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Skytte TB, Holm-Hansen CC, Ali SM, Ame S, Molenaar J, Greisen G, Poulsen A, Sorensen JL, Lund S. Risk factors of stillbirths in four district hospitals on Pemba Island, Tanzania: a prospective cohort study. BMC Pregnancy Childbirth 2023; 23:288. [PMID: 37101264 PMCID: PMC10131471 DOI: 10.1186/s12884-023-05613-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/14/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND More than 2 million third-trimester stillbirths occur yearly, most of them in low- and middle-income countries. Data on stillbirths in these countries are rarely collected systematically. This study investigated the stillbirth rate and risk factors associated with stillbirth in four district hospitals in Pemba Island, Tanzania. METHODS A prospective cohort study was completed between the 13th of September and the 29th of November 2019. All singleton births were eligible for inclusion. Events and history during pregnancy and indicators for adherence to guidelines were analysed in a logistic regression model that identified odds ratios [OR] with a 95% confidence interval [95% CI]. RESULTS A stillbirth rate of 22 per 1000 total births in the cohort was identified; 35.5% were intrapartum stillbirths (total number of stillbirths in the cohort, n = 31). Risk factors for stillbirth were breech or cephalic malpresentation (OR 17.67, CI 7.5-41.64), decreased or no foetal movements (OR 2.6, CI 1.13-5.98), caesarean section [CS] (OR 5.19, CI 2.32-11.62), previous CS (OR 2.63, CI 1.05-6.59), preeclampsia (OR 21.54, CI 5.28-87.8), premature rupture of membranes or rupture of membranes 18 h before birth (OR 2.5, CI 1.06-5.94) and meconium stained amniotic fluid (OR 12.03, CI 5.23-27.67). Blood pressure was not routinely measured, and 25% of women with stillbirths with no registered foetal heart rate [FHR] at admission underwent CS. CONCLUSIONS The stillbirth rate in this cohort was 22 per 1000 total births and did not fulfil the Every Newborn Action Plan's goal of 12 stillbirths per 1000 total births in 2030. Awareness of risk factors associated with stillbirth, preventive interventions and improved adherence to clinical guidelines during labour, and hence improved quality of care, are needed to decrease the stillbirth rate in resource-limited settings.
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Affiliation(s)
- Tine Bruhn Skytte
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, University Hospital Copenhagen, Copenhagen, Denmark.
| | - Charlotte Carina Holm-Hansen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, University Hospital Copenhagen, Copenhagen, Denmark
| | | | - Shaali Ame
- Public Health Laboratory, Ivo de Carneri, Pemba, Tanzania
| | - Jil Molenaar
- Reproductive and Maternal Health Research Group, Public Health Department, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Family Medicine and Population Health (FAMPOP), Faculty of Medical Sciences, University of Antwerp, Antwerp, Belgium
| | - Gorm Greisen
- Department of Neonatology, Juliane Marie Center, University Hospital Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anja Poulsen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, University Hospital Copenhagen, Copenhagen, Denmark
| | - Jette Led Sorensen
- Juliane Marie Centre for Children, Women and Reproduction, University Hospital Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stine Lund
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, University Hospital Copenhagen, Copenhagen, Denmark
- Department of Neonatology, Juliane Marie Center, University Hospital Copenhagen, Copenhagen, Denmark
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Holm-Hansen CC, Poulsen A, Skytte TB, Stensgaard CN, Bech CM, Lopes MN, Kristiansen M, Kjærgaard J, Mzee S, Ali S, Ame S, Sorensen JL, Greisen G, Lund S. Video recording as an objective assessment tool of health worker performance in neonatal resuscitation at a district hospital in Pemba, Tanzania: a feasibility study. BMJ Open 2022; 12:e060642. [PMID: 35584880 PMCID: PMC9119158 DOI: 10.1136/bmjopen-2021-060642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To assess the feasibility of using video recordings of neonatal resuscitation (NR) to evaluate the quality of care in a low-resource district hospital. DESIGN Prospective observational feasibility study. SETTING Chake-Chake Hospital, a district hospital in Pemba, Tanzania, in April and May 2019. PARTICIPANTS All delivering women and their newborns were eligible for participation. MAIN OUTCOME MEASURES Motion-triggered cameras were mounted on resuscitation tables and provided recordings that were analysed for quality of care indicators based on the national NR algorithm. Assessment of feasibility was conducted using Bowen's 8-point framework for feasibility studies. RESULTS 91% (126 of 139) of women and 96% (24 of 26) of health workers were comfortable or very comfortable with the video recordings. Of 139 newborns, 8 underwent resuscitation with bag and mask ventilation. In resuscitations, heat loss prevention measures were not performed in half of the cases (four of eight), clearing the airway was not performed correctly in five of eight cases, and all newborns were suctioned vigorously and repeatedly, even when not indicated. In a quarter (two of eight) of cases, the newborn's head was not positioned correctly. Additionally, two of the eight newborns needing ventilation were not ventilated within the first minute of life. In none of the eight cases did ventilation appear to be performed effectively. CONCLUSIONS It proved feasible to use video recordings to assess quality of care during NR in a low-resource setting, and the method was considered acceptable for the delivering women and health workers. Recordings of eight resuscitations all demonstrated deviations from NR guidelines.
