitojo C, Makene T, Kyaw T, Muller M, Mwanza A, Eckert EL, Parr JB, Lin JT, Juliano JJ, Ngasala B. Similar Prevalence of Plasmodium falciparum and Non-P. falciparum Malaria Infections among Schoolchildren, Tanzania 1. Emerg Infect Dis 2023; 29:1143-1153. [PMID: 37209670 DOI: 10.3201/eid2906.221016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023] Open
Abstract
Achieving malaria elimination requires considering both Plasmodium falciparum and non-P. falciparum infections. We determined prevalence and geographic distribution of 4 Plasmodium spp. by performing PCR on dried blood spots collected within 8 regions of Tanzania during 2017. Among 3,456 schoolchildren, 22% had P. falciparum, 24% had P. ovale spp., 4% had P. malariae, and 0.3% had P. vivax infections. Most (91%) schoolchildren with P. ovale infections had low parasite densities; 64% of P. ovale infections were single-species infections, and 35% of those were detected in low malaria endemic regions. P. malariae infections were predominantly (73%) co-infections with P. falciparum. P. vivax was detected mostly in northern and eastern regions. Co-infections with >1 non-P. falciparum species occurred in 43% of P. falciparum infections. A high prevalence of P. ovale infections exists among schoolchildren in Tanzania, underscoring the need for detection and treatment strategies that target non-P. falciparum species.
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13
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Sendor R, Banek K, Kashamuka MM, Mvuama N, Bala JA, Nkalani M, Kihuma G, Atibu J, Thwai KL, Svec WM, Goel V, Nseka T, Lin JT, Bailey JA, Emch M, Carrel M, Juliano JJ, Tshefu A, Parr JB. Epidemiology of Plasmodium malariae and Plasmodium ovale spp. in a highly malaria-endemic country: a longitudinal cohort study in Kinshasa Province, Democratic Republic of Congo. medRxiv 2023:2023.04.20.23288826. [PMID: 37790376 PMCID: PMC10543032 DOI: 10.1101/2023.04.20.23288826] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background Increasing reports suggest that non-falciparum species are an underappreciated cause of malaria in sub-Saharan Africa, but their epidemiology is not well-defined. This is particularly true in regions of high P. falciparum endemicity such as the Democratic Republic of Congo (DRC), where 12% of the world's malaria cases and 13% of deaths occur. Methods and Findings The cumulative incidence and prevalence of P. malariae and P. ovale spp. infection detected by real-time PCR were estimated among children and adults within a longitudinal study conducted in seven rural, peri-urban, and urban sites from 2015-2017 in Kinshasa Province, DRC. Participants were sampled at biannual household survey visits (asymptomatic) and during routine health facility visits (symptomatic). Participant-level characteristics associated with non-falciparum infections were estimated for single- and mixed-species infections. Among 9,089 samples collected from 1,565 participants over a 3-year period, the incidence of P. malariae and P. ovale spp. infection was 11% (95% CI: 9%-12%) and 7% (95% CI: 5%-8%) by one year, respectively, compared to a 67% (95% CI: 64%-70%) one-year cumulative incidence of P. falciparum infection. Incidence continued to rise in the second year of follow-up, reaching 26% and 15% in school-age children (5-14yo) for P. malariae and P. ovale spp., respectively. Prevalence of P. malariae, P. ovale spp., and P. falciparum infections during household visits were 3% (95% CI: 3%-4%), 1% (95% CI: 1%-2%), and 35% (95% CI: 33%-36%), respectively. Non-falciparum malaria was more prevalent in rural and peri-urban vs. urban sites, in school-age children, and among those with P. falciparum co-infection. A crude association was detected between P. malariae and any anemia in the symptomatic clinic population, although this association did not hold when stratified by anemia severity. No crude associations were detected between non-falciparum infection and fever prevalence. Conclusions P. falciparum remains the primary driver of malaria morbidity and mortality in the DRC. However, non-falciparum species also pose an infection risk across sites of varying urbanicity and malaria endemicity within Kinshasa, DRC, particularly among children under 15 years of age. As P. falciparum interventions gain traction in high-burden settings like the DRC, continued surveillance and improved understanding of non-falciparum infections are warranted.
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Affiliation(s)
- Rachel Sendor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kristin Banek
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | - Nono Mvuama
- Ecole de Santé Publique, Faculté de Médecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Joseph A. Bala
- Ecole de Santé Publique, Faculté de Médecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Marthe Nkalani
- Ecole de Santé Publique, Faculté de Médecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Georges Kihuma
- Ecole de Santé Publique, Faculté de Médecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Joseph Atibu
- Ecole de Santé Publique, Faculté de Médecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Kyaw L. Thwai
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - W. Matthew Svec
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Varun Goel
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Tommy Nseka
- Ecole de Santé Publique, Faculté de Médecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jessica T. Lin
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jeffrey A. Bailey
- Department of Pathology and Laboratory Medicine and Center for Computational Molecular Biology, Brown University, Providence, Rhode Island, United States of America
| | - Michael Emch
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Margaret Carrel
- Department of Geographical and Sustainability Sciences, University of Iowa, Iowa City, Iowa, United States of America
| | - Jonathan J. Juliano
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Antoinette Tshefu
- Ecole de Santé Publique, Faculté de Médecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jonathan B. Parr
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Potlapalli V, Muller MS, Ngasala B, Ali IM, Na YB, Williams DR, Kharabora O, Chhetri S, Liu MS, Carey-Ewend K, Lin FC, Mathias D, Tarimo BB, Juliano JJ, Parr J, Lin JT. Real-time PCR detection of mixed Plasmodium ovale curtisi and wallikeri species infections in human and mosquito hosts. bioRxiv 2023:2023.03.31.535020. [PMID: 37034766 PMCID: PMC10081274 DOI: 10.1101/2023.03.31.535020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Plasmodium ovale curtisi (Poc) and Plasmodium ovale wallikeri (Pow) represent distinct non-recombining malaria species that are increasing in prevalence in sub-Saharan Africa. Though they circulate sympatrically, co-infection within human and mosquito hosts has rarely been described. Separate 18S rRNA real-time PCR assays that detect Poc and Pow were modified to allow species determination in parallel under identical cycling conditions. The lower limit of detection was 0.6 plasmid copies/μL (95% CI 0.4-1.6) for Poc and 4.5 plasmid copies/μL (95% CI( 2.7- 18) for Pow, or 0.1 and 0.8 parasites/μL, respectively, assuming 6 copies of 18s rRNA per genome. However, the assays showed cross-reactivity at concentrations greater than 103 plasmid copies/μL (roughly 200 parasites/μL). Mock mixtures were used to establish criteria for classifying mixed Poc/Pow infections that prevented false-positive detection while maintaining sensitive detection of the minority ovale species down to 10° copies/μL (<1 parasite/μL). When the modified real-time PCR assays were applied to field-collected blood samples from Tanzania and Cameroon, species identification by real-time PCR was concordant with nested PCR, but additionally detected two mixed Poc/Pow infections where nested PCR detected a single Po species. When real-time PCR was applied to 14 oocyst-positive Anopheles midguts saved from mosquitoes fed on P. ovate-infected persons, mixed Poc/Pow infections were detected in 11 (79%). Based on these results, 8/9 P. ovate carriers transmitted both P. ovate species to mosquitoes, though both Po species could only be detected in the blood of two carriers. The described real-time PCR approach can be used to identify the natural occurrence of mixed Poc/Pow infections in human and mosquito hosts and reveals that such co-infections and co-transmission are likely more common than appreciated.
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Affiliation(s)
- Varun Potlapalli
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Meredith S Muller
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Billy Ngasala
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Innocent Mbulli Ali
- Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Yu Bin Na
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Danielle R Williams
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC USA
| | - Oksana Kharabora
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Srijana Chhetri
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Mei S Liu
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Kelly Carey-Ewend
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
| | - Feng-Chang Lin
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
| | - Derrick Mathias
- Florida Medical Entomology Laboratory, Institute of Food & Agricultural Sciences, University of Florida, Vero Beach, FL USA
| | - Brian B Tarimo
- Vector Immunity and Transmission Biology Unit, Department of Environmental Health and Ecological Sciences, Ifakara Health Institute-Bagamoyo Office, Bagamoyo, Tanzania
| | - Jonathan J Juliano
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
| | - Jonathan Parr
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Jessica T Lin
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
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15
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Assefa A, Wamae KK, Hennelly CM, Ngasala B, Muller M, Kalonji A, Phanzu F, Cunningham CH, Lin JT, Parr JB. Detection of P. malariae using a new rapid isothermal amplification lateral flow assay. medRxiv 2023:2023.02.26.23286371. [PMID: 37790493 PMCID: PMC10543045 DOI: 10.1101/2023.02.26.23286371] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
P. malariae is found worldwide and causes chronic parasitism in its human hosts. We developed a P. malariae (Pm) diagnostic assay that uses rapid, isothermal recombinase polymerase amplification (RPA) and lateral-flow-strip detection. Using 18S rRNA plasmid DNA, the assay demonstrates a detection limit of 10 copies /μL (~1.7 genome equivalents) and 100% analytical specificity. Testing in field samples showed 95% clinical sensitivity and 88% specificity compared to qPCR. Total assay time was 35 minutes. Combined with simplified DNA extraction methods, the assay has potential for future field-deployable point-of-care use to detect a parasite species that remains largely undiagnosed.
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Affiliation(s)
- Ashenafi Assefa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Kevin K. Wamae
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Chris M. Hennelly
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Billy Ngasala
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Meredith Muller
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | | | | | - Clark H. Cunningham
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Jessica T. Lin
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Jonathan B. Parr
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
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16
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Rolfes MA, Talbot HK, McLean HQ, Stockwell MS, Ellingson KD, Lutrick K, Bowman NM, Bendall EE, Bullock A, Chappell JD, Deyoe JE, Gilbert J, Halasa NB, Hart KE, Johnson S, Kim A, Lauring AS, Lin JT, Lindsell CJ, McLaren SH, Meece JK, Mellis AM, Moreno Zivanovich M, Ogokeh CE, Rodriguez M, Sano E, Silverio Francisco RA, Schmitz JE, Vargas CY, Yang A, Zhu Y, Belongia EA, Reed C, Grijalva CG. Household Transmission of Influenza A Viruses in 2021-2022. JAMA 2023; 329:482-489. [PMID: 36701144 PMCID: PMC9880862 DOI: 10.1001/jama.2023.0064] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
IMPORTANCE Influenza virus infections declined globally during the COVID-19 pandemic. Loss of natural immunity from lower rates of influenza infection and documented antigenic changes in circulating viruses may have resulted in increased susceptibility to influenza virus infection during the 2021-2022 influenza season. OBJECTIVE To compare the risk of influenza virus infection among household contacts of patients with influenza during the 2021-2022 influenza season with risk of influenza virus infection among household contacts during influenza seasons before the COVID-19 pandemic in the US. DESIGN, SETTING, AND PARTICIPANTS This prospective study of influenza transmission enrolled households in 2 states before the COVID-19 pandemic (2017-2020) and in 4 US states during the 2021-2022 influenza season. Primary cases were individuals with the earliest laboratory-confirmed influenza A(H3N2) virus infection in a household. Household contacts were people living with the primary cases who self-collected nasal swabs daily for influenza molecular testing and completed symptom diaries daily for 5 to 10 days after enrollment. EXPOSURES Household contacts living with a primary case. MAIN OUTCOMES AND MEASURES Relative risk of laboratory-confirmed influenza A(H3N2) virus infection in household contacts during the 2021-2022 season compared with prepandemic seasons. Risk estimates were adjusted for age, vaccination status, frequency of interaction with the primary case, and household density. Subgroup analyses by age, vaccination status, and frequency of interaction with the primary case were also conducted. RESULTS During the prepandemic seasons, 152 primary cases (median age, 13 years; 3.9% Black; 52.0% female) and 353 household contacts (median age, 33 years; 2.8% Black; 54.1% female) were included and during the 2021-2022 influenza season, 84 primary cases (median age, 10 years; 13.1% Black; 52.4% female) and 186 household contacts (median age, 28.5 years; 14.0% Black; 63.4% female) were included in the analysis. During the prepandemic influenza seasons, 20.1% (71/353) of household contacts were infected with influenza A(H3N2) viruses compared with 50.0% (93/186) of household contacts in 2021-2022. The adjusted relative risk of A(H3N2) virus infection in 2021-2022 was 2.31 (95% CI, 1.86-2.86) compared with prepandemic seasons. CONCLUSIONS AND RELEVANCE Among cohorts in 5 US states, there was a significantly increased risk of household transmission of influenza A(H3N2) in 2021-2022 compared with prepandemic seasons. Additional research is needed to understand reasons for this association.
