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Geographic variation in dengue seroprevalence and force of infection in the urban paediatric population of Indonesia

2 November 2018 - 9:00pm

by Clarence C. Tam, Megan O’Driscoll, Anne-Frieda Taurel, Joshua Nealon, Sri Rezeki Hadinegoro

Understanding the heterogeneous nature of dengue transmission is important for prioritizing and guiding the implementation of prevention strategies. However, passive surveillance data in endemic countries are rarely adequately informative. We analyzed data from a cluster-sample, cross-sectional seroprevalence study in 1–18 year-olds to investigate geographic differences in dengue seroprevalence and force of infection in Indonesia. We used catalytic models to estimate the force of infection in each of the 30 randomly selected sub-districts. Based on these estimates, we determined the proportion of sub-districts expected to reach seroprevalence levels of 50%, 70% and 90% by year of age. We used population averaged generalized estimating equation models to investigate individual- and cluster-level determinants of dengue seropositivity. Dengue force of infection varied substantially across Indonesia, ranging from 4.3% to 30.0% between sub-districts. By age nine, 60% of sub-districts are expected to have a seroprevalence ≥70%, rising to 83% by age 11. Higher odds of seropositivity were associated with higher population density (OR = 1.54 per 10-fold rise in population density, 95% CI: 1.03–2.32) and with City (relative to Regency) administrative status (OR = 1.92, 95% CI: 1.32–2.79). Our findings highlight the substantial variation in dengue endemicity within Indonesia and the importance of understanding spatial heterogeneity in dengue transmission intensity for optimal dengue prevention strategies including future implementation of dengue vaccination programmes.

Comprehensive evaluation of stool-based diagnostic methods and benzimidazole resistance markers to assess drug efficacy and detect the emergence of anthelmintic resistance: A Starworms study protocol

2 November 2018 - 9:00pm

by Johnny Vlaminck, Piet Cools, Marco Albonico, Shaali Ame, Mio Ayana, Jeffrey Bethony, Giuseppe Cringoli, Daniel Dana, Jennifer Keiser, Maria P. Maurelli, Antonio Montresor, Zeleke Mekonnen, Greg Mirams, Rodrigo Corrêa-Oliveira, Roger Prichard, Nour Rashwan, Laura Rinaldi, Somphou Sayasone, Eurion Thomas, Jaco J. Verweij, Jozef Vercruysse, Bruno Levecke

Background

To work towards reaching the WHO goal of eliminating soil-transmitted helminth (STH) infections as a public health problem, the total number of children receiving anthelmintic drugs has strongly increased over the past few years. However, as drug pressure levels rise, the development of anthelmintic drug resistance (AR) is more and more likely to appear. Currently, any global surveillance system to monitor drug efficacy and the emergence of possible AR is lacking. Consequently, it remains unclear to what extent the efficacy of drugs may have dropped and whether AR is already present. The overall aim of this study is to recommend the best diagnostic methods to monitor drug efficacy and molecular markers to assess the emergence of AR in STH control programs.

Methods

A series of drug efficacy trials will be performed in four STH endemic countries with varying drug pressure (Ethiopia and Brazil: low drug pressure, Lao PDR: moderate drug pressure and Tanzania: high drug pressure). These trials are designed to assess the efficacy of a single oral dose of 400 mg albendazole (ALB) against STH infections in school-aged children (SAC) by microscopic (duplicate Kato-Katz thick smear, Mini-FLOTAC and FECPAKG2) and molecular stool-based diagnostic methods (quantitative PCR (qPCR)). Data will be collected on the cost of the materials used, as well as the time required to prepare and examine stool samples for the different diagnostic methods. Following qPCR, DNA samples will also be submitted for pyrosequencing to assess the presence and prevalence of single nucleotide polymorphisms (SNPs) in the β-tubulin gene. These SNPs are known to be linked to AR in animal STHs.

Discussion

The results obtained by these trials will provide robust evidence regarding the cost-efficiency and diagnostic performance of the different stool-based diagnostic methods for the assessment of drug efficacy in control programs. The assessment of associations between the frequency of SNPs in the β-tubulin gene and the history of drug pressure and drug efficacy will allow the validation of these SNPs as a marker for AR in human STHs.

