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Kanza EM, Nyathirombo A, Larbelee JP, Opoku NO, Bakajika DK, Howard HM, Mambandu GL, Nigo MM, Wonyarossi DU, Ngave F, Kennedy KK, Kataliko K, Bolay KM, Attah SK, Olipoh G, Asare S, Mumbere M, Vaillant M, Halleux CM, Kuesel AC. Onchocerca volvulus microfilariae in the anterior chambers of the eye and ocular adverse events after a single dose of 8 mg moxidectin or 150 µg/kg ivermectin: results of a randomized double-blind Phase 3 trial in the Democratic Republic of the Congo, Ghana and Liberia. Parasit Vectors 2024; 17:137. [PMID: 38491528 PMCID: PMC10943894 DOI: 10.1186/s13071-023-06087-3] [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: 04/30/2023] [Accepted: 12/07/2023] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND After ivermectin became available, diethylcarbamazine (DEC) use was discontinued because of severe adverse reactions, including ocular reactions, in individuals with high Onchocerca volvulus microfilaridermia (microfilariae/mg skin, SmfD). Assuming long-term ivermectin use led to < 5 SmfD with little or no eye involvement, DEC + ivermectin + albendazole treatment a few months after ivermectin was proposed. In 2018, the US FDA approved moxidectin for treatment of O. volvulus infection. The Phase 3 study evaluated SmfD, microfilariae in the anterior chamber (mfAC) and adverse events (AEs) in ivermectin-naïve individuals with ≥ 10 SmfD after 8 mg moxidectin (n = 978) or 150 µg/kg ivermectin (n = 494) treatment. METHODS We analyzed the data from 1463 participants with both eyes evaluated using six (0, 1-5, 6-10, 11-20, 21-40, > 40) mfAC and three pre-treatment (< 20, 20 to < 50, ≥ 50) and post-treatment (0, > 0-5, > 5) SmfD categories. A linear mixed model evaluated factors and covariates impacting mfAC levels. Ocular AEs were summarized by type and start post-treatment. Logistic models evaluated factors and covariates impacting the risk for ocular AEs. RESULTS Moxidectin and ivermectin had the same effect on mfAC levels. These increased from pre-treatment to Day 4 and Month 1 in 20% and 16% of participants, respectively. Six and 12 months post-treatment, mfAC were detected in ≈5% and ≈3% of participants, respectively. Ocular Mazzotti reactions occurred in 12.4% of moxidectin- and 10.2% of ivermectin-treated participants without difference in type or severity. The risk for ≥ 1 ocular Mazzotti reaction increased for women (OR 1.537, 95% CI 1.096-2.157) and with mfAC levels pre- and 4 days post-treatment (OR 0: > 10 mfAC 2.704, 95% CI 1.27-5.749 and 1.619, 95% CI 0.80-3.280, respectively). CONCLUSIONS The impact of SmfD and mfAC levels before and early after treatment on ocular AEs needs to be better understood before making decisions on the risk-benefit of strategies including DEC. Such decisions should take into account interindividual variability in SmfD, mfAC levels and treatment response and risks to even a small percentage of individuals.
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Affiliation(s)
- Eric M Kanza
- Centre de Recherche Clinique de Butembo, Université Catholique du Graben, Site Horizon, Butembo, Nord Kivu, Democratic Republic of the Congo
- Programme National de Lutte Contre Les Maladies Tropicales Négligées À Chimio-Thérapie Préventive (PNLMTN-CTP), Kinshasa, Democratic Republic of the Congo
| | - Amos Nyathirombo
- Centre de Recherche en Maladies Tropicale de L'Ituri, Hôpital Générale de Référence de Rethy, Ituri, Democratic Republic of the Congo
- Department of Ophthalmology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Jemmah P Larbelee
- Clinical Research Center, Liberia Institute for Biomedical Research, Bolahun, Liberia
- Ministry of Health, Monrovia, Liberia
| | - Nicholas O Opoku
- Onchocerciasis Chemotherapy Research Center, Hohoe, Ghana
- Department of Epidemiology and Biostatistics School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Didier K Bakajika
- Centre de Recherche en Maladies Tropicale de L'Ituri, Hôpital Générale de Référence de Rethy, Ituri, Democratic Republic of the Congo
- ESPEN, African Regional Office of the World Health Organization (WHO/AFRO/ESPEN), Brazzaville, Republic of Congo
| | - Hayford M Howard
- Clinical Research Center, Liberia Institute for Biomedical Research, Bolahun, Liberia
- Ganta United Methodist Hospital, Ganta City, Nimba County, Liberia
| | - Germain L Mambandu
- Centre de Recherche en Maladies Tropicale de L'Ituri, Hôpital Générale de Référence de Rethy, Ituri, Democratic Republic of the Congo
- Inspection Provinciale de La Santé de La Tshopo, Division Provinciale de La Santé de La Tshopo, Kisangani, Province de La Tshopo, Democratic Republic of the Congo