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Affiliation(s)
- Charlotte Carina Holm-Hansen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anja Poulsen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Tine Bruhn Skytte
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christina Nadia Stensgaard
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christine Manich Bech
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mads Nathaniel Lopes
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mads Kristiansen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jesper Kjærgaard
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Said Mzee
- Public Health Laboratory-Ivo de Carneri, Chake-Chake, Tanzania, United Republic of
| | - Said Ali
- Public Health Laboratory-Ivo de Carneri, Chake-Chake, Tanzania, United Republic of
| | - Shaali Ame
- Public Health Laboratory-Ivo de Carneri, Chake-Chake, Tanzania, United Republic of
| | - Jette Led Sorensen
- The Juliane Marie Centre for Children, Women and Reproduction, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medicine Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gorm Greisen
- Department of Clinical Medicine, Faculty of Health and Medicine Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Stine Lund
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Levecke B, Vlaminck J, Andriamaro L, Ame S, Belizario V, Degarege A, Engels D, Erko B, Garba AD, Kaatano GM, Mekonnen Z, Montresor A, Olliaro P, Pieri OS, Sacko M, Sam-Wobo SO, Tchuem Tchuenté LA, Webster JP, Vercruysse J. Evaluation of the therapeutic efficacy of praziquantel against schistosomes in seven countries with ongoing large-scale deworming programs. Int J Parasitol Drugs Drug Resist 2020; 14:183-187. [PMID: 33125936 PMCID: PMC7595844 DOI: 10.1016/j.ijpddr.2020.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 11/27/2022]
Abstract
The World Health Organization (WHO) recommends periodic assessment of the therapeutic efficacy of praziquantel (PZQ) to detect reduced efficacy that may arise from drug resistance in schistosomes. In this multi-country study (2014), we assessed the therapeutic efficacy of a single oral dose of PZQ (40 mg/kg) against Schistosoma mansoni (Brazil, Cameroon, Ethiopia, Mali, Madagascar and Tanzania), S. haematobium (Cameroon, Ethiopia, Mali, Tanzania and Zanzibar) and S. japonicum (the Philippines) infections in school-aged children, across a total of 12 different trials. Each trial was performed according to the standardized methodology for evaluating PZQ efficacy as described by the WHO. Overall, therapeutic efficacy, measured as the reduction in arithmetic mean of schistosome egg counts following drug administration (egg reduction rate; ERR), was high for all three schistosome species (S. mansoni: 93.4% (95%CI: 88.8–96.8); S. haematobium: 97.7% (95%CI: 96.5–98.7) and S. japonicum: 90.0% (95%CI: 68.4–99.3). At the trial level, therapeutic efficacy was satisfactory (point estimate ERR ≥90%) for all three Schistosoma species with the exception of S. mansoni in Cameroon where the ERR was 88.5% (95%CI: 79.0–95.1). Furthermore, we observed that in some trials individual drug response could vary significantly (wide 95%CI) and that few non-responsive individuals could significantly impact ERR point estimates. In conclusion, these results do not suggest any established reduced efficacy of the standard PZQ treatment to any of the three schistosome species within these countries. Nevertheless, the substantial degree of variation in individual responses to treatment in some countries underpins the need for future monitoring. The reported ERR values serve as reference values to compare with outcomes of future PZQ efficacy studies to ensure early detection of reduced efficacies that could occur as drug pressure continues increase. Finally, this study highlights that 95%CI should be considered in WHO guidelines to classify the therapeutic efficacy of PZQ. PZQ efficacy against schistosomes was assessed in school-aged-children in seven countries. There was no overall sign of reduced PZQ efficacy against any schistosome species. Notable variation in individual responses to treatment does require future monitoring. It is recommended to include reporting of the 95%CI in future WHO guidelines.
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Affiliation(s)
- B Levecke
- Laboratory of Parasitology, Faculty of Veterinary Medicine, Ghent University, Belgium.
| | - J Vlaminck
- Laboratory of Parasitology, Faculty of Veterinary Medicine, Ghent University, Belgium
| | - L Andriamaro
- Reseau International Schistosomiase Environnement Amenagement et Lutte (RISEAL), Madagascar
| | - S Ame
- Laboratory Division, Public Health Laboratory-Ivo de Carneri, Chake Chake, United Republic of Tanzania
| | - V Belizario
- Department of Parasitology, College of Public Health, University of the Philippines, Manilla, Philippines
| | - A Degarege
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - D Engels
- Department of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - B Erko
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - A D Garba
- Department of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - G M Kaatano
- National Institute for Medical Research (NIMR), Mwanza Centre, Mwanza City, United Republic of Tanzania
| | - Z Mekonnen
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | - A Montresor
- Department of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - P Olliaro
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - O S Pieri
- Environmental and Health Education Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | - M Sacko
- Service de Parasitologie, Institut National de Recherche en Santé Publique, Bamako, Mali
| | - S O Sam-Wobo
- Department of Pure and Applied Zoology, Federal University of Agriculture Abeokuta, Nigeria
| | - L A Tchuem Tchuenté
- Centre for Schistosomiasis and Parasitology, Faculty of Sciences, University of Yaoundé I, Cameroon
| | - J P Webster
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, UK
| | - J Vercruysse
- Laboratory of Parasitology, Faculty of Veterinary Medicine, Ghent University, Belgium
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Barda B, Schindler C, Wampfler R, Ame S, Ali SM, Keiser J. Comparison of real-time PCR and the Kato-Katz method for the diagnosis of soil-transmitted helminthiasis and assessment of cure in a randomized controlled trial. BMC Microbiol 2020; 20:298. [PMID: 33008301 PMCID: PMC7531123 DOI: 10.1186/s12866-020-01963-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/01/2020] [Indexed: 02/05/2023] Open
Abstract
Background Diagnosis of soil-transmitted helminths (STHs) in developing countries is commonly based on microscopic detection of eggs in stool samples, using the Kato-Katz (KK) method, which has a poor sensitivity for detecting light intensity infections. We compared the performance of the KK method and real-time PCR in the framework of a randomized trial, which evaluated four novel treatments against Trichuris trichiura and concomitant STH infections. Results Two stool samples obtained from 320 participants were examined at baseline and follow-up with quadruplicate KK and PCR analyses of one of the two samples using “bead-beating” for DNA extraction. At follow-up, 80 samples were negative according to both PCR and KK and 173 were positive with both methods for any of the STHs. Relative to PCR, the calculated sensitivity of KK at follow-up was 83.6%, 43.0% and 53.8% for T. trichiura, for hookworm and for Ascaris lumbricoides, respectively. The sensitivity of PCR compared with KK at this time point was 89.1% for T. trichiura, 72.7% for hookworm and 87.5% for A. lumbricoides. Cure rates (CRs) for T. trichiura and A. lumbricoides were slightly lower with the PCR method. For hookworm CRs with KK were mostly significantly lower, namely 36.7%, 91.1%, 72.2% and 77.8% for moxidectin, moxidectin in combination with tribendimidine, moxidectin in combination with albendazole and albendazole in combination with oxantel pamoate, respectively, whereas with PCR the CRs were 8.3%, 82.6%, 37.1% and 57.1%, respectively. Conclusions In conclusion, a single real-time PCR is as sensitive as quadruplicate KK for T. trichiura and A. lumbricoides detection but more sensitive for hookworm, which has an influence on the estimated treatment efficacy. PCR method with DNA extraction using the “bead-beating protocol” should be further promoted in endemic areas and laboratories that can afford the needed equipment. The study is registered at ISRCTN (no. 20398469).
