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Tshimbombu TN, Shin M, Thesen T, Mesu’a Kabwa L, Blackmon K, Kashama JMKW, Jobst BC, Fontaine D, Olarinde I, Okitundu‐Luwa E‐Andjafono D. Review of epilepsy care in the Democratic Republic of the Congo. Epilepsia Open 2024; 9:467-474. [PMID: 38243880 PMCID: PMC10984300 DOI: 10.1002/epi4.12904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/04/2024] [Accepted: 01/11/2024] [Indexed: 01/22/2024] Open
Abstract
Epilepsy imposes a substantial burden on the Democratic Republic of Congo (DRC). These challenges encompass the lack of comprehensive disease surveillance, an unresolved understanding of its pathophysiology, economic barriers limiting access to essential care, the absence of epilepsy surgical capabilities, and deeply ingrained societal stigmas. Notably, the national prevalence of epilepsy remains undetermined, with research primarily concentrating on infectious factors like Onchocerca volvulus, leaving other potential causes underexplored. Most patients lack insurance, incurring out-of-pocket expenses that often lead them to opt for traditional medicine rather than clinical care. Social stigma, perpetuated by common misconceptions, intensifies the social isolation experienced by individuals living with epilepsy. Additionally, surgical interventions are unavailable, and the accessibility of anti-seizure medications and healthcare infrastructure remains inadequate. Effectively tackling these interrelated challenges requires a multifaceted approach, including conducting research into region-specific factors contributing to epilepsy, increasing healthcare funding, subsidizing the costs of treatment, deploying mobile tools for extensive screening, launching awareness campaigns to dispel myths and reduce stigma, and promoting collaborations between traditional healers and medical practitioners to enhance local understanding and epilepsy management. Despite the difficulties, significant progress can be achieved through sustained and compassionate efforts to understand and eliminate the barriers faced by epilepsy patients in the region. This review outlines essential steps for alleviating the epilepsy burden in the DRC. PLAIN LANGUAGE SUMMARY: There are not enough resources to treat epilepsy in the DRC. PWEs struggle with stigma and the lack of money. Many of them still use traditional medicine for treatment and hold wrong beliefs about epilepsy. That is why there is a need for more resources to make the lives of PWEs better in the DRC.
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Affiliation(s)
| | | | - Thomas Thesen
- Geisel School of Medicine at DartmouthHanoverNew HampshireUSA
| | - Luabeya Mesu’a Kabwa
- Department of Neurology and Neuropsychiatry, Center for Neuro‐Psycho‐Pathology of Mont‐Amba, Faculty of MedicineUniversity of KinshasaKinshasaDemocratic Republic of Congo
- Centre Hospitalier ValisanaBrusselsBelgium
| | - Karen Blackmon
- Department of Psychiatry and PsychologyMayo ClinicJacksonvilleFloridaUSA
| | - Jean Marie Kashama wa Kashama
- Department of Neurology and Neuropsychiatry, Center for Neuro‐Psycho‐Pathology of Mont‐Amba, Faculty of MedicineUniversity of KinshasaKinshasaDemocratic Republic of Congo
| | - Barbara C. Jobst
- Department of Neurology, Geisel School of Medicine at DartmouthDartmouth‐Hitchcock Medical CenterLebanonNew HampshireUSA
| | | | - Immanuel Olarinde
- Richmond Gabriel University College of MedicineBelairSaint Vincent and the Grenadines
| | - Daniel Okitundu‐Luwa E‐Andjafono
- Department of Neurology and Neuropsychiatry, Center for Neuro‐Psycho‐Pathology of Mont‐Amba, Faculty of MedicineUniversity of KinshasaKinshasaDemocratic Republic of Congo
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Amaral LJ, Jada SR, Ndjanfa AK, Carter JY, Abd-Elfarag G, Okaro S, Logora MY, Bol YY, Lakwo T, Fodjo JNS, Colebunders R. Impact of annual community-directed treatment with ivermectin on the incidence of epilepsy in Mvolo, a two-year prospective study. PLoS Negl Trop Dis 2024; 18:e0012059. [PMID: 38512994 PMCID: PMC10986994 DOI: 10.1371/journal.pntd.0012059] [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: 12/11/2023] [Revised: 04/02/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVES The potential impact of cumulative community-directed treatment with ivermectin (CDTI) on epilepsy epidemiology in Mvolo County, South Sudan, an onchocerciasis-endemic area with high epilepsy prevalence, was investigated. Annual CDTI was introduced in 2002 in Mvolo, with interruptions in 2016 and 2020. METHODS Comprehensive house-to-house surveys in Mvolo (June 2020 and 2022) identified cases of epilepsy, including probable nodding syndrome (pNS). Community workers screened households in selected sites for suspected epilepsy, and medical doctors confirmed the diagnosis and determined the year of seizure onset. The incidence of epilepsy, including pNS, was analysed using 95% confidence intervals (CIs). Data on ivermectin intake and onchocerciasis-associated manifestations (itching and blindness) were collected. RESULTS The surveys covered 15,755 (2020) and 15,092 (2022) individuals, identifying 809 (5.2%, 95% CI: 4.8-5.5%) and 672 (4.5%, 95% CI: 4.1-4.8%) epilepsy cases, respectively. Each survey reported that a third of the surveyed population experienced skin itching, and 3% were blind. Epilepsy incidence per 100,000 person-years gradually declined, from 326.5 (95% CI: 266.8-399.1) in 2013-2015 to 96.6 (95% CI: 65.5-141.7) in 2019-2021. Similarly, pNS incidence per 100,000 person-years decreased from 151.7 (95% CI: 112.7-203.4) to 27.0 (95% CI: 12.5-55.5). Coverage of CDTI was suboptimal, reaching only 64.0% of participants in 2019 and falling to 24.1% in 2021 following an interruption in 2020 due to COVID-19 restrictions. Additionally, while 99.4% of cases had active epilepsy in 2022, less than a quarter of these had access to antiseizure medication. CONCLUSIONS The observed decrease in epilepsy incidence despite suboptimal CDTI coverage highlights the potential impact of onchocerciasis control efforts and underscores the need to strengthen these efforts in Mvolo County and across South Sudan. As a proactive measure, Mvolo and neighbouring counties are transitioning to biannual CDTI. Furthermore, the substantial epilepsy treatment gap in Mvolo should be addressed.
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Affiliation(s)
| | | | | | | | - Gasim Abd-Elfarag
- Amref Health Africa, South Sudan
- Access for Humanity, Juba, South Sudan
- School of Public Health, University of Juba, Juba, South Sudan
| | | | - Makoy Yibi Logora
- Neglected Tropical Diseases Unit, Ministry of Health, Juba, South Sudan
| | - Yak Yak Bol
- Neglected Tropical Diseases Unit, Ministry of Health, Juba, South Sudan
| | - Thomson Lakwo
- Vector Control Division, Ministry of Health, Kampala, Uganda
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Metanmo S, Dossa D, Ahmat DN, Winkler AS, Boumediene F. Mapping, Associated Factors, and Pathophysiology of Nodding Syndrome in Africa: A Systematic Review. Neuroepidemiology 2024; 58:92-119. [PMID: 38171341 DOI: 10.1159/000536013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Nodding syndrome (NS) remains a poorly understood disorder. For a long time, it has been thought to be restricted to East Africa; however, cases in Central Africa have been increasing over time. The objective of this systematic review (SR) was to provide a summary of the state of knowledge on NS to date. METHODS All original articles published on NS up to November 2021 were searched in four major databases and in the gray literature. Commentaries, editorials, book chapters, books, conference paper, qualitative studies that mentioned NS cases were also included. Data retrieved included study location (with GPS coordinates searched), year of study and publication, population characteristics, definition and diagnosis of NS, associated factors, and treatment if applicable. A meta-analysis of associated factors was performed where possible, and results were presented as odds ratios (ORs) and visualized as forest plots. Geographic information systems were used for cartographic representations. The quality of the articles included was assessed. RESULTS Of the 876 articles initially identified, 67 (corresponding to 59 studies) were included in the SR. NS is only present in Central and East Africa. Interestingly, there were reports of NS in Central Africa prior to 2010, earlier than previously thought. The way NS diagnosis was established varies according to studies, and the 2012 WHO classification was used in only 60% of the studies. Approximately 11% of the articles did not meet the quality requirements set for this review. In our meta-analysis, the main factor associated with NS was onchocerciasis (OR = 8.8 [4.8, 15.9]). However, the pathophysiology of the disease remains poorly understood. The lack of common anti-epileptic drugs is a significant barrier to the management of head nodding and associated epileptic seizures. DISCUSSION/CONCLUSION The lack of an operational definition of NS is an obstacle to its diagnosis and, thus, to its appropriate treatment. Indeed, diagnostic difficulties might have led to false positives and false negatives which could have altered the picture of NS presented in this article. Treatment should take into account nutritional and psychological factors, as well as associated infections. Some risk factors deserve further investigation; therefore, we suggest a multicentric study with an etiological focus using a more operational definition of NS.
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Affiliation(s)
- Salvatore Metanmo
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France
| | - Djamirou Dossa
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France
| | - Djibrine Nassir Ahmat
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France
| | - Andrea Sylvia Winkler
- Department of Neurology, Center for Global Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Farid Boumediene
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France,
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Colebunders R, Siewe Fodjo JN, Kamoen O, Amaral LJ, Hadermann A, Trevisan C, Taylor MJ, Gauglitz J, Hoerauf A, Sato Y, Polman K, Basáñez MG, Bhwana D, Lakwo T, Abd-Elfarag G, Pion SD. Treatment and prevention of epilepsy in onchocerciasis-endemic areas is urgently needed. Infect Dis Poverty 2024; 13:5. [PMID: 38212805 PMCID: PMC10785461 DOI: 10.1186/s40249-024-01174-8] [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: 11/22/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND There is increasing epidemiological evidence supporting the association between onchocerciasis and seizures, reinforcing the concept of onchocerciasis-associated epilepsy (OAE). The aim of this paper is to provide an update on the new knowledge about OAE and to propose recommendations to the World Health Organization how to address this public health problem. MAIN TEXT During the 2nd International Workshop on OAE held on 19-21 September, 2023, in Antwerp, Belgium, participants recognised OAE as a substantial yet neglected public health problem, particularly in areas of sub-Saharan Africa where onchocerciasis remains hyperendemic. Evidence from prospective population-based studies suggest that strengthening onchocerciasis elimination efforts leads to a significant reduction of OAE incidence. There is a need to validate an OAE case definition to estimate the burden of disease and identify onchocerciasis-endemic areas requiring intensification of onchocerciasis elimination programmes and integration of epilepsy care. It is expected that raising awareness about OAE will boost the population uptake of ivermectin. The implementation of a community-based epilepsy treatment programme offering free anti-seizure medications (ASMs) has shown high effectiveness in reducing the frequency of seizures and improving the overall quality of life of people with epilepsy. CONCLUSIONS To reduce OAE burden, enhanced collaboration between onchocerciasis and mental health programmes at community, national, and international levels is required. Urgent efforts are needed to ensure the uninterrupted provision of free ASMs in onchocerciasis-endemic areas. Furthermore, OAE should be included in the quantification of the onchocerciasis disease burden.
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Affiliation(s)
| | | | - Olivia Kamoen
- Department of Neurology, Heilig Hart Ziekenhuis, Lier, Belgium
| | | | - Amber Hadermann
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Chiara Trevisan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Mark J Taylor
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Julia Gauglitz
- Department of Computer Science, University of Antwerp, Antwerp, Belgium
| | - Achim Hoerauf
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn, Germany
| | - Yasuaki Sato
- School of Global Humanities and Social Sciences, Nagasaki University, Nagasaki, Japan
| | - Katja Polman
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - María-Gloria Basáñez
- MRC Centre for Global Infectious Disease Analysis and London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Dan Bhwana
- National Institute for Medical Research, Tanga, Tanzania
| | - Thomson Lakwo
- Vector Control Division, Ministry of Health, Kampala, Uganda
| | - Gasim Abd-Elfarag
- School of Public Health, University of Juba, Juba, South Sudan
- Access for Humanity, Juba, South Sudan
| | - Sébastien D Pion
- French National Research Institute for Sustainable Development, Montpellier, France
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Hadermann A, Jada SR, Sebit WJ, Deng T, Bol YY, Siewe Fodjo JN, De Coninck L, Matthijnssens J, Mertens I, Polman K, Colebunders R. Onchocerciasis-associated epilepsy: an explorative case-control study with viral metagenomic analyses on Onchocerca volvulus. F1000Res 2023; 12:1262. [PMID: 38439783 PMCID: PMC10911407 DOI: 10.12688/f1000research.138774.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 03/06/2024] Open
Abstract
Background A high prevalence of onchocerciasis-associated epilepsy (OAE) has been observed in onchocerciasis-endemic areas with high ongoing Onchocerca volvulus transmission. However, the pathogenesis of OAE remains to be elucidated. We hypothesise that the O. volvulus virome could be involved in inducing epilepsy. With this study, we aim to describe the O. volvulus virome and identify potential neurotropic viruses linked to OAE. Methods In Maridi County, an onchocerciasis endemic area in South Sudan with a high prevalence of OAE, we will conduct an exploratory case-control study enrolling 40 persons aged 12 years and above with palpable onchocerciasis nodules. Cases will be participants with OAE (n=20), who will be age- and village-matched with controls without epilepsy (n=20). For each study participant, two skin snips at the iliac crest will be obtained to collect O. volvulus microfilariae, and one nodulectomy will be performed to obtain adult worms. A viral metagenomic study will be conducted on microfilariae and adult worms, and the O. volvulus virome of persons with and without OAE will be compared. The number, size, and localisation of onchocerciasis nodules in persons with and without OAE will be described. Moreover, the pre- and post-nodulectomy frequency of seizures in persons with OAE will be compared. Ethics and dissemination The protocol has been approved by the Ethics Committee of the University of Antwerp and the Ministry of Health of South Sudan. Findings will be disseminated nationally and internationally via meetings and peer-reviewed publications. Registration ClinicalTrials.gov registration NCT05868551 ( https://clinicaltrials.gov/study/NCT05868551). Protocol version 1.1, dated 09/05/2023.