| | - Maurice M Nigo
- Centre de Recherche en Maladies Tropicale de L'Ituri, Hôpital Générale de Référence de Rethy, Ituri, Democratic Republic of the Congo
- Institut Supérieur Des Techniques Médicales de Nyankunde, Bunia, Ituri, Democratic Republic of the Congo
| | - Deogratias Ucima Wonyarossi
- Centre de Recherche en Maladies Tropicale de L'Ituri, Hôpital Générale de Référence de Rethy, Ituri, Democratic Republic of the Congo
| | - Françoise Ngave
- Centre de Recherche en Maladies Tropicale de L'Ituri, Hôpital Générale de Référence de Rethy, Ituri, Democratic Republic of the Congo
| | - Kambale Kasonia Kennedy
- Centre de Recherche Clinique de Butembo, Université Catholique du Graben, Site Horizon, Butembo, Nord Kivu, Democratic Republic of the Congo
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Kambale Kataliko
- Centre de Recherche en Maladies Tropicale de L'Ituri, Hôpital Générale de Référence de Rethy, Ituri, Democratic Republic of the Congo
- Centre de Santé CECA 20 de Mabakanga, Beni, Nord Kivu, Democratic Republic of the Congo
| | - Kpehe M Bolay
- Clinical Research Center, Liberia Institute for Biomedical Research, Bolahun, Liberia
- National Public Health Institute of Liberia, Public Health & Medical Research, Monrovia, Liberia
| | - Simon K Attah
- Onchocerciasis Chemotherapy Research Center, Hohoe, Ghana
- Department of Microbiology, University of Ghana Medical School, Accra, Ghana
- Baldwin University College, Accra, Ghana
| | - George Olipoh
- Onchocerciasis Chemotherapy Research Center, Hohoe, Ghana
- National Assay Centre, Precious Minerals Marketing Company Ltd., Diamond House, Accra, Ghana
| | - Sampson Asare
- Onchocerciasis Chemotherapy Research Center, Hohoe, Ghana
- Bell Laboratories Inc, Window, WI, USA
| | - Mupenzi Mumbere
- Centre de Recherche Clinique de Butembo, Université Catholique du Graben, Site Horizon, Butembo, Nord Kivu, Democratic Republic of the Congo
- Medicines Development for Global Health (MDGH), Melbourne, Australia
| | - Michel Vaillant
- Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Grand Duchy of Luxembourg
| | - Christine M Halleux
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (WHO/TDR), World Health Organization, Geneva, Switzerland
| | - Annette C Kuesel
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (WHO/TDR), World Health Organization, Geneva, Switzerland.
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Kura K, Milton P, Hamley JID, Walker M, Bakajika DK, Kanza EM, Opoku NO, Howard H, Nigo MM, Asare S, Olipoh G, Attah SK, Mambandu GL, Kennedy KK, Kataliko K, Mumbere M, Halleux CM, Hopkins A, Kuesel AC, Kinrade S, Basáñez MG. Can mass drug administration of moxidectin accelerate onchocerciasis elimination in Africa? Philos Trans R Soc Lond B Biol Sci 2023; 378:20220277. [PMID: 37598705 PMCID: PMC10440165 DOI: 10.1098/rstb.2022.0277] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/16/2022] [Accepted: 04/11/2023] [Indexed: 08/22/2023] Open
Abstract
Epidemiological and modelling studies suggest that elimination of Onchocerca volvulus transmission (EoT) throughout Africa may not be achievable with annual mass drug administration (MDA) of ivermectin alone, particularly in areas of high endemicity and vector density. Single-dose Phase II and III clinical trials demonstrated moxidectin's superiority over ivermectin for prolonged clearance of O. volvulus microfilariae. We used the stochastic, individual-based EPIONCHO-IBM model to compare the probabilities of reaching EoT between ivermectin and moxidectin MDA for a range of endemicity levels (30 to 70% baseline microfilarial prevalence), treatment frequencies (annual and biannual) and therapeutic coverage/adherence values (65 and 80% of total population, with, respectively, 5 and 1% of systematic non-adherence). EPIONCHO-IBM's projections indicate that biannual (six-monthly) moxidectin MDA can reduce by half the number of years necessary to achieve EoT in mesoendemic areas and might be the only strategy that can achieve EoT in hyperendemic areas. Data needed to improve modelling projections include (i) the effect of repeated annual and biannual moxidectin treatment; (ii) inter- and intra-individual variation in response to successive treatments with moxidectin or ivermectin; (iii) the effect of moxidectin and ivermectin treatment on L3 development into adult worms; and (iv) patterns of adherence to moxidectin and ivermectin MDA. This article is part of the theme issue 'Challenges in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs'.