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Affiliation(s)
- Melissa A. Rolfes
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | | | | | | | | | - Jessica E. Deyoe
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Sheroi Johnson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ahra Kim
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | | | | | - Alexandra M. Mellis
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Constance E. Ogokeh
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Ellen Sano
- Columbia University, New York City, New York
| | | | | | | | - Amy Yang
- University of North Carolina at Chapel Hill
| | - Yuwei Zhu
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Carrie Reed
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
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17
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Rubinstein R, Mei W, Cassidy CA, Streeter G, Basham C, Cerami C, Lin FC, Lin JT, Mollan KR. Transmission prevention behaviors in US households with SARS-CoV-2 cases in 2020. medRxiv 2022:2022.11.25.22282730. [PMID: 36451883 PMCID: PMC9709803 DOI: 10.1101/2022.11.25.22282730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Background SARS-CoV-2 transmission frequently occurs within households, yet few studies describe which household contacts and household units are most likely to engage in transmission-interrupting behaviors. Methods We analyzed a COVID-19 prospective household transmission cohort in North Carolina (April-Oct 2020) to quantify changes in physical distancing behaviors among household contacts over 14 days. We evaluated which household contacts were most likely to ever mask at home and to ever share a bedroom with the index case between Days 7-14. Results In the presence of a household COVID-19 infection, 24% of household contacts reported ever masking at home during the week before study entry. Masking in the home between Days 7-14 was reported by 26% of household contacts, and was more likely for participants who observed their household index case wearing a mask. Participants of color and participants in high-density households were more likely to mask at home. After adjusting for race/ethnicity, living density was not as clearly associated with masking. Symptomatic household contacts were more likely to share a bedroom with the index case. Working individuals and those with comorbidities avoided sharing a bedroom with the index case. Conclusion In-home masking during household exposure to COVID-19 was infrequent in 2020. In light of ongoing transmission of SARS-CoV-2, these findings underscore a need for health campaigns to increase the feasibility and social desirability of in-home masking among exposed household members. Joint messaging on social responsibility and prevention of breakthrough infections, reinfections, and long COVID-19 may help motivate transmission-interruption behaviors.
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Affiliation(s)
- Rebecca Rubinstein
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Wenwen Mei
- Department of Biostatistics, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Caitlin A Cassidy
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | | | - Christopher Basham
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Carla Cerami
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Medical Research Council Unit, The Gambia, at the London School of Hygiene & Tropical Medicine, The Gambia
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Jessica T Lin
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Katie R Mollan
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
- Center for AIDS Research, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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18
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Jiang H, Li Q, Lin JT, Lin FC. Classification of disease recurrence using transition likelihoods with expectation-maximization algorithm. Stat Med 2022; 41:4697-4715. [PMID: 35908812 PMCID: PMC9489660 DOI: 10.1002/sim.9534] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/17/2022] [Accepted: 07/10/2022] [Indexed: 11/09/2022]
Abstract
When an infectious disease recurs, it may be due to treatment failure or a new infection. Being able to distinguish and classify these two different outcomes is critical in effective disease control. A multi-state model based on Markov processes is a typical approach to estimating the transition probability between the disease states. However, it can perform poorly when the disease state is unknown. This article aims to demonstrate that the transition likelihoods of baseline covariates can distinguish one cause from another with high accuracy in infectious diseases such as malaria. A more general model for disease progression can be constructed to allow for additional disease outcomes. We start from a multinomial logit model to estimate the disease transition probabilities and then utilize the baseline covariate's transition information to provide a more accurate classification result. We apply the expectation-maximization (EM) algorithm to estimate unknown parameters, including the marginal probabilities of disease outcomes. A simulation study comparing our classifier to the existing two-stage method shows that our classifier has better accuracy, especially when the sample size is small. The proposed method is applied to determining relapse vs reinfection outcomes in two Plasmodium vivax treatment studies from Cambodia that used different genotyping approaches to demonstrate its practical use.
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Affiliation(s)
- Huijun Jiang
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Quefeng Li
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Jessica T. Lin
- Division of Infectious Disease, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
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19
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Li HW, Lin JT. [The value of home monitoring of exhaled nitric oxide and mobile pulmonary function in the management of asthma]. Zhonghua Yi Xue Za Zhi 2022; 102:2679-2683. [PMID: 36096694 DOI: 10.3760/cma.j.cn112137-20220317-00563] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To investigate the application value of household dynamic monitoring of exhaled nitric oxide (FeNO) and pulmonary ventilation function in daily management of asthma. Methods: A total of 22 untreated patients with uncontrolled asthma who visited the Respiratory Disease Clinic of China-Japan Friendship Hospital from October 2019 to December 2020 were enrolled. Demographic characteristics, asthma history, comorbidities, asthma control test (ACT), and mini-asthma quality of life questionnaire (mini-AQLQ) were collected through face-to-face surveys. FeNO, pulmonary ventilation function, sputum eosinophil ratio and blood eosinophil count before treatment were collected through medical records. During the treatment of inhaled corticosteroids (ICS), the subjects were monitored at home for 4 weeks by FeNO analyzer and mobile electronic vital capacity at fixed time in the morning and evening. After the treatment, the above indicators were measured again to evaluate the treatment effect. Diurnal and dynamic changes of FeNO and pulmonary ventilation function monitored at home during treatment were analyzed. Results: The age of the subjects was (40±14) years, and 14 cases were female. After 4 weeks of ICS treatment, ACT score, mini-AQLQ score, forced expiratory volume at 1 second (FEV1, L) and FEV1/forced vital capacity (FVC, %) were 23±2, 5.49±1.04, 2.89±0.60 and 72.2±7.8, respectively, higher than before treatment [16±4, 4.06±0.95, 2.47±0.76 and 66.4±14.3, respectively]. FeNO [ppb (part per billion)], sputum eosinophil percentage (%) and blood eosinophil levels (×106/L) [M (Q1, Q3)] were 27 (18, 47), 2.8 (1.0, 14.0) and 255 (188, 280), respectively, lower than before treatment [80 (56, 117), 25.8 (15.0, 59.6) and 380 (283, 658)] (all P values<0.05). The level of FeNO in the morning was higher than that in the evening 2 weeks before routine monitoring (P=0.028), and no statistical difference was found in pulmonary ventilation function between day and night (P>0.05). The curve fitting of daily monitoring of FeNO and lung ventilation function showed that FeNO and lung ventilation function were gradually improved, and the effective time of treatment determined by FeNO was 3.5 (3.0, 5.3) d, which was earlier than all lung ventilation function indicators (all P values<0.05). The maximum action time of FeNO was (14.5±2.2) d, which was earlier than that of FEV1 (20.7±2.8) d (all P values<0.05), but there was no statistically difference between the maximum effect time determined by other lung ventilation function indicators (all P values>0.05). Conclusion: Household dynamic daily monitoring of FeNO and pulmonary ventilation function can be used to assess the response to ICS treatment, with FeNO being the more sensitive indicator.
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Affiliation(s)
- H W Li
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - J T Lin
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
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20
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Nong Y, Lin JT. [Application of exhaled nitric oxide detection in the diagnosis, treatment and management of chronic airway diseases: current status and prospects]. Zhonghua Yi Xue Za Zhi 2022; 102:2643-2646. [PMID: 36096691 DOI: 10.3760/cma.j.cn112137-20220317-00560] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Airway inflammation is the most important pathological basis of chronic airway diseases. The detection and evaluation of airway inflammation is helpful for the diagnosis, treatment and management of airway diseases. Exhaled nitric oxide is the most widely used noninvasive airway inflammation detection technique in recent years, which provides a simple and quick reference for the diagnosis and management of chronic airway diseases, but there are still some controversies and deficiencies. This paper briefly expounds the biological significance of exhaled nitric oxide and detecting technique, summarizes the clinical application and the deficiencies of exhaled nitric oxide detection. In the future, with the further researchers on technology and the accumulation of application experiences, the detection technology of exhaled nitric oxide will play a more significant role in the accurate management of chronic airway diseases.
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Affiliation(s)
- Y Nong
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - J T Lin
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
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21
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Noviyanti R, Carey-Ewend K, Trianty L, Parobek C, Puspitasari AM, Balasubramanian S, Park Z, Hathaway N, Utami RAS, Soebianto S, Jeny J, Yudhaputri F, Perkasa A, Coutrier FN, Tirta YK, Ekawati L, Tjahyono B, Sutanto I, Nelwan EJ, Sudoyo H, Baird JK, Lin JT. Hypnozoite depletion in successive Plasmodium vivax relapses. PLoS Negl Trop Dis 2022; 16:e0010648. [PMID: 35867730 PMCID: PMC9348653 DOI: 10.1371/journal.pntd.0010648] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/03/2022] [Accepted: 07/09/2022] [Indexed: 11/17/2022] Open
Abstract
Genotyping Plasmodium vivax relapses can provide insights into hypnozoite biology. We performed targeted amplicon sequencing of 127 relapses occurring in Indonesian soldiers returning to malaria-free Java after yearlong deployment in malarious Eastern Indonesia. Hepatic carriage of multiple hypnozoite clones was evident in three-quarters of soldiers with two successive relapses, yet the majority of relapse episodes only displayed one clonal population. The number of clones detected in relapse episodes decreased over time and through successive relapses, especially in individuals who received hypnozoiticidal therapy. Interrogating the multiplicity of infection in this P. vivax relapse cohort reveals evidence of independent activation and slow depletion of hypnozoites over many months by multiple possible mechanisms, including parasite senescence and host immunity. Investigating relapse patterns in infections of Plasmodium vivax, a parasite that causes malaria, is challenging due to concurrent reinfection events alongside true relapses in most clinical cohorts. We performed sequencing on P. vivax samples from a cohort of Indonesian soldiers who were exposed to the parasite while deployed in a malaria-endemic region and then experienced relapses after their return to a region with no current malaria transmission. From these true relapses, we show that most infected individuals harbor multiple lineages of hypnozoites (latent liver stage parasites that reactivate to cause relapse) but individual relapses are largely driven by a single hypnozoite lineage or clone. Additionally, the average number of parasite clones detected in each relapse decreases over time. These findings suggest that P. vivax hypnozoites activate independently from each other and that their population in the liver decreases over time after the initial infection, possibly due to immune clearance or loss of parasite viability.
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Affiliation(s)
| | - Kelly Carey-Ewend
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
- * E-mail: (KCE); (JTL)
| | - Leily Trianty
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Christian Parobek
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | | | - Sujata Balasubramanian
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Zackary Park
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Nicholas Hathaway
- University of Massachusetts Chan Medical School of Medicine, Worcester, Massachusetts, United States of America
| | | | | | - Jeny Jeny
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | | | - Aditya Perkasa
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | | | | | - Lenny Ekawati
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Bagus Tjahyono
- Health Services, Army of the Republic of Indonesia, Jakarta, Indonesia
| | - Inge Sutanto
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Erni J. Nelwan
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | | | - J. Kevin Baird
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Jessica T. Lin
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
- * E-mail: (KCE); (JTL)
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22
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Cerami C, Popkin-Hall ZR, Rapp T, Tompkins K, Zhang H, Muller MS, Basham C, Whittelsey M, Chhetri SB, Smith J, Litel C, Lin KD, Churiwal M, Khan S, Rubinstein R, Claman F, Mollan K, Wohl D, Premkumar L, Powers KA, Juliano JJ, Lin FC, Lin JT. Household Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 in the United States: Living Density, Viral Load, and Disproportionate Impact on Communities of Color. Clin Infect Dis 2022; 74:1776-1785. [PMID: 34383889 PMCID: PMC8436395 DOI: 10.1093/cid/ciab701] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Households are hot spots for severe acute respiratory syndrome coronavirus 2 transmission. METHODS This prospective study enrolled 100 coronavirus disease 2019 (COVID-19) cases and 208 of their household members in North Carolina though October 2020, including 44% who identified as Hispanic or non-White. Households were enrolled a median of 6 days from symptom onset in the index case. Incident secondary cases within the household were detected using quantitative polymerase chain reaction of weekly nasal swabs (days 7, 14, 21) or by seroconversion at day 28. RESULTS Excluding 73 household contacts who were PCR-positive at baseline, the secondary attack rate (SAR) among household contacts was 32% (33 of 103; 95% confidence interval [CI], 22%-44%). The majority of cases occurred by day 7, with later cases confirmed as household-acquired by viral sequencing. Infected persons in the same household had similar nasopharyngeal viral loads (intraclass correlation coefficient = 0.45; 95% CI, .23-.62). Households with secondary transmission had index cases with a median viral load that was 1.4 log10 higher than those without transmission (P = .03), as well as higher living density (more than 3 persons occupying fewer than 6 rooms; odds ratio, 3.3; 95% CI, 1.02-10.9). Minority households were more likely to experience high living density and had a higher risk of incident infection than did White households (SAR, 51% vs 19%; P = .01). CONCLUSIONS Household crowding in the context of high-inoculum infections may amplify the spread of COVID-19, potentially contributing to disproportionate impact on communities of color.