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Affiliation(s)
- Beatrice Barda
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Rahel Wampfler
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Shaali Ame
- Laboratory Division, Public Health Laboratory-Ivo de Carneri, Chake-Chake, Tanzania
| | - Said M Ali
- Laboratory Division, Public Health Laboratory-Ivo de Carneri, Chake-Chake, Tanzania
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
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Vlaminck J, Cools P, Albonico M, Ame S, Ayana M, Dana D, Keiser J, Matoso LF, Montresor A, Mekonnen Z, Corrêa-Oliveira R, Pinto SA, Sayasone S, Vercruysse J, Levecke B. An in-depth report of quality control on Kato-Katz and data entry in four clinical trials evaluating the efficacy of albendazole against soil-transmitted helminth infections. PLoS Negl Trop Dis 2020; 14:e0008625. [PMID: 32956390 PMCID: PMC7549791 DOI: 10.1371/journal.pntd.0008625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/12/2020] [Accepted: 07/22/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Efforts to control soil-transmitted helminth (STH) infections have intensified over the past decade. Field-survey data on STH prevalence, infection intensity and drug efficacy is necessary to guide the implementation of control programs and should be of the best possible quality. METHODOLOGY During four clinical trials designed to evaluate the efficacy of albendazole against STHs in Brazil, Ethiopia, Lao PDR and Tanzania, quality control (QC) was performed on the duplicate Kato-Katz thick smears and the data entry. We analyzed datasets following QC on both fecal egg counts (FECs) and data entry, and compared the prevalence of any STH infection and moderate-to-heavy intensity (MHI) infections and the drug efficacy against STH infections. RESULTS Across the four study sites, a total of 450 out of 4,830 (9.3%) Kato-Katz thick smears were re-examined. Discrepancies in FECs varied from ~3% (hookworms) to ~6.5% (Ascaris lumbricoides and Trichuris trichiura). The difference in STH prevalence and prevalence of MHI infections using the datasets with and without QC of the FECs did not exceed 0.3%, except for hookworm infections in Tanzania, where we noted a 2.2 percentage point increase in MHI infections (pre-QC: 1.6% vs. post-QC: 3.8%). There was a 100% agreement in the classification of drug efficacy of albendazole against STH between the two datasets. In total, 201 of the 28,980 (0.65%) data entries that were made to digitize the FECs were different between both data-entry clerks. Nevertheless, the overall prevalence of STH, the prevalence of MHI infections and the classification of drug efficacy remained largely unaffected. CONCLUSION/SIGNIFICANCE In these trials, where staff was informed that QC would take place, minimal changes in study outcomes were reported following QC on FECs or data entry. Nevertheless, imposing QC did reduce the number of errors. Therefore, application of QC together with proper training of the personnel and the availability of clear standard operating procedures is expected to support higher data quality.
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Affiliation(s)
- Johnny Vlaminck
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
- * E-mail: (JV); (BL)
| | - Piet Cools
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Marco Albonico
- Center for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Negrar, Italy
- Department of Life Sciences and Systems Biology, University of Turin, Turin, Italy
| | - Shaali Ame
- Laboratory Division, Public Health Laboratory-Ivo de Carneri, Chake Chake, United Republic of Tanzania
| | - Mio Ayana
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | - Daniel Dana
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Leonardo F. Matoso
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
- Nursing school, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Zeleke Mekonnen
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | | | - Simone A. Pinto
- Nursing school, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Jozef Vercruysse
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Bruno Levecke
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
- * E-mail: (JV); (BL)
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Levecke B, Cools P, Albonico M, Ame S, Angebault C, Ayana M, Behnke JM, Bethony JM, Cringoli G, Dana D, Guillard B, Viet Hoa NT, Kang G, Kattula D, Keiser J, Kotze AC, Matoso LF, Maurelli MP, McCarthy JS, Mekonnen Z, Mirams G, Montresor A, Oliveira RC, Periago MV, Pinto SA, Rinaldi L, Sayasone S, Sumo L, Tchuem-Tchuenté LA, Cam Thach DT, Thomas E, Zeynudin A, Verweij JJ, Vlaminck J, Vercruysse J. Identifying thresholds for classifying moderate-to-heavy soil-transmitted helminth intensity infections for FECPAKG2, McMaster, Mini-FLOTAC and qPCR. PLoS Negl Trop Dis 2020; 14:e0008296. [PMID: 32614828 PMCID: PMC7413557 DOI: 10.1371/journal.pntd.0008296] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 09/13/2019] [Revised: 08/07/2020] [Accepted: 04/15/2020] [Indexed: 11/18/2022] Open
Abstract
The World Health Organization (WHO) has defined moderate-to-heavy intensity (M&HI) infections with soil-transmitted helminths (Ascaris lumbricoides, Trichuris trichiura and the two hookworms, Ancylostoma duodenale and Necator americanus) based on specific values of eggs per gram of stool, as measured by the Kato-Katz method. There are a variety of novel microscopy and DNA-based methods but it remains unclear whether applying current WHO thresholds on to these methods allows for a reliable classification of M&HI infections. We evaluated both WHO and method-specific thresholds for classifying the M&HI infections for novel microscopic (FECPAKG2, McMaster and Mini-FLOTAC) and DNA-based (qPCR) diagnostic methods. For this, we determined method-specific thresholds that best classified M&HI infections (defined by Kato-Katz and WHO thresholds; reference method) in two multi-country drug efficacy studies. Subsequently, we verified whether applying these method-specific thresholds improved the agreement in classifying M&HI infections compared to the reference method. When we applied the WHO thresholds, the new microscopic methods mainly misclassified M&HI as low intensity, and to a lesser extent low intensity infection as M&HI. For FECPAKG2, applying the method-specific thresholds significantly improved the agreement for Ascaris (moderate → substantial), Trichuris and hookworms (fair → moderate). For Mini-FLOTAC, a significantly improved agreement was observed for hookworms only (fair → moderate). For the other STHs, the agreement was almost perfect and remained unchanged. For McMaster, the method-specific thresholds revealed a fair to a substantial agreement but did not significantly improve the agreement. For qPCR, the method-specific thresholds based on genome equivalents per ml of DNA moderately agreed with the reference method for hookworm and Trichuris infections. For Ascaris, there was a substantial agreement. We defined method-specific thresholds that improved the classification of M&HI infections. Validation studies are required before they can be recommended for general use in assessing M&HI infections in programmatic settings.