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Affiliation(s)
- Klodeta Kura
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Philip Milton
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Jonathan I. D. Hamley
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Martin Walker
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield AL9 7TA, UK
| | - Didier K. Bakajika
- Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN), African Regional Office of the World Health Organization (WHO/AFRO/ESPEN), Brazzaville, Democratic Republic of Congo
| | - Eric M. Kanza
- Programme Nationale de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive (PNLMTN-CTP), Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo
| | - Nicholas O. Opoku
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Hayford Howard
- Liberia Institute for Biomedical Research (LIBR), Monrovia, Liberia
| | - Maurice M. Nigo
- Institut Supérieur des Techniques Médicales de Nyankunde, Bunia, Democratic Republic of the Congo
| | | | - George Olipoh
- Precious Minerals Marketing Company, National Assay Centre, Technical Department, Diamond House, Accra, GA-143-2548, Ghana
| | - Simon K. Attah
- Department of Medical Microbiology, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Germain L. Mambandu
- Inspection Provinciale de la Santé de la Tshopo, Kisangani, Democratic Republic of the Congo
| | - Kambale Kasonia Kennedy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Kambale Kataliko
- Centre de Santé CECA 20 de Mabakanga, Beni, Nord Kivu, Democratic Republic of the Congo
| | - Mupenzi Mumbere
- Medicines Development for Global Health, 18 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Christine M. Halleux
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, 1211 Geneva 27, Switzerland
| | - Adrian Hopkins
- Neglected and Disabling Diseases of Poverty Consultant, Gravesend, Kent DA11 OSL, UK
| | - Annette C. Kuesel
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, 1211 Geneva 27, Switzerland
| | - Sally Kinrade
- Medicines Development for Global Health, 18 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Maria-Gloria Basáñez
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
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Bakajika D, Kanza EM, Opoku NO, Howard HM, Mambandu GL, Nyathirombo A, Nigo MM, Kennedy KK, Masembe SL, Mumbere M, Kataliko K, Bolay KM, Attah SK, Olipoh G, Asare S, Vaillant M, Halleux CM, Kuesel AC. Effect of a single dose of 8 mg moxidectin or 150 μg/kg ivermectin on O. volvulus skin microfilariae in a randomized trial: Differences between areas in the Democratic Republic of the Congo, Liberia and Ghana and impact of intensity of infection. PLoS Negl Trop Dis 2022; 16:e0010079. [PMID: 35476631 PMCID: PMC9084535 DOI: 10.1371/journal.pntd.0010079] [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: 12/12/2021] [Revised: 05/09/2022] [Accepted: 03/13/2022] [Indexed: 11/21/2022] Open
Abstract
Background Our study in CDTI-naïve areas in Nord Kivu and Ituri (Democratic Republic of the Congo, DRC), Lofa County (Liberia) and Nkwanta district (Ghana) showed that a single 8 mg moxidectin dose reduced skin microfilariae density (microfilariae/mg skin, SmfD) better and for longer than a single 150μg/kg ivermectin dose. We now analysed efficacy by study area and pre-treatment SmfD (intensity of infection, IoI). Methodology/Principal findings Four and three IoI categories were defined for across-study and by-study area analyses, respectively. We used a general linear model to analyse SmfD 1, 6, 12 and 18 months post-treatment, a logistic model to determine the odds of undetectable SmfD from month 1 to month 6 (UD1-6), month 12 (UD1-12) and month 18 (UD1-18), and descriptive statistics to quantitate inter-interindividual response differences. Twelve months post-treatment, treatment differences (difference in adjusted geometric mean SmfD after moxidectin and ivermectin in percentage of the adjusted geometric mean SmfD after ivermectin treatment) were 92.9%, 90.1%, 86.8% and 84.5% in Nord Kivu, Ituri, Lofa and Nkwanta, and 74.1%, 84.2%, 90.0% and 95.4% for participants with SmfD 10–20, ≥20-<50, ≥50-<80, ≥80, respectively. Ivermectin’s efficacy was lower in Ituri and Nkwanta than Nord Kivu and Lofa (p≤0.002) and moxidectin’s efficacy lower in Nkwanta than Nord Kivu, Ituri and Lofa (p<0.006). Odds ratios for UD1-6, UD1-12 or UD1-18 after moxidectin versus ivermectin treatment exceeded 7.0. Suboptimal response (SmfD 12 months post-treatment >40% of pre-treatment SmfD) occurred in 0%, 0.3%, 1.6% and 3.9% of moxidectin and 12.1%, 23.7%, 10.8% and 28.0% of ivermectin treated participants in Nord Kivu, Ituri, Lofa and Nkwanta, respectively. Conclusions/Significance The benefit of moxidectin vs ivermectin treatment increased with pre-treatment IoI. The possibility that parasite populations in different areas have different drug susceptibility without prior ivermectin selection pressure needs to be considered and further investigated. Clinical Trial Registration Registered on 14 November 2008 in Clinicaltrials.gov (ID: NCT00790998). Onchocerciasis or river blindness is a parasitic disease primarily in sub-Saharan Africa and Yemen. It can cause debilitating morbidity including severe itching, skin changes, visual impairment and even blindness. Many years of control efforts, today primarily based on mass administration of ivermectin (MDA) in endemic communities, have reduced morbidity and the percentage of infected individuals so that elimination of parasite transmission is now planned. WHO estimated that in 2020 more than 239 million people required MDA. Ivermectin may not be sufficiently efficacious to achieve elimination everywhere. Our study in areas in Liberia, Ghana and the Democratic Republic of the Congo where MDA had not been implemented yet showed that one treatment with 8 mg moxidectin reduced parasite levels in the skin better and for longer than one treatment with 150 μg/kg ivermectin, the dose used during MDA. Here we show that people with higher numbers of parasites in the skin benefited more from moxidectin treatment than those with lower numbers and that the efficacy of ivermectin and moxidectin differed between study areas. Provided WHO and countries include moxidectin in guidelines and policies, this information could help decisions on when and where to use moxidectin.