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Affiliation(s)
- Carla Cerami
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Zachary R Popkin-Hall
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Tyler Rapp
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Kathleen Tompkins
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Haoming Zhang
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Meredith S Muller
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Christopher Basham
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Maureen Whittelsey
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Srijana B Chhetri
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Judy Smith
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Christy Litel
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Kelly D Lin
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Mehal Churiwal
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Salman Khan
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Rebecca Rubinstein
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Faith Claman
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Katie Mollan
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David Wohl
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Lakshmanane Premkumar
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Kimberly A Powers
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jonathan J Juliano
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Feng-Chang Lin
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jessica T Lin
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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23
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Figueiredo JC, Hirsch FR, Kushi LH, Nembhard WN, Crawford JM, Mantis N, Finster L, Merin NM, Merchant A, Reckamp KL, Melmed GY, Braun J, McGovern D, Parekh S, Corley DA, Zohoori N, Amick BC, Du R, Gregersen PK, Diamond B, Taioli E, Sariol C, Espino A, Weiskopf D, Gifoni A, Brien J, Hanege W, Lipsitch M, Zidar DA, McAlearney AS, Wajnberg A, LaBaer J, Lewis EY, Binder RA, Moormann AM, Forconi C, Forrester S, Batista J, Schieffelin J, Kim D, Biancon G, VanOudenhove J, Halene S, Fan R, Barouch DH, Alter G, Pinninti S, Boppana SB, Pati SK, Latting M, Karaba AH, Roback J, Sekaly R, Neish A, Brincks AM, Granger DA, Karger AB, Thyagarajan B, Thomas SN, Klein SL, Cox AL, Lucas T, Furr-Holden D, Key K, Jones N, Wrammerr J, Suthar M, Yu Wong S, Bowman NM, Simon V, Richardson LD, McBride R, Krammer F, Rana M, Kennedy J, Boehme K, Forrest C, Granger SW, Heaney CD, Knight Lapinski M, Wallet S, Baric RS, Schifanella L, Lopez M, Fernández S, Kenah E, Panchal AR, Britt WJ, Sanz I, Dhodapkar M, Ahmed R, Bartelt LA, Markmann AJ, Lin JT, Hagan RS, Wolfgang MC, Skarbinski J. Mission, Organization and Future Direction of the Serological Sciences Network for COVID-19 (SeroNet) Epidemiologic Cohort Studies. Open Forum Infect Dis 2022; 9:ofac171. [PMID: 35765315 PMCID: PMC9129196 DOI: 10.1093/ofid/ofac171] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/22/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Global efforts are needed to elucidate the epidemiology of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the underlying cause of coronavirus disease 2019 (COVID-19) including seroprevalence, risk factors and long-term sequelae, as well as immune responses following vaccination across populations and the social dimensions of prevention and treatment strategies. In the U.S., the National Cancer Institute in partnership with the National Institute of Allergy and Infectious Diseases, established the SARS-CoV-2 Serological Sciences Network (SeroNet) as the nation’s largest coordinated effort to study COVID-19. The network is comprised of multidisciplinary researchers bridging gaps and fostering collaborations between immunologists, epidemiologists, virologists, clinicians and clinical laboratories, social and behavioral scientists, policy makers, data scientists, and community members. In total, 49 institutions form the SeroNet consortium to study individuals with cancer, autoimmune disease, inflammatory bowel diseases, cardiovascular diseases, HIV, transplant recipients, as well as otherwise healthy pregnant women, children, college students, and high-risk occupational workers (including health care workers and first responders). Several studies focus on underrepresented populations, including ethnic minorities and rural communities. To support integrative data analyses across SeroNet studies, efforts are underway to define common data elements for standardized serology measurements, cellular and molecular assays, self-reported data, treatment, and clinical outcomes. In this paper, we discuss the overarching framework for SeroNet epidemiology studies, critical research questions under investigation, and data accessibility for the worldwide scientific community. Lessons learned will help inform preparedness and responsiveness to future emerging diseases.
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Affiliation(s)
- Jane C Figueiredo
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Fred R Hirsch
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Wendy N Nembhard
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - James M Crawford
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Nicholas Mantis
- Division of Infectious Diseases Wadsworth Center, New York State Department of Health, New York, NY, USA
| | - Laurel Finster
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Noah M Merin
- Division of Hematology and Cellular Therapy, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Akil Merchant
- Division of Hematology and Cellular Therapy, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Karen L Reckamp
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Gil Y Melmed
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, CA, USA
| | - Jonathan Braun
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, CA, USA
| | - Dermot McGovern
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, CA, USA
| | - Samir Parekh
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Namvar Zohoori
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Benjamin C Amick
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ruofei Du
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Peter K Gregersen
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Betty Diamond
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Emanuela Taioli
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carlos Sariol
- Unit of Comparative Medicine, University of Puerto Rico, Medical Sciences, San Juan, PR
| | - Ana Espino
- Unit of Comparative Medicine, University of Puerto Rico, Medical Sciences, San Juan, PR
| | | | - Alba Gifoni
- La Jolla Institute of Immunology, La Jolla CA, USA
| | - James Brien
- Department of Molecular Microbiology & Immunology, Saint Louis University, St. Louis MI, USA
| | - William Hanege
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Bethesda, MD, USA
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Bethesda, MD, USA
| | - David A Zidar
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ann Scheck McAlearney
- Department of Family and Community Medicine, Ohio State University College of Medicine, Columbus, OH, USA
| | - Ania Wajnberg
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua LaBaer
- Biodesign Virginia G. Piper Center for Personalized Diagnostics, Arizona State University, Tempe AZ, USA
| | - E Yvonne Lewis
- Department of Public Health, Michigan State University, Flint, MI, USA
| | - Raquel A Binder
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Ann M Moormann
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Catherine Forconi
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Sarah Forrester
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jennifer Batista
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - John Schieffelin
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
| | - Dongjoo Kim
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Giulia Biancon
- Section of Hematology, Department of Internal Medicine and Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | - Jennifer VanOudenhove
- Section of Hematology, Department of Internal Medicine and Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | - Stephanie Halene
- Section of Hematology, Department of Internal Medicine and Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Rong Fan
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Dan H Barouch
- The Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Galit Alter
- Ragon Institute, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Swetha Pinninti
- Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suresh B Boppana
- Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sunil K Pati
- Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Misty Latting
- Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew H Karaba
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - John Roback
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Rafick Sekaly
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew Neish
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Ahnalee M Brincks
- Department of Human Development and Family Studies, College of Social Science, Michigan State University, East Lansing, MI, USA
| | - Douglas A Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California at Irvine; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy B Karger
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Stefani N Thomas
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrea L Cox
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Todd Lucas
- Division of Public Health, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Debra Furr-Holden
- Division of Public Health, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Kent Key
- Division of Public Health, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Nicole Jones
- Division of Public Health, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Jens Wrammerr
- Department of Pediatrics, Division of Infectious Disease, Emory University, Atlanta, GA, USA
| | - Mehul Suthar
- Department of Pediatrics, Division of Infectious Disease, Emory University, Atlanta, GA, USA
| | - Serre Yu Wong
- The Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Natalie M Bowman
- University of North Carolina School of Medicine, Division of Infectious Diseases, Chapel Hill, NC, USA
| | - Viviana Simon
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lynne D Richardson
- Institute for Health Equity Research and Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Russell McBride
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Meenakshi Rana
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua Kennedy
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Karl Boehme
- Department of Microbiology and Immunology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Craig Forrest
- Department of Microbiology and Immunology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Christopher D Heaney
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Maria Knight Lapinski
- Department of Communication, Michigan AgBio Research, Michigan State University, East Lansing, MI, USA
| | - Shannon Wallet
- School of Dentistry, Department of Oral and Craniofacial Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Ralph S Baric
- Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Luca Schifanella
- Division of Surgical Outcomes and Precision Medicine Research, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Marcos Lopez
- Puerto Rico Public Health Trust, Puerto Rico Science, Technology and Research Trust and University of Puerto Rico at Humacao, Medical Sciences, San Juan, PR, USA
| | - Soledad Fernández
- Department of Biomedical Informatics, Center for Biostatistics, Ohio State University College of Medicine, Columbus, OH, USA
| | - Eben Kenah
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Ashish R Panchal
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - William J Britt
- Department of Immunology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Iñaki Sanz
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Madhav Dhodapkar
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Rafi Ahmed
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA
| | - Luther A Bartelt
- Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Alena J Markmann
- Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jessica T Lin
- Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Robert S Hagan
- Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Matthew C Wolfgang
- Marsico Lung Institute and Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jacek Skarbinski
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Tarimo BB, Nyasembe VO, Ngasala B, Basham C, Rutagi IJ, Muller M, Chhetri SB, Rubinstein R, Juliano JJ, Loya M, Dinglasan RR, Lin JT, Mathias DK. Seasonality and transmissibility of Plasmodium ovale in Bagamoyo District, Tanzania. Parasit Vectors 2022; 15:56. [PMID: 35164867 PMCID: PMC8842944 DOI: 10.1186/s13071-022-05181-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/12/2021] [Indexed: 01/26/2023] Open
Abstract
Background Plasmodium ovale is a neglected malarial parasite that can form latent hypnozoites in the human liver. Over the last decade, molecular surveillance studies of non-falciparum malaria in Africa have highlighted that P. ovale is circulating below the radar, including areas where Plasmodium falciparum is in decline. To eliminate malaria where P. ovale is endemic, a better understanding of its epidemiology, asymptomatic carriage, and transmission biology is needed. Methods We performed a pilot study on P. ovale transmission as part of an ongoing study of human-to-mosquito transmission of P. falciparum from asymptomatic carriers. To characterize the malaria asymptomatic reservoir, cross-sectional qPCR surveys were conducted in Bagamoyo, Tanzania, over three transmission seasons. Positive individuals were enrolled in transmission studies of P. falciparum using direct skin feeding assays (DFAs) with Anopheles gambiae s.s. (IFAKARA strain) mosquitoes. For a subset of participants who screened positive for P. ovale on the day of DFA, we incubated blood-fed mosquitoes for 14 days to assess sporozoite development. Results Molecular surveillance of asymptomatic individuals revealed a P. ovale prevalence of 11% (300/2718), compared to 29% (780/2718) for P. falciparum. Prevalence for P. ovale was highest at the beginning of the long rainy season (15.5%, 128/826) in contrast to P. falciparum, which peaked later in both the long and short rainy seasons. Considering that these early-season P. ovale infections were low-density mono-infections (127/128), we speculate many were due to hypnozoite-induced relapse. Six of eight P. ovale-infected asymptomatic individuals who underwent DFAs successfully transmitted P. ovale parasites to A. gambiae. Conclusions Plasmodium ovale is circulating at 4–15% prevalence among asymptomatic individuals in coastal Tanzania, largely invisible to field diagnostics. A different seasonal peak from co-endemic P. falciparum, the capacity to relapse, and efficient transmission to Anopheles vectors likely contribute to its persistence amid control efforts focused on P. falciparum. Graphical Abstract ![]()
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Liu Y, Lin FC, Lin JT, Li Q. Dynamic Classification of Plasmodium vivax Malaria Recurrence: An Application of Classifying Unknown Cause of Failure in Competing Risks. J Data Sci 2022; 20:51-78. [PMID: 35928784 PMCID: PMC9347664 DOI: 10.6339/21-jds1026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A standard competing risks set-up requires both time to event and cause of failure to be fully observable for all subjects. However, in application, the cause of failure may not always be observable, thus impeding the risk assessment. In some extreme cases, none of the causes of failure is observable. In the case of a recurrent episode of Plasmodium vivax malaria following treatment, the patient may have suffered a relapse from a previous infection or acquired a new infection from a mosquito bite. In this case, the time to relapse cannot be modeled when a competing risk, a new infection, is present. The efficacy of a treatment for preventing relapse from a previous infection may be underestimated when the true cause of infection cannot be classified. In this paper, we developed a novel method for classifying the latent cause of failure under a competing risks set-up, which uses not only time to event information but also transition likelihoods between covariates at the baseline and at the time of event occurrence. Our classifier shows superior performance under various scenarios in simulation experiments. The method was applied to Plasmodium vivax infection data to classify recurrent infections of malaria.