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Affiliation(s)
- Amber Hadermann
- Global Health Institute, University of Antwerp, Antwerp, 2610, Belgium
| | | | - Wilson J. Sebit
- Public Health Laboratory, Ministry of Health South Sudan, Juba, South Sudan
| | | | - Yak Y. Bol
- Neglected Tropical Diseases Unit, Ministry of Health South Sudan, Juba, South Sudan
| | | | - Lander De Coninck
- Laboratory of Viral Metagenomics, KU Leuven, Leuven, Flanders, 3000, Belgium
| | - Jelle Matthijnssens
- Laboratory of Viral Metagenomics, KU Leuven, Leuven, Flanders, 3000, Belgium
| | - Inge Mertens
- Health Unit, VITO (Vlaamse Instelling voor Technologisch Onderzoek), Mol, 2400, Belgium
- Centre for Proteomics, University of Atwerp, Antwerp, Belgium
| | - Katja Polman
- Department of Health Sciences, VU Amsterdam, Amsterdam, 1081, The Netherlands
- Department Public Health, Institute of Tropical Medicine, Antwerp, 2600, Belgium
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Otabil KB, Basáñez MG, Ankrah B, Opoku SA, Kyei DO, Hagan R, Ababio R, Bart-Plange EJ, Babae TN, Kudzordzi PC, Darko VA, Bamfo JG, Ameyaw J, Raji AS, Hadermann A, Schallig HDFH, Colebunders R. Persistence of onchocerciasis and associated dermatologic and ophthalmic pathologies after 27 years of ivermectin mass drug administration in the middle belt of Ghana. Trop Med Int Health 2023; 28:844-854. [PMID: 37846505 DOI: 10.1111/tmi.13937] [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] [Indexed: 10/18/2023]
Abstract
OBJECTIVES There is a pressing need to regularly evaluate the progress of onchocerciasis elimination programmes to timely identify and mitigate potential risks hindering the reaching of the 2030 targets proposed by the World Health Organization (WHO) in its roadmap on neglected tropical diseases (NTDs). We determined the prevalence of onchocerciasis and associated dermatological and ophthalmological manifestations in six endemic communities in the Bono Region of Ghana after 27 years of ivermectin mass treatment. METHODS In a cross-sectional study, 564 participants aged ≥5 years were enrolled (49.1% females), with a median age of 26 (range: 5-89) years. In 54% and 47%, skin-snip microscopy and Ov16 rapid diagnostic tests were performed, respectively. Skin disease was determined using the WHO Skin NTD App. Visual function assessments included tests of visual acuity. RESULTS The overall microfilarial prevalence was 12.5% (38/305) and Ov16 seroprevalence was 24.2% (64/265). Severe itching was recorded in 24.3%, acute papular onchodermatitis in 52.8%, chronic papular onchodermatitis in 12.5%, lichenified onchodermatitis in 0.7%, skin atrophy in 11.3%, depigmentation in 1.7% and palpable nodules in 5.3%. Of the 301 persons in which visual acuity was examined, 17% were visually impaired and 5.3% were blind and 47.3% presented with cataract. Chronic papular onchodermatitis, lichenified onchodermatitis, depigmentation and visual impairment were significantly associated with the presence of skin microfilariae and Ov16 seropositivity. CONCLUSIONS The persistence of Onchocerca volvulus infection and onchocerciasis-associated dermatological and ophthalmological pathologies after prolonged treatment is of concern. There is a need to include morbidity management in onchocerciasis elimination programmes and understand better patterns of treatment coverage, adherence and actual intake of ivermectin.
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Affiliation(s)
- Kenneth Bentum Otabil
- Consortium for Neglected Tropical Diseases and One Health, Department of Biological Science, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
- Department of Biological Science, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - María-Gloria Basáñez
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis (MRC GIDA), and London Centre for Neglected Tropical Disease Research, School of Public Health, Imperial College London, London, UK
| | - Blessing Ankrah
- Consortium for Neglected Tropical Diseases and One Health, Department of Biological Science, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
| | - Stephen Agyemang Opoku
- Department of Medical Laboratory Science, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
| | - Dennis Ofori Kyei
- Department of Medical Laboratory Science, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
| | - Rhoda Hagan
- Department of Medical Laboratory Science, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
| | - Richmond Ababio
- Department of Medical Laboratory Science, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
| | - Emmanuel John Bart-Plange
- Consortium for Neglected Tropical Diseases and One Health, Department of Biological Science, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
| | - Theophilus Nti Babae
- Consortium for Neglected Tropical Diseases and One Health, Department of Biological Science, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
| | - Prince-Charles Kudzordzi
- Consortium for Neglected Tropical Diseases and One Health, Department of Biological Science, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
| | - Vera Achiaa Darko
- Consortium for Neglected Tropical Diseases and One Health, Department of Biological Science, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
- STU Clinic, Sunyani Technical University, Sunyani, Bono Region, Ghana
| | | | | | - Abdul Sakibu Raji
- Department of Biological Science, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
| | - Amber Hadermann
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Henk D F H Schallig
- Department of Medical Microbiology, Experimental Parasitology Unit, Amsterdam University Medical Centres, Academic Medical Centre at the University of Amsterdam, Amsterdam, The Netherlands
| | - Robert Colebunders
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Bhwana D, Siewe Fodjo JN, Amaral LJ, Vandevenne L, Francis F, Challe DP, Mmbando BP, Colebunders R. Disability assessment among persons with epilepsy in Mahenge, an onchocerciasis-endemic area in Tanzania: A cross-sectional study. Epilepsy Behav 2023; 146:109367. [PMID: 37523798 DOI: 10.1016/j.yebeh.2023.109367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND A high prevalence of epilepsy has been observed in the onchocerciasis-endemic focus of Mahenge, Tanzania. This study sought to assess the degree of disability experienced by persons with epilepsy (PWE) in Mahenge and identify associations with sociodemographic and clinical features. METHOD This cross-sectional study was conducted in Mahenge, Tanzania, between February and July 2020. PWE were recruited from the Mahenge epilepsy clinic and four neighbouring rural villages (Mdindo, Mzogezi, Mzelezi and Sali). Data were collected using the 36-item version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire for adults. For children aged 5-17 years, we used the Module on Child Functioning developed by UNICEF and the Washington Group. Questionnaires were administered by trained research assistants. Descriptive statistics were performed, and multivariable analyses (gamma and logistic regressions) were conducted. RESULTS A total of 321 adults (45.5% males) and 48 children (55.3% males) with epilepsy participated. The overall median WHODAS 2.0 score was 4.8% (IQR: 0.9-18.9). The most affected disability domain was 'participating in the society' (median score: 12.5%, IQR: 0-29.2). Fifteen (31.3%) of the children with epilepsy had a disability in at least one domain of the child functioning module, with the 'accepting change' domain harbouring the highest proportion of disabled children (12.5%). Higher seizure frequency and longer epilepsy duration were associated with more disability. CONCLUSION PWE in Mahenge experience variable degrees of disability. The affected domains indicate the need for societal rehabilitation of PWE in various community and/or social activities. Peer-support groups were instituted at the study sites to address these needs.
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Affiliation(s)
- Dan Bhwana
- National Institute of Medical Research, Tanga, P.O Box 5004, Tanzania.
| | | | - Luís-Jorge Amaral
- Global Health Institute, University of Antwerp, 2610 Antwerp, Belgium.
| | - Lauren Vandevenne
- Global Health Institute, University of Antwerp, 2610 Antwerp, Belgium.
| | - Filbert Francis
- National Institute of Medical Research, Tanga, P.O Box 5004, Tanzania.
| | - Daniel P Challe
- National Institute of Medical Research, Tanga, P.O Box 5004, Tanzania.
| | - Bruno P Mmbando
- National Institute of Medical Research, Tanga, P.O Box 5004, Tanzania.
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Abstract
Nodding syndrome (NS) is a phenotypic presentation of onchocerciasis-associated epilepsy (OAE). OAE is an important public health problem in areas with high ongoing Onchocerca volvulus transmission. OAE, including NS, is preventable by strengthening onchocerciasis elimination programs. The presence of tau in OAE postmortem brains could be the consequence of neuroinflammation directly or indirectly induced by O. volvulus. Omics research is needed to investigate whether O. volvulus worms contain a neurotropic virus.
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Affiliation(s)
| | - Amber Hadermann
- Global Health Institute University of Antwerp, Antwerp, Belgium
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Kamgno J, Djeunga HN. Further evidence of the potential causative relationship between onchocerciasis and epilepsy. Lancet Glob Health 2023; 11:e1152-e1153. [PMID: 37474214 DOI: 10.1016/s2214-109x(23)00310-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/23/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Joseph Kamgno
- Higher Institute for Scientific and Medical Research, Yaoundé, Cameroon); Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
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Mazumder R, Lubowa SK, Salamon N, Jackson NJ, Kawooya M, Akun PR, Anguzu R, Ogwang RJ, Kubofcik J, Nutman T, Marsh K, Newton C, Vincent A, Idro R. Comparison of Structural Changes in Nodding Syndrome and Other Epilepsies Associated With Onchocerca volvulus. Neurol Neuroimmunol Neuroinflamm 2022; 10:10/2/e200074. [PMID: 36543539 PMCID: PMC9773419 DOI: 10.1212/nxi.0000000000200074] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Nodding syndrome (NS) is a unique childhood-onset epileptic disorder that occurs predominantly in several regions of sub-Saharan Africa. The disease has been associated with Onchocerca volvulus (Ov)-induced immune responses and possible cross-reactivity with host proteins. The aim of this study was to compare structural changes in the brain on MRI between NS and other forms of onchocerciasis-associated epilepsies (OAEs) and to relate structural changes to the Ov-induced immune responses and level of disability. METHODS Thirty-nine children with NS and 14 age-matched participants with other forms of OAE from an endemic region in Uganda underwent detailed clinical examination, serologic evaluation (including Ov-associated antibodies to Ov-16 and Hu-leiomodin-1) and quantitative volumetric analysis of brain MRIs (1.5 T scanner) using Neuroreader, a cloud-based software. RESULTS Cerebral and cerebellar atrophy were the predominant features in both NS and OAE. On quantitative volumetric analysis, participants with NS had larger ventricular volumes compared with participants with OAE, indicative of increased global cortical atrophy (pcorr = 0.036). Among children with NS, severe disability correlated with higher degree of atrophy in the gray matter volume (pcorr = 0.009) and cerebellar volume (pcorr = 0.009). NS cases had lower anti-Ov-16 IgG signal-to-noise ratios than the OAE cases (p < 0.01), but no difference in the levels of the Hu-leiomodin-1 antibodies (p = 0.64). The levels of Ov-associated antibodies did not relate to the degree of cerebral or cerebellar atrophy in either NS or OAE cases. DISCUSSION This is the first study to show that cerebral and cerebellar atrophy correlated with the severity of NS disability, providing an imaging marker for these endemic epileptic disorders that until now have remained poorly characterized. Both NS and OAE have cerebral and cerebellar atrophy, and the levels of Ov-associated antibodies do not seem to be related to the structural changes on MRI.
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Affiliation(s)
- Rajarshi Mazumder
- From the Department of Neurology (R.M.), David Geffen School of Medicine at University of California Los Angeles; Kampala MRI Centre (S.K.L., M.K.), Uganda; Department of Radiological Sciences (N.S.), David Geffen School of Medicine, University of California Los Angeles, CA; Division of General Internal Medicine and Health Services Research (N.J.J.), David Geffen School of Medicine at UCLA; Centre of Tropical Neuroscience (P.R.A., R.A., R.I.), Kitgum Site, Uganda; Makerere University (R.A., R.J.O., R.I.), College of Health Sciences, Kampala, Uganda; Laboratory of Parasitic Diseases (J.K., T.N.), National Institutes of Health, Bethesda, MD; Centre for Tropical Medicine and Global Health (K.M., R.I.), Nuffield Department of Medicine, University of Oxford, United Kingdom; Department of Psychiatry (C.N.), University of Oxford, United Kingdom; and Nuffield Department of Clinical Neurosciences (A.V.), University of Oxford, United Kingdom
| | - Samson Kamya Lubowa
- From the Department of Neurology (R.M.), David Geffen School of Medicine at University of California Los Angeles; Kampala MRI Centre (S.K.L., M.K.), Uganda; Department of Radiological Sciences (N.S.), David Geffen School of Medicine, University of California Los Angeles, CA; Division of General Internal Medicine and Health Services Research (N.J.J.), David Geffen School of Medicine at UCLA; Centre of Tropical Neuroscience (P.R.A., R.A., R.I.), Kitgum Site, Uganda; Makerere University (R.A., R.J.O., R.I.), College of Health Sciences, Kampala, Uganda; Laboratory of Parasitic Diseases (J.K., T.N.), National Institutes of Health, Bethesda, MD; Centre for Tropical Medicine and Global Health (K.M., R.I.), Nuffield Department of Medicine, University of Oxford, United Kingdom; Department of Psychiatry (C.N.), University of Oxford, United Kingdom; and Nuffield Department of Clinical Neurosciences (A.V.), University of Oxford, United Kingdom
| | - Noriko Salamon
- From the Department of Neurology (R.M.), David Geffen School of Medicine at University of California Los Angeles; Kampala MRI Centre (S.K.L., M.K.), Uganda; Department of Radiological Sciences (N.S.), David Geffen School of Medicine, University of California Los Angeles, CA; Division of General Internal Medicine and Health Services Research (N.J.J.), David Geffen School of Medicine at UCLA; Centre of Tropical Neuroscience (P.R.A., R.A., R.I.), Kitgum Site, Uganda; Makerere University (R.A., R.J.O., R.I.), College of Health Sciences, Kampala, Uganda; Laboratory of Parasitic Diseases (J.K., T.N.), National Institutes of Health, Bethesda, MD; Centre for Tropical Medicine and Global Health (K.M., R.I.), Nuffield Department of Medicine, University of Oxford, United Kingdom; Department of Psychiatry (C.N.), University of Oxford, United Kingdom; and Nuffield Department of Clinical Neurosciences (A.V.), University of Oxford, United Kingdom
| | - Nicholas J Jackson