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Affiliation(s)
- Didier Bakajika
- Centre de Recherche en Maladies Tropicale de l’Ituri, Hôpital Générale de Référence de Rethy, Ituri, Democratic Republic of the Congo Democratic Republic of the Congo (DRC)
| | - Eric M. Kanza
- Centre de Recherche Clinique de Butembo, Université Catholique du Graben, Site Horizon, Butembo, Nord Kivu, Democratic Republic of the Congo (DRC)
| | | | - Hayford M. Howard
- Clinical Research Center, Liberia Institute for Biomedical Research, Bolahun, Liberia
| | - Germain L. Mambandu
- Centre de Recherche en Maladies Tropicale de l’Ituri, Hôpital Générale de Référence de Rethy, Ituri, Democratic Republic of the Congo Democratic Republic of the Congo (DRC)
| | - Amos Nyathirombo
- Centre de Recherche en Maladies Tropicale de l’Ituri, Hôpital Générale de Référence de Rethy, Ituri, Democratic Republic of the Congo Democratic Republic of the Congo (DRC)
| | - Maurice M. Nigo
- Centre de Recherche en Maladies Tropicale de l’Ituri, Hôpital Générale de Référence de Rethy, Ituri, Democratic Republic of the Congo Democratic Republic of the Congo (DRC)
| | - Kambale Kasonia Kennedy
- Centre de Recherche Clinique de Butembo, Université Catholique du Graben, Site Horizon, Butembo, Nord Kivu, Democratic Republic of the Congo (DRC)
| | - Safari L. Masembe
- Centre de Recherche Clinique de Butembo, Université Catholique du Graben, Site Horizon, Butembo, Nord Kivu, Democratic Republic of the Congo (DRC)
| | - Mupenzi Mumbere
- Centre de Recherche Clinique de Butembo, Université Catholique du Graben, Site Horizon, Butembo, Nord Kivu, Democratic Republic of the Congo (DRC)
| | - Kambale Kataliko
- Centre de Recherche Clinique de Butembo, Université Catholique du Graben, Site Horizon, Butembo, Nord Kivu, Democratic Republic of the Congo (DRC)
| | - Kpehe M. Bolay
- Clinical Research Center, Liberia Institute for Biomedical Research, Bolahun, Liberia
| | - Simon K. Attah
- Onchocerciasis Chemotherapy Research Center, Hohoe, Ghana
| | - George Olipoh
- Onchocerciasis Chemotherapy Research Center, Hohoe, Ghana
| | - Sampson Asare
- Onchocerciasis Chemotherapy Research Center, Hohoe, Ghana
| | - Michel Vaillant
- Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Grand Duchy of Luxembourg
| | - Christine M. Halleux
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (WHO/TDR), World Health Organization, Geneva, Switzerland
| | - Annette C. Kuesel
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (WHO/TDR), World Health Organization, Geneva, Switzerland
- * E-mail:
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Nigo MM, Odermatt P, Salieb–Beugelaar GB, Morozov O, Battegay M, Hunziker PR. Epidemiology of Schistosoma mansoni infection in Ituri Province, north-eastern Democratic Republic of the Congo. PLoS Negl Trop Dis 2021; 15:e0009486. [PMID: 34855748 PMCID: PMC8638996 DOI: 10.1371/journal.pntd.0009486] [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: 04/10/2020] [Accepted: 05/14/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Schistosomiasis, caused by Schistosoma mansoni, is of great significance to public health in sub-Saharan Africa. In the Democratic Republic of Congo (DRC), information on the burden of S. mansoni infection is scarce, which hinders the implementation of adequate control measures. We assessed the geographical distribution of S. mansoni infection across Ituri province in north-eastern DRC and determined the prevailing risk factors. METHODS/PRINCIPAL FINDINGS Two province-wide, community-based studies were conducted. In 2016, a geographical distribution study was carried out in 46 randomly selected villages across Ituri. In 2017, an in-depth study was conducted in 12 purposively-selected villages, across the province. Households were randomly selected, and members were enrolled. In 2016, one stool sample was collected per participant, while in 2017, several samples were collected per participant. S. mansoni eggs were detected using the Kato-Katz technique. In 2017, a point-of-care circulating cathodic S. mansoni antigen (POC-CCA) urine test was the second used diagnostic approach. Household and individual questionnaires were used to collect data on demographic, socioeconomic, environmental, behavioural and knowledge risk factors. Of the 2,131 participants in 2016, 40.0% were positive of S. mansoni infection. Infection prevalence in the villages ranged from 0 to 90.2%. Of the 707 participants in 2017, 73.1% were tested positive for S. mansoni. Prevalence ranged from 52.8 to 95.0% across the health districts visited. Infection prevalence increased from north to south and from west to east. Exposure to the waters of Lake Albert and the villages' altitude above sea level were associated with the distribution. Infection prevalence and intensity peaked in the age groups between 10 and 29 years. Preschool children were highly infected (62.3%). Key risk factors were poor housing structure (odds ratio [OR] 2.1, 95% 95% confidence interval [CI] 1.02-4.35), close proximity to water bodies (OR 1.72, 95% CI 1.1-2.49), long-term residence in a community (OR 1.41, 95% CI 1.11-1.79), lack of latrine in the household (OR 2.00, 95% CI 1.11-3.60), and swimming (OR 2.53, 95% CI 1.20-5.32) and washing (OR 1.75, 95% CI 1.10-2.78) in local water bodies. CONCLUSIONS/SIGNIFICANCE Our results show that S. mansoni is highly endemic and a major health concern in Ituri province, DRC. Infection prevalence and intensity, and the prevailing socioeconomic, environmental, and behavioural risk factors in Ituri reflect intense exposure and alarming transmission rates. A robust plan of action is urgently needed in the province.