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Affiliation(s)
- Bruno Levecke
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
- * E-mail:
| | - Piet Cools
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Marco Albonico
- Center for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Negrar, Italy
- Department of Life Sciences and Systems Biology, University of Turin, Turin, Italy
| | - Shaali Ame
- Public Health Laboratory-Ivo de Carneri, Chake Chake, United Republic of Tanzania
| | | | - Mio Ayana
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | - Jerzy M. Behnke
- School of Life Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Jeffrey M. Bethony
- Microbiology, Immunology, and Tropical Medicine, George Washington University Medical Center, Washington D.C., United States of America
| | - Giuseppe Cringoli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Daniel Dana
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | | | - Nguyen Thi Viet Hoa
- Department of Parasitology, National Institute of Malariology, Parasitology and Entomology, Ha Noi, Vietnam
| | - Gagandeep Kang
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Deepthi Kattula
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland & University of Basel, Basel, Switzerland
| | - Andrew C. Kotze
- Division of Agriculture and Food, Commonwealth Scientific and Industrial Research Organization, St. Lucia, Australia
| | - Leonardo F. Matoso
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou - FIOCRUZ, Belo Horizonte, Brazil
| | - Maria P. Maurelli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - James S. McCarthy
- QIMR Berghofer Medical Research Institute, University of Queensland, Brisbane, Australia
| | - Zeleke Mekonnen
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | | | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Rodrigo Corrêa Oliveira
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou - FIOCRUZ, Belo Horizonte, Brazil
| | - Maria V. Periago
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou - FIOCRUZ, Belo Horizonte, Brazil
| | - Simone A. Pinto
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou - FIOCRUZ, Belo Horizonte, Brazil
| | - Laura Rinaldi
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane Capital, Lao People’s Democratic Republic
| | - Laurentine Sumo
- Centre for Schistosomiasis and Parasitology, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Dang Thi Cam Thach
- Department of Parasitology, National Institute of Malariology, Parasitology and Entomology, Ha Noi, Vietnam
| | | | - Ahmed Zeynudin
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | - Jaco J. Verweij
- Laboratory for Medical Microbiology and Immunology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Johnny Vlaminck
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Jozef Vercruysse
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
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Vlaminck J, Cools P, Albonico M, Ame S, Chanthapaseuth T, Viengxay V, Do Trung D, Osei-Atweneboana MY, Asuming-Brempong E, Jahirul Karim M, Al Kawsar A, Keiser J, Khieu V, Faye B, Turate I, Mbonigaba JB, Ruijeni N, Shema E, Luciañez A, Santiago Nicholls R, Jamsheed M, Mikhailova A, Montresor A, Mupfasoni D, Yajima A, Ngina Mwinzi P, Gilleard J, Prichard RK, Verweij JJ, Vercruysse J, Levecke B. Piloting a surveillance system to monitor the global patterns of drug efficacy and the emergence of anthelmintic resistance in soil-transmitted helminth control programs: a Starworms study protocol. Gates Open Res 2020; 4:28. [PMID: 32266328 PMCID: PMC7120503 DOI: 10.12688/gatesopenres.13115.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2020] [Indexed: 11/20/2022] Open
Abstract
To eliminate soil-transmitted helminth (STH) infections as a public health problem, the administration of benzimidazole (BZ) drugs to children has recently intensified. But, as drug pressure increases, the development of anthelmintic drug resistance (AR) becomes a major concern. Currently, there is no global surveillance system to monitor drug efficacy and the emergence of AR. Consequently, it is unclear what the current efficacy of the used drugs is and whether AR is already present. The aim of this study is to pilot a global surveillance system to assess anthelmintic drug efficacy and the emergence of AR in STH control programs. For this, we will incorporate drug efficacy trials into national STH control programs of eight countries (Bangladesh, Cambodia, Lao PDR, Vietnam, Ghana, Rwanda, Senegal and a yet to be defined country in the Americas). In each country, one trial will be performed in one program implementation unit to assess the efficacy of BZ drugs against STHs in school-aged children by faecal egg count reduction test. Stool samples will be collected before and after treatment with BZs for Kato-Katz analysis and preserved to purify parasite DNA. The presence and frequency of known single nucleotide polymorphisms (SNPs) in the β-tubulin genes of the different STHs will subsequently be assessed. This study will provide a global pattern of drug efficacy and emergence of AR in STH control programs. The results will provide complementary insights on the validity of known SNPs in the ß-tubulin gene as a marker for AR in human STHs as well as information on the technical and financial resources required to set up a surveillance system. Finally, the collected stool samples will be an important resource to validate different molecular technologies for the detection of AR markers or to identify novel potential molecular markers associated with AR in STH.
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Affiliation(s)
- Johnny Vlaminck
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Piet Cools
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Marco Albonico
- Center for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Negrar, Italy.,Department of Life Sciences and Systems Biology, University of Turin, Turin, Italy
| | - Shaali Ame
- Laboratory of Parasitology, Public Health Laboratory Ivo de Carneri, Chake Chake, Tanzania
| | | | - Vanisaveth Viengxay
- National institute of Health, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Dung Do Trung
- National Institute of Malariology, Parasitology and Entomology, Ministry of Health, Hanoi, Vietnam
| | | | | | - Mohammad Jahirul Karim
- Filariasis Elimination, STH Control and Little Doctor Programme, CDC, Directorate General of Health Services, Dhaka, Bangladesh
| | - Abdullah Al Kawsar
- Filariasis Elimination, STH Control and Little Doctor Programme, CDC, Directorate General of Health Services, Dhaka, Bangladesh
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Virak Khieu
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Babacar Faye
- Service of Parasitology and Mycology, University of Cheikh Anta DIOP, Dakar, Senegal
| | - Innocent Turate
- The institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Jean Bosco Mbonigaba
- The institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Nadine Ruijeni
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Eliah Shema
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Ana Luciañez
- Neglected Tropical Diseases, Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington D.C., USA
| | - Ruben Santiago Nicholls
- Neglected Tropical Diseases, Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington D.C., USA
| | - Mohamed Jamsheed
- Department of Communicable Diseases, World Health Organization, New Delhi, India
| | - Alexei Mikhailova
- Department of Control of Neglected Tropical Diseases, World Health organization, Geneva, Switzerland
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health organization, Geneva, Switzerland
| | - Denise Mupfasoni
- Department of Control of Neglected Tropical Diseases, World Health organization, Geneva, Switzerland
| | - Aya Yajima
- Western Pacific Regional Office, World Health Organization, Manilla, Philippines
| | - Pauline Ngina Mwinzi
- Expanded Special Project for Elimination of NTDs (ESPEN), World Health Organization, Brazzaville, Congo
| | - John Gilleard
- Department of Comparative Biology and Experimental Medicine, University of Calgary, Calgary, Canada
| | | | - Jaco J Verweij
- Laboratory for Parasitology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Jozef Vercruysse
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Bruno Levecke
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
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Vlaminck J, Cools P, Albonico M, Ame S, Ayana M, Cringoli G, Dana D, Keiser J, Maurelli MP, Matoso LF, Montresor A, Mekonnen Z, Mirams G, Corrêa-Oliveira R, Pinto SA, Rinaldi L, Sayasone S, Thomas E, Vercruysse J, Verweij JJ, Levecke B. Therapeutic efficacy of albendazole against soil-transmitted helminthiasis in children measured by five diagnostic methods. PLoS Negl Trop Dis 2019; 13:e0007471. [PMID: 31369562 PMCID: PMC6675043 DOI: 10.1371/journal.pntd.0007471] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 02/04/2019] [Accepted: 05/16/2019] [Indexed: 01/15/2023] Open