- From the Department of Neurology (R.M.), David Geffen School of Medicine at University of California Los Angeles; Kampala MRI Centre (S.K.L., M.K.), Uganda; Department of Radiological Sciences (N.S.), David Geffen School of Medicine, University of California Los Angeles, CA; Division of General Internal Medicine and Health Services Research (N.J.J.), David Geffen School of Medicine at UCLA; Centre of Tropical Neuroscience (P.R.A., R.A., R.I.), Kitgum Site, Uganda; Makerere University (R.A., R.J.O., R.I.), College of Health Sciences, Kampala, Uganda; Laboratory of Parasitic Diseases (J.K., T.N.), National Institutes of Health, Bethesda, MD; Centre for Tropical Medicine and Global Health (K.M., R.I.), Nuffield Department of Medicine, University of Oxford, United Kingdom; Department of Psychiatry (C.N.), University of Oxford, United Kingdom; and Nuffield Department of Clinical Neurosciences (A.V.), University of Oxford, United Kingdom
| | - Michael Kawooya
- From the Department of Neurology (R.M.), David Geffen School of Medicine at University of California Los Angeles; Kampala MRI Centre (S.K.L., M.K.), Uganda; Department of Radiological Sciences (N.S.), David Geffen School of Medicine, University of California Los Angeles, CA; Division of General Internal Medicine and Health Services Research (N.J.J.), David Geffen School of Medicine at UCLA; Centre of Tropical Neuroscience (P.R.A., R.A., R.I.), Kitgum Site, Uganda; Makerere University (R.A., R.J.O., R.I.), College of Health Sciences, Kampala, Uganda; Laboratory of Parasitic Diseases (J.K., T.N.), National Institutes of Health, Bethesda, MD; Centre for Tropical Medicine and Global Health (K.M., R.I.), Nuffield Department of Medicine, University of Oxford, United Kingdom; Department of Psychiatry (C.N.), University of Oxford, United Kingdom; and Nuffield Department of Clinical Neurosciences (A.V.), University of Oxford, United Kingdom
| | - Pamela Rosemary Akun
- From the Department of Neurology (R.M.), David Geffen School of Medicine at University of California Los Angeles; Kampala MRI Centre (S.K.L., M.K.), Uganda; Department of Radiological Sciences (N.S.), David Geffen School of Medicine, University of California Los Angeles, CA; Division of General Internal Medicine and Health Services Research (N.J.J.), David Geffen School of Medicine at UCLA; Centre of Tropical Neuroscience (P.R.A., R.A., R.I.), Kitgum Site, Uganda; Makerere University (R.A., R.J.O., R.I.), College of Health Sciences, Kampala, Uganda; Laboratory of Parasitic Diseases (J.K., T.N.), National Institutes of Health, Bethesda, MD; Centre for Tropical Medicine and Global Health (K.M., R.I.), Nuffield Department of Medicine, University of Oxford, United Kingdom; Department of Psychiatry (C.N.), University of Oxford, United Kingdom; and Nuffield Department of Clinical Neurosciences (A.V.), University of Oxford, United Kingdom
| | - Ronald Anguzu
- From the Department of Neurology (R.M.), David Geffen School of Medicine at University of California Los Angeles; Kampala MRI Centre (S.K.L., M.K.), Uganda; Department of Radiological Sciences (N.S.), David Geffen School of Medicine, University of California Los Angeles, CA; Division of General Internal Medicine and Health Services Research (N.J.J.), David Geffen School of Medicine at UCLA; Centre of Tropical Neuroscience (P.R.A., R.A., R.I.), Kitgum Site, Uganda; Makerere University (R.A., R.J.O., R.I.), College of Health Sciences, Kampala, Uganda; Laboratory of Parasitic Diseases (J.K., T.N.), National Institutes of Health, Bethesda, MD; Centre for Tropical Medicine and Global Health (K.M., R.I.), Nuffield Department of Medicine, University of Oxford, United Kingdom; Department of Psychiatry (C.N.), University of Oxford, United Kingdom; and Nuffield Department of Clinical Neurosciences (A.V.), University of Oxford, United Kingdom
| | - Rodney J Ogwang
- From the Department of Neurology (R.M.), David Geffen School of Medicine at University of California Los Angeles; Kampala MRI Centre (S.K.L., M.K.), Uganda; Department of Radiological Sciences (N.S.), David Geffen School of Medicine, University of California Los Angeles, CA; Division of General Internal Medicine and Health Services Research (N.J.J.), David Geffen School of Medicine at UCLA; Centre of Tropical Neuroscience (P.R.A., R.A., R.I.), Kitgum Site, Uganda; Makerere University (R.A., R.J.O., R.I.), College of Health Sciences, Kampala, Uganda; Laboratory of Parasitic Diseases (J.K., T.N.), National Institutes of Health, Bethesda, MD; Centre for Tropical Medicine and Global Health (K.M., R.I.), Nuffield Department of Medicine, University of Oxford, United Kingdom; Department of Psychiatry (C.N.), University of Oxford, United Kingdom; and Nuffield Department of Clinical Neurosciences (A.V.), University of Oxford, United Kingdom
| | - Joseph Kubofcik
- From the Department of Neurology (R.M.), David Geffen School of Medicine at University of California Los Angeles; Kampala MRI Centre (S.K.L., M.K.), Uganda; Department of Radiological Sciences (N.S.), David Geffen School of Medicine, University of California Los Angeles, CA; Division of General Internal Medicine and Health Services Research (N.J.J.), David Geffen School of Medicine at UCLA; Centre of Tropical Neuroscience (P.R.A., R.A., R.I.), Kitgum Site, Uganda; Makerere University (R.A., R.J.O., R.I.), College of Health Sciences, Kampala, Uganda; Laboratory of Parasitic Diseases (J.K., T.N.), National Institutes of Health, Bethesda, MD; Centre for Tropical Medicine and Global Health (K.M., R.I.), Nuffield Department of Medicine, University of Oxford, United Kingdom; Department of Psychiatry (C.N.), University of Oxford, United Kingdom; and Nuffield Department of Clinical Neurosciences (A.V.), University of Oxford, United Kingdom
| | - Thomas Nutman
- From the Department of Neurology (R.M.), David Geffen School of Medicine at University of California Los Angeles; Kampala MRI Centre (S.K.L., M.K.), Uganda; Department of Radiological Sciences (N.S.), David Geffen School of Medicine, University of California Los Angeles, CA; Division of General Internal Medicine and Health Services Research (N.J.J.), David Geffen School of Medicine at UCLA; Centre of Tropical Neuroscience (P.R.A., R.A., R.I.), Kitgum Site, Uganda; Makerere University (R.A., R.J.O., R.I.), College of Health Sciences, Kampala, Uganda; Laboratory of Parasitic Diseases (J.K., T.N.), National Institutes of Health, Bethesda, MD; Centre for Tropical Medicine and Global Health (K.M., R.I.), Nuffield Department of Medicine, University of Oxford, United Kingdom; Department of Psychiatry (C.N.), University of Oxford, United Kingdom; and Nuffield Department of Clinical Neurosciences (A.V.), University of Oxford, United Kingdom
| | - Kevin Marsh
- From the Department of Neurology (R.M.), David Geffen School of Medicine at University of California Los Angeles; Kampala MRI Centre (S.K.L., M.K.), Uganda; Department of Radiological Sciences (N.S.), David Geffen School of Medicine, University of California Los Angeles, CA; Division of General Internal Medicine and Health Services Research (N.J.J.), David Geffen School of Medicine at UCLA; Centre of Tropical Neuroscience (P.R.A., R.A., R.I.), Kitgum Site, Uganda; Makerere University (R.A., R.J.O., R.I.), College of Health Sciences, Kampala, Uganda; Laboratory of Parasitic Diseases (J.K., T.N.), National Institutes of Health, Bethesda, MD; Centre for Tropical Medicine and Global Health (K.M., R.I.), Nuffield Department of Medicine, University of Oxford, United Kingdom; Department of Psychiatry (C.N.), University of Oxford, United Kingdom; and Nuffield Department of Clinical Neurosciences (A.V.), University of Oxford, United Kingdom
| | - Charles Newton
- From the Department of Neurology (R.M.), David Geffen School of Medicine at University of California Los Angeles; Kampala MRI Centre (S.K.L., M.K.), Uganda; Department of Radiological Sciences (N.S.), David Geffen School of Medicine, University of California Los Angeles, CA; Division of General Internal Medicine and Health Services Research (N.J.J.), David Geffen School of Medicine at UCLA; Centre of Tropical Neuroscience (P.R.A., R.A., R.I.), Kitgum Site, Uganda; Makerere University (R.A., R.J.O., R.I.), College of Health Sciences, Kampala, Uganda; Laboratory of Parasitic Diseases (J.K., T.N.), National Institutes of Health, Bethesda, MD; Centre for Tropical Medicine and Global Health (K.M., R.I.), Nuffield Department of Medicine, University of Oxford, United Kingdom; Department of Psychiatry (C.N.), University of Oxford, United Kingdom; and Nuffield Department of Clinical Neurosciences (A.V.), University of Oxford, United Kingdom
| | - Angela Vincent
- From the Department of Neurology (R.M.), David Geffen School of Medicine at University of California Los Angeles; Kampala MRI Centre (S.K.L., M.K.), Uganda; Department of Radiological Sciences (N.S.), David Geffen School of Medicine, University of California Los Angeles, CA; Division of General Internal Medicine and Health Services Research (N.J.J.), David Geffen School of Medicine at UCLA; Centre of Tropical Neuroscience (P.R.A., R.A., R.I.), Kitgum Site, Uganda; Makerere University (R.A., R.J.O., R.I.), College of Health Sciences, Kampala, Uganda; Laboratory of Parasitic Diseases (J.K., T.N.), National Institutes of Health, Bethesda, MD; Centre for Tropical Medicine and Global Health (K.M., R.I.), Nuffield Department of Medicine, University of Oxford, United Kingdom; Department of Psychiatry (C.N.), University of Oxford, United Kingdom; and Nuffield Department of Clinical Neurosciences (A.V.), University of Oxford, United Kingdom
| | - Richard Idro
- From the Department of Neurology (R.M.), David Geffen School of Medicine at University of California Los Angeles; Kampala MRI Centre (S.K.L., M.K.), Uganda; Department of Radiological Sciences (N.S.), David Geffen School of Medicine, University of California Los Angeles, CA; Division of General Internal Medicine and Health Services Research (N.J.J.), David Geffen School of Medicine at UCLA; Centre of Tropical Neuroscience (P.R.A., R.A., R.I.), Kitgum Site, Uganda; Makerere University (R.A., R.J.O., R.I.), College of Health Sciences, Kampala, Uganda; Laboratory of Parasitic Diseases (J.K., T.N.), National Institutes of Health, Bethesda, MD; Centre for Tropical Medicine and Global Health (K.M., R.I.), Nuffield Department of Medicine, University of Oxford, United Kingdom; Department of Psychiatry (C.N.), University of Oxford, United Kingdom; and Nuffield Department of Clinical Neurosciences (A.V.), University of Oxford, United Kingdom.
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11
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Bhwana D, Mmbando BP, Dusabimana A, Mhina A, Challe DP, Fodjo JNS, Makunde WH, Colebunders R. Ivermectin treatment response in two rural villages with a high prevalence of onchocerciasis and epilepsy, Mahenge Tanzania. Afr Health Sci 2022; 22:607-616. [PMID: 36910370 PMCID: PMC9993262 DOI: 10.4314/ahs.v22i3.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Despite 20 years of ivermectin mass distribution in the Mahenge area, Tanzania, the prevalence of onchocerciasis and epilepsy has remained high in rural villages. Objectives We investigated the efficacy of ivermectin in reducing Onchocerca volvulus microfilariae and predictors for parasitic load following ivermectin treatment in persons with (PWE) and without epilepsy (PWOE). Methods Between April and September 2019, 50 PWE and 160 randomly selected PWOE from Msogezi and Mdindo villages participated in a follow-up study. Skin snips were obtained pre (baseline) and three months post-ivermectin treatment. Results The overall prevalence of O. volvulus positive skin snips at baseline was 49% (103/210), with no significant difference between PWE (58.0%) and PWOE (46.3%); p=0.197. The overall mean microfilarial density was significantly higher at baseline 1.45(95%CI:0.98-2.04)) than three-month post-ivermectin treatment (0.23(95%CI:0.11-0.37), p<0.001. Three months after ivermectin, the microfilarial density had decreased by ≥80% in 54 (81.8%, 95%CI: 72.3-91.4) of the 66 individuals with positive skin snips at baseline. High microfilarial density at baseline was the only significant predictor associated with higher microfilarial density in the post-ivermectin skin snips. Conclusion Our study reports a decrease in microfilarial density following ivermectin treatment in most individuals. Optimizing ivermectin coverage will address the ongoing onchocerciasis transmission in Mahenge.
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Affiliation(s)
- Dan Bhwana
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Bruno P Mmbando
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | | | - Athanas Mhina
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - Daniel P Challe
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | | | - Williams H Makunde
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
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12
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Dolo H, Konipo FDN, Sow F, Kane F, Sangare M, Daou M, Sangare M, Sangho O, Koné H, Coulibaly FD, Coulibaly SY, Doumbia SS, Koita A, Sangaré B, Djimdé S, Goita S, Bagayoko T, Dem AB, Fomba Z, Gari M, Kotchene CE, Orsot KE, Diarra D, Colebunders R, Coulibaly YI, Sangho H, Maiga YM, Doumbia S. Prevalence and risk factors associated with epilepsy in six health districts of Mali: a community-based cross-sectional and nested case-control study. Neuroepidemiology 2022; 56:127-137. [PMID: 35045422 DOI: 10.1159/000522021] [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: 08/15/2021] [Accepted: 01/10/2022] [Indexed: 11/19/2022] Open
Abstract
In resource-limited countries, epilepsy prevalence is underestimated and little is known about its risk factors. Objectives: This study aimed to determine the prevalence and risk factors for epilepsy in six health districts (HD) in Mali. Methods A community-based cross-sectional and nested-case-control study was conducted in 180 villages with the highest number of suspicious epilepsy cases (SEC) in the six study HD. The SEC were observed as part of a Phase 1 screening conducted by community health workers (CHWs). For the nested case-control study, one case was matched with at least one control based on residence and age. A case of epilepsy was any person diagnosed with convulsive epilepsy after clinical assessment by a neurologist. A control was a person diagnosed as normal after neurological assessment by a neurologist. Data were collected on sociodemographic characteristics, familial and medical history of epilepsy, consanguinity, place of delivery, pre-term birth, length/type of delivery, and history of meningitis and cerebral malaria. A univariate and multivariate binomial logistic regression model was used to analyse factors associated with epilepsy. Results A total of 1,506 cases of epilepsy and 2,199 controls were enrolled in six HDs. The mean prevalence of epilepsy was 2‰, with the highest in Kenieba (3‰), a previously meso-endemic-onchocerciasis HD, and the lowest in Kadiolo (1.5‰), an hypo-endemic-onchocerciasis HD. Age [aOR=1.02 (95% CI 1.02-1.03)], history of cerebral malaria [aOR=11.41 (95% CI 8.86-14.85)], history of meningitis [aOR=1.95 (95% CI 1.16-3.29)], living in the HD of Tominian [aOR= 1.69 (95% CI 1.29-2.22)], delayed delivery [aOR= 3.21 (95% CI 2.07-5.07)] and dystocia [aOR= 3.37 (95% CI 2.03-5.73)] were all significantly associated with epilepsy. Discussion/Conclusion The prevalence of epilepsy (3‰) in a previously meso-endemic-onchocerciasis HD was much lower than the prevalence (13.35‰) documented in onchocerciasis endemic areas in 2000. This decrease epilepsy prevalence in the previously meso-endemic-region was induced by onchocerciasis and the reduction was due to an effective community direct treatment with ivermectin programme. Cerebral malaria and obstetrical complications were the main risk factors for epilepsy and interventions improving malaria prevention/treatment and optimising prenatal and obstetrical care need to be implemented to reduce incidence.