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Affiliation(s)
- Maurice M. Nigo
- Nanomedicine Translation Group, Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
- CLINAM–European Foundation for Clinical Nanomedicine, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Institut Supérieur des Techniques Médicales (ISTM) Nyankunde, Bunia, Democratic Republic of Congo
| | - Peter Odermatt
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Georgette B. Salieb–Beugelaar
- Nanomedicine Translation Group, Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
- CLINAM–European Foundation for Clinical Nanomedicine, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Oleksii Morozov
- Nanomedicine Translation Group, Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
- CLINAM–European Foundation for Clinical Nanomedicine, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Manuel Battegay
- University of Basel, Basel, Switzerland
- Department of Infectiology & Hospital Hygiene, University Hospital Basel, Basel, Switzerland
| | - Patrick R. Hunziker
- Nanomedicine Translation Group, Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
- CLINAM–European Foundation for Clinical Nanomedicine, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Nigo MM, Odermatt P, Nigo DW, Salieb-Beugelaar GB, Battegay M, Hunziker PR. Morbidity associated with Schistosoma mansoni infection in north-eastern Democratic Republic of the Congo. PLoS Negl Trop Dis 2021; 15:e0009375. [PMID: 34855763 PMCID: PMC8638987 DOI: 10.1371/journal.pntd.0009375] [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: 04/18/2020] [Accepted: 04/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Reducing morbidity is the main target of schistosomiasis control efforts, yet only rarely do control programmes assess morbidity linked to Schistosoma sp. infection. In the Democratic Republic of Congo (DRC), and particularly in north-eastern Ituri Province, little is known about morbidity associated with Schistosoma mansoni infection. For this reason, we aimed to assess intestinal and hepatosplenic morbidity associated with S. mansoni infection in Ituri Province. METHODS/PRINCIPAL FINDINGS In 2017, we conducted a cross-sectional study in 13 villages in Ituri Province, DRC. S. mansoni infection was assessed with a Kato-Katz stool test (2 smears) and a point-of-care circulating cathodic antigen (POC-CCA) urine test. A questionnaire was used to obtain demographic data and information about experienced intestinal morbidity. Each participant underwent an abdominal ultrasonography examination to diagnose hepatosplenic morbidity. Of the 586 study participants, 76.6% tested positive for S. mansoni. Intestinal morbidity reported in the two preceding weeks was very frequent, and included abdominal pain (52.7%), diarrhoea (23.4%) and blood in the stool (21.5%). Hepatosplenic morbidity consisted of abnormal liver parenchyma patterns (42.8%), hepatomegaly (26.5%) and splenomegaly (25.3%). Liver pathology (adjusted odds ratio [aOR] 1.20, 95% confidence interval [CI] 1.06-1.37, p = 0.005) was positively and significantly associated with S. mansoni infection. Hepatomegaly (aOR 1.52, 95% CI 0.99-2.32, p = 0.053) and splenomegaly (aOR 1.12, 95% CI 0.73-1.72, p = 0.619) were positively but not significantly associated with S. mansoni infection at the individual level. At the village level, S. mansoni prevalence was positively associated with the prevalence of hepatomegaly and splenomegaly. High-intensity S. mansoni infections were associated with diarrhoea, blood in the stool, hepatomegaly, splenomegaly, and liver parenchyma (C, D, E and F pathology patterns). Four study participants were diagnosed with ascites and five reported hematemesis. CONCLUSIONS/SIGNIFICANCE Our study documents a high burden of intestinal and hepatosplenic morbidity associated with S. mansoni infection status in Ituri Province. The findings call for targeted interventions to address both S. mansoni infection and related morbidity.