Trial registration

The trial was retrospectively registered the 7th of March 2018 on Clinicaltrials.gov (ID: NCT03465488).

Comparison of different drug regimens for the treatment of loiasis—A TropNet retrospective study

1 November 2018 - 9:00pm

by Federico Gobbi, Emmanuel Bottieau, Olivier Bouchaud, Dora Buonfrate, Fernando Salvador, Gerardo Rojo-Marcos, Paola Rodari, Jan Clerinx, Begoña Treviño, Juan Paulo Herrera-Ávila, Andreas Neumayr, Guido Calleri, Andrea Angheben, Camilla Rothe, Lorenzo Zammarchi, Massimo Guerriero, Zeno Bisoffi

Background

Loa loa infection is endemic in limited areas of West-Central Africa. Loiasis has been associated with excess mortality, but clinical studies on its treatment are scant, particularly outside endemic areas, due to the rarity of cases diagnosed.

Methodology/Principal findings

With this retrospective TropNet (European Network for Tropical Medicine and Travel Health) study, we aimed at outlining the treatment schedules followed by different reference centers for tropical medicine across Europe. We gathered information about 238 cases of loiasis, 165 of which had follow up data. The regimens followed by the different centers were heterogeneous. The drugs most frequently administered were: diethylcarbamazine alone (74/165, 45.1%), ivermectin alone (41/165, 25%), albendazole + ivermectin (21/164, 11.6%), ivermectin + diethylcarbamazine (16/165, 9.7%).

Conclusions/Significance

The management of loiasis substantially differs across specialized travel clinics in Europe. These discrepancies could be due to different local protocols as well as to (un)availability of the drugs. An harmonization of clinical protocols for the treatment of loiasis would be suggested across reference centers for tropical medicine in Europe.

Beneficial effects of benznidazole in Chagas disease: NIH SaMi-Trop cohort study

1 November 2018 - 9:00pm

by Clareci Silva Cardoso, Antonio Luiz P. Ribeiro, Claudia Di Lorenzo Oliveira, Lea Campos Oliveira, Ariela Mota Ferreira, Ana Luiza Bierrenbach, José Luiz Padilha Silva, Enrico Antonio Colosimo, João Eduardo Ferreira, Tzong-Hae Lee, Michael P. Busch, Arthur Lawrence Reingold, Ester Cerdeira Sabino

Background

The effectiveness of anti-parasite treatment with benznidazole in the chronic Chagas disease (ChD) remains uncertain. We evaluated, using data from the NIH-sponsored SaMi-Trop prospective cohort study, if previous treatment with benznidazole is associated with lower mortality, less advanced cardiac disease and lower parasitemia in patients with chronic ChD.

Methods

The study enrolled 1,959 ChD patients and abnormal electrocardiogram (ECG) from in 21 remote towns in Brazil. A total of 1,813 patients were evaluated at baseline and after two years of follow-up. Those who received at least one course of benznidazole were classified as treated group (TrG = 493) and those who were never treated as control group (CG = 1,320). The primary outcome was death after two-year follow-up; the secondary outcomes were presence at the baseline of major ChD-associated ECG abnormalities, NT-ProBNP levels suggestive of heart failure, and PCR positivity.

Results

Mortality after two years was 6.3%; it was lower in the TrG (2.8%) than the CG (7.6%); adjusted OR: 0.37 (95%CI: 0.21;0.63). The ECG abnormalities typical for ChD and high age-adjusted NT-ProBNP levels suggestive of heart failure were lower in the TrG than the CG, OR: 0.35 [CI: 0.23;0.53]. The TrG had significantly lower rates of PCR positivity, OR: 0.35 [CI: 0.27;0.45].

Conclusion

Patients previously treated with benznidazole had significantly reduced parasitemia, a lower prevalence of markers of severe cardiomyopathy, and lower mortality after two years of follow-up. If used in the early phases, benznidazole treatment may improve clinical and parasitological outcomes in patients with chronic ChD.

Trial registration

ClinicalTrials.gov, Trial registration: NCT02646943.