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Affiliation(s)
- Housseini Dolo
- Faculté de Medecine et d'Odonto Stomatologie (FMOS), Université Des Sciences, Des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali
- Département d'Enseignement et de Recherche en Santé Publique et Spécialités, FMOS, USTTB, Bamako, Mali
- Unité Filariose, International Center of Excellence in Research, USTTB, Bamako, Mali
| | | | - Fanta Sow
- Département d'Enseignement et de Recherche en Santé Publique et Spécialités, FMOS, USTTB, Bamako, Mali
| | - Fousseyni Kane
- Faculté de Medecine et d'Odonto Stomatologie (FMOS), Université Des Sciences, Des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali
| | - Modibo Sangare
- Faculté de Medecine et d'Odonto Stomatologie (FMOS), Université Des Sciences, Des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali
| | - Mariam Daou
- Département de Neurologie, Centre Hospitalo Universitaire, Point G, Bamako, Mali
| | - Moussa Sangare
- Faculté de Medecine et d'Odonto Stomatologie (FMOS), Université Des Sciences, Des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali
- Département d'Enseignement et de Recherche en Santé Publique et Spécialités, FMOS, USTTB, Bamako, Mali
- Unité Filariose, International Center of Excellence in Research, USTTB, Bamako, Mali
| | - Oumar Sangho
- Département d'Enseignement et de Recherche des Sciences Biologiques et Médicales (DERSBM), Faculté de Pharmacie (FAPH), USTTB, Bamako, Mali
| | - Harouna Koné
- Unité Filariose, International Center of Excellence in Research, USTTB, Bamako, Mali
| | - Fousseyni D Coulibaly
- Unité Filariose, International Center of Excellence in Research, USTTB, Bamako, Mali
| | | | - Salif Seriba Doumbia
- Unité Filariose, International Center of Excellence in Research, USTTB, Bamako, Mali
| | - Abdou Koita
- Département de Neurologie, Centre Hospitalo Universitaire, Gabriel Toure, Bamako, Mali
| | - Birama Sangaré
- Département de Neurologie, Centre Hospitalo Universitaire, Point G, Bamako, Mali
| | - Samba Djimdé
- Département de Neurologie, Centre Hospitalo Universitaire, Point G, Bamako, Mali
| | - Sekouba Goita
- Département de Neurologie, Centre Hospitalo Universitaire, Gabriel Toure, Bamako, Mali
| | - Tenimba Bagayoko
- Département de Neurologie, Centre Hospitalo Universitaire, Point G, Bamako, Mali
| | - Aly Badhara Dem
- Département de Neurologie, Centre Hospitalo Universitaire, Point G, Bamako, Mali
| | - Zoumana Fomba
- Département de Neurologie, Centre Hospitalo Universitaire, Point G, Bamako, Mali
| | - Mamadou Gari
- Département de Neurologie, Centre Hospitalo Universitaire, Point G, Bamako, Mali
| | | | - Kissy Elvira Orsot
- Unité Filariose, International Center of Excellence in Research, USTTB, Bamako, Mali
| | - Dansine Diarra
- Faculté d'Histoire et de Geography, Université des Sciences Sociales et de Gestion de Bamako (USSGB) Bamako, Bamako, Mali
| | | | | | - Hamadoun Sangho
- Faculté de Medecine et d'Odonto Stomatologie (FMOS), Université Des Sciences, Des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali
- Département d'Enseignement et de Recherche en Santé Publique et Spécialités, FMOS, USTTB, Bamako, Mali
| | - Youssoufa M Maiga
- Faculté de Medecine et d'Odonto Stomatologie (FMOS), Université Des Sciences, Des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali
- Département de Neurologie, Centre Hospitalo Universitaire, Point G, Bamako, Mali
| | - Seydou Doumbia
- Faculté de Medecine et d'Odonto Stomatologie (FMOS), Université Des Sciences, Des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali
- Département d'Enseignement et de Recherche en Santé Publique et Spécialités, FMOS, USTTB, Bamako, Mali
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
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Morin A, Guillaume M, Ngarka L, Tatah GY, Siewe Fodjo JN, Wyart G, Nokam G, Tchoumi T, Nkinin MB, Njamnshi WY, Chokote E, Boussinesq M, Colebunders R, Chesnais CB, Gargala G, Parain D, Njamnshi AK. Epilepsy in the Sanaga-Mbam valley, an onchocerciasis-endemic region in Cameroon: electroclinical and neuropsychological findings. Epilepsia Open 2021; 6:513-527. [PMID: 35138694 PMCID: PMC8408605 DOI: 10.1002/epi4.12510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Epilepsy is highly prevalent in onchocerciasis-endemic African regions. Various types of epilepsy have been described in such regions based essentially on clinical characteristics. METHODS We conducted a clinical, neurophysiological and neuropsychological study of epilepsy in the onchocerciasis-endemic region of Ntui, Sanaga-Mbam area, Cameroon. RESULTS One hundred and eighty-seven persons with presumed epilepsy were recruited in an epilepsy clinic in Ntui. Epilepsy was clinically confirmed in 144 (79%) subjects, 69 (46.0%) of them met the onchocerciasis-associated epilepsy (OAE) criteria, and 51 of 106 tested (48.1%) presented Ov16 antibodies. Electroencephalograms (EEG) were recorded in 91 participants, of which 36 (33%) were considered abnormal and 27 of 36 (75%) revealed bifrontotemporal spike and slow waves. Concerning the neuropsychological evaluation, 29% showed severe global cognitive impairment, 28% severe episodic memory impairment, and 66% severe frontal cognitive impairment. Half of the persons with epilepsy (PWE) suffered from a mental disorder. SIGNIFICANCE In PWE in the Sanaga-Mbam area in Cameroon, we observed EEG patterns similar to those described among persons with OAE, including nodding syndrome in other onchocerciasis-endemic areas. Most PWE presented with severe cognitive impairment. We hypothesize that onchocerciasis may induce neurocognitive disorders and epilepsy via a mechanism that involves mainly the frontal and temporal regions of the brain.
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Affiliation(s)
| | | | - Leonard Ngarka
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Department of NeurologyYaoundé Central Hospital/Faculty of Medicine and Biomedical SciencesThe University of Yaoundé 1YaoundéCameroon
| | - Godwin Y. Tatah
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Department of NeurologyCH Saint‐NazaireSaint‐NazaireFrance
| | - Joseph Nelson Siewe Fodjo
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Global Health InstituteUniversity of AntwerpAntwerpBelgium
| | | | | | | | - Mary Bello Nkinin
- Department of NeurologyYaoundé Central Hospital/Faculty of Medicine and Biomedical SciencesThe University of Yaoundé 1YaoundéCameroon
| | - Wepnyu Y. Njamnshi
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Department of NeurologyYaoundé Central Hospital/Faculty of Medicine and Biomedical SciencesThe University of Yaoundé 1YaoundéCameroon
| | - Eric‐Samuel Chokote
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
| | - Michel Boussinesq
- UMI 233Institut de Recherche pour le Développement (IRD)/Research and Development InstituteMontpellierFrance
- Montpellier UniversityMontpellierFrance
- INSERM Unit 1175MontpellierFrance
| | | | - Cédric B. Chesnais
- UMI 233Institut de Recherche pour le Développement (IRD)/Research and Development InstituteMontpellierFrance
- Montpellier UniversityMontpellierFrance
- INSERM Unit 1175MontpellierFrance
| | - Gilles Gargala
- Laboratory of Parasitology‐Mycology & EA7510Rouen University HospitalRouenFrance
| | | | - Alfred K. Njamnshi
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Department of NeurologyYaoundé Central Hospital/Faculty of Medicine and Biomedical SciencesThe University of Yaoundé 1YaoundéCameroon
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Luna J, Metanmo S, Boumediene F, Mbelesso P, Auditeau E, Ajzenberg D, Preux PM. Onchocerciasis in tropical neurology: A scoping review. J Neurol Sci 2021; 421:117314. [PMID: 33493958 DOI: 10.1016/j.jns.2021.117314] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Onchocerciasis is a serious problem in tropical areas. The role of the parasite as a factor associated with neurological diseases needs to be addressed because it might involve a reduction of the risk via elimination strategies. We performed a systematic scoping review to identify available studies on this association and put into perspective the different methodological approaches for interpreting the evidence. METHODOLOGY A literature search was conducted using MEDLINE (Pubmed) through October 1, 2020. We included all the studies evaluating the association between onchocerciasis and four neurological diseases (epilepsy, nodding syndrome, Nakalanga syndrome, and encephalitis) in tropical countries. A descriptive and critical summary of the results was conducted to provide an overview of the findings. RESULTS Overall, 161 articles were identified in the literature search. After full-length examination, we included twelve articles for epilepsy and three for nodding syndrome. Two meta-analyses of case-control studies found a modest strength of the association between O. volvulus and epilepsy. Recent meta-analyses and original studies support a significant association. Epidemiological studies suggest an association between onchocerciasis and nodding syndrome, however, the level of evidence from case-control studies was relatively low. No measure of association was reported for Nakalanga syndrome. There was no specific study on the association between O. volvulus and encephalitis. CONCLUSION The association between onchocerciasis and epilepsy seems increasingly likely. However, there are still many unanswered questions about the different clinical presentations of this epilepsy. Strong international collaboration is essential to improve our understanding of risk factors and physiopathological mechanisms of these intriguing conditions.
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Affiliation(s)
- Jaime Luna
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Salvatore Metanmo
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Farid Boumediene
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Pascal Mbelesso
- Department of Neurology, Amitié Hospital, Bangui, Central African Republic
| | - Emilie Auditeau
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Daniel Ajzenberg
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Pierre-Marie Preux
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.
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Mandro M, Siewe Fodjo JN, Mukendi D, Dusabimana A, Menon S, Haesendonckx S, Lokonda R, Nakato S, Nyisi F, Abhafule G, Wonya’Rossi D, Jakwong JM, Suykerbuyk P, Meganck J, Hotterbeekx A, Colebunders R. Ivermectin as an adjuvant to anti-epileptic treatment in persons with onchocerciasis-associated epilepsy: A randomized proof-of-concept clinical trial. PLoS Negl Trop Dis 2020; 14:e0007966. [PMID: 31923177 PMCID: PMC6977765 DOI: 10.1371/journal.pntd.0007966] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/23/2020] [Accepted: 12/03/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Recent findings from onchocerciasis-endemic foci uphold that increasing ivermectin coverage reduces the epilepsy incidence, and anecdotal evidence suggests seizure frequency reduction in persons with onchocerciasis-associated epilepsy, when treated with ivermectin. We conducted a randomized clinical trial to assess whether ivermectin treatment decreases seizure frequency. METHODS A proof-of-concept randomized clinical trial was conducted in the Logo health zone in the Ituri province, Democratic Republic of Congo, to compare seizure frequencies in onchocerciasis-infected persons with epilepsy (PWE) randomized to one of two treatment arms: the anti-epileptic drug phenobarbital supplemented with ivermectin, versus phenobarbital alone. The primary endpoint was defined as the probability of being seizure-free at month 4. A secondary endpoint was defined as >50% reduction in seizure frequency at month 4, compared to baseline. Both endpoints were analyzed using multiple logistic regression. In longitudinal analysis, the probability of seizure freedom during the follow-up period was assessed for both treatment arms by fitting a logistic regression model using generalized estimating equations (GEE). RESULTS Ninety PWE enrolled between October and November 2017 were eligible for analysis. A multiple logistic regression analysis showed a borderline association between ivermectin treatment and being seizure-free at month 4 (OR: 1.652, 95% CI 0.975-2.799; p = 0.062). There was no significant difference in the probability of experiencing >50% reduction of the seizure frequency at month 4 between the two treatment arms. Also, treatment with ivermectin did not significantly increase the odds of being seizure-free during the individual follow-up visits. CONCLUSION Whether ivermectin has an added value in reducing the frequency of seizures in PWE treated with AED remains to be determined. A larger study in persons with OAE on a stable AED regimen and in persons with recent epilepsy onset should be considered to further investigate the potential beneficial effect of ivermectin treatment in persons with OAE. TRIAL REGISTRATION Registration: www.clinicaltrials.gov; NCT03052998.
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Affiliation(s)
- Michel Mandro
- Provincial Ministry of Health, Bunia, Ituri, Democratic Republic of Congo
| | | | - Deby Mukendi
- Centre Neuro-Psycho Pathologique, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | - Sonia Menon
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | | | - Richard Lokonda
- Centre Neuro-Psycho Pathologique, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Swabra Nakato
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Francoise Nyisi
- Centre de Recherche en Maladies Tropicales de l'Ituri, Rethy, Ituri, Democratic Republic of Congo
| | - Germain Abhafule
- Centre de Recherche en Maladies Tropicales de l'Ituri, Rethy, Ituri, Democratic Republic of Congo
| | - Deogratias Wonya’Rossi
- Programme National de Lutte contre l’Onchocercose, Bunia, Ituri, Democratic Republic of Congo
| | - Jean Marie Jakwong
- Hôpital Général de Référence de Logo, Logo, Ituri, Democratic Republic of Congo
| | | | - Jacques Meganck
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - An Hotterbeekx
- Global Health Institute, University of Antwerp, Antwerp, Belgium
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Siewe Fodjo JN, Mandro M, Mukendi D, Tepage F, Menon S, Nakato S, Nyisi F, Abhafule G, Wonya’rossi D, Anyolito A, Lokonda R, Hotterbeekx A, Colebunders R. Onchocerciasis-associated epilepsy in the Democratic Republic of Congo: Clinical description and relationship with microfilarial density. PLoS Negl Trop Dis 2019; 13:e0007300. [PMID: 31314757 PMCID: PMC6663032 DOI: 10.1371/journal.pntd.0007300] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [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: 03/07/2019] [Revised: 07/29/2019] [Accepted: 06/13/2019] [Indexed: 11/21/2022] Open
Abstract
Background High epilepsy prevalence and incidence were observed in onchocerciasis-endemic villages in the Democratic Republic of Congo (DRC). We investigated the clinical characteristics of onchocerciasis-associated epilepsy (OAE), and the relationship between seizure severity and microfilarial density. Methods In October 2017, ivermectin-naive persons with epilepsy (PWE) were recruited from onchocerciasis-endemic areas in the Logo health zone in the DRC. Additional PWE were enrolled in the Aketi health zone, where ivermectin had been distributed annually for 14 years. Past medical history, clinical characteristics and skin snips for Onchocerca volvulus detection were obtained from participants. Bivariate and multivariable analyses were used to investigate associations with microfilarial density. Results Of the 420 PWE in the Logo health zone, 392 were skin snipped (36.5% positive). Generalized motor seizures were most frequent (392 PWE, 93.3%), and nodding seizures were reported in 32 (7.6%) participants. Twelve PWE (3.1%) presented Nakalanga features. Sixty-three (44.1%) skin snip-positive PWE had a family history of epilepsy, compared to only 82 (32.9%) skin snip-negative PWE (p = 0.027). Eighty-one onchocerciasis-infected PWE were recruited in the Aketi health zone. Positive correlations between seizure frequency and microfilarial density were observed in Logo (Spearman-rho = 0.175; p<0.001) and Aketi (Spearman-rho = 0.249; p = 0.029). In the multivariable model adjusted for age, gender, and previous treatment, high seizure frequency was associated with increasing microfilarial density in Aketi (p = 0.025) but not in Logo (p = 0.148). Conclusion In onchocerciasis-endemic regions in the DRC, a wide spectrum of seizures was observed. The occurrence of Nodding seizures and Nakalanga features, as well as an association between seizure severity and O. volvulus microfilarial density suggest a high OAE prevalence in the study villages. Trial registration ClinicalTrials.gov NCT03052998. Several epidemiological surveys suggest that onchocerciasis (a disease resulting from an infection with the parasite Onchocerca volvulus) is a cause of epilepsy. We conducted a study to describe the clinical characteristics of persons with epilepsy (PWE) living in onchocerciasis-endemic villages in the Democratic Republic of Congo. In some study sites, the frequency of seizures increased with increasing number of O. volvulus microfilariae detected in the skin snips of participants. A wide spectrum of seizures was observed, including generalized tonic-clonic seizures, absence seizures, and focal seizures. Growth retardation and household clustering of PWE were common. Specific clinical presentations such as nodding seizures and Nakalanga features were encountered. These results suggest a high prevalence of onchocerciasis-associated epilepsy (OAE) in the study villages.