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Affiliation(s)
- Maurice M. Nigo
- Nanomedicine Translation Group, Medical Intensive Care Clinic, University Hospital Basel University of Basel, Basel, Switzerland
- CLINAM—European Foundation for Clinical Nanomedicine, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Institut Supérieur des Techniques Médicales (ISTM) Nyankunde, Democratic Republic of Congo
| | - Peter Odermatt
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - David Wully Nigo
- Centre Hospitalier, Ingbokolo Town, Democratic Republic of Congo
| | - Georgette B. Salieb-Beugelaar
- Nanomedicine Translation Group, Medical Intensive Care Clinic, University Hospital Basel University of Basel, Basel, Switzerland
- CLINAM—European Foundation for Clinical Nanomedicine, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Manuel Battegay
- University of Basel, Basel, Switzerland
- Department of Infectiology & Hospital Hygiene, University Hospital Basel, Basel, Switzerland
| | - Patrick R. Hunziker
- Nanomedicine Translation Group, Medical Intensive Care Clinic, University Hospital Basel University of Basel, Basel, Switzerland
- CLINAM—European Foundation for Clinical Nanomedicine, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Nigo MM, Odermatt P, Nigo DW, Salieb-Beugelaar GB, Battegay M, Hunziker PR. Patients with severe schistosomiasis mansoni in Ituri Province, Democratic Republic of the Congo. Infect Dis Poverty 2021; 10:39. [PMID: 33762007 PMCID: PMC7992822 DOI: 10.1186/s40249-021-00815-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 03/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severe hepatosplenic complications arise in patients with chronic Schistosoma mansoni infection after heavy exposure to disease agents in endemic areas. These complications are rarely reported and, hence, underestimated. CASE PRESENTATION We report on eight patients with severe morbidity associated with S. mansoni infection in Ituri Province, northeastern Democratic Republic of Congo (DRC). The patients were identified during a community-based survey in 2017; one patient was seen at the district hospital. After taking the patients' history, a clinical examination and an abdominal ultrasonographical examination were performed. S. mansoni infection was diagnosed in fecal (Kato-Katz technique) and urine (point-of-case circulating cathodic antigen test) samples. These eight patients with severe intestinal and hepatosplenic complications were identified from four villages with high S. mansoni infection prevalence and related morbidity. The patients' ages ranged from 19 to 57 years; four patients were women. Three patients reported hematemesis. Two patients were severely anemic. All patients reported non-specific abdominal symptoms, such as diarrhea (six patients), abdominal pain (seven patients), and blood in the stool (five patients), as well as weight loss (two patients). Abdominal ultrasonography revealed ascites in four patients. All patients had portal hypertension with hepatomegaly (seven patients) or splenomegaly (five patients). Of the six patients with a discernable liver parenchyma pattern, five displayed pattern F and three patient displayed pattern E. Liver parenchyma was not visible for two patients with severe ascites. An S. mansoni infection was confirmed in six patients, with infection intensity ranging from light to heavy. All S. mansoni positive patients were treated with praziquantel (40 mg/kg body weight) and referred to the district hospital for follow-up. One patient with severe ascites died two weeks after we saw her. Due to security and accessibility reasons, the villages could not be visited again and the patients were lost to follow-up. CONCLUSIONS Our observations of patients with severe schistosomiasis document the severe degree of endemicity of S. mansoni in the province and suggest an urgent need for adequate schistosomiasis control measures that target vulnerable population groups and address severe complications.
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Affiliation(s)
- Maurice M Nigo
- Nanomedicine Translation Group, Intensive Care Unit, University Hospital Basel University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
- CLINAM-European Foundation for Clinical Nanomedicine, Alemannengasse 12, P.O. Box, 4016, Basel, Switzerland.
- University of Basel, Petersplatz 1, Basel, Switzerland.
- Institut Supérieur Des Techniques Médicales (ISTM) Nyankunde, BP 55, Bunia, Democratic Republic of Congo.