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Affiliation(s)
- Yutong Liu
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Jessica T Lin
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Quefeng Li
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
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26
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Zhang MY, Ren W, Chen SS, Zhang Q, Li CX, Wan JX, Lin JT. [Exploring and bioinformatics analysis of differentially expressed genes in bronchial asthma]. Zhonghua Yi Xue Za Zhi 2021; 101:3809-3813. [PMID: 34895422 DOI: 10.3760/cma.j.cn112137-20210607-01293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To screen core differentially expressed genes of bronchial asthma and conduct bioinformatics analysis. Methods: Macrophage microarray data GSE22528 from asthma patients were downloaded from gene expression database (GEO). The dataset included transcriptome information from 10 human alveolar lavage fluid samples, and five of them were from allergic asthmatic subjects and five from control subjects. Differential expression genes (DEGs) were screened by R 4.0.4 software. Gene ontology (GO) function and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were performed to select DEGs using DAVID 6.8 database. Protein interaction network (PPI) was constructed from DEGs encoded proteins using STRING online database. Cytoscape software was used to construct core modules and determine core DEGs. Results: Alveolar lavage fluid samples were all collected from Caucasian Canadians, with age range as (20, 37) and (18, 36) years, respectively, including 3 males for each group. In asthmatic patients, 449 genes were up-regulated and 47 down-regulated. GO analysis showed that the up-regulated genes in asthmatic patients were mainly involved in biological processes such as response to folded proteins, and the molecular function was focused on binding of folded proteins and growth factors. Down-regulated genes were mainly involved in biological processes such as histone deacetylation and ubiquitin-mediated protein degradation, and their molecular functions focused on histone deacetylation activity. KEGG pathway enrichment analysis showed that pathways were mainly enriched by up-regulation genes, involving Hippo signaling pathway, hypertrophic cardiomyopathy, estrogen signaling pathway, arrhythmogenic right ventricular cardiomyopathy, basal cell carcinoma, neuro-activated receptor ligand interaction, dilated cardiomyopathy and adhesion and connection signaling pathways. Two core modules were obtained by PPI analysis, and 14 core DEGs were screened out. They were pro-melanin concentrating hormone (PMCH), prepronociceptin (PNOC), Sphingosinol-1-phosphate receptor 2 (S1PR2), Sphingosinol-1-phosphate receptor 5 (S1PR5), CC-type chemokine ligand 21 (CCL21), Kelch-like protein 25 (KLHL25), ubiquitin binding enzyme E2V2 (UBE2V2), F-box protein 17 (FBXO17), taste receptor type 2 member 3 (TAS2R3), somatostatin receptor 2 (SSTR2), metabolic glutamate receptor 2 (GRM2), Lister E3 ubiquitin protein ligase 1 (LTN1), LIM domain specific protein 7 (LMO7) and ring finger protein 19A gene(RNF19A), in which LTN1 and UBE2V2 were down-regulated and the rest were up-regulated. Conclusion: DEGs was found in macrophages of asthmatic and control individuals. PMCH, PNOC, S1PR2, S1PR5 and CCL21 might be the core genes in the pathological process of asthma.
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Affiliation(s)
- M Y Zhang
- Graduate School of Peking Union Medical College, Beijing 100730, China
| | - W Ren
- Department of Respiratory, Aero Space Center Hospital, Beijing 100039, China
| | - S S Chen
- Graduate School of Peking Union Medical College, Beijing 100730, China
| | - Q Zhang
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Nanchang University, Nanchang 330000, China
| | - C X Li
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - J X Wan
- Graduate School of Peking Union Medical College, Beijing 100730, China
| | - J T Lin
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
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Li CX, Lin JT, Zhang Q, Wang JR, Gao SN, Li HW, Wan JX, Zhang JY, Zhang MY, Gao X. [Human bone marrow mesenchymal stem cells improve steroid resistance of human airway epithelial BEAS-2B cells in vitro]. Zhonghua Jie He He Hu Xi Za Zhi 2021; 44:1097-1102. [PMID: 34915624 DOI: 10.3760/cma.j.cn112147-20210607-00398] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To explore the effect of human bone marrow mesenchymal stem cells(MSC) on the steroid resistance of human airway epithelial cells. Methods: Ovalbumin (OVA)/lipopolysaccharide (LPS) were used to construct steroid resistant BEAS-2B cells, which were then co-cultured with MSC. Groups were set as follows: blank group, model group, Glucocorticoid group, MSC group, MSC+Glucocorticoid group (MSC+bud group). The expression of interleukin (IL)-8 in the cell supernatant was detected by enzyme-linked immunosorbent assay (ELISA); the expression of reactive oxygen species (ROS) in the cells was detected by flow cytometry; the expression of glucocorticoid receptor α (GRα) and histone deacetylase 2 (HDAC2) protein in the cell was detected by Western blotting; and the expression of GRα and HDAC2 mRNA was detected by reverse transcription-polymerase chain reaction (RTPCR). Results: The expression level of IL-8 in the MSC group was significantly lower than that in the Glucocorticoid group (31.7±0.7 vs. 49.8±3.6, P<0.01). The expression of ROS in the MSC group was significantly lower than that in the Glucocorticoid group (2754±154 vs.4624±228, P<0.05). The expression level of HDAC2 mRNA in the MSC group was significantly higher than that in the Glucocorticoid group(1.749±0.005 vs. 1.283±0.098, P<0.05). The expression level of GRα mRNA in the MSC group was significantly higher than that in the Glucocorticoid group (1.623±0.079 vs.1.047±0.220, P<0.01). The expression of HDAC2 protein in the MSC group was significantly higher than that in the Glucocorticoid group (1.067±0.100 vs. 0.620±0.083, P<0.01). The expression of GRα protein in the MSC group was significantly higher than that in the Glucocorticoid group (0.834±0.053 vs. 0.579±0.017, P<0.01). ROS was positively correlated with the IL-8 expression (r=0.796, P<0.01) and negatively correlated with the HDAC2 and GRα mRNA expression (r=-0.893 3, P<0.01; r=0.931 4, P<0.01, respectively), as well as the HDAC2 and GRα Protein expression (r=-0.929 5, P<0.01;r=-0.864 3, P<0.01, respectively). Conclusions: Human MSC can improve steroid resistance of airway epithelial cells in an exocrine manner. The mechanism may be related to the down-regulation of ROS and up-regulation of HDAC2, which lead to GRα overexpression. In addition, MSC may improve the steroid resistance by reducing the expression of IL-8.
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Affiliation(s)
- C X Li
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China
| | - J T Lin
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Q Zhang
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - J R Wang
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - S N Gao
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - H W Li
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - J X Wan
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - J Y Zhang
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - M Y Zhang
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - X Gao
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
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Churiwal M, Lin KD, Khan S, Chhetri S, Muller MS, Tompkins K, Smith J, Litel C, Whittelsey M, Basham C, Rapp T, Cerami C, Premkumar L, Lin JT. Assessment of the Field Utility of a Rapid Point-of-Care Test for SARS-CoV-2 Antibodies in a Household Cohort. Am J Trop Med Hyg 2021; 106:156-159. [PMID: 34818625 PMCID: PMC8733539 DOI: 10.4269/ajtmh.21-0592] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/11/2021] [Indexed: 11/07/2022] Open
Abstract
Point-of-care (POC) tests to detect SARS-CoV-2 antibodies offer quick assessment of serostatus after natural infection or vaccination. We compared the field performance of the BioMedomics COVID-19 IgM/IgG Rapid Antibody Test against an ELISA in 303 participants enrolled in a SARS-CoV-2 household cohort study. The rapid antibody test was easily implemented with consistent interpretation across 14 users in a variety of field settings. Compared with ELISA, detection of seroconversion lagged by 5 to 10 days. However, it retained a sensitivity of 90% (160/177, 95% confidence interval [CI] 85-94%) and specificity of 100% (43/43, 95% CI 92-100%) for those tested 3 to 5 weeks after symptom onset. Sensitivity was diminished among those with asymptomatic infection (74% [14/19], 95% CI 49-91%) and early in infection (45% [29/64], 95% CI 33-58%). When used appropriately, rapid antibody tests offer a convenient way to detect symptomatic infections during convalescence.
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Affiliation(s)
- Mehal Churiwal
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Kelly D. Lin
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Salman Khan
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Srijana Chhetri
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Meredith S. Muller
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Kathleen Tompkins
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Judy Smith
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Christy Litel
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Maureen Whittelsey
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Christopher Basham
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Tyler Rapp
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Carla Cerami
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Lakshmanane Premkumar
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jessica T. Lin
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Muller MS, Chhetri SB, Basham C, Rapp T, Lin FC, Lin K, Westreich D, Cerami C, Juliano JJ, Lin JT. Practical strategies for SARS-CoV-2 RT-PCR testing in resource-constrained settings. Diagn Microbiol Infect Dis 2021; 101:115469. [PMID: 34280773 PMCID: PMC8230941 DOI: 10.1016/j.diagmicrobio.2021.115469] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 06/18/2021] [Accepted: 06/19/2021] [Indexed: 01/14/2023]
Abstract
Alternatives to nasopharyngeal sampling are needed to increase capacity for SARS-CoV-2 testing. Among 275 participants, we piloted the collection of nasal mid-turbinate swabs amenable to self-testing, including polyester flocked swabs as well as 3D-printed plastic lattice swabs, placed into viral transport media or an RNA stabilization agent. Flocked nasal swabs identified 104/121 individuals who were PCR-positive for SARS-CoV-2 by nasopharyngeal sampling (sensitivity 87%, 95% CI 79-92%), missing those with low viral load (<106 viral copies/mL). 3D-printed nasal swabs showed similar sensitivity. When nasal swabs were placed directly into RNA preservative, the mean 1.4 log decrease in viral copies/uL compared to nasopharyngeal samples was reduced to <1 log, even when samples were left at room temperature for up to 7 days. We also evaluated pooling strategies that involved pooling specimens in the lab versus pooling swabs at the point of collection, finding both successfully detected samples with >105 viral copies/mL.
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Affiliation(s)
- Meredith S Muller
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Srijana B Chhetri
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Christopher Basham
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Tyler Rapp
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Feng-Chang Lin
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Kelly Lin
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Daniel Westreich
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Carla Cerami
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia
| | - Jonathan J Juliano
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jessica T Lin
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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30
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Cunningham CH, Hennelly CM, Lin JT, Ubalee R, Boyce RM, Mulogo EM, Hathaway N, Thwai KL, Phanzu F, Kalonji A, Mwandagalirwa K, Tshefu A, Juliano JJ, Parr JB. A novel CRISPR-based malaria diagnostic capable of Plasmodium detection, species differentiation, and drug-resistance genotyping. EBioMedicine 2021; 68:103415. [PMID: 34139428 PMCID: PMC8213918 DOI: 10.1016/j.ebiom.2021.103415] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/26/2022] Open
Abstract
Background CRISPR-based diagnostics are a new class of highly sensitive and specific assays with multiple applications in infectious disease diagnosis. SHERLOCK, or Specific High-Sensitivity Enzymatic Reporter UnLOCKing, is one such CRISPR-based diagnostic that combines recombinase polymerase pre-amplification, CRISPR-RNA base-pairing, and LwCas13a activity for nucleic acid detection. Methods We developed SHERLOCK assays capable of detecting all Plasmodium species known to cause human malaria and species-specific detection of P. vivax and P. falciparum, the species responsible for the majority of malaria cases worldwide. We further tested these assays using a diverse panel of clinical samples from the Democratic Republic of the Congo, Uganda, and Thailand and pools of Anopheles mosquitoes from Thailand. In addition, we developed a prototype SHERLOCK assay capable of detecting the dihydropteroate synthetase (dhps) single nucleotide variant A581G associated with P. falciparum sulfadoxine resistance. Findings The suite of Plasmodium assays achieved analytical sensitivities ranging from 2•5-18•8 parasites per reaction when tested against laboratory strain genomic DNA. When compared to real-time PCR, the P. falciparum assay achieved 94% sensitivity and 94% specificity during testing of 123 clinical samples. Compared to amplicon-based deep sequencing, the dhps SHERLOCK assay achieved 73% sensitivity and 100% specificity when applied to a panel of 43 clinical samples, with false-negative calls only at lower parasite densities. Interpretation These novel SHERLOCK assays demonstrate the versatility of CRISPR-based diagnostics and their potential as a new generation of molecular tools for malaria diagnosis and surveillance. Funding National Institutes of Health (T32GM007092, R21AI148579, K24AI134990, R01AI121558, UL1TR002489, P30CA016086)
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Affiliation(s)
- Clark H Cunningham
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Jessica T Lin
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ratawan Ubalee
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Ross M Boyce
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edgar M Mulogo
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Nicholas Hathaway
- University of Massachusetts School of Medicine, Worcester, MA, United States
| | - Kyaw L Thwai
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Fernandine Phanzu
- SANRU ASBL (Global Fund), Kinshasa, Democratic Republic of the Congo
| | - Albert Kalonji
- SANRU ASBL (Global Fund), Kinshasa, Democratic Republic of the Congo
| | | | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Jonathan J Juliano
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jonathan B Parr
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
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Cerami C, Rapp T, Lin FC, Tompkins K, Basham C, Muller MS, Whittelsey M, Zhang H, Chhetri SB, Smith J, Litel C, Lin K, Churiwal M, Khan S, Claman F, Rubinstein R, Mollan K, Wohl D, Premkumar L, Juliano JJ, Lin JT. High household transmission of SARS-CoV-2 in the United States: living density, viral load, and disproportionate impact on communities of color. medRxiv 2021:2021.03.10.21253173. [PMID: 33758871 PMCID: PMC7987030 DOI: 10.1101/2021.03.10.21253173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Few prospective studies of SARS-CoV-2 transmission within households have been reported from the United States, where COVID-19 cases are the highest in the world and the pandemic has had disproportionate impact on communities of color. Methods and Findings This is a prospective observational study. Between April-October 2020, the UNC CO-HOST study enrolled 102 COVID-positive persons and 213 of their household members across the Piedmont region of North Carolina, including 45% who identified as Hispanic/Latinx or non-white. Households were enrolled a median of 6 days from onset of symptoms in the index case. Secondary cases within the household were detected either by PCR of a nasopharyngeal (NP) swab on study day 1 and weekly nasal swabs (days 7, 14, 21) thereafter, or based on seroconversion by day 28. After excluding household contacts exposed at the same time as the index case, the secondary attack rate (SAR) among susceptible household contacts was 60% (106/176, 95% CI 53%-67%). The majority of secondary cases were already infected at study enrollment (73/106), while 33 were observed during study follow-up. Despite the potential for continuous exposure and sequential transmission over time, 93% (84/90, 95% CI 86%-97%) of PCR-positive secondary cases were detected within 14 days of symptom onset in the index case, while 83% were detected within 10 days. Index cases with high NP viral load (>10^6 viral copies/ul) at enrollment were more likely to transmit virus to household contacts during the study (OR 4.9, 95% CI 1.3-18 p=0.02). Furthermore, NP viral load was correlated within families (ICC=0.44, 95% CI 0.26-0.60), meaning persons in the same household were more likely to have similar viral loads, suggesting an inoculum effect. High household living density was associated with a higher risk of secondary household transmission (OR 5.8, 95% CI 1.3-55) for households with >3 persons occupying <6 rooms (SAR=91%, 95% CI 71-98%). Index cases who self-identified as Hispanic/Latinx or non-white were more likely to experience a high living density and transmit virus to a household member, translating into an SAR in minority households of 70%, versus 52% in white households (p=0.05). Conclusions SARS-CoV-2 transmits early and often among household members. Risk for spread and subsequent disease is elevated in high-inoculum households with limited living space. Very high infection rates due to household crowding likely contribute to the increased incidence of SARS-CoV-2 infection and morbidity observed among racial and ethnic minorities in the US. Quarantine for 14 days from symptom onset of the first case in the household is appropriate to prevent onward transmission from the household. Ultimately, primary prevention through equitable distribution of effective vaccines is of paramount importance.