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Affiliation(s)
| | - Michel Mandro
- Ministry of Health, Ituri, Democratic Republic of Congo
| | - Deby Mukendi
- Mont Amba Neuropsychopathologic Center, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | - Sonia Menon
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Swabra Nakato
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Françoise Nyisi
- Centre de Recherche en Maladies Tropicales de l'Ituri, Rethy, Democratic Republic of Congo
| | - Germain Abhafule
- Centre de Recherche en Maladies Tropicales de l'Ituri, Rethy, Democratic Republic of Congo
| | | | - Aimé Anyolito
- Hôpital Général de Référence de Logo, Ituri, Democratic Republic of Congo
| | - Richard Lokonda
- Mont Amba Neuropsychopathologic Center, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - An Hotterbeekx
- Global Health Institute, University of Antwerp, Antwerp, Belgium
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Colebunders R, Siewe Fodjo JN, Hopkins A, Hotterbeekx A, Lakwo TL, Kalinga A, Logora MY, Basáñez MG. From river blindness to river epilepsy: Implications for onchocerciasis elimination programmes. PLoS Negl Trop Dis 2019; 13:e0007407. [PMID: 31318857 PMCID: PMC6638735 DOI: 10.1371/journal.pntd.0007407] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | | | - Adrian Hopkins
- Neglected and Disabling Diseases of Poverty Consultant, Kent, United Kingdom
| | - An Hotterbeekx
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Thomson L. Lakwo
- Neglected Tropical Diseases Control Programme, Ministry of Health, Kampala, Uganda
| | - Akili Kalinga
- National institute for Medical Research, Ministry of Health, Dar es Salaam, Tanzania
| | - Makoy Yibi Logora
- Neglected Tropical Diseases Unit, Ministry of Health, Juba, South Sudan
| | - Maria-Gloria Basáñez
- London Centre for Neglected Tropical Disease Research and MRC Centre for Global Infectious Disease Analysis (MRC-GIDA), Imperial College London, London, United Kingdom
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18
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Siewe Fodjo JN, Dekker MCJ, Idro R, Mandro MN, Preux PM, Njamnshi AK, Colebunders R. Comprehensive management of epilepsy in onchocerciasis-endemic areas: lessons learnt from community-based surveys. Infect Dis Poverty 2019; 8:11. [PMID: 30738437 PMCID: PMC6368958 DOI: 10.1186/s40249-019-0523-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 06/19/2018] [Accepted: 01/23/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Onchocerciasis-endemic regions are known to have a high epilepsy prevalence. Limited resources in these areas and poor access to healthcare by persons with epilepsy (PWE) result in a wide anti-epileptic treatment gap, poor seizure control and a high burden of seizure-related complications. Recent community-based surveys highlight the need for epilepsy management strategies suitable for remote onchocerciasis-endemic villages to ensure better health outcomes for PWE. In this paper, we propose a feasible approach to manage PWE in such settings. MAIN TEXT Improved management of PWE in onchocerciasis-endemic areas may be achieved by decentralizing epilepsy care. Simplified approaches for the diagnosis and treatment of epilepsy may be used by non-physicians, under the supervision of physicians or specialists. To reduce the treatment gap, a regular supply of subsidized anti-epileptic drugs (AED) appropriate for different types of onchocerciasis-associated epilepsy should be instituted. Setting up a community-based epilepsy surveillance system will enable early diagnosis and treatment of PWE thereby preventing complications. Community awareness programs on epilepsy must be implemented to reduce stigma and facilitate the social rehabilitation of PWE. Finally, strengthening onchocerciasis elimination programs by optimizing community-directed treatment with ivermectin (CDTI) and considering alternative treatment strategies might reduce the incidence of epilepsy. CONCLUSIONS A community-based approach with task-shifting of epilepsy care from specialists to non-physician health workers will reduce epilepsy-associated morbidity. Increased advocacy and collaboration with various stakeholders is needed to establish a sustainable, cost-effective chronic care model for epilepsy that will significantly improve the quality of life of PWE in onchocerciasis-endemic regions.
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Affiliation(s)
| | - Marieke C. J. Dekker
- Department of Internal Medicine and Pediatrics, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Richard Idro
- Department of Paediatrics and Child Health, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Michel Ndahura Mandro
- Global Health Institute, University of Antwerp, Antwerp, Belgium
- Provincial Health Division Ituri, Ministry of Health, Bunia, Democratic Republic of the Congo
| | - Pierre-Marie Preux
- INSERM, Univ. Limoges, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, GEIST, 87000, Limoges, CHU, UMR 1094 Limoges, France
| | - Alfred K. Njamnshi
- Department of Neurology, Yaoundé Central Hospital / FMBS, The University of Yaoundé 1, Yaoundé, Cameroon
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
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Abd-Elfarag G, Logora MY, Carter JY, Ojok M, Songok J, Menon S, Wit F, Lako R, Colebunders R. The effect of bi-annual community-directed treatment with ivermectin on the incidence of epilepsy in onchocerciasis endemic villages in South Sudan: a study protocol. Infect Dis Poverty 2018; 7:112. [PMID: 30424817 PMCID: PMC6234538 DOI: 10.1186/s40249-018-0496-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 04/18/2018] [Accepted: 10/19/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Nodding syndrome (NS) is a devastating epileptic illness of unknown aetiology mainly affecting children 5-15 years of age. Head nodding distinguishes NS from other forms of epilepsy. Other manifestations of the illness include mental and physical growth retardation. Many children die as a result of falling in fires or drowning. Recently, it was shown that NS is only one of the phenotypic presentations of onchocerciasis associated epilepsy (OAE). Despite the strong epidemiological association between epilepsy and onchocerciasis, the causal mechanism is unknown. After implementation of bi-annual community directed treatment with ivermectin (CDTi) and larviciding of rivers in northern Uganda, new cases of NS have ceased, while new cases continue to emerge in South Sudanese onchocerciasis-endemic areas with an interrupted CDTi programme. This study is designed to evaluate the potential effects of bi-annual CDTi on reducing the incidence of NS/OAE in onchocerciasis-endemic areas in South Sudan. METHODS A pre-intervention door-to-door population-based household survey will be conducted in selected onchocerciasis-endemic villages in Mundri and Maridi Counties, which have a high prevalence of epilepsy. Using a validated questionnaire, the entire village will be screened by community research assistants for suspected epilepsy cases. Suspected cases will be interviewed and examined by a trained clinical officer or medical doctor who will confirm or reject the diagnosis of epilepsy. Bi-annual CDTi will be implemented in the villages and a surveillance system for epilepsy set up. By implementing an epilepsy onchocerciasis awareness campaign we expect to obtain > 90% CDTi coverage of eligible individuals. The door-to-door survey will be repeated two years after the baseline survey. The incidence of NS/OAE will be compared before and after bi-annual CDTi. DISCUSSION Our study is the first population-based study to evaluate the effect of bi-annual CDTi to reduce the incidence of NS/OAE. If the study demonstrates such a reduction, these findings are expected to motivate communities in onchocerciasis-endemic regions to participate in CDTi, and will encourage policy makers, funders and other stakeholders to increase their efforts to eliminate onchocerciasis.
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Affiliation(s)
- Gasim Abd-Elfarag
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Makoy Yibi Logora
- Neglected Tropical Diseases Unit, Ministry of Health, Juba, Republic of South Sudan
| | | | | | | | - Sonia Menon
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Ferdinand Wit
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Richard Lako
- Policy, Planning, Budgeting and Research, Ministry of Health, Juba, Republic of South Sudan
| | - Robert Colebunders
- Global Health Institute, University of Antwerp, Kinsbergen Centrum, Doornstraat 331, 2610 Antwerp, Belgium
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Kaiser C, Asaba G, Rubaale T, Tukesiga E, Kipp W. Onchocerciasis-Associated Epilepsy with Head Nodding Seizures-Nodding Syndrome: A Case Series of 15 Patients from Western Uganda, 1994. Am J Trop Med Hyg 2018; 99:1211-1218. [PMID: 30226148 PMCID: PMC6221207 DOI: 10.4269/ajtmh.18-0511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 06/16/2018] [Accepted: 08/05/2018] [Indexed: 11/07/2022] Open
Abstract
Nodding syndrome (NS) is an encephalopathy characterized by the core symptom of epileptic head nodding seizures, affecting children at the age between 3 and 18 years in distinct areas of tropical Africa. A consistent correlation with onchocerciasis was found, but so far, the causation of NS has not been fully clarified. With a systematic analysis of features of a cohort of epilepsy patients examined in the Itwara onchocerciasis focus of western Uganda in 1994, we provide evidence that NS actually occurred in this area at this time, and we demonstrate a correlation between prevalence of NS and that of onchocerciasis in different villages. Following the elimination of onchocerciasis by community-directed treatment with ivermectin and ground larviciding, our data provide a baseline to examine the question whether NS will disappear once its putative cause has been removed.
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Affiliation(s)
- Christoph Kaiser
- Basic Health Services Kabarole and Bundibugyo Districts, Fort Portal, Uganda; Vector Control Unit, Ministry of Health, Fort Portal, Uganda; Department of Public Health Sciences, University of Alberta, Edmonton, Canada
| | - George Asaba
- Basic Health Services Kabarole and Bundibugyo Districts, Fort Portal, Uganda; Vector Control Unit, Ministry of Health, Fort Portal, Uganda; Department of Public Health Sciences, University of Alberta, Edmonton, Canada
| | - Tom Rubaale
- Basic Health Services Kabarole and Bundibugyo Districts, Fort Portal, Uganda; Vector Control Unit, Ministry of Health, Fort Portal, Uganda; Department of Public Health Sciences, University of Alberta, Edmonton, Canada
| | - Ephraim Tukesiga
- Basic Health Services Kabarole and Bundibugyo Districts, Fort Portal, Uganda; Vector Control Unit, Ministry of Health, Fort Portal, Uganda; Department of Public Health Sciences, University of Alberta, Edmonton, Canada
| | - Walter Kipp
- Basic Health Services Kabarole and Bundibugyo Districts, Fort Portal, Uganda; Vector Control Unit, Ministry of Health, Fort Portal, Uganda; Department of Public Health Sciences, University of Alberta, Edmonton, Canada
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21
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Affiliation(s)
- M Glover
- Royal London Hospital, Whitechapel
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22
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Kamgno J, Pion SD, Chesnais CB, Bakalar MH, D'Ambrosio MV, Mackenzie CD, Nana-Djeunga HC, Gounoue-Kamkumo R, Njitchouang GR, Nwane P, Tchatchueng-Mbouga JB, Wanji S, Stolk WA, Fletcher DA, Klion AD, Nutman TB, Boussinesq M. A Test-and-Not-Treat Strategy for Onchocerciasis in Loa loa-Endemic Areas. N Engl J Med 2017; 377:2044-2052. [PMID: 29116890 PMCID: PMC5629452 DOI: 10.1056/nejmoa1705026] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Implementation of an ivermectin-based community treatment strategy for the elimination of onchocerciasis or lymphatic filariasis has been delayed in Central Africa because of the occurrence of serious adverse events, including death, in persons with high levels of circulating Loa loa microfilariae. The LoaScope, a field-friendly diagnostic tool to quantify L. loa microfilariae in peripheral blood, enables rapid, point-of-care identification of persons at risk for serious adverse events. METHODS A test-and-not-treat strategy was used in the approach to ivermectin treatment in the Okola health district in Cameroon, where the distribution of ivermectin was halted in 1999 after the occurrence of fatal events related to L. loa infection. The LoaScope was used to identify persons with an L. loa microfilarial density greater than 20,000 microfilariae per milliliter of blood, who were considered to be at risk for serious adverse events, and exclude them from ivermectin distribution. Active surveillance for posttreatment adverse events was performed daily for 6 days. RESULTS From August through October 2015, a total of 16,259 of 22,842 persons 5 years of age or older (71.2% of the target population) were tested for L. loa microfilaremia. Among the participants who underwent testing, a total of 15,522 (95.5%) received ivermectin, 340 (2.1%) were excluded from ivermectin distribution because of an L. loa microfilarial density above the risk threshold, and 397 (2.4%) were excluded because of pregnancy or illness. No serious adverse events were observed. Nonserious adverse events were recorded in 934 participants, most of whom (67.5%) had no detectable L. loa microfilariae. CONCLUSIONS The LoaScope-based test-and-not-treat strategy enabled the reimplementation of community-wide ivermectin distribution in a heretofore "off limits" health district in Cameroon and is a potentially practical approach to larger-scale ivermectin treatment for lymphatic filariasis and onchocerciasis in areas where L. loa infection is endemic. (Funded by the Bill and Melinda Gates Foundation and others.).
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Affiliation(s)
- Joseph Kamgno
- From the Center for Research on Filariasis and other Tropical Diseases (J.K., H.C.N.-D., R.G.-K., G.-R.N., P.N., J.B.T.-M.) and the Faculty of Medicine and Biomedical Sciences, University of Yaounde I (J.K.), Yaounde, and the Faculty of Health Sciences, Department of Microbiology and Parasitology, University of Buea, and Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea (S.W.) - all in Cameroon; Institut de Recherche pour le Développement Unité Mixte Internationale 233-INSERM Unité 1175, Montpellier University, Montpellier, France (S.D.P., C.B.C., M.B.); the Department of Bioengineering and the Biophysics Program, University of California, Berkeley, Berkeley (M.H.B., M.V.D., D.A.F.); the Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing (C.D.M.); the Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (W.A.S.); the Chan Zuckerberg Biohub, San Francisco (D.A.F.); and the Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD (A.D.K., T.B.N.)
| | - Sébastien D Pion
- From the Center for Research on Filariasis and other Tropical Diseases (J.K., H.C.N.-D., R.G.-K., G.-R.N., P.N., J.B.T.-M.) and the Faculty of Medicine and Biomedical Sciences, University of Yaounde I (J.K.), Yaounde, and the Faculty of Health Sciences, Department of Microbiology and Parasitology, University of Buea, and Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea (S.W.) - all in Cameroon; Institut de Recherche pour le Développement Unité Mixte Internationale 233-INSERM Unité 1175, Montpellier University, Montpellier, France (S.D.P., C.B.C., M.B.); the Department of Bioengineering and the Biophysics Program, University of California, Berkeley, Berkeley (M.H.B., M.V.D., D.A.F.); the Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing (C.D.M.); the Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (W.A.S.); the Chan Zuckerberg Biohub, San Francisco (D.A.F.); and the Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD (A.D.K., T.B.N.)
| | - Cédric B Chesnais
- From the Center for Research on Filariasis and other Tropical Diseases (J.K., H.C.N.-D., R.G.-K., G.-R.N., P.N., J.B.T.-M.) and the Faculty of Medicine and Biomedical Sciences, University of Yaounde I (J.K.), Yaounde, and the Faculty of Health Sciences, Department of Microbiology and Parasitology, University of Buea, and Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea (S.W.) - all in Cameroon; Institut de Recherche pour le Développement Unité Mixte Internationale 233-INSERM Unité 1175, Montpellier University, Montpellier, France (S.D.P., C.B.C., M.B.); the Department of Bioengineering and the Biophysics Program, University of California, Berkeley, Berkeley (M.H.B., M.V.D., D.A.F.); the Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing (C.D.M.); the Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (W.A.S.); the Chan Zuckerberg Biohub, San Francisco (D.A.F.); and the Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD (A.D.K., T.B.N.)
| | - Matthew H Bakalar
- From the Center for Research on Filariasis and other Tropical Diseases (J.K., H.C.N.-D., R.G.-K., G.-R.N., P.N., J.B.T.-M.) and the Faculty of Medicine and Biomedical Sciences, University of Yaounde I (J.K.), Yaounde, and the Faculty of Health Sciences, Department of Microbiology and Parasitology, University of Buea, and Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea (S.W.) - all in Cameroon; Institut de Recherche pour le Développement Unité Mixte Internationale 233-INSERM Unité 1175, Montpellier University, Montpellier, France (S.D.P., C.B.C., M.B.); the Department of Bioengineering and the Biophysics Program, University of California, Berkeley, Berkeley (M.H.B., M.V.D., D.A.F.); the Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing (C.D.M.); the Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (W.A.S.); the Chan Zuckerberg Biohub, San Francisco (D.A.F.); and the Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD (A.D.K., T.B.N.)