| | - Peter Odermatt
- University of Basel, Petersplatz 1, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland
| | | | - Georgette B Salieb-Beugelaar
- Nanomedicine Translation Group, Intensive Care Unit, University Hospital Basel University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- CLINAM-European Foundation for Clinical Nanomedicine, Alemannengasse 12, P.O. Box, 4016, Basel, Switzerland
- University of Basel, Petersplatz 1, Basel, Switzerland
| | - Manuel Battegay
- University of Basel, Petersplatz 1, Basel, Switzerland
- Department of Infectiology and Hospital Hygiene, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Patrick R Hunziker
- Nanomedicine Translation Group, Intensive Care Unit, University Hospital Basel University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- CLINAM-European Foundation for Clinical Nanomedicine, Alemannengasse 12, P.O. Box, 4016, Basel, Switzerland
- University of Basel, Petersplatz 1, Basel, Switzerland
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Opoku NO, Bakajika DK, Kanza EM, Howard H, Mambandu GL, Nyathirombo A, Nigo MM, Kasonia K, Masembe SL, Mumbere M, Kataliko K, Larbelee JP, Kpawor M, Bolay KM, Bolay F, Asare S, Attah SK, Olipoh G, Vaillant M, Halleux CM, Kuesel AC. Single dose moxidectin versus ivermectin for Onchocerca volvulus infection in Ghana, Liberia, and the Democratic Republic of the Congo: a randomised, controlled, double-blind phase 3 trial. Lancet 2018; 392:1207-1216. [PMID: 29361335 PMCID: PMC6172290 DOI: 10.1016/s0140-6736(17)32844-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 09/25/2017] [Accepted: 11/02/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The morbidity and socioeconomic effects of onchocerciasis, a parasitic disease that is primarily endemic in sub-Saharan Africa, have motivated large morbidity and transmission control programmes. Annual community-directed ivermectin treatment has substantially reduced prevalence. Elimination requires intensified efforts, including more efficacious treatments. We compared parasitological efficacy and safety of moxidectin and ivermectin. METHODS This double-blind, parallel group, superiority trial was done in four sites in Ghana, Liberia, and the Democratic Republic of the Congo. We enrolled participants (aged ≥12 years) with at least 10 Onchocerca volvulus microfilariae per mg skin who were not co-infected with Loa loa or lymphatic filariasis microfilaraemic. Participants were randomly allocated, stratified by sex and level of infection, to receive a single oral dose of 8 mg moxidectin or 150 μg/kg ivermectin as overencapsulated oral tablets. The primary efficacy outcome was skin microfilariae density 12 months post treatment. We used a mixed-effects model to test the hypothesis that the primary efficacy outcome in the moxidectin group was 50% or less than that in the ivermectin group. The primary efficacy analysis population were all participants who received the study drug and completed 12-month follow-up (modified intention to treat). This study is registered with ClinicalTrials.gov, number NCT00790998. FINDINGS Between April 22, 2009, and Jan 23, 2011, we enrolled and allocated 998 participants to moxidectin and 501 participants to ivermectin. 978 received moxidectin and 494 ivermectin, of which 947 and 480 were included in primary efficacy outcome analyses. At 12 months, skin microfilarial density (microfilariae per mg of skin) was lower in the moxidectin group (adjusted geometric mean 0·6 [95% CI 0·3-1·0]) than in the ivermectin group (4·5 [3·5-5·9]; difference 3·9 [3·2-4·9], p<0·0001; treatment difference 86%). Mazzotti (ie, efficacy-related) reactions occurred in 967 (99%) of 978 moxidectin-treated participants and in 478 (97%) of 494 ivermectin-treated participants, including ocular reactions (moxidectin 113 [12%] participants and ivermectin 47 [10%] participants), laboratory reactions (788 [81%] and 415 [84%]), and clinical reactions (944 [97%] and 446 [90%]). No serious adverse events were considered to be related to treatment. INTERPRETATION Skin microfilarial loads (ie, parasite transmission reservoir) are lower after moxidectin treatment than after ivermectin treatment. Moxidectin would therefore be expected to reduce parasite transmission between treatment rounds more than ivermectin could, thus accelerating progress towards elimination. FUNDING UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases.
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Affiliation(s)
- Nicholas O Opoku
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | | | - Eric M Kanza
- Centre de Recherche Clinique de Butembo (CRCB), Departement de la Recherche aux Cliniques du Graben, Université Catholique du Graben (UCG), Butembo, Democratic Republic of the Congo
| | | | - Germain L Mambandu
- Ministère Provincial de la Santé, Kisangani, Democratic Republic of the Congo
| | - Amos Nyathirombo
- Department of Ophthalmology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Maurice M Nigo
- Nanomedicine Research Lab, CLINAM, University Hospital Basel, Basel, Switzerland
| | - Kambale Kasonia
- Centre de Recherche Clinique de Butembo (CRCB), Departement de la Recherche aux Cliniques du Graben, Université Catholique du Graben (UCG), Butembo, Democratic Republic of the Congo
| | - Safari L Masembe
- Centre de Recherche Clinique de Butembo (CRCB), Departement de la Recherche aux Cliniques du Graben, Université Catholique du Graben (UCG), Butembo, Democratic Republic of the Congo
| | - Mupenzi Mumbere
- Centre de Recherche Clinique de Butembo (CRCB), Departement de la Recherche aux Cliniques du Graben, Université Catholique du Graben (UCG), Butembo, Democratic Republic of the Congo
| | - Kambale Kataliko
- Centre de Recherche Clinique de Butembo (CRCB), Departement de la Recherche aux Cliniques du Graben, Université Catholique du Graben (UCG), Butembo, Democratic Republic of the Congo
| | | | - Mawolo Kpawor
- Liberia Institute for Biomedical Research (LIBR), Monrovia, Liberia
| | - Kpehe M Bolay
- Liberia Institute for Biomedical Research (LIBR), Monrovia, Liberia
| | - Fatorma Bolay
- Liberia Institute for Biomedical Research (LIBR), Monrovia, Liberia
| | - Sampson Asare
- Department of Chemistry and Biochemistry, South Dakota State University, Brookings, SD, USA
| | - Simon K Attah
- Department of Microbiology, University of Ghana Medical School, Accra, Ghana
| | - George Olipoh
- Ghana Institute of Management and Public Administration, Centre for Management Development, Accra, Ghana
| | - Michel Vaillant
- Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Christine M Halleux
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), WHO, Geneva, Switzerland
| | - Annette C Kuesel
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), WHO, Geneva, Switzerland.
