Microgeographic variations in Burkitt's lymphoma incidence correlate with differences in malnutrition, malaria and Epstein-Barr virus

BACKGROUND

Endemic Burkitt's lymphoma (eBL) has been associated with Epstein-Barr virus (EBV) and holoendemic Plasmodium falciparum malaria. But recent evidence suggests that other risk factors are involved.

METHODS

We hypothesised that selenoprotein glutathione peroxidase (GPx), a surrogate of nutritional status, is an important biomarker for eBL risk. We measured plasma GPx, anthropometric markers of malnutrition, EBV viral loads and malaria parasitaemia in children aged 1-9 years (n=258) from two locations in Nyanza Province, Kenya, with higher-than-expected and lower-than-expected incidence of eBL. The study participants were malaria asymptomatic children from the community.

RESULTS

Children from eBL high-incidence areas had significantly lower GPx levels, high EBV viral load and more evidence of chronic malnutrition than children from eBL low-incidence areas (all P<0.001). Additionally, GPx levels were significantly lower in children with the highest EBV viral load and for those with P. falciparum infections (P=0.035 and P=0.004, respectively).

CONCLUSIONS

These results suggest that selenium deficiency may be a risk factor for eBL.

Accuracy of an anaemia scoring chart applied on goats in sub-humid Kenya and its potential for control of Haemonchus contortus infections

We tested the practical application of an anaemia scoring chart (the FAMACHA chart) as a method for controlling Haemonchus contortus in goats kept under smallholder conditions in a sub-humid area of Central Kenya. The objectives were: (1) to test the accuracy of the FAMACHA chart in identifying anaemic goats (PCV< or =18); (2) to quantify the proportion of goats left untreated at farm level when using the chart. On each of two farms, Small East African goats of various ages were allocated to two treatment groups; a FAMACHA group (F1 (n=34) and F2 (n=31) on farms 1 and 2, respectively) and a control group (C1 (n=34) and C2 (n=30)). In F1 and F2 goats with a FAMACHA score of 3, 4 or 5 were treated with anthelmintic after scoring. In C1 and C2 goats were treated every 4 weeks from 15 February to 20 July. Every 2 weeks all goats were scored with the FAMACHA chart and weighed. Furthermore, faecal samples were collected for faecal egg counts (FEC) and blood samples were collected for packed cell volume (PCV) determination. H. contortus was found to be the predominant nematode on both farms. The mean FECs were higher on farm 1 compared to farm 2, while in contrast the mean PCV levels were lowest on farm 2. The latter was most likely due to the presence of Fasciola spp., flea and tick infections on farm 2. The accuracy of the chart was evaluated by using PCV as the gold standard for anaemia (PCV< or =18%). The mean percentage of false-negative scorings per sampling was 0.7% on farm 1 and 1.6% on farm 2, while the mean percentage of false-positive scorings was 9.7% and 21.4%, respectively. It is most likely that the accuracy of the chart was negatively affected by the concurrent parasite infections on farm 2. The mean proportion of untreated goats per sampling was 89% and 77% on farm 1 and farm 2. It was concluded that the FAMACHA chart can be a valuable tool for decision-making in control of H. contortus in goats kept under smallholder conditions, without morbidity or mortality unacceptable to the farmer. The application may further reduce the risk of development of anthelmintic resistance by increasing refugia. However, caution should be taken under conditions where other anaemia-causing parasites are present (e.g. Fasciola spp. and ecto-parasites), since this possibly decreases the accuracy of the FAMACHA chart.

Effects of three anthelmintic treatment regimes against Fasciola and nematodes on the performance of ewes and lambs on pasture in the highlands of Kenya

The efficacy of strategic anthelmintic control of liver flukes (Fasciola) and gastrointestinal (GI) nematodes on the performance of ewes and lambs on pasture was assessed on a farm in the highlands of Kenya. In May 1999, 45 Corriedale ewes, aged between 2 and 3 years, were ear-tagged, weighed and allocated randomly to three equal treatment groups based on body weight. Faecal samples taken at this time revealed low levels of strongyle-type eggs per gram of faeces (EPG) and the presence of liver fluke eggs in only a few of the animals. All the animals were then set stocked for 12 months on separate paddocks in an area endemic for both Fasciola and GI nematodes. The ewes in group 1 were given a combined anthelmintic treatment against Fasciola and GI nematodes during the periods recommended for the control of Fasciola in the area (February, June and October). The ewes in group 2 were given the combined treatments 3 weeks after the onset of both the short and long rainy seasons (November and April, respectively). Those in group 3 were given separate treatments for Fasciola (February, June and October) and nematodes (3 weeks after the onset of the rainy seasons). The anthelmintic treatment against Fasciola consisted of triclabendazole at 10 mg per kg body weight, and that against nematodes was levamisole at 10 mg per kg body weight. The nematode EPG for the ewes in group 1 were higher than in groups 2 and 3 during both rainy seasons. The nematode EPG did not differ significantly between groups 2 and 3. The prevalence of Fasciola eggs (number of ewes shedding eggs in a group) in the ewes in groups I and 3 remained very low throughout the study period compared to those in group 2. The highest birth weights and the weight gains of lambs were recorded for the group of ewes given separate anthelmintic treatments for Fasciola and nematodes (group 3). The results of this trial indicated that, in an area like Nyandarua District, where liver flukes and GI nematodes are important constraints to sheep production, the best practice is to give separate treatments for the two groups of parasites at the recommended times.