Abstract
Background Preventive chemotherapy (PC) with benzimidazole drugs is the backbone of soil-transmitted helminth (STH) control programs. Over the past decade, drug coverage has increased and with it, the possibility of developing anthelmintic resistance. It is therefore of utmost importance to monitor drug efficacy. Currently, a variety of novel diagnostic methods are available, but it remains unclear whether they can be used to monitor drug efficacy. In this study, we compared the efficacy of albendazole (ALB) measured by different diagnostic methods in a head-to-head comparison to the recommended single Kato-Katz. Methods An ALB efficacy trial was performed in 3 different STH-endemic countries (Ethiopia, Lao PDR and Tanzania), each with a different PC-history. During these trials, stool samples were evaluated with Kato-Katz (single and duplicate), Mini-FLOTAC, FECPAKG2, and qPCR. The reduction rate in mean eggs per gram of stool (ERR) and mean genome equivalents / ml of DNA extract (GERR) were calculated to estimate drug efficacy. Principal findings and conclusions The results of the efficacy trials showed that none of the evaluated diagnostic methods could provide reduction rates that were equivalent to a single Kato-Katz for all STH. However, despite differences in clinical sensitivity and egg counts, they agreed in classifying efficacy according to World Health Organization (WHO) guidelines. This demonstrates that diagnostic methods for assessing drug efficacy should be validated with their intended-use in mind and that other factors like user-friendliness and costs will likely be important factors in driving the choice of diagnostics. In addition, ALB efficacy against STH infections was lower in sites with a longer history of PC. Yet, further research is needed to identify factors that contribute to this finding and to verify whether reduced efficacy can be associated with mutations in the β-tubulin gene that have previously been linked to anthelmintic resistance. Trial registration ClinicalTrials.gov NCT03465488. During the last decade, the scale of deworming programs that aim to eliminate the morbidity caused by intestinal worms has increased to a level that is unprecedented in history. It is therefore of utmost importance to monitor any change in therapeutic efficacy that may arise from emerging drug resistance. Currently, a variety of novel methods have been described, but it remains unclear whether they can be used for monitoring drug efficacy. We applied different diagnostic methods to measure the efficacy of a commonly administered drug in deworming programs in 3 countries with different historical exposure to deworming programs. Compared to the standard diagnostic method, all diagnostic methods revealed good agreement in classifying the therapeutic efficacy according to World Health Organization guidelines, despite clear differences in diagnostic performance. We also noticed that the drug efficacy was lower in countries where drug pressure has been high. However, more research is necessary to identify factors that explain this variation in drug efficacy, including but not limited to the frequency in mutations in genes that are known to be linked with anthelmintic resistance.
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Affiliation(s)
- Johnny Vlaminck
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Piet Cools
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Marco Albonico
- Center for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Negrar, Italy
- Department of Life Sciences and Systems Biology, University of Turin, Turin, Italy
| | - Shaali Ame
- Laboratory Division, Public Health Laboratory-Ivo de Carneri, Chake Chake, United Republic of Tanzania
| | - Mio Ayana
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | - Giuseppe Cringoli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Daniel Dana
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Maria P. Maurelli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Leonardo F. Matoso
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
- Nursing school, Federal University of Minas Gerais, Brazil
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Zeleke Mekonnen
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | | | - Rodrigo Corrêa-Oliveira
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
| | - Simone A. Pinto
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
| | - Laura Rinaldi
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | | | - Jozef Vercruysse
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Jaco J. Verweij
- Laboratory for Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Bruno Levecke
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
- * E-mail:
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Cools P, Vlaminck J, Albonico M, Ame S, Ayana M, José Antonio BP, Cringoli G, Dana D, Keiser J, Maurelli MP, Maya C, Matoso LF, Montresor A, Mekonnen Z, Mirams G, Corrêa-Oliveira R, Pinto SA, Rinaldi L, Sayasone S, Thomas E, Verweij JJ, Vercruysse J, Levecke B. Diagnostic performance of a single and duplicate Kato-Katz, Mini-FLOTAC, FECPAKG2 and qPCR for the detection and quantification of soil-transmitted helminths in three endemic countries. PLoS Negl Trop Dis 2019; 13:e0007446. [PMID: 31369558 PMCID: PMC6675048 DOI: 10.1371/journal.pntd.0007446] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [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: 02/13/2019] [Accepted: 05/07/2019] [Indexed: 12/20/2022] Open
Abstract
Background Because the success of deworming programs targeting soil-transmitted helminths (STHs) is evaluated through the periodically assessment of prevalence and infection intensities, the use of the correct diagnostic method is of utmost importance. The STH community has recently published for each phase of a deworming program the minimal criteria that a potential diagnostic method needs to meet, the so-called target product profiles (TPPs). Methodology We compared the diagnostic performance of a single Kato-Katz (reference method) with that of other microscopy-based methods (duplicate Kato-Katz, Mini-FLOTAC and FECPAKG2) and one DNA-based method (qPCR) for the detection and quantification of STH infections in three drug efficacy trials in Ethiopia, Lao PDR, and Tanzania. Furthermore, we evaluated a selection of minimal diagnostic criteria of the TPPs. Principal findings All diagnostic methods showed a clinical sensitivity of ≥90% for all STH infections of moderate-to-heavy intensities. For infections of very low intensity, only qPCR resulted in a sensitivity that was superior to a single Kato-Katz for all STHs. Compared to the reference method, both Mini-FLOTAC and FECPAKG2 resulted in significantly lower fecal egg counts for some STHs, leading to a substantial underestimation of the infection intensity. For qPCR, there was a positive significant correlation between the egg counts of a single Kato-Katz and the DNA concentration. Conclusions/Significance Our results indicate that the diagnostic performance of a single Kato-Katz is underestimated by the community and that diagnostic specific thresholds to classify intensity of infection are warranted for Mini-FLOTAC, FECPAKG2 and qPCR. When we strictly apply the TPPs, Kato-Katz is the only microscopy-based method that meets the minimal diagnostic criteria for application in the planning, monitoring and evaluation phase of an STH program. qPCR is the only method that could be considered in the phase that aims to seek confirmation for cessation of program. Trial registration ClinicalTrials.gov NCT03465488 To control the burden caused by intestinal worms, the World Health Organization recommends large-scale deworming programs where anti-worm drugs are administered to at-risk populations. The decision to scale down drug distribution is based on the periodically assessment of prevalence and intensity of infections using a standard diagnostic method. Today, the scientific community strongly doubts whether this method can be used throughout the program. This is in particular when it fails to detect infections of low intensity, and hence may result in prematurely stopping the distribution of drugs. We compared the diagnostic performance of alternative diagnostic methods in three drug efficacy trials in two African and one Asian country. The diagnostic methods were based on demonstration of worm eggs or worm DNA in stool. We also checked the results with minimal diagnostic criteria which have been recently been proposed by the scientific community. Our results indicate that of all diagnostic methods based on demonstration of worm eggs, only the current standard method fulfills the diagnostic criteria for planning, monitoring and evaluation phases of deworming program. Furthermore, we showed that DNA-based methods could be considered in the phase that aims to seek confirmation for cessation of the deworming program.