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Affiliation(s)
- Carla Cerami
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, The Gambia
| | - Tyler Rapp
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Feng-Chang Lin
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
| | - Kathleen Tompkins
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Christopher Basham
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Meredith S Muller
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Maureen Whittelsey
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Haoming Zhang
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
| | - Srijana B Chhetri
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Judy Smith
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Christy Litel
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Kelly Lin
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Mehal Churiwal
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Salman Khan
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Faith Claman
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Rebecca Rubinstein
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
| | - Katie Mollan
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
| | - David Wohl
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Lakshmanane Premkumar
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Jonathan J Juliano
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Jessica T Lin
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
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Muller MS, Chhetri SB, Basham C, Rapp T, Lin FC, Lin K, Westreich D, Cerami C, Juliano JJ, Lin JT. Practical strategies for SARS-CoV-2 RT-PCR testing in resource-constrained settings. medRxiv 2021. [PMID: 33655269 PMCID: PMC7924294 DOI: 10.1101/2021.02.18.21251999] [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] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Standard nasopharyngeal swab testing for SARS-CoV-2 detection by PCR is not always feasible due to limitations in trained personnel, personal protective equipment, swabs, PCR reagents, and access to cold chain and biosafety hoods. Methods We piloted the collection of nasal mid-turbinate swabs amenable to self-testing, including both standard polyester flocked swabs as well as 3D printed plastic lattice swabs, placed into either viral transport media or an RNA stabilization agent. Quantitative SARS-CoV-2 viral detection by RT-qPCR was compared to that obtained by nasopharyngeal sampling as the reference standard. Pooling specimens in the lab versus pooling swabs at the point of collection was also evaluated. Results Among 275 participants, flocked nasal swabs identified 104/121 individuals who were PCR-positive for SARS-CoV-2 by nasopharyngeal sampling (sensitivity 87%, 95% CI 79-92%), mostly missing those with low viral load (<10^3 viral copies/uL). 3D-printed nasal swabs showed similar sensitivity. When nasal swabs were placed directly into an RNA stabilizer, the mean 1.4 log decrease in viral copies/uL compared to nasopharyngeal samples was reduced to <1 log, even when samples were left at room temperature for up to 7 days. Pooling sample specimens or swabs both successfully detected samples >102 viral copies/uL. Conclusions Nasal swabs are likely adequate for clinical diagnosis of acute infections to help expand testing capacity in resource-constrained settings. When collected into an RNA preservative that also inactivates infectious virus, nasal swabs yielded quantitative viral loads approximating those obtained by nasopharyngeal sampling.
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Affiliation(s)
- Meredith S Muller
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Srijana Bhattarai Chhetri
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Christopher Basham
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Tyler Rapp
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Feng-Chang Lin
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
| | - Kelly Lin
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Daniel Westreich
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
| | - Carla Cerami
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine
| | - Jonathan J Juliano
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Jessica T Lin
- Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA
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Markwalter CF, Ngasala B, Mowatt T, Basham C, Park Z, Loya M, Muller M, Plowe C, Nyunt M, Lin JT. Direct Comparison of Standard and Ultrasensitive PCR for the Detection of Plasmodium falciparum from Dried Blood Spots in Bagamoyo, Tanzania. Am J Trop Med Hyg 2021; 104:1371-1374. [PMID: 33556035 DOI: 10.4269/ajtmh.20-1233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/29/2020] [Indexed: 11/07/2022] Open
Abstract
Ultrasensitive PCR used in low-transmission malaria-endemic settings has revealed a much higher burden of asymptomatic infections than that detected by rapid diagnostic tests (RDTs) or standard PCR, but there is limited evidence as to whether this is the case in higher transmission settings. Using dried blood spots (DBS) collected among 319 schoolchildren in Bagamoyo, Tanzania, we found good correlation (Pearson's R = 0.995) between Plasmodium falciparum parasite densities detected by a DNA-based 18s rRNA real-time PCR (qPCR) and an RNA-based ultrasensitive RT-PCR (usPCR) for the same target. Whereas prevalence by usPCR was higher than that found by qPCR (37% versus 32%), the proportion of additionally detected low-density infections (median parasite density < 0.050 parasites/µL) represented an incremental increase. It remains unclear to what extent these low-density infections may contribute to the infectious reservoir in different malaria transmission settings.
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Affiliation(s)
| | - Billy Ngasala
- 2Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Tonelia Mowatt
- 1Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Christopher Basham
- 3Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Zackary Park
- 3Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Mwajabu Loya
- 2Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Meredith Muller
- 3Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Myaing Nyunt
- 4University of Maryland School of Medicine, Baltimore, Maryland
| | - Jessica T Lin
- 3Institute of Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Shrestha B, Shah Z, Morgan AP, Saingam P, Chaisatit C, Chaorattanakawee S, Praditpol C, Boonyalai N, Lertsethtakarn P, Wojnarski M, Deutsch-Feldman M, Adams M, Sea D, Chann S, Tyner SD, Lanteri CA, Spring MD, Saunders DL, Smith PL, Lon C, Gosi P, Sok S, Satharath P, Rekol H, Lek D, Vesely BA, Lin JT, Waters NC, Takala-Harrison S. Distribution and temporal dynamics of P. falciparum chloroquine resistance transporter mutations associated with piperaquine resistance in Northern Cambodia. J Infect Dis 2021; 224:1077-1085. [PMID: 33528566 DOI: 10.1093/infdis/jiab055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/14/2020] [Accepted: 01/26/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Newly emerged mutations within the Plasmodium falciparum chloroquine resistance transporter (PfCRT) can confer piperaquine resistance in the absence of amplified plasmepsin II (pfpm2). In this study, we estimated the prevalence of co-circulating piperaquine resistance mutations in P. falciparum isolates collected in northern Cambodia from 2009-2017. METHODS The sequence of pfcrt was determined for 410 P. falciparum isolates using PacBio amplicon sequencing or whole genome sequencing. Quantitative PCR was used to estimate pfpm2 and pfmdr1 copy number. RESULTS Newly emerged PfCRT mutations increased in prevalence after the change to dihydroartemisinin-piperaquine in 2010, with >98% of parasites harboring these mutations by 2017. After 2014, the prevalence of PfCRT F145I declined, being out-competed by parasites with less resistant, but more fit PfCRT alleles. After the change to artesunate-mefloquine, the prevalence of parasites with amplified pfpm2 decreased, with nearly half of piperaquine-resistant PfCRT mutants having single copy pfpm2. CONCLUSIONS The large proportion of PfCRT mutants that lack pfpm2 amplification emphasizes the importance of including PfCRT mutations as part of molecular surveillance for piperaquine resistance in this region. Likewise, it is critical to monitor for amplified pfmdr1 in these PfCRT mutants, as increased mefloquine pressure could lead to mutants resistant to both drugs.
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Affiliation(s)
- Biraj Shrestha
- Malaria Research Program, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Zalak Shah
- Malaria Research Program, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew P Morgan
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Piyaporn Saingam
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Suwanna Chaorattanakawee
- Department of Parasitology and Entomology, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | | | | | | | - Mariusz Wojnarski
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Matthew Adams
- Malaria Research Program, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Darapiseth Sea
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Soklyda Chann
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Stuart D Tyner
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Michele D Spring
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - David L Saunders
- US Army Research Institute of Infectious Diseases, Ft. Detrick, MD, USA
| | - Philip L Smith
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Chanthap Lon
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Panita Gosi
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Somethy Sok
- Royal Cambodian Armed Forces, Phnom Penh, Cambodia
| | | | - Huy Rekol
- National Center for Parasitology Entomology and Malaria Control, Village Trapangsvay, Sanakat Phnom Penh, Cambodia
| | - Dysoley Lek
- National Center for Parasitology Entomology and Malaria Control, Village Trapangsvay, Sanakat Phnom Penh, Cambodia
| | - Brian A Vesely
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Jessica T Lin
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Norman C Waters
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Shannon Takala-Harrison
- Malaria Research Program, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
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35
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Nong Y, Lin JT, Sun XW, Wang J, Ma X, Liu XP, Wang HQ, Zha RT, Shen DP, Jiang SJ, Luo SK, Zhao Q, Meng L, Wang WP, Fang J, Han LM, Lu GB, Zhang W, Li GF, Wang H, Zhao ZY, Zhou W, Wei BL, Yuan YD, Peng LP, Lu XL, Pang GF, Li FH, Li L, Zhen H. [Efficacy and safety of Kangbingdu granules in the treatment of influenza: a randomized, double-blind, double-dummy, positive-drug parallel control multicenter clinical trial]. Zhonghua Yi Xue Za Zhi 2021; 101:205-211. [PMID: 33370867 DOI: 10.3760/cma.j.cn112137-20201122-03166] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To observe the efficacy and safety of Kangbingdu granules (KBD) in the treatment of influenza. Methods: A multicenter, randomized, double-blind, double-dummy, and positive-drug parallel control trial was conducted in 27 Grade ⅢA hospitals in China and the subjects were randomly assigned to the KBD test group or the oseltamivir phosphate capsule control group at a ratio of 1∶1. 200 subjects were planned to be enrolled in each group. The experimental group was given KBD (18g each time, 3 times a day) and oseltamivir phosphate simulator orally, while the control group was given oseltamivir phosphate capsule (75 mg each time, twice a day) and KBD simulator orally for 5 days. The primary efficacy indicators included the remission time of major clinical symptoms and the time of complete defervescence. The secondary efficacy indicators included dosage of acetaminophen, the change of traditional Chinese medicine (TCM) syndrome score and the remission time of other important clinical symptoms. The efficacy of KBD in the test group and Oseltamivir phosphate control group were compared. Adverse events or adverse reactions were observed at the same time to evaluate the safety of KBD Granules. Results: A total of 393 subjects from 27 Grade ⅢA hospitals in China were enrolled. The experimental group included 195 subjects and 191 subjects (97.95%) completed the trial, While the control group included 198 subjects and 195 subjects (98.48%) completed the trial. There was no significant difference in the shedding rate and rejection rate between the two groups (P>0.05). In the Full Analysis Set (FAS), the mean age of the experimental group was (34.9±14.4) years old, with 83 males (42.78%). The mean age of the control group was (33.3±13.5) years old, with 78 males (39.59%). There were no statistically significant differences between the two groups in demographic data, physical examination, viral pathogen detection, total score of TCM syndromes and scores of each symptom at baseline (P>0.05). In the FAS, the remission time M (Q1, Q3) of major clinical symptoms was 3.0 (3.0, 4.0) days in the experimental group and 3.0 (3.0, 4.0) days in the control group, and the difference was not statistically significant (P>0.05). The time M (Q1, Q3) of complete defervescence was 34.0 (20.3, 49.0) hours in the experimental group and 36.5 (19.6, 48.8) hours in the control group, and the difference was not statistically significant (P>0.05). KBD granules had the same effect as Oseltamivir phosphate capsule (P>0.05) in terms of acetaminophen dosage, TCM syndrome effect and disappearance rate of most important clinical symptoms. Meanwhile, the disappearance rate of dizziness and chest distress on day 3 in the KBD granules group was better than that of oseltamivir phosphate capsule (P<0.05). Conclusion: KBD granules have the same efficacy as Oseltamivir Phosphate capsule in the treatment of influenza and the drug safety is good.