| | - Michael V D'Ambrosio
- From the Center for Research on Filariasis and other Tropical Diseases (J.K., H.C.N.-D., R.G.-K., G.-R.N., P.N., J.B.T.-M.) and the Faculty of Medicine and Biomedical Sciences, University of Yaounde I (J.K.), Yaounde, and the Faculty of Health Sciences, Department of Microbiology and Parasitology, University of Buea, and Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea (S.W.) - all in Cameroon; Institut de Recherche pour le Développement Unité Mixte Internationale 233-INSERM Unité 1175, Montpellier University, Montpellier, France (S.D.P., C.B.C., M.B.); the Department of Bioengineering and the Biophysics Program, University of California, Berkeley, Berkeley (M.H.B., M.V.D., D.A.F.); the Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing (C.D.M.); the Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (W.A.S.); the Chan Zuckerberg Biohub, San Francisco (D.A.F.); and the Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD (A.D.K., T.B.N.)
| | - Charles D Mackenzie
- From the Center for Research on Filariasis and other Tropical Diseases (J.K., H.C.N.-D., R.G.-K., G.-R.N., P.N., J.B.T.-M.) and the Faculty of Medicine and Biomedical Sciences, University of Yaounde I (J.K.), Yaounde, and the Faculty of Health Sciences, Department of Microbiology and Parasitology, University of Buea, and Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea (S.W.) - all in Cameroon; Institut de Recherche pour le Développement Unité Mixte Internationale 233-INSERM Unité 1175, Montpellier University, Montpellier, France (S.D.P., C.B.C., M.B.); the Department of Bioengineering and the Biophysics Program, University of California, Berkeley, Berkeley (M.H.B., M.V.D., D.A.F.); the Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing (C.D.M.); the Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (W.A.S.); the Chan Zuckerberg Biohub, San Francisco (D.A.F.); and the Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD (A.D.K., T.B.N.)
| | - Hugues C Nana-Djeunga
- From the Center for Research on Filariasis and other Tropical Diseases (J.K., H.C.N.-D., R.G.-K., G.-R.N., P.N., J.B.T.-M.) and the Faculty of Medicine and Biomedical Sciences, University of Yaounde I (J.K.), Yaounde, and the Faculty of Health Sciences, Department of Microbiology and Parasitology, University of Buea, and Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea (S.W.) - all in Cameroon; Institut de Recherche pour le Développement Unité Mixte Internationale 233-INSERM Unité 1175, Montpellier University, Montpellier, France (S.D.P., C.B.C., M.B.); the Department of Bioengineering and the Biophysics Program, University of California, Berkeley, Berkeley (M.H.B., M.V.D., D.A.F.); the Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing (C.D.M.); the Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (W.A.S.); the Chan Zuckerberg Biohub, San Francisco (D.A.F.); and the Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD (A.D.K., T.B.N.)
| | - Raceline Gounoue-Kamkumo
- From the Center for Research on Filariasis and other Tropical Diseases (J.K., H.C.N.-D., R.G.-K., G.-R.N., P.N., J.B.T.-M.) and the Faculty of Medicine and Biomedical Sciences, University of Yaounde I (J.K.), Yaounde, and the Faculty of Health Sciences, Department of Microbiology and Parasitology, University of Buea, and Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea (S.W.) - all in Cameroon; Institut de Recherche pour le Développement Unité Mixte Internationale 233-INSERM Unité 1175, Montpellier University, Montpellier, France (S.D.P., C.B.C., M.B.); the Department of Bioengineering and the Biophysics Program, University of California, Berkeley, Berkeley (M.H.B., M.V.D., D.A.F.); the Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing (C.D.M.); the Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (W.A.S.); the Chan Zuckerberg Biohub, San Francisco (D.A.F.); and the Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD (A.D.K., T.B.N.)
| | - Guy-Roger Njitchouang
- From the Center for Research on Filariasis and other Tropical Diseases (J.K., H.C.N.-D., R.G.-K., G.-R.N., P.N., J.B.T.-M.) and the Faculty of Medicine and Biomedical Sciences, University of Yaounde I (J.K.), Yaounde, and the Faculty of Health Sciences, Department of Microbiology and Parasitology, University of Buea, and Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea (S.W.) - all in Cameroon; Institut de Recherche pour le Développement Unité Mixte Internationale 233-INSERM Unité 1175, Montpellier University, Montpellier, France (S.D.P., C.B.C., M.B.); the Department of Bioengineering and the Biophysics Program, University of California, Berkeley, Berkeley (M.H.B., M.V.D., D.A.F.); the Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing (C.D.M.); the Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (W.A.S.); the Chan Zuckerberg Biohub, San Francisco (D.A.F.); and the Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD (A.D.K., T.B.N.)
| | - Philippe Nwane
- From the Center for Research on Filariasis and other Tropical Diseases (J.K., H.C.N.-D., R.G.-K., G.-R.N., P.N., J.B.T.-M.) and the Faculty of Medicine and Biomedical Sciences, University of Yaounde I (J.K.), Yaounde, and the Faculty of Health Sciences, Department of Microbiology and Parasitology, University of Buea, and Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea (S.W.) - all in Cameroon; Institut de Recherche pour le Développement Unité Mixte Internationale 233-INSERM Unité 1175, Montpellier University, Montpellier, France (S.D.P., C.B.C., M.B.); the Department of Bioengineering and the Biophysics Program, University of California, Berkeley, Berkeley (M.H.B., M.V.D., D.A.F.); the Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing (C.D.M.); the Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (W.A.S.); the Chan Zuckerberg Biohub, San Francisco (D.A.F.); and the Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD (A.D.K., T.B.N.)
| | - Jules B Tchatchueng-Mbouga
- From the Center for Research on Filariasis and other Tropical Diseases (J.K., H.C.N.-D., R.G.-K., G.-R.N., P.N., J.B.T.-M.) and the Faculty of Medicine and Biomedical Sciences, University of Yaounde I (J.K.), Yaounde, and the Faculty of Health Sciences, Department of Microbiology and Parasitology, University of Buea, and Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea (S.W.) - all in Cameroon; Institut de Recherche pour le Développement Unité Mixte Internationale 233-INSERM Unité 1175, Montpellier University, Montpellier, France (S.D.P., C.B.C., M.B.); the Department of Bioengineering and the Biophysics Program, University of California, Berkeley, Berkeley (M.H.B., M.V.D., D.A.F.); the Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing (C.D.M.); the Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (W.A.S.); the Chan Zuckerberg Biohub, San Francisco (D.A.F.); and the Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD (A.D.K., T.B.N.)
| | - Samuel Wanji
- From the Center for Research on Filariasis and other Tropical Diseases (J.K., H.C.N.-D., R.G.-K., G.-R.N., P.N., J.B.T.-M.) and the Faculty of Medicine and Biomedical Sciences, University of Yaounde I (J.K.), Yaounde, and the Faculty of Health Sciences, Department of Microbiology and Parasitology, University of Buea, and Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea (S.W.) - all in Cameroon; Institut de Recherche pour le Développement Unité Mixte Internationale 233-INSERM Unité 1175, Montpellier University, Montpellier, France (S.D.P., C.B.C., M.B.); the Department of Bioengineering and the Biophysics Program, University of California, Berkeley, Berkeley (M.H.B., M.V.D., D.A.F.); the Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing (C.D.M.); the Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (W.A.S.); the Chan Zuckerberg Biohub, San Francisco (D.A.F.); and the Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD (A.D.K., T.B.N.)
| | - Wilma A Stolk
- From the Center for Research on Filariasis and other Tropical Diseases (J.K., H.C.N.-D., R.G.-K., G.-R.N., P.N., J.B.T.-M.) and the Faculty of Medicine and Biomedical Sciences, University of Yaounde I (J.K.), Yaounde, and the Faculty of Health Sciences, Department of Microbiology and Parasitology, University of Buea, and Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea (S.W.) - all in Cameroon; Institut de Recherche pour le Développement Unité Mixte Internationale 233-INSERM Unité 1175, Montpellier University, Montpellier, France (S.D.P., C.B.C., M.B.); the Department of Bioengineering and the Biophysics Program, University of California, Berkeley, Berkeley (M.H.B., M.V.D., D.A.F.); the Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing (C.D.M.); the Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (W.A.S.); the Chan Zuckerberg Biohub, San Francisco (D.A.F.); and the Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD (A.D.K., T.B.N.)
| | - Daniel A Fletcher
- From the Center for Research on Filariasis and other Tropical Diseases (J.K., H.C.N.-D., R.G.-K., G.-R.N., P.N., J.B.T.-M.) and the Faculty of Medicine and Biomedical Sciences, University of Yaounde I (J.K.), Yaounde, and the Faculty of Health Sciences, Department of Microbiology and Parasitology, University of Buea, and Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea (S.W.) - all in Cameroon; Institut de Recherche pour le Développement Unité Mixte Internationale 233-INSERM Unité 1175, Montpellier University, Montpellier, France (S.D.P., C.B.C., M.B.); the Department of Bioengineering and the Biophysics Program, University of California, Berkeley, Berkeley (M.H.B., M.V.D., D.A.F.); the Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing (C.D.M.); the Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (W.A.S.); the Chan Zuckerberg Biohub, San Francisco (D.A.F.); and the Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD (A.D.K., T.B.N.)
| | - Amy D Klion
- From the Center for Research on Filariasis and other Tropical Diseases (J.K., H.C.N.-D., R.G.-K., G.-R.N., P.N., J.B.T.-M.) and the Faculty of Medicine and Biomedical Sciences, University of Yaounde I (J.K.), Yaounde, and the Faculty of Health Sciences, Department of Microbiology and Parasitology, University of Buea, and Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea (S.W.) - all in Cameroon; Institut de Recherche pour le Développement Unité Mixte Internationale 233-INSERM Unité 1175, Montpellier University, Montpellier, France (S.D.P., C.B.C., M.B.); the Department of Bioengineering and the Biophysics Program, University of California, Berkeley, Berkeley (M.H.B., M.V.D., D.A.F.); the Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing (C.D.M.); the Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (W.A.S.); the Chan Zuckerberg Biohub, San Francisco (D.A.F.); and the Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD (A.D.K., T.B.N.)
| | - Thomas B Nutman
- From the Center for Research on Filariasis and other Tropical Diseases (J.K., H.C.N.-D., R.G.-K., G.-R.N., P.N., J.B.T.-M.) and the Faculty of Medicine and Biomedical Sciences, University of Yaounde I (J.K.), Yaounde, and the Faculty of Health Sciences, Department of Microbiology and Parasitology, University of Buea, and Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea (S.W.) - all in Cameroon; Institut de Recherche pour le Développement Unité Mixte Internationale 233-INSERM Unité 1175, Montpellier University, Montpellier, France (S.D.P., C.B.C., M.B.); the Department of Bioengineering and the Biophysics Program, University of California, Berkeley, Berkeley (M.H.B., M.V.D., D.A.F.); the Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing (C.D.M.); the Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (W.A.S.); the Chan Zuckerberg Biohub, San Francisco (D.A.F.); and the Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD (A.D.K., T.B.N.)
| | - Michel Boussinesq
- From the Center for Research on Filariasis and other Tropical Diseases (J.K., H.C.N.-D., R.G.-K., G.-R.N., P.N., J.B.T.-M.) and the Faculty of Medicine and Biomedical Sciences, University of Yaounde I (J.K.), Yaounde, and the Faculty of Health Sciences, Department of Microbiology and Parasitology, University of Buea, and Research Foundation for Tropical Diseases and Environment (REFOTDE), Buea (S.W.) - all in Cameroon; Institut de Recherche pour le Développement Unité Mixte Internationale 233-INSERM Unité 1175, Montpellier University, Montpellier, France (S.D.P., C.B.C., M.B.); the Department of Bioengineering and the Biophysics Program, University of California, Berkeley, Berkeley (M.H.B., M.V.D., D.A.F.); the Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing (C.D.M.); the Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (W.A.S.); the Chan Zuckerberg Biohub, San Francisco (D.A.F.); and the Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD (A.D.K., T.B.N.)
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Develoux M, Hennequin C, Le Loup G, Paris L, Magne D, Belkadi G, Pialoux G. Imported filariasis in Europe: A series of 31 cases from Metropolitan France. Eur J Intern Med 2017; 37:e37-e39. [PMID: 27733303 DOI: 10.1016/j.ejim.2016.09.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 09/21/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Affiliation(s)
- M Develoux
- AP-HP, Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, F-75012 Paris, France
| | - C Hennequin
- AP-HP, Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, F-75012 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, Inserm UMR S 1135, CNRS ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), F-75013 Paris, France.
| | - G Le Loup
- AP-HP, Hôpital Tenon, Service des Maladies Infectieuses et Tropicales, F-75020 Paris, France
| | - L Paris
- APHP, Service de parasitologie-mycologie, Hôpital Pitié-Salpêtrière, Paris 75013, France
| | - D Magne
- AP-HP, Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, F-75012 Paris, France
| | - G Belkadi
- AP-HP, Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, F-75012 Paris, France
| | - G Pialoux
- AP-HP, Hôpital Tenon, Service des Maladies Infectieuses et Tropicales, F-75020 Paris, France
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Krotneva SP, Coffeng LE, Noma M, Zouré HGM, Bakoné L, Amazigo UV, de Vlas SJ, Stolk WA. African Program for Onchocerciasis Control 1995-2010: Impact of Annual Ivermectin Mass Treatment on Off-Target Infectious Diseases. PLoS Negl Trop Dis 2015; 9:e0004051. [PMID: 26401658 PMCID: PMC4581698 DOI: 10.1371/journal.pntd.0004051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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] [Received: 04/21/2015] [Accepted: 08/12/2015] [Indexed: 12/17/2022] Open
Abstract
Since its initiation in 1995, the African Program for Onchocerciasis Control (APOC) has had a substantial impact on the prevalence and burden of onchocerciasis through annual ivermectin mass treatment. Ivermectin is a broad-spectrum anti-parasitic agent that also has an impact on other co-endemic parasitic infections. In this study, we roughly assessed the additional impact of APOC activities on the burden of the most important off-target infections: soil-transmitted helminthiases (STH; ascariasis, trichuriasis, hookworm, and strongyloidiasis), lymphatic filariasis (LF), and scabies. Based on a literature review, we formulated assumptions about the impact of ivermectin treatment on the disease burden of these off-target infections. Using data on the number of ivermectin treatments in APOC regions and the latest estimates of the burden of disease, we then calculated the impact of APOC activities on off-target infections in terms of disability-adjusted life years (DALYs) averted. We conservatively estimated that between 1995 and 2010, annual ivermectin mass treatment has cumulatively averted about 500 thousand DALYs from co-endemic STH infections, LF, and scabies. This impact comprised approximately an additional 5.5% relative to the total burden averted from onchocerciasis (8.9 million DALYs) and indicates that the overall cost-effectiveness of APOC is even higher than previously reported. Onchocerciasis, or river blindness, is an infectious disease caused by the worm Onchocerca volvulus, which is transmitted between humans through the bites of blackflies and causes deforming skin disease, itch, and vision loss. The African Programme for Onchocerciasis Control (APOC) aims to control morbidity due to onchocerciasis by implementing mass drug administration (MDA) with ivermectin in endemic areas, targeting the whole population except for children under five and pregnant women. Aside from its effect on onchocerciasis, ivermectin also affects other parasitic infections such as lymphatic filariasis, intestinal worm infections, and scabies, which are all significantly co-endemic in areas covered by APOC. In this paper, the researchers roughly estimate the health impact of ivermectin MDA on off-target infections based on the number of dispensed treatments up to 2010, published estimates of the disease burden of off-target infections, and the expected effect of ivermectin treatment on the burden of these infections (based on literature review). This off-target health impact of APOC constitutes about 500 thousand years worth of healthy years of life (an additional 5.5% on top of the impact of APOC on the burden of onchocerciasis) and indicates that the cost-effectiveness of APOC is even higher than previously estimated.
