JANUARY

1.     ONCHOCERCIASIS IN YEMEN: MOVING FORWARD TOWARDS AN ELIMINATION PROGRAM

Abdul-Samid Al-Kubati, Charles D Mackenzie, Daniel Boakye, Yasin Al-Qubati, Abdul-Rahim Al-Samie, Isam E Awad, Bjorn Thylefors, Adrian Hopkins

International Health, Volume 10, Issue suppl_1, March 2018, Pages i89–i96, https://doi.org/10.1093/inthealth/ihx055

Abstract

The onchocerciasis focus in Yemen has been known for many years as an endemic area with unique characteristics, notably the atypical and most severe form of onchodermatitis, known as sowda or reactive onchodermatitis (ROD). The national effort to control the disease began in 1992 as an individual case treatment program by administering ivermectin to those presenting with ROD. The challenging geography of the endemic area and the current political and military unrest both underscore a need for special approaches when attempting to eliminate onchocerciasis from this country. An assessment of the national situation regarding this disease was carried out in 2011–2013 aimed at defining the best approach for moving from individual clinical case treatment to elimination of transmission. The history of the control efforts and the current status of the disease are reviewed and the essential changes needed to a mass drug administration (MDA) approach are identified as the national program addresses elimination. Yemen, despite the current troubles, has shown that it can successfully implement MDA programs despite many difficulties and therefore should be supported in its efforts towards countrywide elimination of this infection; however, success will need renewed national and international efforts.

 

2. NATURAL AND VACCINE-INDUCED ACQUISITION OF CROSS-REACTIVE IGG-INHIBITING ICAM 1-SPECIFIC BINDING OF A PLASMODIUM FALCIPARUM PFEMP1 SUBTYPE ASSOCIATED SPECIFICALLY WITH CEREBRAL MALARIA

Rebecca W. Olsen, Gertrude Ecklu-Mensah, Anja Bengtsson, Michael F. Ofori, John P. A. Lusingu, Filip C. Castberg, Lars Hviid, Yvonne Adams, Anja T. R. Jensena

 

ABSTRACT

Cerebral malaria (CM) is a potentially deadly outcome of Plasmodium

falciparum malaria that is precipitated by sequestration of infected erythrocytes (IEs)

in the brain. The adhesion of IEs to brain endothelial cells is mediated by a subtype

of parasite-encoded erythrocyte membrane protein 1 (PfEMP1) that facilitates dual

binding to host intercellular adhesion molecule 1 (ICAM-1) and endothelial protein

receptor C (EPCR). The PfEMP1 subtype is characterized by the presence of a particular

motif (DBL__motif) in the constituent ICAM-1-binding DBL_ domain. The rate of

natural acquisition of DBL__motif-specific IgG antibodies and the ability to induce

such antibodies by vaccination are unknown, and the aim of this study was to provide

such data. We used an enzyme-linked immunosorbent assay (ELISA) to measure

DBL_-specific IgG in plasma from Ghanaian children with malaria. The ability of human

immune plasma and DBL_-specific rat antisera to inhibit the interaction between

ICAM-1 and DBL_ was assessed using ELISA and in vitro assays of IE adhesion

under flow. The acquisition of DBL__motif-specific IgG coincided with age-specific

susceptibility to CM. Broadly cross-reactive antibodies inhibiting the interaction between

ICAM-1 and DBL__motif domains were detectable in immune plasma and in

sera of rats immunized with specific DBL__motif antigens. Importantly, antibodies

against the DBL__motif inhibited ICAM-1-specific in vitro adhesion of erythrocytes

infected by four of five P. falciparum isolates from cerebral malaria patients. We conclude

that natural exposure to P. falciparum as well as immunization with specific

DBL__motif antigens can induce cross-reactive antibodies that inhibit the interaction

between ICAM-1 and a broad range of DBL__motif domains. These findings raise

hope that a vaccine designed specifically to prevent CM is feasible.

 

3.     MOLECULAR XENOMONITORING FOR POST-VALIDATION SURVEILLANCE OF LYMPHATIC FILARIASIS IN TOGO: NO EVIDENCE FOR ACTIVE TRANSMISSION.

Dorkenoo MA, de Souza DK, Apetogbo Y, Oboussoumi K, Yehadji D, Tchalim M, Etassoli S, Koudou B, Ketoh GK, Sodahlon Y, Bockarie MJ, Boakye DA.

 

Abstract

Lymphatic filariasis (LF) is a mosquito-borne filarial disease targeted for elimination by the year 2020. The Republic of Togo undertook mass treatment of entire endemic communities from 2000 to 2009 to eliminate the transmission of the disease and is currently the first sub-Saharan African country to be validated by WHO for the elimination of LF as a public health problem. However, post-validation surveillance activities are required to ensure the gains achieved are sustained. This survey assessed the mosquito vectors of the disease and determined the presence of infection in these vectors, testing the hypothesis that transmission has already been interrupted in Togo.