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Affiliation(s)
- Piet Cools
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Johnny Vlaminck
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Marco Albonico
- Center for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Negrar, Italy
- Department of Life Sciences and Systems Biology, University of Turin, Italy
| | - Shaali Ame
- Public Health Laboratory-Ivo de Carneri, Chake Chake, United Republic of Tanzania
| | - Mio Ayana
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | | | - Giuseppe Cringoli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Daniel Dana
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Maria P. Maurelli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Catalina Maya
- Engineering Institute of National Autonomous University of Mexico, Mexico City, Mexico
| | - Leonardo F. Matoso
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Zeleke Mekonnen
- Jimma University Institute of Health, Jimma University, Jimma, Ethiopia
| | | | - Rodrigo Corrêa-Oliveira
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
| | - Simone A. Pinto
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
| | - Laura Rinaldi
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | | | - Jaco J. Verweij
- Laboratory for Medical Microbiology and Immunology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Jozef Vercruysse
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Bruno Levecke
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
- * E-mail:
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Ayana M, Vlaminck J, Cools P, Ame S, Albonico M, Dana D, Keiser J, Manly H, Matoso LF, Mekonnen Z, Montresor A, Correa-Oliveira R, Rinaldi L, Sayasone S, Sowerby SJ, Tesfaye L, Vercruysse J, Mirams G, Levecke B. Correction: Modification and optimization of the FECPAKG2 protocol for the detection and quantification of soil-transmitted helminth eggs in human stool. PLoS Negl Trop Dis 2019; 13:e0007224. [PMID: 30830914 PMCID: PMC6398824 DOI: 10.1371/journal.pntd.0007224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Ayana M, Vlaminck J, Cools P, Ame S, Albonico M, Dana D, Keiser J, Manly H, Matoso LF, Mekonnen Z, Montresor A, Correa-Oliveira R, Rinaldi L, Sayasone S, Sowersby S, Tesfaye L, Vercruysse J, Mirams G, Levecke B. Modification and optimization of the FECPAKG2 protocol for the detection and quantification of soil-transmitted helminth eggs in human stool. PLoS Negl Trop Dis 2018; 12:e0006655. [PMID: 30321180 PMCID: PMC6224113 DOI: 10.1371/journal.pntd.0006655] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 11/08/2018] [Accepted: 06/29/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Standard diagnosis of human soil-transmitted helminth (STH) infections is based on the microscopic detection of helminth eggs in stool and supports programmatic decision making in control programs. However, the current standard diagnostic techniques still show a number of limitations. Recently, the FECPAKG2 method was developed to detect helminth infections and asses drug efficacy in sheep or cattle. It includes a device that takes digital images of helminth eggs that have been concentrated into one microscopic field of view and stores these images online for future evaluation. The goal of this study was to introduce a standard operating procedure (SOP) for the detection and quantification of human STH eggs using the FECPAKG2 and to optimize 2 crucial steps of the protocol, namely the sedimentation step (aimed at separating sinking eggs from floating debris) and the accumulation step (aimed at concentrating the eggs by flotation). METHODOLOGY/PRINCIPAL FINDINGS A total of 55 stool samples from naturally infected children were used from 4 different geographical areas (Ethiopia, Laos, Tanzania and Brazil). The results showed that Trichuris eggs generally moved slower than eggs of the other two STH species during both sedimentation in water in the FECPAKG2 sedimenter as during accumulation in flotation solution in the FECPAKG2 cassettes. The highest number of eggs were present in the slurry of the sedimenter after overnight sedimentation (Ascaris: 95.7%, Trichuris: 89.8% and hookworm: 94.2% of the eggs). A minimum of 24 minutes were needed to ensure the accumulation of at least 80% of the eggs from all three STH species in the FECPAKG2 cassette (Ascaris: 96.1%; Trichuris: 88.2% and hookworm: 87.6%). CONCLUSIONS/SIGNIFICANCE This study introduces for the first time a SOP for the FECPAKG2 method. Different aspects of the method for diagnosing human STH infections were optimized. Our study forms the basis for a thorough and objective evaluation of the system as a diagnostic tool that could be implemented in STH control programs.