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Affiliation(s)
- Stanimira P. Krotneva
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Luc E. Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Mounkaila Noma
- African Programme for Onchocerciasis Control, Ouagadougou, Burkina Faso
| | | | - Lalle Bakoné
- African Programme for Onchocerciasis Control, Ouagadougou, Burkina Faso
| | | | - Sake J. de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wilma A. Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Coffeng LE, Stolk WA, Zouré HGM, Veerman JL, Agblewonu KB, Murdoch ME, Noma M, Fobi G, Richardus JH, Bundy DAP, Habbema D, de Vlas SJ, Amazigo UV. African programme for onchocerciasis control 1995-2015: updated health impact estimates based on new disability weights. PLoS Negl Trop Dis 2014; 8:e2759. [PMID: 24901642 PMCID: PMC4046979 DOI: 10.1371/journal.pntd.0002759] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Luc E. Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Wilma A. Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - J. Lennert Veerman
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- School of Population Health, The University of Queensland, Herston, Australia
| | | | - Michele E. Murdoch
- Department of Dermatology, Watford General Hospital, Watford, United Kingdom
| | - Mounkaila Noma
- African Programme for Onchocerciasis Control, Ouagadougou, Burkina Faso
| | - Grace Fobi
- African Programme for Onchocerciasis Control, Ouagadougou, Burkina Faso
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Donald A. P. Bundy
- Human Development Network, The World Bank, Washington, D.C., United States of America
| | - Dik Habbema
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sake J. de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Kipp W, Bamhuhiiga J, Rubaale T, Kabagambe G. Adverse reactions to the ivermectin treatment of onchocerciasis patients: does infection with the human immunodeficiency virus play a role? Annals of Tropical Medicine & Parasitology 2013; 99:395-402. [PMID: 15949187 DOI: 10.1179/136485905x36262] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To assess and compare the adverse effects resulting from ivermectin treatment of onchocerciasis patients with and without infection with human immunodeficiency virus (HIV-1), 1256 Ugandan cases of onchocerciasis were investigated as they were treated for the first time with the drug. Treatment followed the protocol of the Mectizan Expert Committee (i.e. a single dose of 150 mug/kg body weight). Adverse reactions to the ivermectin were determined, within 48 h of treatment, through questioning and clinical examinations during house-to-house visits. The HIV-1 status of each patient aged >15 years was initially determined using indirect ELISA, and any ELISA-positives were then confirmed in a western-blot assay. Among the cases aged >15 years, the frequency of adverse reactions to ivermectin was higher among those seropositive for HIV-1 (53.4%) than among the seronegative (45.7%) but the difference was not statistically significant (P = 0.25). The severity of the adverse reactions observed was, however, significantly lower in the HIV-1-positive patients than in the seronegative patients, with median scores of 1.37 and 1.68, respectively (P = 0.044). The conclusion is that ivermectin can be safely used for mass treatment in areas where the prevalences of onchocerciasis and HIV-1 infection are both high.
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Affiliation(s)
- W Kipp
- Department of Public Health Sciences, Faculty of Medicine and Dentistry, 13-103 Clinical Sciences Building, University of Alberta, Edmonton, Canada.
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Twum-Danso NAY. Mass treatment of onchocerciasis with ivermectin: should people with epilepsy and/or growth-retardation syndromes be excluded? Annals of Tropical Medicine & Parasitology 2013; 98:99-114. [PMID: 15035720 DOI: 10.1179/000349804225003208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In many areas of Africa where human onchocerciasis is endemic there are now programmes for mass treatment with ivermectin (Mectizan), to eliminate the disease as a public-health problem. To determine whether those with epilepsy and/or growth-retardation syndromes (GRS) should be excluded from such mass drug administrations, literature searches of the standard biomedical databases were performed for all relevant articles published in English or French before January 2003. Cross-referencing and the retrieving of articles recommended by experts completed the search. The literature review revealed that there is insufficient evidence for an association between onchocerciasis and epilepsy or GRS. Since ivermectin does not normally cross the blood-brain barrier, the drug is unlikely to have direct pro- or anti-convulsive activity. Furthermore, an estimated 1-2 million epileptics in Africa have been treated with ivermectin, in onchocerciasis-control programmes, without any reports of serious adverse events (SAE) to the passive surveillance system for such events. As there are few data on the prevalence of GRS in Africa, it is difficult to estimate the number of GRS cases who have been treated with ivermectin or the incidence of ivermectin-related SAE among such cases. Epileptics should not be excluded from mass treatments with ivermectin unless they are actively seizing or postictal. Although those with GRS associated with chronic wasting, with or without epilepsy, should be excluded, they should be eligible for clinic-based treatment if the diagnosis of onchocerciasis is confirmed and the benefits of treatment are deemed to outweigh any potential risks.
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Affiliation(s)
- N A Y Twum-Danso
- Mectizan Donation Program, 750 Commerce Drive, Suite 400, Decatur, GA 30030, USA.
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Kuehn BM. Scientists celebrate successes, new tools in fight against human parasitic worms. JAMA 2013; 310:19-20. [PMID: 23821071 DOI: 10.1001/jama.2013.7665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Kaiser C, Pion SDS, Boussinesq M. Case-control studies on the relationship between onchocerciasis and epilepsy: systematic review and meta-analysis. PLoS Negl Trop Dis 2013; 7:e2147. [PMID: 23556028 PMCID: PMC3610636 DOI: 10.1371/journal.pntd.0002147] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [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] [Received: 09/01/2012] [Accepted: 02/20/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE A systematic review and meta-analysis of all available case-control studies on the relationship between onchocerciasis and epilepsy. Because age and level of onchocerciasis endemicity in the area of residence are major determinants for infection, an additional analysis was performed, restricted to studies achieving control of these confounding factors. DATA SOURCES Medical databases, the "African Neurology Database, Institute of Neuroepidemiology and Tropical Neurology, Limoges," reference lists of relevant articles, commercial search engines, up to May 2012. METHODS We searched for studies examining infection status with Onchocerca volvulus in persons with epilepsy (PWE) and without epilepsy (PWOE) providing data suitable for the calculation of pooled odds ratios (ORp) and/or standardized mean differences (SMD) using random-effects models. RESULTS Eleven studies providing data of qualitative skin biopsies for diagnosis of onchocerciasis were identified. Combined analysis on the total sample of 876 PWE and 4712 PWOE resulted in an ORp of 2.49 (95% confidence interval (95%CI): 1.61-3.86, p<0.001). When this analysis was restricted to those studies achieving control for age, residence and sex (367 PWE, 624 PWOE), an ORp of 1.29 (95% CI: 0.93-1.79; p = 0.139) was found. Presence of nodules for diagnosis of onchocerciasis was analyzed in four studies (225 PWE, 189 PWOE; ORp 1.74; 95%CI: 0.94-3.20; p<0.076), including two studies of the restricted analysis (106 PWE, 106 PWOE; ORp 2.81; 95%CI: 1.57-5.00; p<0.001). One study examined quantitative microfilariae counts in patients without preceding microfilaricidal treatment and demonstrated significantly higher counts in PWE than in PWOE. INTERPRETATION Our results strengthen the hypothesis that, in onchocerciasis foci, epilepsy and infection with O. volvulus are associated. Analysis of indicators giving information on infection intensity, namely nodule palpation and quantitative microfilaria count in untreated patients, support the hypothesis that intensity of infection with O. volvulus is involved in the etiology of epilepsy.
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Affiliation(s)
- Christoph Kaiser
- Basic Health Services Kabarole & Bundibugyo Districts, Fort Portal, Uganda.
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Tumwine JK, Vandemaele K, Chungong S, Richer M, Anker M, Ayana Y, Opoka ML, Klaucke DN, Quarello A, Spencer PS. Clinical and epidemiologic characteristics of nodding syndrome in Mundri County, southern Sudan. Afr Health Sci 2012; 12:242-8. [PMID: 23382736 DOI: 10.4314/ahs.v12i3.1] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Nodding syndrome (repetitive nodding and progressive generalized seizures) is assuming epidemic proportions in South Sudan, Tanzania and Uganda. OBJECTIVE To describe clinical and epidemiological features of nodding syndrome in southern Sudan based on preliminary investigations conducted in 2001 and 2002. METHOD Household surveys, clinical, electrophysiological (EEG) assessments, informant interviews and case-control studies were conducted in the town of Lui and the village of Amadi in southern Sudan. RESULTS Nodding syndrome is characterized by involuntary repetitive nodding of the head, progressing to generalized seizures; mental and physical deterioration. The EEGs were consistent with progressive epileptic encephalopathy. Prevalence of Nodding syndrome in Lui and Amadi was 2.3% and 6.7% respectively. All case control studies showed a positive association between cases and Onchocerca volvulus. A history of measles was negatively associated with being a case: 2/13 of cases and 11/19 of controls had had measles: odds ratio 0.13 (95% CI 0.02, 0.76). Environmental assessment did not reveal any naturally occurring or manmade neurotoxic factors to explain Nodding Syndrome, although fungal contamination of food could not be ruled out. CONCLUSION Nodding Syndrome was strongly associated with Onchocerca volvulus. There was no evidence to suggest an environmental pollutant, chemical agent, or other toxic factor.
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Affiliation(s)
- J K Tumwine
- Department of Paediatrics and Child Health Makerere University, Kampala, Uganda.
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Abstract
Lymphatic filariasis and onchocerciasis are parasitic helminth diseases that constitute a serious public health issue in tropical regions. The filarial nematodes that cause these diseases are transmitted by blood-feeding insects and produce chronic and long-term infection through suppression of host immunity. Disease pathogenesis is linked to host inflammation invoked by the death of the parasite, causing hydrocoele, lymphoedema, and elephantiasis in lymphatic filariasis, and skin disease and blindness in onchocerciasis. Most filarial species that infect people co-exist in mutualistic symbiosis with Wolbachia bacteria, which are essential for growth, development, and survival of their nematode hosts. These endosymbionts contribute to inflammatory disease pathogenesis and are a target for doxycycline therapy, which delivers macrofilaricidal activity, improves pathological outcomes, and is effective as monotherapy. Drugs to treat filariasis include diethylcarbamazine, ivermectin, and albendazole, which are used mostly in combination to reduce microfilariae in blood (lymphatic filariasis) and skin (onchocerciasis). Global programmes for control and elimination have been developed to provide sustained delivery of drugs to affected communities to interrupt transmission of disease and ultimately eliminate this burden on public health.
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Affiliation(s)
- Mark J Taylor
- Liverpool School of Tropical Medicine, Liverpool, UK.
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Turner JD, Tendongfor N, Esum M, Johnston KL, Langley RS, Ford L, Faragher B, Specht S, Mand S, Hoerauf A, Enyong P, Wanji S, Taylor MJ. Macrofilaricidal activity after doxycycline only treatment of Onchocerca volvulus in an area of Loa loa co-endemicity: a randomized controlled trial. PLoS Negl Trop Dis 2010; 4:e660. [PMID: 20405054 PMCID: PMC2854122 DOI: 10.1371/journal.pntd.0000660] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 03/04/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The risk of severe adverse events following treatment of onchocerciasis with ivermectin in areas co-endemic with loiasis currently compromises the development of control programmes and the treatment of co-infected individuals. We therefore assessed whether doxycycline treatment could be used without subsequent ivermectin administration to effectively deliver sustained effects on Onchocerca volvulus microfilaridermia and adult viability. Furthermore we assessed the safety of doxycycline treatment prior to ivermectin administration in a subset of onchocerciasis individuals co-infected with low to moderate intensities of Loa loa microfilaraemia. METHODS A double-blind, randomized, field trial was conducted of 6 weeks of doxycycline (200 mg/day) alone, doxycycline in combination with ivermectin (150 microg/kg) at +4 months or placebo matching doxycycline + ivermectin at +4 months in 150 individuals infected with Onchocerca volvulus. A further 22 individuals infected with O. volvulus and low to moderate intensities of Loa loa infection were administered with a course of 6 weeks doxycycline with ivermectin at +4 months. Treatment efficacy was determined at 4, 12 and 21 months after the start of doxycycline treatment together with the frequency and severity of adverse events. RESULTS One hundred and four (60.5%) participants completed all treatment allocations and follow up assessments over the 21-month trial period. At 12 months, doxycycline/ivermectin treated individuals had lower levels of microfilaridermia and higher frequency of amicrofilaridermia compared with ivermectin or doxycycline only groups. At 21 months, microfilaridermia in doxycycline/ivermectin and doxycycline only groups was significantly reduced compared to the ivermectin only group. 89% of the doxycycline/ivermectin group and 67% of the doxycycline only group were amicrofilaridermic, compared with 21% in the ivermectin only group. O. volvulus from doxycycline groups were depleted of Wolbachia and all embryonic stages in utero. Notably, the viability of female adult worms was significantly reduced in doxycycline treated groups and the macrofilaricidal and sterilising activity was unaffected by the addition of ivermectin. Treatment with doxycycline was well tolerated and the incidence of adverse event to doxycycline or ivermectin did not significantly deviate between treatment groups. CONCLUSIONS A six-week course of doxycycline delivers macrofilaricidal and sterilizing activities, which is not dependent upon co-administration of ivermectin. Doxycycline is well tolerated in patients co-infected with moderate intensities of L. loa microfilariae. Therefore, further trials are warranted to assess the safety and efficacy of doxycycline-based interventions to treat onchocerciasis in individuals at risk of serious adverse reactions to standard treatments due to the co-occurrence of high intensities of L. loa parasitaemias. The development of an anti-wolbachial treatment regime compatible with MDA control programmes could offer an alternative to the control of onchocerciasis in areas of co-endemicity with loiasis and at risk of severe adverse reactions to ivermectin. TRIAL REGISTRATION Controlled-Trials.com ISRCTN48118452.