 

1.     EXPANDING MOLECULAR DIAGNOSTICS OF HELMINTHIASIS: PILOTING USE OF THE GPLN PLATFORM FOR SURVEILLANCE OF SOIL TRANSMITTED HELMINTHIASIS AND SCHISTOSOMIASIS IN GHANA

Lucas J. Cunningham, John Odoom , Deborah Pratt, Linda Boatemaa, Nana Asante-Ntim, Keren Attiku, Bismarck Banahene, Mike Osei-Atweneboana,  Jaco J. Verweij ,David Molyneux, Russell J. Stothard , Emily R. Adams

 

Abstract

The efforts to control and eradicate polio as a global health burden have been successful to the point where currently only three countries now report endemic polio, and the number of cases of polio continues to decrease. The success of the polio programme has been dependant on a well-developed network of laboratories termed the global polio laboratory network (GPLN). Here we explore collaborative opportunities with the GPLN to target two of the 18 diseases listed as a neglected tropical diseases (NTD) namely soil transmitted helminthiasis (STH) and Schistosomiasis (SCH). These were chosen based on prevalence and the use of faecal materials to identify both polio, STH and SCH. Our study screened 448 faecal samples from the Ghana GPLN using three triplex TaqMan assays to identify Ascaris lumbricoides, Necator americanus, Ancylostoma spp, Trichuris trchiura, Strongyloides stercoralis and Schistosoma spp. Our results found a combined helminth prevalence of 22%. The most common helminth infection was A. lumbricoides with a prevalence of 15% followed by N. americanus (5%), Ancylostoma spp. (2.5%), Schistosoma spp. (1.6%) and S. stercoralis (1%). These results show that it is possible to identify alternative pathogens to polio in the samples collected by the GPLN platform and to introduce new diagnostic assays to their laboratories. The diagnostic methods employed were also able to identify S. stercoralis positive samples, which are difficult to identify using parasitological methods such as Kato-Katz. This study raises the possibility of collaboration with the GPLN for the surveillance of a wider range of diseases which would both benefit the efforts to control the NTDs and also increase the scope of the GPLN as a diagnostic platform.

 

2.     DYNAMICS OF ANTI-MSP3 AND PFS230 ANTIBODY RESPONSES AND MULTIPLICITY OF INFECTION IN ASYMPTOMATIC CHILDREN FROM SOUTHERN GHANA.

 

Amoah LE, Acquah FK, Ayanful-Torgby  R, Oppong A, Abankwa J, Obboh  EK, Singh SK, Theisen M.

 

Abstract

During a Plasmodium infection, exposure of human host immune cells to both the asexual and the sexual stages of the parasite elicit immune responses. These responses may be protective and prevent the development of high parasitaemia and its associated clinical symptoms, or block the transmission of malaria to an uninfected person. This study aimed at examining the dynamics of naturally acquired immune responses against the asexual and sexual forms of Plasmodium falciparum as well as assessing differences in the multiplicity of infection (MOI) in asymptomatic Ghanaian children living in two communities with varying malaria transmission intensities.

3.     ASSESSMENT OF THE QUALITY AND QUANTITY OF NATURALLY INDUCED ANTIBODY RESPONSES TO EBA175RIII-V IN GHANAIAN CHILDREN LIVING IN TWO COMMUNITIES WITH VARYING MALARIA TRANSMISSION PATTERNS.

 

Abagna HB, Acquah FK, Okonu R, Aryee NA, Theisen M, Amoah LE.

Abstract

Recent global reports on malaria suggest significant decrease in disease severity and an increase in control interventions in many malaria endemic countries, including Ghana. However, a major driving force sustaining malaria transmission in recent times is the asymptomatic carriage of malaria parasites, which can enhance immune responses against parasite antigens. This study determined the prevalence and relative avidities of naturally induced antibodies to EBA175RIII-V_Ll in asymptomatic children living in two communities with varying malaria transmission patterns.

 

4. IS THERE A "COMPLEMENTARY FEEDING CULTURAL CORE" IN RURAL KENYA? RESULTS FROM ETHNOGRAPHIC RESEARCH IN FIVE COUNTIES.

Thuita FM, Pelto GH, Musinguzi E, Armar-Klemesu M.

Matern Child Nutr. 2019 Jan;15(1):e12671. doi: 10.1111/mcn.12671. Epub 2018 Sep 14.