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Affiliation(s)
- Y Nong
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - J T Lin
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - X W Sun
- Department of Lung Diseases, Mudanjiang Hospital of Traditional Chinese Medicine, Mudanjiang 157009, China
| | - J Wang
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250001, China
| | - X Ma
- Emergency Department, Luohe Hospital of traditional Chinese Medicine, Luohe 462000, China
| | - X P Liu
- Department of Pulmonary and Critical Care Medicine, the Second People's Hospital of Gansu Province, Lanzhou 730030, China
| | - H Q Wang
- Respiratory Department, the Second Affiliated Hospital of Shanxi University of traditional Chinese Medicine, Xianyang 712021, China
| | - R T Zha
- Respiratory Department of Wuhu First people's Hospital, Wuhu 241000, China
| | - D P Shen
- Department of Internal Medicine, Zaozhuang Maternal and Child Health Hospital, Zaozhuang 277800, China
| | - S J Jiang
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital, Jinan 250021, China
| | - S K Luo
- Department of Internal Medicine, Urumqi Hospital of Traditional Chinese Medicine, Urumqi 830000, China
| | - Q Zhao
- Department of Respiratory Medicine, Heilongjiang Red Cross (Forest Industry General) Hospital, Haerbin 150040, China
| | - L Meng
- Department of Pulmonary and Critical Care medicine, the Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China
| | - W P Wang
- Department of Respiratory Medicine, Changzhi People's Hospital, Changzhi 046000, China
| | - J Fang
- Department of Respiratory Medicine, Dezhou People's Hospital, Dezhou 253020, China
| | - L M Han
- Department of Respiratory Medicine, the Second Affiliated Hospital of Xinjiang Medical University, Urumqi 830063, China
| | - G B Lu
- Department of Pulmonary and Critical Care Medicine, Meishan Hospital of Traditional Chinese Medicine, Meishan 620010, China
| | - W Zhang
- Department of Lung Diseases, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250011, China
| | - G F Li
- Respiratory Department of General Hospital of Jizhou Energy Fengfeng Group Co., Ltd, Handan 056011, China
| | - H Wang
- Department of Respiratory Medicine, Mudanjiang First People's Hospital, Mudanjiang 157011, China
| | - Z Y Zhao
- Respiratory Department of Baoding Second Hospital, Baoding 071051, China
| | - W Zhou
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan 750003, China
| | - B L Wei
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300250, China
| | - Y D Yuan
- Department of Pulmonary and Critical Care Medicine, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - L P Peng
- Department of Pulmonary and Critical Care Medicine, the First Hospital of Jilin University, Changchun 130021, China
| | - X L Lu
- Department of Respiratory Medicine, the First Affiliated Hospital of Medical College of Shihezi University, Shihezi 832008, China
| | - G F Pang
- Department of Pulmonary and Critical Care medicine, Affiliated Hospital of Chengde Medical College, Chengde 067000, China
| | - F H Li
- Department of Respiratory Medicine, Weinan Central Hospital, Weinan 714000, China
| | - L Li
- Technical Center for Drug Research and Evaluation of China Association of Traditional Chinese Medicine, Beijing 100101, China
| | - H Zhen
- Technical Center for Drug Research and Evaluation of China Association of Traditional Chinese Medicine, Beijing 100101, China
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Lin JT, Mollan KR, Cerami C. The consequences of isolating at home. Clin Infect Dis 2020; 73:e2823. [PMID: 32986803 DOI: 10.1093/cid/ciaa1476] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jessica T Lin
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, USA
| | - Katie R Mollan
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Carla Cerami
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
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Nong Y, Lin JT, Chen X, Long HY, Li HW. [Evaluation of the effectiveness of bronchial thermoplasty in patients with severe asthma in the real world two years after bronchial thermoplasty treatment]. Zhonghua Yi Xue Za Zhi 2020; 100:1730-1735. [PMID: 32536095 DOI: 10.3760/cma.j.cn112137-20200211-00245] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To assess the effectiveness of bronchial thermoplasty (BT) in "real-world" patients with severe asthma at 2 years post therapy. Method: Outcomes of 70 patients with severe asthma undergoing bronchial thermoplasty from March 2014 to November 2017 in China-Japan Friendship Hospital were retrospectively analyzed two years post therapy. The scores of Asthma Control Test (ACT) and Mini Asthma Quality of Life Questionnaire (mini-AQLQ), the number of severe exacerbations, emergency department visits and hospitalizations for asthma symptoms in the past year, indicators of pulmonary function including forced expiratory volume in one second (FEV(1)), FEV(1) as a percentage of predicted value (FEV(1)%pred) and FEV(1)/forced vital capacity (FEV(1)/FVC), maintenance asthma medications, the cost of asthma drugs and the total annual cost of asthma treatment were evaluated and analyzed before and 2 years after BT therapy, and the subjective assessment about effectiveness of BT were given by the patients. Results: Before and 2 years after BT, the numbers of subjects suffering severe exacerbations in the past year were 70 (100%) and 37 (52.9%), and the numbers of total severe exacerbations were 575 and 162 respectively. The numbers of patients having emergency department visits due to asthma exacerbation were 46 (65.7%) and 9 (12.9%), and the numbers of emergency department visits were 186 and 19 respectively. The numbers of patients hospitalized due to asthma exacerbation were 43 (61.4%) and 16 (22.9%), and the numbers of total hospitalizations were 124 and 24, respectively. The rate of severe exacerbation, emergency department visit and hospitalization were significantly reduced two years after the treatment by 71.9%, 88.9% and 83.3% (all P<0.001). The scores of ACT and mini-AQLQ were significantly increased [22 (21, 24) vs 17 (13, 19), (5.57±0.89) vs (3.83±0.92); both P<0.001]. Two years after BT, 4 patients (5.7%) were weaned off inhaled corticosteroids (ICS) and long-acting β(2)-agonist (LABA), while 14 patients (37.8%) were weaned off oral corticosteroid (OCS), with daily dose of ICS and OCS significantly decreased (both P<0.05). The proportion of patients treated with montelukast sodium and theophylline was also significantly reduced after BT (40.0% vs 81.4%, 27.1% vs 71.4%; both P<0.001). In addition, the indicator of FEV(1), FEV(1)%pred and FEV(1)/FVC ratio were all greatly improved two years after the treatment [2.27 (1.84, 2.82) vs 2.10 (1.70, 2.61) L, (76.8±19.5)% vs (72.5±19.8)%, (66.3±13.6)% vs (63.8±13.0)%; all P<0.05]. The annual cost for asthma drug and asthma treatment after BT were significantly decreased (P<0.001). Fifty-nine patients (84.3%) subjectively assessed the treatment as effective. Conclusion: The bronchial thermoplasty in "real-world" patients with severe asthma could significantly improve the asthma control, lung function and quality of life, and reduce severe exacerbations, emergency department visits and hospitalizations for asthma symptoms, while the maintenance asthma medications, the cost of asthma drugs and the total annual cost of asthma treatment are significantly decreased.
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Affiliation(s)
- Y Nong
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - J T Lin
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - X Chen
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - H Y Long
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - H W Li
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
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Gu XM, Lin JT, Nong Y, Chen X, Long HY. [Effects of bronchial thermoplasty on airway remodeling, asthma control and quality of life in patients with severe asthma]. Zhonghua Yi Xue Za Zhi 2020; 100:1573-1577. [PMID: 32450647 DOI: 10.3760/cma.j.cn112137-20200217-00311] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the effects of bronchial thermoplasty (BT) on airway remodeling, asthma control and quality of life in patients with severe asthma. Methods: From January to September 2019, 11 patients with severe asthma were recruited from China Japan Friendship Hospital to receive BT treatment. The treatment was performed over three sessions separated by 3-week intervals. The right lower lobe, the left lower lobe and the bilateral upper lobes were treated respectively. In this study, patients' self-control method was used. The timepoint before the first BT treatment was defined as pre-treatment group, and the timepoint before the third treatment was defined as post-treatment group. Histological staining was used to detect the airway remodeling of the left lower lobe in two groups, including the mass of airway smooth muscle (ASM) and collagen in airway wall, and the thickness of basement membrane. The cell classification of bronchoalveolar lavage fluid (BALF) from the left lower lobe and peripheral blood, total serum IgE, asthma control test (ACT), mini asthma quality of life questionnaire (miniAQLQ) and the forced expiratory volume in 1 second expressed as percent predicted (FEV(1)%pred) were evaluated in the two groups. The correlation was analyzed between airway remodeling and asthma control and quality of life. Results: Effects of BT in post-treatment group, compared with pre-treatment group: the mass of ASM and collagen in airway wall was significantly decreased [(9.8±2.5)% vs (25.8±7.7)%, (12.9±4.0)% vs (17.4±5.6)%] (both P<0.05), while basement membrane thickness was not significantly different (P>0.05); the percentage of eosinophils in BALF and peripheral blood, and total serum IgE were not significantly different (all P>0.05); ACT score and miniAQLQ score were significantly increased [(23.1±1.8) vs (13.8±6.2) points, (5.3±1.3) vs (3.6±1.5) points] (both P<0.05), while FEV(1)% pred was not statistically different (P>0.05). The mass of ASM was negatively correlated with ACT score (r=-0.712), miniAQLQ score (r=-0.557) and FEV(1)%pred (r=-0.477), while the mass of collagen was negatively correlated with ACT score (r=-0.549) and miniAQLQ score (r=-0.639) (all P<0.05). Conclusion: BT treatment could improve airway remodeling, asthma control and quality of life in patients with severe asthma; besides, the reduction of remodeling is related to the improvements of asthma control and quality of life.
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Affiliation(s)
- X M Gu
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - J T Lin
- Department of Respiratory and Critical Care Medicine, China Japan Friendship Hospital, Beijing 100029, China
| | - Y Nong
- Department of Respiratory and Critical Care Medicine, China Japan Friendship Hospital, Beijing 100029, China
| | - X Chen
- Department of Respiratory and Critical Care Medicine, China Japan Friendship Hospital, Beijing 100029, China
| | - H Y Long
- Department of Respiratory and Critical Care Medicine, China Japan Friendship Hospital, Beijing 100029, China
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Wang WY, Lin JT, Zhou X, Chen P, Wan HY, Yin KS, Ma LJ, Wu CG, Li J, Liu CT, Xie H, Tang W, Huang M, Chen Y, Liu YH, Song LQ, Chen XL, Liu GL, Zhang YM, Li W, Sun LC. [An epidemiological survey on clinical features, self-management and cognitive level of elderly asthmatics in China]. Zhonghua Yi Xue Za Zhi 2020; 100:1426-1431. [PMID: 32392995 DOI: 10.3760/cma.j.cn112137-20191117-02498] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective: To investigate the prevalence of asthma among the elderly people in China and to analyze the clinical features, self-management and cognitive level of elderly asthma patients. Methods: According to the multi-stage random cluster sampling methods, a total of 164 215 subjects were visited by a questionnaire in the last epidemiology survey from eight provinces (Beijing, Shanghai, Guangdong, Liaoning, Henan, Shanxi, Jiangsu, Sichuan provinces) and seven regions (north, northeast, southern china, east, south, southwest and northwest) in China from February 2010 to August 2012. 2 034 were diagnosed as asthma. The elderly patients aged ≥65 years were selected from the 2 034 asthma patients. The clinical characteristics, comorbidities, the status of asthma control and self-management and insights of the disease in elderly asthma patients were analyzed. Results: Among the 2 034 asthma patients, 584 (28.7%) were elderly asthmatics aged ≥65 years old and 1 450 (71.3%) were<65 years old. In the elderly asthma group, Early-onset asthma accounted for 439 (75.2%) and 145 (24.8%) were late-onset. The common clinical manifestations of elderly asthma patients were: chest distress 395 (67.6%), wheezing 304 (52.1%), cough 298 (51.0%). Common comorbidities of elderly asthmatics were: chronic obstructive pulmonary disease 144 (24.7%), allergic rhinitis 122(20.9%), gastroesopheal reflux disease (GERD) 114(19.5%), allergic conjunctivitis 86 (14.7%), eczema 82 (14.0%), chronic bronchitis 76 (13.0%). The Asthma Control Test (ACT) scores of elderly asthmatics and non-elderly asthmatics were (18.5±3.2) and (21.7±3.4) respectively. There was a significant difference between the two groups (P=0.042). Of the elderly asthmatics, only 13 (2.2%) patients monitored daily using a peak flow meter. 93 (15.9%) patients aware that asthma was characterized by chronic airway inflammation. 64 (11.0%) asthmatics understood that the treatment goal. Conclusions: The clinical manifestations of elderly asthmatics are atypical, especially paroxysmal wheezing. Asthma in elderly people causes more comorbidities and mortality. The self-management and cognitive level of patients with asthma needs to be improved.