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Affiliation(s)
- Mio Ayana
- Institute of Health, Faculty of Health Science, School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia
| | - Johnny Vlaminck
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Piet Cools
- Institute of Health, Faculty of Health Science, School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia
| | - Shaali Ame
- Public Health Laboratory-Ivo de Carneri, Chake Chake, United Republic of Tanzania
| | - Marco Albonico
- Center for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Negrar, Italy
- Department of Life Sciences and Systems Biology, University of Turin, Turin, Italy
| | - Daniel Dana
- Institute of Health, Faculty of Health Science, School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Leonardo F. Matoso
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
- Nursing school, Federal university of Minas Gerais, Belo Horizonte, Brazil
| | - Zeleke Mekonnen
- Institute of Health, Faculty of Health Science, School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia
| | | | - Rodrigo Correa-Oliveira
- Laboratory of Molecular and Cellular Immunology, Research Center René Rachou—FIOCRUZ, Belo Horizonte, Brazil
| | - Laura Rinaldi
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Somphou Sayasone
- National Institute of Public Health, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Stephen Sowersby
- Department of Biochemistry, University of Otago, Otago, New Zealand
| | - Lensa Tesfaye
- Institute of Health, Faculty of Health Science, School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia
| | - Jozef Vercruysse
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | | | - Bruno Levecke
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
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Levecke B, Easton AV, Cools P, Albonico M, Ame S, Gilleard JS, Keiser J, Montresor A, Prichard R, Vlaminck J, Vercruysse J. The optimal timing of post-treatment sampling for the assessment of anthelminthic drug efficacy against Ascaris infections in humans. Int J Parasitol Drugs Drug Resist 2018; 8:67-69. [PMID: 29414108 PMCID: PMC6114078 DOI: 10.1016/j.ijpddr.2017.12.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/18/2017] [Accepted: 12/22/2017] [Indexed: 11/20/2022]
Abstract
The egg reduction rate (ERR) is the current standard mean to assess the efficacy of drugs against human soil-transmitted helminths (STHs; Ascaris lumbricoides, Trichuris trichiura and hookworm). Although the timing of post-treatment sampling is pivotal for a readily interpretation of drug efficacy, there is lack empirical data that allows recommending the optimal time point for a follow-up egg counting. In the present study, we re-analyzed both the kinetics of worm expulsion and egg output for Ascaris lumbricoides following a single oral dose of albendazole in a series of studies previously conducted in Kenyan communities. The results indicate that it takes up to 10 days post-treatment before the expulsion of both adult male and female Ascaris worms is completed, approximately 20% of the worms being expelled between day 7 and 10 post-treatment. The sequential analysis of the egg out put, indicated a poor ERR (89.4%) at day 7 post-treatment, but a 100% ERR at day 14 and 21 post-treatment. Based on our findings we recommend to wait at least 14 days after an albendazole treatment before conducting the follow-up egg count. Any sampling before this time point may result in biased ERR estimates, due the release of residual eggs from moribund or degenerating worms.
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Affiliation(s)
- Bruno Levecke
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
| | - Alice V Easton
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA; Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Piet Cools
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Marco Albonico
- Center for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Shaali Ame
- Public Health Laboratory-Ivo de Carneri, Chake Chake, United Republic of Tanzania
| | - John S Gilleard
- Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, Canada
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Roger Prichard
- Institute of Parasitology, McGill University, Montreal, QC, Canada
| | - Johnny Vlaminck
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Jozef Vercruysse
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Glady L, Guerin E, Ame S, Maloisel F, Lessinger J. A single-nucleotide polymorphism of ABCB1 (MDR1) is correlated with poor response to Imatinib chronic myeloid leukemia. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx508.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Campelo MD, Lorenzo J, Itzykson R, Rojas S, Berthon C, Luño E, Beyne-Rauzy O, Pérez-Oteyza J, Vey N, Bargay J, Park S, Cedena T, Bordessoule D, Muñoz J, Gyan E, Such E, Visanica S, Benlloch L, de Botton S, Hernández-Rivas J, Ame S, Stamatoullas A, Delaunay J, Salanoubat C, Isnard F, Guieze R, Sanz G, Cañizo M, Fenaux P. 213 AZACITIDINE (AZA) IN HIGHER RISK MDS PATIENTS WITH CHROMOSOME 7 ABNORMALITIES (ABN 7): RESULTS OF A RETROSPECTIVE STUDY FROM THE GFM AND GESMD REGISTRIES. Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30214-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rebollo MP, Mohammed KA, Thomas B, Ame S, Ali SM, Cano J, Escalada AG, Bockarie MJ. Cessation of mass drug administration for lymphatic filariasis in Zanzibar in 2006: was transmission interrupted? PLoS Negl Trop Dis 2015; 9:e0003669. [PMID: 25816287 PMCID: PMC4376862 DOI: 10.1371/journal.pntd.0003669] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 07/26/2014] [Accepted: 03/03/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) is targeted for elimination through annual mass drug administration (MDA) for 4-6 years. In 2006, Zanzibar stopped MDA against LF after five rounds of MDA revealed no microfilaraemic individuals during surveys at selected sentinel sites. We asked the question if LF transmission was truly interrupted in 2006 when MDA was stopped. METHODOLOGY/PRINCIPAL FINDINGS In line with ongoing efforts to shrink the LF map, we performed the WHO recommended transmission assessment surveys (TAS) in January 2012 to verify the absence of LF transmission on the main Zanzibar islands of Unguja and Pemba. Altogether, 3275 children were tested on both islands and 89 were found to be CFA positive; 70 in Pemba and 19 in Unguja. The distribution of schools with positive children was heterogeneous with pronounced spatial variation on both islands. Based on the calculated TAS cut-offs of 18 and 20 CFA positive children for Pemba and Unguja respectively, we demonstrated that transmission was still ongoing in Pemba where the cut-off was exceeded. CONCLUSIONS Our findings indicated ongoing transmission of LF on Pemba in 2012. Moreover, we presented evidence from previous studies that LF transmission was also active on Unguja shortly after stopping MDA in 2006. Based on these observations the government of Zanzibar decided to resume MDA against LF on both islands in 2013.