Developing mobile health applications for neglected tropical disease research

1 November 2018 - 9:00pm

by Andrés Navarro, Luisa Rubiano, Juan David Arango, Carlos A. Rojas, Neal Alexander, Nancy Gore Saravia, Eliah Aronoff-Spencer

Mobile applications (apps) can bring health research and its potential downstream benefits closer to underserved populations. Drawing on experience developing an app for detecting and referring cases of cutaneous leishmaniasis in Colombia, called Guaral/app, we review key steps in creating such mobile health (mHealth) tools. These require consideration of the sociotechnical context using methods such as systems analysis and human-centered design (HCD), predicated on engagement and iteration with all stakeholders. We emphasize usability and technical concerns and describe the interdependency of technical and human considerations for mHealth systems in rural communities.

Identification of a host collagen inducing factor from the excretory secretory proteins of <i>Trichinella spiralis</i>

1 November 2018 - 9:00pm

by Mi Kyung Park, Hae-Jin Kim, Min Kyoung Cho, Shin Ae Kang, So Young Park, Se Bok Jang, Hak Sun Yu

Background

In a previous study, we found that Trichinella spiralis muscle larva excretory and secretory proteins (ES-P) most likely activate collagen synthesis via TGF-β/Smad signaling, and this event could influence collagen capsule formation.

Methodology/Principal findings

In order to identify the specific collagen inducing factor, ES-P was fractionated by a Superdex 200 10/300 GL column. We obtained three large fractions, F1, F2, and F3, but only F3 had collagen gene inducing ability. After immunoscreening, 10 collagen inducing factor candidates were identified. Among them, TS 15–1 and TS 15–2 were identical to the putative trypsin of T. spiralis. The deduced TS 15–1 (M.W. = 72 kDa) had two conserved catalytic motifs, an N-terminal Tryp_SPc domain (TS 15-1n) and a C-terminal Tryp_SPc domain (TS 15-1c). To determine their collagen inducing ability, recombinant proteins (rTS 15-1n and rTS 15-1c) were produced using the pET-28a expression system. TS 15–1 is highly expressed during the muscle larval stage and has strong antigenicity. We determined that rTS 15-1c could elevate collagen I via activation of the TGF-β1 signaling pathway in vitro and in vivo.

Conclusion/Significance

In conclusion, we identified a host collagen inducing factor from T. spiralis ES-P using immunoscreening and demonstrated its molecular characteristics and functions.

Activity profiling of peptidases in <i>Angiostrongylus costaricensis</i> first-stage larvae and adult worms

31 October 2018 - 9:00pm

by Karina M. Rebello, James H. McKerrow, Ester M. Mota, Anthony J. O´Donoghue, Ana Gisele C. Neves-Ferreira

Background

Angiostrongylus costaricensis is a relatively uncharacterized nematode that causes abdominal angiostrongyliasis in Latin America, a human parasitic disease. Currently, no effective pharmacological treatment for angiostrongyliasis exists. Peptidases are known to be druggable targets for a variety of diseases and are essential for several biological processes in parasites. Therefore, this study aimed to systematically characterize the peptidase activity of A. costaricensis in different developmental stages of this parasitic nematode.

Methodology/Principal findings

A library of diverse tetradecapeptides was incubated with cellular lysates from adult worms and from first-stage larvae (L1) and cleaved peptide products were identified by mass spectrometry. Lysates were also treated with class specific peptidase inhibitors to determine which enzyme class was responsible for the proteolytic activity. Peptidase activity from the four major mechanistic classes (aspartic, metallo, serine and cysteine) were detected in adult worm lysate, whereas aspartic, metallo and serine peptidases were found in the larval lysates. In addition, the substrate specificity profile was found to vary at different pH values.

Conclusions/Significance

The proteolytic activities in adult worm and L1 lysates were characterized using a highly diversified library of peptide substrates and the activity was validated using a selection of fluorescent substrates. Taken together, peptidase signatures for different developmental stages of this parasite has improved our understanding of the disease pathogenesis and may be useful as potential drug targets or vaccine candidates.