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Salieb-Beugelaar GB, Zhang B, Nigo MM, Frischmann S, Hunziker PR. Improving diagnosis of pneumococcal disease by multiparameter testing and micro/nanotechnologies. European Journal of Nanomedicine 2016. [DOI: 10.1515/ejnm-2016-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
AbstractThe diagnosis and management of pneumococcal disease remains challenging, in particular in children who often are asymptomatic carriers, and in low-income countries with a high morbidity and mortality from febrile illnesses where the broad range of bacterial, viral and parasitic cases are in contrast to limited, diagnostic resources. Integration of multiple markers into a single, rapid test is desirable in such situations. Likewise, the development of multiparameter tests for relevant arrays of pathogens is important to avoid overtreatment of febrile syndromes with antibiotics. Miniaturization of tests through use of micro- and nanotechnologies combines several advantages: miniaturization reduces sample requirements, reduces the use of consumables and reagents leading to a reduction in costs, facilitates parallelization, enables point-of-care use of diagnostic equipment and even reduces the amount of potentially infectious disposables, characteristics that are highly desirable in most healthcare settings. This critical review emphasizes our vision on the importance of multiparametric testing for diagnosing pneumococcal infections in patients with fever and examines recent relevant developments in micro/nanotechnologies to achieve this goal.
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Bakajika DK, Nigo MM, Lotsima JP, Masikini GA, Fischer K, Lloyd MM, Weil GJ, Fischer PU. Filarial antigenemia and Loa loa night blood microfilaremia in an area without bancroftian filariasis in the Democratic Republic of Congo. Am J Trop Med Hyg 2014; 91:1142-1148. [PMID: 25223938 PMCID: PMC4257636 DOI: 10.4269/ajtmh.14-0358] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Implementation of mass drug administration for lymphatic filariasis (LF) has been delayed in central Africa because of incomplete mapping and coendemic loiasis. We mapped two regions in eastern Democratic Republic of Congo that were suspected to have LF. Night blood samples were collected from 2,724 subjects in 30 villages. Filarial antigenemia rates by card test exceeded 1% in 28 villages (range = 0–14%). Prevalence rates for large sheathed microfilariae (Mf) ranged from 4% to 40%; Mansonella perstans rates ranged from 22% to 98%. Large Mf were exclusively Loa loa by microscopy, and only 1 of 337 samples tested by quantitative polymerase chain reaction (qPCR) was positive for Wuchereria bancrofti DNA. Filarial antigen positivity was strongly associated with high L. loa Mf counts. Periodicity studies revealed atypical patterns, with no significant diurnal periodicity in some individuals. Thus, methods routinely used for LF mapping may not be reliable in areas in central Africa that are highly endemic for loiasis.
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Affiliation(s)
| | | | | | | | | | | | | | - Peter U. Fischer
- *Address correspondence to Peter U. Fischer, Infectious Diseases Division, Department of Internal Medicine, Washington University School of Medicine, 4444 Forest Parkway, St. Louis, MO 63110. E-mail:
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Chetoui H, Melin P, Struelens MJ, Delhalle E, Nigo MM, De Ryck R, De Mol P. Comparison of biotyping, ribotyping, and pulsed-field gel electrophoresis for investigation of a common-source outbreak of Burkholderia pickettii bacteremia. J Clin Microbiol 1997; 35:1398-403. [PMID: 9163452 PMCID: PMC229757 DOI: 10.1128/jcm.35.6.1398-1403.1997] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Over a 3-month period, six immunocompromised patients developed one or more episodes of Burkholderia pickettii bacteremia and/or catheter infection. Vials of a commercially available, "sterile" saline for injection which had been used for flushing the patients' indwelling intravenous devices were implicated as the common source of the organisms. No further cases were diagnosed once the use of this saline was discontinued. Twenty-six isolates, including 9 outbreak-related strains from case patients and contaminated saline as well as 17 control strains, were tested comparatively by biotyping, ribotyping with EcoRI and HindIII, and pulsed-field gel electrophoresis (PFGE) with SpeI. Macrorestriction analysis revealed nine PFGE groups and was more discriminating than ribotyping (seven ribotypes) and biotyping (two biovars). Among the outbreak-related isolates, one B. pickettii type was found by the three typing methods. Furthermore, PFGE was useful for subdividing ribotypes and for distinguishing isolates involved in the outbreak from all epidemiologically unrelated strains.
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Affiliation(s)
- H Chetoui
- Service de Microbiologie Médicale, Institut de Pathologie, Universitéde Liège, Belgium
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