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Affiliation(s)
- W Y Wang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - J T Lin
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - X Zhou
- Department of Respiratory Diseases, Shanghai General Hospital of Shanghai Jiaotong University, Shanghai 201315, China
| | - P Chen
- Department of Pulmonary and Critical Care Medicine, General Hospital of Northen Theater Shenyang Command, Shenyang 110016, China
| | - H Y Wan
- Department of Pulmonary and Critical CareMedicine, Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200025, China
| | - K S Yin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - L J Ma
- Department of Pulmonary and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - C G Wu
- Department of Pulmonary and Critical Care Medicine, Chest Hospital of Xi'an International Medical Center, Xi'an 710100, China
| | - J Li
- Guangzhou Institute of Respiratory Disease, Department of Respiratory Diseases, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - C T Liu
- Department of Respiratory Diseases West China Hospital of Sichuan University, Chengdu 610041, China
| | - H Xie
- Department of Pulmonary and Critical Care Medicine, General Hospital of Northen Theater Shenyang Command, Shenyang 110016, China
| | - W Tang
- Department of Pulmonary and Critical CareMedicine, Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200025, China
| | - M Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Y Chen
- Guangzhou Institute of Respiratory Disease, Department of Respiratory Diseases, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Y H Liu
- Department of Respiratory Diseases West China Hospital of Sichuan University, Chengdu 610041, China
| | - L Q Song
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital of Air Force Military Medical University, Xi'an 710032, China
| | - X L Chen
- Department of Pulmonary and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - G L Liu
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Y M Zhang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - W Li
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - L C Sun
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
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40
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Lin LJ, Zhu L, Shi GC, Wu JQ, Li HX, Sun BJ, Lin JT, Xu ZJ, Sun TY, Li J, Yu SY, Liu XM. [Experts consensus for the diagnosis, treatment, and prevention of Coronavirus disease 2019 in the elderly]. Zhonghua Nei Ke Za Zhi 2020; 59:588-597. [PMID: 32521953 DOI: 10.3760/cma.j.cn112138-20200228-00151] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Coronavirus disease 2019 (COVID-19) can cause great damage to the elderly patients and lead to high mortality. The clinical presentations and auxiliary examinations of the elderly patients with COVID-19 are atypical, due to the physiological ageing deterioration and basal pathological state. The treatment strategy for the elderly patients has its own characteristics and treatment protocol should be considered accordingly. To improve the diagnosis, treatment, and prevention of COVID-19 in the elderly, the Expert Committee of Geriatric Respiratory and Critical Care Medicine, China Society of Geriatrics established the "Expert consensus for the diagnosis, treatment, and prevention of Coronavirus disease 2019 in the elderly" . We focused on the clinical characteristics and key points for better treatment and prevention of COVID-19 in the elderly. (1) For diagnosis, atypical clinical presentation of COVID-19 in the elderly should be emphasized, which may be complicated by underlying disease. (2) For treatment, strategy of multiple disciplinary team (mainly the respiratory and critical care medicine) should be adopted and multiple systemic functions should be considered. (3) For prevention, health care model about integrated management of acute and chronic diseases, in and out of hospital should be applied.
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Affiliation(s)
- L J Lin
- Department of Geriatrics, Peking University First Hospital, Beijing 100034, China
| | - L Zhu
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - G C Shi
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - J Q Wu
- Department of Geriatrics, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - H X Li
- Department of Respiratory Medicine, The Second Medical Center of PLA General Hospital, Beijing 100853, China
| | - B J Sun
- Department of Respiratory Medicine, The Second Medical Center of PLA General Hospital, Beijing 100853, China
| | - J T Lin
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Z J Xu
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - T Y Sun
- Department of Respiratory and Critical Medicine, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - J Li
- Beijing Hospital, Beijing Institute of Geriatrics of National Health Commission, Beijing 100730, China
| | - S Y Yu
- Department of Respiratory Medicine, The Second Medical Center of PLA General Hospital, Beijing 100853, China
| | - X M Liu
- Department of Geriatrics, Peking University First Hospital, Beijing 100034, China
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Wang WY, Lin JT, Zhou X, Chen P, Wan HY, Yin KS, Ma LJ, Wu CG, Li J, Liu CT, Xie H, Tang W, Huang M, Chen Y, Liu YH, Song LQ, Chen XL, Liu GL, Zhang YM, Li W, Sun LC. [A survey on clinical characteristics and risk factors of severe asthma in China]. Zhonghua Yi Xue Za Zhi 2020; 100:1106-1111. [PMID: 32294877 DOI: 10.3760/cma.j.cn112137-20191117-02497] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective: To investigate the clinical characteristics and risk factors of severe bronchial asthma in Chinese people over 14 years old. Methods: According to the multi-stage random cluster sampling methods, a total of 164 215 subjects were visited by a questionnaire in the epidemiology survey from eight provinces (Beijing, Shanghai, Guangdong, Liaoning, Henan, Shanxi, Jiangsu, Sichuan provinces) located in seven regions (north, northeast, east, central China, south, southwest and northwest) of China from February 2010 to August 2012. A total of 2 034 were diagnosed as asthma. The clinical characteristics and related risk factors of patients with severe asthma in China were analyzed. Results: Among all asthma patients, 560 were newly diagnosed, accounting for 27.5% (560/2 034) and the percentage of previously confirmed patients was 72.5% (1 474/2 034). A total of 145 were eligible for severe asthma, accounting for 9.8% (145/1 474) of previously confirmed asthmatics and 7.1% (145/2 034) of all asthmatics. 83.5% (121/145) severe asthmatics had at least one trigger factor. Correlation analysis showed that the risk factors of severe asthma were: smoking (OR=1.543, 95%CI: 1.250-1.814), obesity (OR=2.186, 95%CI: 1.972-2.354), petting (OR=2.135, 95%CI: 1.904-2.283), combined with allergic rhinitis (OR=3.456, 95%CI: 2.721-4.326), gastroesophageal reflux disease (OR=1.842, 95%CI: 1.682-2.140), bronchiectasis (OR=1.665, 95%CI: 1.347-1.912) or chronic obstructive pulmonary disease (OR=1.312, 95%CI: 1.171-1.694). Conclusions: The most common comorbidities in severe asthmatics in China are allergic rhinitis and gastroesophageal reflux disease. The risk factors of severe asthma include obesity, allergic rhinitis, gastroesophageal reflux disease, chronic obstructive pulmonary disease, bronchiectasis, smoking and petting.
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Affiliation(s)
- W Y Wang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - J T Lin
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - X Zhou
- Department of Respiratory Diseases, Shanghai General Hospital of Shanghai Jiaotong University, Shanghai 201315, China
| | - P Chen
- Department of Pulmonary and Critical Care Medicine, General Hospital of Northen Theater Shenyang Command, Shenyang 110016, China
| | - H Y Wan
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200025, China
| | - K S Yin
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - L J Ma
- Department of Pulmonary and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - C G Wu
- Department of Pulmonary and Critical Care Medicine, Chest Hospital of Xi'an International Medical Center, Xi'an 710100, China
| | - J Li
- Guangzhou Institute of Respiratory Disease, Department of Respiratory Diseases, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - C T Liu
- Department of Pulmonary and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - H Xie
- Department of Pulmonary and Critical Care Medicine, General Hospital of Northen Theater Shenyang Command, Shenyang 110016, China
| | - W Tang
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200025, China
| | - M Huang
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Y Chen
- Guangzhou Institute of Respiratory Disease, Department of Respiratory Diseases, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Y H Liu
- Department of Pulmonary and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - L Q Song
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital of Air Force Military Medical University, Xi'an 710032, China
| | - X L Chen
- Department of Pulmonary and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - G L Liu
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Y M Zhang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - W Li
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - L C Sun
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
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Spring MD, Lon C, Sok S, Sea D, Wojnarski M, Chann S, Kuntawunginn W, Kheang Heng T, Nou S, Arsanok M, Sriwichai S, Vanachayangkul P, Lin JT, Manning JE, Jongsakul K, Pichyangkul S, Satharath P, Smith PL, Dysoley L, Saunders DL, Waters NC. Prevalence of CYP2D6 Genotypes and Predicted Phenotypes in a Cohort of Cambodians at High Risk for Infections with Plasmodium vivax. Am J Trop Med Hyg 2020; 103:756-759. [PMID: 32394887 PMCID: PMC7410472 DOI: 10.4269/ajtmh.20-0061] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Indexed: 01/07/2023] Open
Abstract
Clinical failure of primaquine (PQ) has been demonstrated in people with CYP450 2D6 genetic polymorphisms that result in reduced or no enzyme activity. The distribution of CYP2D6 genotypes and predicted phenotypes in the Cambodian population is not well described. Surveys in other Asian countries have shown an approximate 50% prevalence of the reduced activity CYP2D6 allele *10, which could translate into increased risk of PQ radical cure failure and repeated relapses, making interruption of transmission and malaria elimination difficult to achieve. We determined CYP2D6 genotypes from 96 volunteers from Oddor Meanchey Province, Cambodia, an area endemic for Plasmodium vivax. We found a 54.2% frequency of the *10 allele, but in approximately half of our subjects, it was paired with a normal activity allele, either *1 or *2. The prevalence of *5, a null allele, was 9.4%. Overall predicted phenotype percentages were normal metabolizers, 46%; intermediate metabolizers, 52%; and poor metabolizers, 1%.
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Affiliation(s)
- Michele D Spring
- US Army Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - Chanthap Lon
- US Army Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Somethy Sok
- US Army Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Darapiseth Sea
- US Army Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Mariusz Wojnarski
- US Army Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Soklyda Chann
- US Army Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Thay Kheang Heng
- US Army Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Samon Nou
- US Army Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Montri Arsanok
- US Army Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Sabaithip Sriwichai
- US Army Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Jessica T Lin
- University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Jessica E Manning
- US National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia
| | - Krisada Jongsakul
- US Army Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Sathit Pichyangkul
- US Army Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Philip L Smith
- Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Lek Dysoley
- National Malaria Program of Cambodia, Phnom Penh, Cambodia
| | - David L Saunders
- U.S. Army Medical Research Institute of Infectious Diseases, Ft. Detrick, Maryland
| | - Norman C Waters
- US Army Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
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43
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Affiliation(s)
- Jessica T Lin
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill
| | - Jonathan B Parr
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill
| | - Billy Ngasala
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Lin FC, Li Q, Lin JT. Relapse or reinfection: Classification of malaria infection using transition likelihoods. Biometrics 2020; 76:1351-1363. [PMID: 32022247 DOI: 10.1111/biom.13226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/29/2018] [Revised: 12/15/2019] [Accepted: 12/31/2019] [Indexed: 11/29/2022]
Abstract
In patients with Plasmodium vivax malaria treated with effective blood-stage therapy, the recurrent illness may occur due to relapse from latent liver-stage infection or reinfection from a new mosquito bite. Classification of the recurrent infection as either relapse or reinfection is critical when evaluating the efficacy of an anti-relapse treatment. Although one can use whether a shared genetic variant exists between baseline and recurrence genotypes to classify the outcome, little has been suggested to use both sharing and nonsharing variants to improve the classification accuracy. In this paper, we develop a novel classification criterion that utilizes transition likelihoods to distinguish relapse from reinfection. When tested in extensive simulation experiments with known outcomes, our classifier has superior operating characteristics. A real data set from 78 Cambodian P. vivax malaria patients was analyzed to demonstrate the practical use of our proposed method.