Epidemiological characterization of incident cases of <i>Rickettsia</i> infection in rural areas of Urabá region, Colombia

31 October 2018 - 9:00pm

by Juan Carlos Quintero Vélez, Daniel Camilo Aguirre-Acevedo, Juan David Rodas, Margarita Arboleda, Adriana Troyo, Francisco Vega Aguilar, Lisardo Osorio Quintero, Carlos Rojas Arbeláez

Introduction

Most of the studies related to rickettsial infection in Colombia are cross-sectional because of the challenge in conducting prospective studies on infectious disease that may have a difficult diagnosis. Although cross-sectional studies are essential to detect people exposed to rickettsiae, they are not suited to demonstrate the recent circulation of this pathogen in areas at risk of transmission.

Objective

To characterize the epidemiology of incident cases of Spotted fever group (SFG) rickettsial infection in humans and equines from rural areas of Urabá region in Colombia where outbreaks of rickettsiae previously occurred.

Materials and methods

A prospective study was conducted in the Alto de Mulatos and Las Changas in the Urabá region. Serum samples and socio-ecological information were collected from 597 people enrolled in 2015, and a second sample was collected from 273 people a year later. Indirect immune-fluorescence assays for detection of IgG antibody against rickettsiae were done using slides with Rickettsia rickettsii antigens. A titer ≥128 was considered positive. Incident cases were defined as (i) serological conversion of IgG titers from seronegative to seropositive or (ii) at least a four-fold increase in IgG end point titers in the second sample.

Results

The cumulative incidence of rickettsial infection was 6.23% (95%CI 3.67–9.78) in humans and 32.31% (21/65) of incident cases in equines. Incident cases were mostly females (82.35%), the median age of cases was 41.02 years (IQR 18.62–54.1), and 29.41% reported tick bites during the study period. Results from multivariate analysis showed that removal of ticks after working outdoors is a protective factor for rickettsial infection (RR 0.26, 95%CI 0.08–0.84) and that a higher incidence of infection occurred in people who reported fever in the last year (RR 4.26, 95%CI 1.15–9.31).

Conclusions

These results showed recent circulation of SFG rickettsiae in areas where previous lethal outbreaks have been reported, supporting the implementation of preventive measures to halt rickettsial transmission in the studied communities.

An open label randomized clinical trial comparing the safety and effectiveness of one, two or three weekly pentamidine isethionate doses (seven milligrams per kilogram) in the treatment of cutaneous leishmaniasis in the Amazon Region

31 October 2018 - 9:00pm

by Ellen Priscilla Nunes Gadelha, Rajendranath Ramasawmy, Bruna da Costa Oliveira, Nágila Moraes Rocha, Jorge Augusto de Oliveira Guerra, George Allan Villa Rouco da Silva, Tirza Gabrielle Ramos de Mesquita, Carolina Chrusciak Talhari Cortez, Anette Chrusciak Talhari

Background

American Cutaneous Leishmaniasis (ACL), a vector borne disease, is caused by various species of Leishmania and in the Amazonas, Leishmania guyanensis is predominant. The recommended drugs for treatment of cutaneous leishmaniasis (CL) in Brazil are pentavalent antimonials, pentamidine isethionate (PI) and amphotericin B. Pentamidine was initially used as metanolsulfonate or mesylate (Lomidine) at a dose of 4 mg/kg/daily, containing 2.3mg of base. This drug was withdrawn from the market in the eighties, and currently is available as PI. The PI dose required to achieve an equivalent dose of pentamidine base is 7 mg/kg, rather than the 4 mg/kg that is currently recommended in Brazil.

Objectives

The aim of this study was to evaluate the efficacy and safety of PI in a single dose, two or three doses of 7 mg/kg body weight, intramuscularly, with an interval of seven days between each dose.

Materials and methods

This study was conducted as a controlled, randomized, open–label clinical trial for a total number of 159 patients with CL. Individuals aged 16–64 years with one to six lesions of confirmed CL based on amastigotes visualization in direct examination of Giemsa stained of dermal scraping from the border of the lesion with no previous treatment for CL and no abnormal values for liver enzymes were eligible to participate in the study. Patients with history of diabetes, cardiac, renal, and hepatic disease as well as pregnant women were excluded. Cure was defined as complete healing in the diameters of the ulcers and lesions skin six months after the end of the treatment.