Strategic control of gastrointestinal nematodes of sheep in the highlands of central Kenya

The effectiveness of anthelmintic treatments given 3 weeks after the onset of rains to control gastrointestinal nematodes in sheep in the highlands of central Kenya was investigated. The study was carried out on a farm situated approximately 85 km north west of Nairobi in Nyandarua District of central Kenya. In May 1999, 35 Corriedale ram lambs aged between 8 and 10 months were eartagged, weighed and given albendazole at 3.8 mg/kg body mass. The animals were then allocated to three treatment groups. Three weeks after onset of both the short and long rains' season in November 1999 and April 2000 respectively, lambs in groups 1 and 2 were dewormed. Lambs in group 1 were given closantel at 10 mg/kg body mass in November and closantel plus albendazole at 3.8 mg/kg body mass in April. Lambs in group 2 were given albendazole at 3.8 mg/kg body mass on both occasions, while lambs in group 3 were maintained as the untreated controls. Nematode eggs per gram of faeces (epg) for lambs in the control group were significantly higher (P < 0.05) than in the treated groups beginning from November, when the strategic treatments started. The levels of epg did not differ significantly between the two treated groups. Body mass for the treated groups was significantly higher (P< 0.05) than for the control group from January 2000 until the experiment was terminated. The rainfall received in the study area in 2000 during the long rain season was inadequate and only occurred for a short period. The amount of herbage on pastures was therefore not adequate and all the study animals started losing mass from June 2000 until the experiment was terminated. The cumulative mass gain and amount of wool produced by the treated lambs during the study period did not differ significantly. There was therefore no difference in using either of the two drugs. It is concluded that, strategic anthelmintic treatments of sheep at the start of the wet season in the highlands of central Kenya is effective in controlling gastrointestinal nematodes. To prevent high levels of re-infection during the season of the long rains (April to June), it is recommended that, during this season, a second treatment be given 5-6 weeks after the first one or at the start of the dry season.

Seasonal availability of gastrointestinal nematode larvae to cattle on pasture in the central highlands of Kenya

The type and level of infective strongylid nematode larvae on pasture were monitored fortnightly from July 1995 to June 1996 in the central highlands of Kenya. The number of larvae on pasture was moderate, reaching > 1,200 kg(-1) dry matter of grass during the period of, and soon after, the rains, and remained low in the dry seasons. The number of larvae on pasture was directly related to the rain-fall pattern which was found to be the most important factor for the development of eggs and free-living stages. Haemonchus was the predominant genus, followed in decreasing order by Trichostrongylus, Cooperia, Oesophagostomum and Bunostomum. The mean total adult worm burdens of tracer calves released at monthly intervals were related to the levels of herbage larvae and there was a positive correlation between faecal worm egg counts and worm burdens (r = 0.58) during the study period. These results indicate that a reduction in the contamination of pasture with nematode eggs before the rains could result in pastures carrying fewer larvae and thus form the basis of effective worm control programmes for cattle.

Comparative efficacies of closantel, ivermectin, oxfendazole, thiophanate and levamisole against thiabendazole resistant Haemonchus contortus in sheep

Forty-nine sheep artificially exposed to a thiabendazole (TBZ) resistant isolate of Haemonchus contortus were assigned to 7 groups of 7 animals each and used to conduct a controlled anthelmintic trial. One group of sheep served as untreated infected controls and 6 groups were treated as follows: closantel, 5.0 mg kg-1; ivermectin, 0.2 mg kg-1; oxfendazole, 5.0 mg kg-1; thiophanate, 50 mg kg-1, levamisole, 7.5 mgkg-1 and thiabendazole, 66 mg kg-1. Eggs per gram of faeces were determined on days 21, 24 and day 34 (10 days post-treatment) after infection and all animals were necropsied for residual worm counts. The calculated efficacies of the treatments against H. contortus as indicated by worm reduction were closantel (100%), ivermectin (99.3%), oxfendazole (35.2%), thiophanate (56.7%), levamisole (98.6%) and thiabendazole (24.3%). The data therefore indicate that the TBZ-resistant isolate of H. contortus used was highly resistant to the 2 benzimidazole (BZ) anthelmintics, oxfendazole and thiophanate. This is the first report in Kenya of a field strain of H. contortus resistant to thiophanate.