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Affiliation(s)
- Feng-Chang Lin
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Quefeng Li
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Jessica T Lin
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
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Balasubramanian S, Rahman RS, Lon C, Parobek C, Ubalee R, Hathaway N, Kuntawunginn W, My M, Vy D, Saxe J, Lanteri C, Lin FC, Spring M, Meshnick SR, Juliano JJ, Saunders DL, Lin JT. Efficient Transmission of Mixed Plasmodium falciparum/vivax Infections From Humans to Mosquitoes. J Infect Dis 2020; 221:428-437. [PMID: 31549156 PMCID: PMC7184918 DOI: 10.1093/infdis/jiz388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 04/16/2019] [Accepted: 07/23/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In Southeast Asia, people are often coinfected with different species of malaria (Plasmodium falciparum [Pf] and Plasmodium vivax [Pv]) as well as with multiple clones of the same species. Whether particular species or clones within mixed infections are more readily transmitted to mosquitoes remains unknown. METHODS Laboratory-reared Anopheles dirus were fed on blood from 119 Pf-infected Cambodian adults, with 5950 dissected to evaluate for transmitted infection. Among 12 persons who infected mosquitoes, polymerase chain reaction and amplicon deep sequencing were used to track species and clone-specific transmission to mosquitoes. RESULTS Seven of 12 persons that infected mosquitoes harbored mixed Pf/Pv infection. Among these 7 persons, all transmitted Pv with 2 transmitting both Pf and Pv, leading to Pf/Pv coinfection in 21% of infected mosquitoes. Up to 4 clones of each species were detected within persons. Shifts in clone frequency were detected during transmission. However, in general, all parasite clones in humans were transmitted to mosquitoes, with individual mosquitoes frequently carrying multiple transmitted clones. CONCLUSIONS Malaria diversity in human hosts was maintained in the parasite populations recovered from mosquitoes fed on their blood. However, in persons with mixed Pf/Pv malaria, Pv appears to be transmitted more readily, in association with more prevalent patent gametocytemia.
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Affiliation(s)
- Sujata Balasubramanian
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill
| | - Rifat S Rahman
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill
| | - Chanthap Lon
- Armed Forces Research Institute of Medical Sciences, Phnom Penh, Cambodia
| | - Christian Parobek
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill
| | - Ratawan Ubalee
- Department of Entomology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Nicholas Hathaway
- Department of Bioinformatics and Integrated Biology, University of Massachusetts, Worcester
| | - Worachet Kuntawunginn
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Mok My
- Royal Cambodian Armed Forces, Phnom Penh, Cambodia
| | - Dav Vy
- Royal Cambodian Armed Forces, Phnom Penh, Cambodia
| | - Jeremy Saxe
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Charlotte Lanteri
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Feng-Chang Lin
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Michele Spring
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Steven R Meshnick
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Jonathan J Juliano
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill
| | - David L Saunders
- Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
- US Army Medical Materiel Development Activity, Fort Detrick, Maryland
| | - Jessica T Lin
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill
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46
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Boyce RM, Speight C, Lin JT, Farel CE. Errors in Diagnostic Test Use and Interpretation Contribute to the High Number of Lyme Disease Referrals in a Low-Incidence State. Open Forum Infect Dis 2020; 7:ofaa009. [PMID: 31988970 PMCID: PMC6976340 DOI: 10.1093/ofid/ofaa009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/08/2020] [Indexed: 11/21/2022] Open
Abstract
Lyme disease accounted for more than two-thirds (56 of 81, 69.1%) of all tick-borne disease referrals to a large, academic infectious diseases clinic in a low-incidence state. Deviations from diagnostic testing guidelines and errors in test interpretation were common (23 of 35, 65.7%), suggesting that frontline providers need additional clinical support.
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Affiliation(s)
- Ross M Boyce
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Carly Speight
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessica T Lin
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Claire E Farel
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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47
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Wang RY, Li HW, Zhang Q, Lin JT. [Effect of artesunate on airway responsiveness and airway inflammation in asthmatic mice]. Zhonghua Yi Xue Za Zhi 2019; 99:2536-2541. [PMID: 31484283 DOI: 10.3760/cma.j.issn.0376-2491.2019.32.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To observe the effects of artesunate on airway responsiveness and airway inflammation in asthmatic mice. Methods: Thirty female BALB/c mice aged 6-8 weeks were randomly divided into control group, asthma group and artesunate group. In the asthma group and the artesunate group, the mice were sensitized by intraperitoneal injection of 20 μg of ovalbumin (OVA) and 0.2 ml of aluminum hydroxide suspension (2 mg) on day 0 and 14, respectively, and 1% OVA 10 ml dissolved in sterile phosphate (PBS) buffer was aerosolized for 30 min from the 21st to 28th day. The control group was sensitized with 0.2 ml of 2 mg suspension of aluminum hydroxide on day 0 and 14, and aerosolized by 10 ml of sterile PBS from the 21st to 28th day. Before the challenge, the artesunate group was intraperitoneally injected with 0.2 ml of artesunate. Artesunate was replaced with the same amount of normal saline in the control group and the asthma group. The mice were treated after 24 hours of last stimulation. The airway responsiveness of mice was measured by airway intubation and the changes of airway resistance and compliance were observed. Bronchoalveolar lavage fluid (BALF) was classified by cytology, and pathological changes of left lung tissue were observed and scored. Results: The airway resistance of the three groups increased and the lung compliance decreased with the increase of methacholine (Ach) concentration. The airway resistance and lung compliance of the three groups were different under the same concentration (P<0.05). The airway resistance of the artesunate group at Ach 6.25, 12.5, 25, 50, 100 mg/ml was lower than that of the asthma group at the same concentration [(1.01±0.48) vs (1.30±0.22), (1.06±0.44) vs (1.70±0.31), (1.30±0.64) vs (2.66±0.79), (1.82±0.55) vs (3.38±1.35), (2.49±0.85) vs (4.07±1.34) cmH(2)O·s(-1)·ml(-1)(1 cmH(2)O=0.098 kPa); t=3.862, 7.376, 9.113, 7.051, 6.685, all P<0.05]; the degree of lung compliance decrease at the concentration of Ach 3.125, 6.25, 12.5, 25, 50, 100 mg/ml was lower than that of the asthma group at the same concentration [(3.89±0.55)×10(-2) vs (3.07±0.63)×10(-2), (3.61±0.52)×10(-2) vs (3.04±0.58)×10(-2), (3.48±0.38)×10(-2) vs (2.78±0.57)×10(-2), (3.09±0.52)×10(-2) vs (1.73±0.62)×10(-2), (2.32±0.60)×10(-2) vs (1.29±0.54)×10(-2), (1.87±0.59)×10(-2) vs (1.15±0.44)×10(-2) ml/cmH(2)O; t=-6.295, -4.921, -6.533, -11.135, -8.48, -6.319, all P<0.05]. The proportion of eosinophils in artesunate group in BALF was significantly lower than that in asthma group [(16.63±8.58)% vs (40.44±12.94)%; t=4.336, P<0.05]. In the asthma group, the inflammatory cells infiltration of the bronchi and the perivascular area, the bronchial epithelial edema and degeneration can be observed, and the artesunate could reduce the infiltration of inflammatory cells around the bronchus and blood vessels, and the mucus secretion was also reduced in the artesunate group. Conclusion: Artesunate can improve airway hyperresponsiveness and airway inflammation in asthmatic mice and has a certain therapeutic effect on asthma.
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Affiliation(s)
- R Y Wang
- Graduate School of Beijing University of Chinese Medicine, Beijing 100029, China
| | - H W Li
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Q Zhang
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - J T Lin
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
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Lin JT, Patel JC, Levitz L, Wojnarski M, Chaorattanakawee S, Gosi P, Buathong N, Chann S, Huy R, Thay K, Sea D, Samon N, Takala-Harrison S, Fukuda M, Smith P, Spring M, Saunders D, Lon C. Gametocyte Carriage, Antimalarial Use, and Drug Resistance in Cambodia, 2008-2014. Am J Trop Med Hyg 2019; 99:1145-1149. [PMID: 30226145 DOI: 10.4269/ajtmh.18-0509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Gametocytes are the malaria parasite stages responsible for transmission from humans to mosquitoes. Gametocytemia often follows drug treatment, especially as therapies start to fail. We examined Plasmodium falciparum gametocyte carriage and drug resistance profiles among 824 persons with uncomplicated malaria in Cambodia to determine whether prevalent drug resistance and antimalarial use has led to a concentration of drug-resistant parasites among gametocyte carriers. Although report of prior antimalarial use increased from 2008 to 2014, the prevalence of study participants presenting with microscopic gametocyte carriage declined. Gametocytemia was more common in those reporting antimalarial use within the past year, and prior antimalarial use was correlated with higher IC50s to piperaquine and mefloquine, as well as to increased pfmdr1 copy number. However, there was no association between microscopic gametocyte carriage and parasite drug resistance. Thus, we found no evidence that the infectious reservoir, marked by those carrying gametocytes, is enriched with drug-resistant parasites.
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Affiliation(s)
- Jessica T Lin
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jaymin C Patel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Lauren Levitz
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Mariusz Wojnarski
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Suwanna Chaorattanakawee
- Department of Parasitology and Entomology, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Panita Gosi
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Nillawan Buathong
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Soklyda Chann
- Armed Forces Research Institute of Medical Sciences, Phnom Penh, Cambodia
| | - Rekol Huy
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Khengheng Thay
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Darapiseth Sea
- Armed Forces Research Institute of Medical Sciences, Phnom Penh, Cambodia
| | - Nou Samon
- Armed Forces Research Institute of Medical Sciences, Phnom Penh, Cambodia
| | - Shannon Takala-Harrison
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mark Fukuda
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Philip Smith
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Michele Spring
- Department of Immunology and Medicine, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - David Saunders
- U.S. Army Medical Materiel Development Activity, Fort Detrick, Maryland
| | - Chanthap Lon
- Armed Forces Research Institute of Medical Sciences, Phnom Penh, Cambodia
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49
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Li HW, Lin JT, Nong Y, Ren ZC, Han QQ. [Distribution of airway inflammation phenotype in patients with bronchial asthma and its correlation with control level]. Zhonghua Yi Xue Za Zhi 2019; 99:1692-1697. [PMID: 31216813 DOI: 10.3760/cma.j.issn.0376-2491.2019.22.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the distribution of airway inflammation phenotypes in patients with bronchial asthma and its correlation with asthma control level. Methods: Patients who met GINA 2017 asthma diagnostic criteria from October 2017 to April 2018 in respiratory outpatient department of China-Japan Friendship Hospital were included. The clinical data of non-acute asthma patients were prospectively collected, including general data, asthma control level, pulmonary function, induced sputum cell classification, serum total IgE, exhaled nitric oxide (FeNO), blood cell classification. The correlation between phenotype distribution of airway inflammation and airway inflammation markers (eosinophils in sputum, FeNO, blood eosinophil, serum IgE) and asthma control was analyzed by correlation analysis. The correlation between sputum eosinophil level and FeNO, blood eosinophil count, serum total IgE, forced expiratory volume in one-second (FEV(1)) predicted (FEV(1)%pred) was analyzed by correlation analysis too. Results: A total of 97 asthmatic patients were enrolled. There were 38 males (39.2%) and 59 females (60.8%), aged (48±14) (range 22 to 80). Control level of asthma:13 cases (13.4%) were controlled, 39 cases(40.2%) were partially controlled and 45 cases (46.4%) were uncontrolled. The phenotypes of airway inflammation were eosinophilic 51 cases (52.6%), neutrophilic 9 cases (9.3%), mixed 35 cases (36.1%) and paucigranulocytic 2 cases (2.1%). There was no significant correlation between airway inflammation phenotype distribution, airway inflammation markers and asthma control level (P>0.05). Sputum eosinophil level was positively correlated with FeNO level in controlled and uncontrolled patients (r=0.420, P=0.008 and r=0.325, P=0.031); sputum eosinophil level was positively correlated with blood eosinophil level in uncontrolled asthma patients (r=0.328, P=0.037). There was no significant correlation between sputum eosinophil level and FEV(1)%pred (P>0.05). Conclusions: Eosinophil type is the dominant type of airway inflammation in asthmatic patients, and there is no significant correlation between airway inflammation and asthma control level. At present, airway inflammation cannot be used to assess asthma control level.
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Affiliation(s)
- H W Li
- Department of Pμlmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
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50
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Lin JT, Zhang XY. [Do not diagnose postinfectious cough as cough variant asthma]. Zhonghua Jie He He Hu Xi Za Zhi 2019; 42:167-169. [PMID: 30845390 DOI: 10.3760/cma.j.issn.1001-0939.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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