Results

From November 2013 to December 2015, 159 patients were screened and allocated in three groups for treatment with PI: i) 53 patients were treated with a single dose intramuscularly injection of 7 mg/kg body weight; ii) 53 received two doses of 7 mg/kg within an interval of seven days; and iii) 53 were treated with three doses of 7mg/kg with an interval of seven days between each dose. In 120 patients, L. guyanensis was identified. A cure rate of 45%, 81.1% and 96.2% were observed in the first, second and third group, respectively. The cure in the three PI dose group was higher compared to the single-dose (p<0.0001) and two-dose groups (p = 0.03). No serious adverse events occurred.

Conclusion

The present study shows that PI is a safe drug and its efficacy varied with the number of doses. The administration of PI in patients with ACL, predominantly caused by L. guyanensis, was mostly efficient in three or two doses of 7 mg/kg.

Trial registration

ClinicalTrials.gov NCT02919605

Participatory survey of Rift Valley fever in nomadic pastoral communities of North-central Nigeria: The associated risk pathways and factors

30 October 2018 - 9:00pm

by Nma Bida Alhaji, Olutayo Olajide Babalobi, Yiltawe Wungak, Hussaini Gulak Ularamu

Background

Rift Valley fever (RVF) is an emerging neglected mosquito-borne viral zoonotic disease of domestic animals and humans, with potential for global expansion. The objectives of this study were: to assess perceived relative burden and seasonality of RVF in nomadic cattle herds and validate the burden with sero-prevalence impact; and assess perceived risk factors associated with the disease and risk pathways for RVF virus in nomadic pastoral herds of North-central Nigeria using pastoralists’ existing veterinary knowledge.

Methods

Participatory Epidemiology (PE) survey was conducted in Fulani nomadic pastoral communities domiciled in Niger State between January and December 2015. A cross-sectional sero-prevalence investigation was also carried out in nomadic pastoral cattle herds to validate outcomes of PE. A total of nine nomadic pastoral communities were purposively selected for qualitative impact assessment using Participatory Rural Appraisal tools, while 97 cattle randomly sampled from 15 purposively selected nomadic herds and had their sera analyzed using c-ELISA. Kendall’s Coefficient of Concordance W statistics and OpenEpi 2.3.1 were used for statistical analyses.

Results

Mean proportional piles (relative burden) of RVF (Gabi-gabiF) was 8.3%, and nomads agreement on the burden was strong (W = 0.6855) and statistically significant (P<0.001). This was validated by 11.3% (11/97; 95% CI: 6.1–18.9) sero-positivity (quantitative impact). Mean matrix scores of prominent clinical signs associated with RVF were fever (3.1), anorexia (2.1), abortion (4.1), nasal discharge (3.3), neurological disorder (8.4), diarrhoea (3.2), and sudden death (4.4), with strong agreement (W = 0.6687) and statistically significant (p<0.001). Mean proportional piles of pastoralists’ perceived risk factors identified to influenced RVF occurrence were: availability of mosquitoes (18 piles, 17.6%), high cattle density (16 piles, 15.9%) and high rainfall (12 piles, 12.2%). Agreement on the risk factors was strong (W = 0.8372) and statistically significant (p<0.01). Mean matrix scores for the Entry pathway of RVF virus into the nomadic pastoral herds were: presence of RVFV infected mosquitoes (tiny biting flies) (7.9), presence of infected cattle in herds (8.4), and contacts of herd with infected wild animals at grazing (10.1). Mean matrix scores for the Spread pathway of RVF virus in herds were bites of infected mosquitoes (5.1), contacts with infected aborted fetuses/fluids (7.8), and contaminated pasture with aborted fetuses/fluids (9.7). Agreement on risk pathways was strong (W = 0.6922) and statistically significant (p<0.03). Key informants scored RVF to occurred more in Damina or late rainy season (5.3), followed by Kaka or early dry season (3.3), with strong agreement (W = 0.8719) and statistically significant (P<0.01). This study highlighted the significant existing knowledge level about RVF contained in nomadic pastoralists.

Conclusions

The use of PE approach is needful in active surveillance of livestock diseases in pastoral communities domiciled in highly remote areas. RVF surveillance system, control and prevention programmes that take the identified risk factors and pathways into consideration will be beneficial to the livestock industry in Nigeria, and indeed Africa. An ‘OneHealth’ approach is needed to improve efficiency of RVF research, surveillance, prevention and control systems, so as to assure food security and public health in developing countries.

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