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Affiliation(s)
- Joseph D. Turner
- Filariasis Research Laboratory, Molecular and Biochemical Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Nicholas Tendongfor
- Department of Life Sciences, Faculty of Science, University of Buea, Buea, Cameroon
- Research Foundation in Tropical Diseases and Environment (REFOTDE), Buea, Cameroon
| | - Mathias Esum
- Department of Life Sciences, Faculty of Science, University of Buea, Buea, Cameroon
- Research Foundation in Tropical Diseases and Environment (REFOTDE), Buea, Cameroon
| | - Kelly L. Johnston
- Filariasis Research Laboratory, Molecular and Biochemical Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - R. Stuart Langley
- Filariasis Research Laboratory, Molecular and Biochemical Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Louise Ford
- Filariasis Research Laboratory, Molecular and Biochemical Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Brian Faragher
- Filariasis Research Laboratory, Molecular and Biochemical Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sabine Specht
- Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany
| | - Sabine Mand
- Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany
| | - Achim Hoerauf
- Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany
| | - Peter Enyong
- Tropical Medicine Research Station, Kumba, Cameroon
| | - Samuel Wanji
- Department of Life Sciences, Faculty of Science, University of Buea, Buea, Cameroon
- Research Foundation in Tropical Diseases and Environment (REFOTDE), Buea, Cameroon
| | - Mark J. Taylor
- Filariasis Research Laboratory, Molecular and Biochemical Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
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Pion SDS, Kaiser C, Boutros-Toni F, Cournil A, Taylor MM, Meredith SEO, Stufe A, Bertocchi I, Kipp W, Preux PM, Boussinesq M. Epilepsy in onchocerciasis endemic areas: systematic review and meta-analysis of population-based surveys. PLoS Negl Trop Dis 2009; 3:e461. [PMID: 19529767 PMCID: PMC2691484 DOI: 10.1371/journal.pntd.0000461] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [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] [Received: 09/19/2008] [Accepted: 05/18/2009] [Indexed: 11/30/2022] Open
Abstract
Objective We sought to evaluate the relationship between onchocerciasis prevalence and that of epilepsy using available data collected at community level. Design We conducted a systematic review and meta-regression of available data. Data Sources Electronic and paper records on subject area ever produced up to February 2008. Review Methods We searched for population-based studies reporting on the prevalence of epilepsy in communities for which onchocerciasis prevalence was available or could be estimated. Two authors independently assessed eligibility and study quality and extracted data. The estimation of point prevalence of onchocerciasis was standardized across studies using appropriate correction factors. Variation in epilepsy prevalence was then analyzed as a function of onchocerciasis endemicity using random-effect logistic models. Results Eight studies from west (Benin and Nigeria), central (Cameroon and Central African Republic) and east Africa (Uganda, Tanzania and Burundi) met the criteria for inclusion and analysis. Ninety-one communities with a total population of 79,270 individuals screened for epilepsy were included in the analysis. The prevalence of epilepsy ranged from 0 to 8.7% whereas that of onchocerciasis ranged from 5.2 to 100%. Variation in epilepsy prevalence was consistent with a logistic function of onchocerciasis prevalence, with epilepsy prevalence being increased, on average, by 0.4% for each 10% increase in onchocerciasis prevalence. Conclusion These results give further evidence that onchocerciasis is associated with epilepsy and that the disease burden of onchocerciasis might have to be re-estimated by taking into account this relationship. Epilepsy is particularly common in tropical areas. One main reason is that many endemic infections have neurological consequences. In addition, the medical, social and demographic burden of epilepsy remains substantial in these countries where it is often seen as a contagious condition and where the aetiology is often undetermined. For several decades, field researchers had reported some overlapping between the geographical distributions of epilepsy and onchocerciasis, a parasitic disease caused by the filarial worm Onchocerca volvulus which afflicts some 40 million persons worldwide. Here, we conducted a statistical analysis of all the data available on the relationship between the two conditions to determine whether the proportion of people suffering from epilepsy in a community could be related to the frequency of onchocerciasis. The combined results of the eight studies carried out in west, central and east Africa indicate a close epidemiological association between the two diseases. Should a causative relationship be demonstrated, onchocerciasis, which is known as “river blindness” because of its most serious sequela and the distribution of its vectors, could thus also be called “river epilepsy”. More research is needed to determine the mechanisms explaining this association and to assess the burden of onchocerciasis-associated epilepsy.
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Affiliation(s)
- Sébastien D S Pion
- Unité Mixte de Recherche 145, Institut de Recherche pour le Développement (IRD) and University of Montpellier 1, Montpellier, France.
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Kaiser C, Pion S, Preux PM, Kipp W, Dozie I, Boussinesq M. Onchocerciasis, cysticercosis, and epilepsy. Am J Trop Med Hyg 2008; 79:643-645. [PMID: 18981494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
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Katabarwa M, Lakwo T, Habumogisha P, Richards F, Eberhard M. Could neurocysticercosis be the cause of "onchocerciasis-associated" epileptic seizures? Am J Trop Med Hyg 2008; 78:400-401. [PMID: 18337333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
We conducted a nodule prevalence survey in four onchocerciasis sentinel communities in Moyo and two in Kanungu districts of Uganda. Seven (33.3%) out of 21 excised "onchocercomas" (nodules) in Moyo District and excised onchocercomas from four of six persons in Kanungu District turned out to be cysts of Taenia solium. We concluded that the prediction of nodule prevalence for noninvasive rapid epidemiologic assessment (REA) to target areas for mass chemotherapy with ivermectin in the African Program for Onchocerciasis Control (APOC) supported areas may have been influenced by other pathologies. T. solium infection may be the main cause of "onchocerciasis-associated epileptic seizures" in many onchocerciasis endemic communities that have been causally linked to onchocerciasis. Lastly, widespread neurocysticercosis may be a concern in mass treatment programs that provide praziquantel (for managing schistosomiasis) or albendazole (for managing intestinal worms or lymphatic filariasis) because these drugs may kill cerebral cysticerci, resulting in severe adverse events.
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Ebong CE, Alemnji GA, Ashuntantang G, Asonganyi T. Proteinuria and onchocerciasis in an endemic area in Cameroon under community-based treatment with ivermectin. Trop Doct 2007; 37:156-8. [PMID: 17716503 DOI: 10.1258/004947507781524566] [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] [Indexed: 11/18/2022]
Abstract
The present study was aimed at determining the prevalence of onchocerciasis and proteinuria as well as the association between manifestations of heavy chronic onchocerciasis (HCO) and proteinuria among patients in Cameroon. Of the 482 (277: 57.5% females and 205: 42.5% males) subjects recruited from an area with an ivermectin treatment coverage rate of 77.8%, the average prevalence of microfilaridermia by skin snip (mf/ss) was 31.9%, the community microfilaria load was 9.3 mf/ss and the overall prevalence of proteinuria was 4.4%. There was no statistically significant difference in the prevalence of symptoms of HCO when subjects were matched in the presence and absence of proteinuria with regard to positive ss ( P = 0.0860), presence of nodules ( P = 0.5000), depigmentation ( P = 0.1459), visual impairment ( P = 0.5000) and recent ingestion of ivermectin ( P = 0.6366). Fourteen (66.6%) of the 21 subjects with protein to creatinine ratios (P/CR) 0.2 had HCO, while 15 (71.4%) of the 21 subjects with P/CR < 0.2 had HCO. This gives an odd ratio of 0.8 and a P value of 0.62. However, there is need to carry out studies with a larger sample size before firm conclusions can be drawn about the association between onchocerciasis and proteinuria.
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Affiliation(s)
- C E Ebong
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, BP 8283, Cameroon
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Mai CS, Hamm DM, Banla M, Agossou A, Schulz-Key H, Heuschkel C, Soboslay PT. Onchocerca volvulus-specific antibody and cytokine responses in onchocerciasis patients after 16 years of repeated ivermectin therapy. Clin Exp Immunol 2007; 147:504-12. [PMID: 17302900 PMCID: PMC1810490 DOI: 10.1111/j.1365-2249.2006.03312.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The recommended control option against onchocerciasis is repeated ivermectin treatment, which will need to be implemented for decades, and it remains unknown how repeated ivermectin therapy might affect immunity against Onchocerca volvulus in the long term. O. volvulus-specific antibody reactivity and cellular cytokine production were investigated in onchocerciasis patients receiving ivermectin (150 microg/kg) annually for 16 years. In treated patients, the T helper type 2 (Th2) cytokine interleukin (IL)-5 and T regulatory IL-10 in response to O. volvulus antigen (OvAg) and bacteria-derived Streptolysin O (SL-O) diminished to levels found in infection-free endemic controls; also, cellular release of Th1-type interferon (IFN)-gamma at 16 years post initial ivermectin treatment (p.i.t.) approached control levels. In ivermectin-treated onchocerciasis patients, IL-5 production in responses to the mitogen phytohaemagglutinin (PHA) decreased, but IL-10 in response PHA increased, and neither attained the cytokine production levels of endemic controls. At 16 years p.i.t., O. volvulus-specific IgG1 and IgG4 subclass reactivity still persisted at higher levels in onchocerciasis patients than in O. volvulus exposed but microfilariae-free endemic controls. In addition, cytokine responses remained depressed in onchocerciasis patients infected concurrently with Mansonella perstans and Necator americanus or Entamoeba histolytica/dispar. Thus, long-term ivermectin therapy of onchocerciasis may not suffice to re-establish fully a balanced Th1 and Th2 immune responsiveness in O. volvulus microfilariae-negative individuals. Such deficient reconstitution of immune competence may be due to an as yet continuing and uncontrolled reinfection with O. volvulus, but parasite co-infections can also bias and may prevent the development of such immunity.
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Affiliation(s)
- C S Mai
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
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Carme B. [Filariasis]. Rev Prat 2007; 57:157-65. [PMID: 17432520] [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: 05/14/2023]
Abstract
Filariasis are vector-transmitted parasitoses, exclusively tropical, except for dirofilariosis. Their impact differs according to the type of filaria and the induced immune response. The diagnosis is made based on the presence of dermatological or lymphatic manifestations, acute or chronic, associated with usually extended stays in an endemic country. It can also be established following a laboratory examination revealing hypereosinophilia or correspond to the incidental finding of microfilariae (blood or skin). The visualization of the embryonic and/or adult parasite confirms the infection. For pathogenic filariasis with microfilaremiae, paradoxically, clinically positive subjects are often amicrofilaremic. In this case, the presence of antibodies and/or specific serum antigens confirms the diagnosis. On the contrary, asymptomatic microfilariaecarriers are common but there is no guarantee that they will remain asymptomatic. The etiological treatment of choice is based on a combination of ivermectin and albendazole. However, diethylcarbamazine, which was formerly used, is still indicated. Dracunculiasis has been almost eradicated and the elimination of lymphatic filariasis and onchocerciasis as public health problems can be contemplated in the medium term.
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Affiliation(s)
- Bernard Carme
- Service de parasitologie et mycologie, équipe UPRES EA 3595, faculté de médecine Antilles-Guyane et centre hospitalier de Cayenne, BP 6006, 97306 Cayenne, Guyane française.
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Pion SDS, Filipe JAN, Kamgno J, Gardon J, Basáñez MG, Boussinesq M. Microfilarial distribution of Loa loa in the human host: population dynamics and epidemiological implications. Parasitology 2006; 133:101-9. [PMID: 16764737 DOI: 10.1017/s0031182006000035] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [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: 11/16/2005] [Revised: 01/10/2006] [Accepted: 01/10/2006] [Indexed: 11/05/2022]
Abstract
Severe adverse events (SAEs) following ivermectin treatment may occur in people harbouring high Loa loa microfilarial (mf) densities. In the context of mass ivermectin distribution for onchocerciasis control in Africa, it is crucial to define precisely the geographical distribution of L. loa in relation to that of Onchocerca volvulus and predict the prevalence of heavy infections. To this end, we analysed the distribution of mf loads in 4183 individuals living in 36 villages of central Cameroon. Mf loads were assessed quantitatively by calibrated blood smears, collected prior to ivermectin distribution. We explored the pattern of L. loa mf aggregation by fitting the (zero-truncated) negative binomial distribution and estimating its overdispersion parameter k by maximum likelihood. The value of k varied around 0.3 independently of mf intensity, host age, village and endemicity level. Based on these results, we developed a semi-empirical model to predict the prevalence of heavy L. loa mf loads in a community given its overall mf prevalence. If validated at the continental scale and linked to predictive spatial models of loiasis distribution, this approach would be particularly useful for optimizing the identification of areas at risk of SAEs and providing estimates of populations at risk in localities where L. loa and O. volvulus are co-endemic.
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Affiliation(s)
- S D S Pion
- Laboratoire mixte IRD (Institut de Recherche pour le Développement) - CPC (Centre Pasteur du Cameroun) d'Epidémiologie et de Santé publique, Centre Pasteur du Cameroun, BP 1274, Yaoundé, Cameroun.
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Lammie PJ. The Promise of Wolbachia-Targeted Chemotherapy as a Public Health Intervention for Lymphatic Filariasis and Onchocerciasis. Clin Infect Dis 2006; 42:1090-2. [PMID: 16575725 DOI: 10.1086/501361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Accepted: 01/06/2006] [Indexed: 11/03/2022] Open
Affiliation(s)
- Patrick J Lammie
- Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Dozie INS, Onwuliri COE, Nwoke BEB, Chukwuocha UM, Chikwendu CI, Okoro I, Njemanze PC. Onchocerciasis and epilepsy in parts of the Imo river basin, Nigeria: a preliminary report. Public Health 2006; 120:448-50. [PMID: 16524608 DOI: 10.1016/j.puhe.2005.10.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2005] [Revised: 07/09/2005] [Accepted: 10/13/2005] [Indexed: 11/24/2022]
Affiliation(s)
- I N S Dozie
- Medical and Public Health Unit, Department of Microbiology, Imo State University Owerri, P.M.B. 2000 Imo State, Nigeria.
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Pion SDS, Clarke P, Filipe JAN, Kamgno J, Gardon J, Basáñez MG, Boussinesq M. Co-infection withOnchocerca volvulusandLoa loamicrofilariae in central Cameroon: are these two species interacting? Parasitology 2006; 132:843-54. [PMID: 16469200 DOI: 10.1017/s003118200600984x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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: 08/16/2005] [Revised: 10/03/2005] [Accepted: 12/09/2005] [Indexed: 11/05/2022]
Abstract
Ivermectin treatment may induce severe adverse reactions in some individuals heavily infected withLoa loa. This hampers the implementation of mass ivermectin treatment against onchocerciasis in areas whereOnchocerca volvulusandL. loaare co-endemic. In order to identify factors, including co-infections, which may explain the presence of highL. loamicrofilaraemia in some individuals, we analysed data collected in 19 villages of central Cameroon. Two standardized skin snips and 30 μl of blood were obtained from each of 3190 participants and the microfilarial (mf) loads of bothO. volvulusandL. loawere quantified. The data were analysed using multivariate hierarchical models. Individual-level variables were: age, sex, mf presence, and mf load; village-related variables included the endemicity levels for each infection. The two species show a certain degree of ecological separation in the study area. However, for a given individual host, the presence of microfilariae of one species was positively associated with the presence of microfilariae of the other (OR=1·79, 95% CI [1·43–2·24]). Among individuals harbouringLoamicrofilariae, there was a slight positive relationship between theL. loaandO. volvulusmf loads which corresponded to an 11% increase inL. loamf load per 100O. volvulusmicrofilariae. Co-infection withO. volvulusis not sufficient to explain the very highL. loamf loads harboured by some individuals.
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Affiliation(s)
- S D S Pion
- Laboratoire mixte IRD, Institut de Recherche pour le Développement, CPC, Centre Pasteur du Cameroun d'Epidémiologie et de Santé publique, Centre Pasteur du Cameroun, BP 1274, Yaoundé, Cameroun.
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Abstract
Travelers to West Central Africa are at risk for infection with Onchocerca volvulus. We describe the case of an adventurous traveler who became infected with O volvulus after a 10-day stay in rural Cameroon. Two years after his return, he was diagnosed with a 3-month history of limb swelling with pruritus and fixed edema of the right arm. He was successfully treated by a single dose of ivermectin, with an additional treatment with doxycycline. The patient was followed-up during 1 year after therapy without relapse. Such travelers experiencing unusual dermatitis syndromes should prompt evaluation for onchocerciasis.
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Affiliation(s)
- Khaled Ezzedine
- Department of Dermatology, University Hospital Center, Hôpital Erasme, Brussels, Belgium
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Ryan ET, Felsenstein D, Aquino SL, Branda JA, Morgan JG. Case records of the Massachusetts General Hospital. Case 39-2005. A 63-year-old woman with a positive serologic test for syphilis and persistent eosinophilia. N Engl J Med 2005; 353:2697-705. [PMID: 16371636 DOI: 10.1056/nejmcpc059036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Edward T Ryan
- Tropical and Geographic Medicine Center, Massachusetts General Hospital, USA
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Affiliation(s)
- José Arribas
- Department of Radiology, Hospital Universitario Central de Asturias, Oviedo, Spain
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