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Affiliation(s)
- Maria P. Rebollo
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | | | - Brent Thomas
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Shaali Ame
- Public Health Laboratory-IdC, Chake-chake, Pemba, Zanzibar, Tanzania
| | | | - Jorge Cano
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Moses J. Bockarie
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
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Bird C, Ame S, Albonico M, Bickle Q. Do shoes reduce hookworm infection in school-aged children on Pemba Island, Zanzibar? A pragmatic trial. Trans R Soc Trop Med Hyg 2014; 108:297-304. [DOI: 10.1093/trstmh/tru037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kelaidi C, Beyne-Rauzy O, Braun T, Sapena R, Cougoul P, Adès L, Pillard F, Lamberto C, Charniot JC, Guerci A, Choufi B, Stamatoullas A, Slama B, De Renzis B, Ame S, Damaj G, Boyer F, Chaury MP, Legros L, Cheze S, Testu A, Gyan E, Béné MC, Rose C, Dreyfus F, Fenaux P. Erratum to: High response rate and improved exercise capacity and quality of life with a new regimen of darbepoetin alfa with or without filgrastim in lower-risk myelodysplastic syndromes: a phase II study by the GFM. Ann Hematol 2013. [DOI: 10.1007/s00277-013-1713-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kelaidi C, Beyne-Rauzy O, Braun T, Sapena R, Cougoul P, Adès L, Pillard F, Lamberto C, Lambert C, Charniot JC, Guerci A, Choufi B, Stamatoullas A, Slama B, De Renzis B, Ame S, Damaj G, Boyer F, Chaury MP, Legros L, Cheze S, Testu A, Gyan E, Béné MC, Rose C, Dreyfus F, Fenaux P. High response rate and improved exercise capacity and quality of life with a new regimen of darbepoetin alfa with or without filgrastim in lower-risk myelodysplastic syndromes: a phase II study by the GFM. Ann Hematol 2013; 92:621-31. [PMID: 23358617 DOI: 10.1007/s00277-013-1686-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 01/17/2013] [Indexed: 11/24/2022]
Abstract
Darbepoetin (DAR), with or without granulocyte colony-stimulating factor (G-CSF), has proved effective in treating anemia in patients with lower-risk myelodysplastic syndrome (MDS), but its effects on quality of life (QoL) and exercise functioning are less well established. In this phase II study (no. NCT00443339), lower-risk MDS patients with anemia and endogenous erythropoietin (EPO) level <500 IU/L received DAR 500 μg once every 2 weeks for 12 weeks, with G-CSF added at week 12 in non-responders. Physical performance was assessed with the 6-min walking test and, for fit patients, maximal oxygen consumption (VO2max). QoL was evaluated using SF-36 and FACT-An tests. In 99 patients, erythroid response rate according to IWG 2006 criteria was 48 and 56 % at 12 and 24 weeks, respectively. Addition of G-CSF rescued 22 % of non-responders. In 48 % of the responders, interval between darbepoetin injections could be increased for maintenance treatment. Serum EPO level was the only independent predictive factor of response at 12 weeks, and its most discriminant cutoff value was 100 IU/L. QoL and VO2max showed improvement over time in responders, compared with non-responders. With a median follow-up of 52 months, median response duration was not reached, and 3-year cumulative incidence of acute myeloid leukemia and overall survival (OS) was 14.5 and 70 %, respectively. Baseline transfusion dependence, International Prognostic Score System (IPSS), and Revised IPSS accurately predicted OS from treatment onset. Tolerance of darbepoetin was good. In conclusion, this regimen of darbepoetin every 2 weeks yielded high response rates and prolonged response duration. Objective improvement in exercise testing and in patient-reported QoL confirms the clinical relevance of anemia correction with erythropoiesis-stimulating agents.
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Affiliation(s)
- C Kelaidi
- GFM Service d'Hématogie Clinique, Hôpital Avicenne, Assistance Publique des Hôpitaux de Paris, Université Paris 13, 125 rue de Stalingrad, Bobigny, France
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Thriemer K, Ley B, Ame S, von Seidlein L, Pak GD, Chang NY, Hashim R, Schmied WH, Busch CJL, Nixon S, Morrissey A, Puri MK, Ali M, Ochiai RL, Wierzba T, Jiddawi MS, Clemens JD, Ali SM, Deen JL. The burden of invasive bacterial infections in Pemba, Zanzibar. PLoS One 2012; 7:e30350. [PMID: 22363426 PMCID: PMC3281825 DOI: 10.1371/journal.pone.0030350] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [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: 09/23/2011] [Accepted: 12/14/2011] [Indexed: 11/18/2022] Open
Abstract
Background We conducted a surveillance study to determine the leading causes of bloodstream infection in febrile patients seeking treatment at three district hospitals in Pemba Island, Zanzibar, Tanzania, an area with low malaria transmission. Methods All patients above two months of age presenting to hospital with fever were screened, and blood was collected for microbiologic culture and malaria testing. Bacterial sepsis and malaria crude incidence rates were calculated for a one-year period and were adjusted for study participation and diagnostic sensitivity of blood culture. Results Blood culture was performed on 2,209 patients. Among them, 166 (8%) samples yielded bacterial growth; 87 (4%) were considered as likely contaminants; and 79 (4%) as pathogenic bacteria. The most frequent pathogenic bacteria isolated were Salmonella Typhi (n = 46; 58%), followed by Streptococcus pneumoniae (n = 12; 15%). The crude bacteremia rate was 6/100,000 but when adjusted for potentially missed cases the rate may be as high as 163/100,000. Crude and adjusted rates for S. Typhi infections and malaria were 4 and 110/100,000 and 4 and 47/100,000, respectively. Twenty three (51%), 22 (49%) and 22 (49%) of the S.Typhi isolates were found to be resistant toward ampicillin, chloramphenicol and cotrimoxazole, respectively. Multidrug resistance (MDR) against the three antimicrobials was detected in 42% of the isolates. Conclusions In the presence of very low malaria incidence we found high rates of S. Typhi and S. pneumoniae infections on Pemba Island, Zanzibar. Preventive measures such as vaccination could reduce the febrile disease burden.
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Itzykson R, Thépot S, Beyne-Rauzy O, Ame S, Isnard F, Dreyfus F, Salanoubat C, Taksin AL, Chelgoum Y, Berthon C, Malfuson JV, Legros L, Vey N, Turlure P, Gardin C, Boehrer S, Ades L, Fenaux P. Does addition of erythropoiesis stimulating agents improve the outcome of higher-risk myelodysplastic syndromes treated with azacitidine? Leuk Res 2011; 36:397-400. [PMID: 22177456 DOI: 10.1016/j.leukres.2011.11.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 11/10/2011] [Accepted: 11/24/2011] [Indexed: 11/25/2022]
Abstract
We studied a retrospective cohort of 282 higher-risk MDS treated with azacitidine, including 32 patients who concomitantly received an ESA for a median of 5.8 months after azacitidine onset. Forty-four percent of ESA and 29% of no-ESA patients reached HI-E (p=0.07); 48% and 20% achieved transfusion independence (p=0.01). Median OS was 19.6 months in the ESA and 11.9 months in the no-ESA groups (p=0.04). Addition of an ESA significantly improved OS (p=0.03) independently of azacitidine schedule and duration, and of our proposed azacitidine risk score (Blood 2011;117:403-11). Adding an ESA to azacitidine in higher-risk MDS should be studied prospectively.
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Affiliation(s)
- R Itzykson
- Service d'Hématogie Clinique Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, and Paris 13 University, France
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Park S, Sapena R, Kelaidi C, Vassilieff D, Bordessoule D, Stamatoullas A, Cheze S, Beyne-Rauzy O, Vey N, Rose C, Guerci A, Ame S, Tercian G, Slama B, Fenaux P, Dreyfus F. 99 Correlation between serum ferritin level at diagnosis and survival in lower risk, non-transfusion dependent, MDS patients. Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70101-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Prebet T, Braun T, Beyne-Rauzy O, Dreyfus F, Stammatoulas A, Wattel E, Ame S, Raffoux E, Ades L, Fenaux P, Vey N. 191 Vorinostat and low dose cytarabine for high risk myelodysplastic syndromes with azacytidine failure: the GFM-VOR2007 study. Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70193-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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