Abstract

This investigation used data from focused ethnographic studies in five rural counties in Kenya to determine whether the concept of "special foods for infants and young children" exists in the different ethnic groups in these areas as an identifiable component of cultural beliefs and knowledge, as well as in practice, and whether they can be characterized as a "complementary feeding cultural core." The concept of "cultural core foods" refers to the set of foods that have a central role in diets of a population and, as a consequence, also have significant social and emotional components. We used the ethnographic cognitive mapping technique of "free listing" and a qualitative 24-hr recall of infants and young children (IYC) intake, with probing, to obtain data on caregivers' beliefs and behaviours. The results show that an IYC cultural food core can be identified in all of the counties. A related finding that supports the argument for an "IYC cultural core" with respect to appropriate foods for IYC is the clear cognitive consensus within sites about its content, although in practice, food insecurity and food shortage constrain household abilities to put their beliefs into practice. We conclude that interventions to improve IYC feeding in rural Kenya that build on the concept of "IYC cultural core foods" will be congruent with basic cultural ideas about managing IYC feeding and could take advantage of this cultural feature.

AGRO-ECOLOGICAL ZONE AND FARM DIVERSITY ARE FACTORS ASSOCIATED WITH HAEMOGLOBIN AND ANAEMIA AMONG RURAL SCHOOL-AGED CHILDREN AND ADOLESCENTS IN GHANA.

Azupogo F,  Aurino E,  Gelli A,  Bosompem KM,  Ayi I,  Osendarp SJM, Brouwer ID, Folson G.

Matern Child Nutr. 2019 Jan;15(1):e12643. doi: 10.1111/mcn.12643. Epub 2018 Jul 25.

Abstract

Understanding contextual risk factors for haemoglobin (Hb) status and anaemia of rural school-aged children (SAC) and adolescents is critical in developing appropriate interventions to prevent anaemia. We analysed secondary data from the baseline of an impact evaluation of the Ghana School Feeding Programme to determine the severity of anaemia and contextual factors associated with anaemia and Hb status among rural SAC (6-9 years; n = 323) and adolescents (10-17 years; n = 319) in Ghana. We used regression models with variable selection based on backward elimination in our analyses. The mean Hb was 113.8 ± 13.1 g/L, and the overall prevalence of anaemia was 52.3%, being 55.1% and 49.5% among SAC and adolescents, respectively. We identified child's age (β = 2.21, P < 0.001); farm diversity score (β = 0.59, P = 0.036); and agro-ecological zone (P trend <0.001) as the main predictors of Hb of SAC. Household asset index (P trend = 0.042) and agro-ecological zone (P trend <0.001) were predictors of Hb in adolescents. Agro-ecological zone and age were predictors of anaemia, but the effect of age was only significant for girls and not boys (prevalence odds ratio [POR] = 1.35, 95% CI [1.04, 1.76] vs. POR = 1.14, 95% CI [0.88, 1.46]). SAC in households with maize stock were less likely to be anaemic (POR = 0.55, 95% CI [0.32, 0.97]). Household dietary diversity score (β = 0.59, P = 0.033) was associated with Hb status for the full sample only. Anaemia is a severe public health problem among SAC and adolescents in rural Ghana irrespective of sex. Farm diversity score, availability of maize stock in the household, household asset index, and agro-ecological zone were the main predictors of Hb and anaemia among the rural SAC and adolescents.

FEBRUARY

Using Ethnography to Identify Barriers and Facilitators to Optimal Infant and Young Child Feeding in Rural Ghana: Implications for Programs

 

Margaret Armar-Klemesu, PhD1, Sarah Osei-Menya, MA1, Sawudatu Zakariah-Akoto, MPhill1, Alison Tumilowicz, PhD2, James Lee, MEd2, and Christine Hotz, PhD2

Abstract

Background: Understanding the context of infant and young child feeding (IYCF) is recognized as essential for designing appropriate complementary feeding interventions.

Objective: Our objective was to study household IYCF behaviors in 2 districts in southern and

northern Ghana to identify opportunities to improve existing nutrition programs.

Methods:We interviewed 80 caregivers of children aged 6 to 23 months using ethnographic methods, including free listing, guided discussions and cognitive mapping techniques, and 24-hour dietary recall.

Descriptive statistics and thematic content analysis were used to analyze quantitative and qualitative data.

Results: In both settings, children’s diets were predominantly maize based. Fish, the main animal source food, was consumed daily but in very small quantities. Milk was consumed by only a few

 

 

SECOND-LINE ANTI-TUBERCULOSIS DRUG RESISTANCE TESTING IN GHANA IDENTIFIES THE FIRST EXTENSIVELY DRUG-RESISTANT TUBERCULOSIS CASE.

Osei-Wusu S, Amo Omari M, Asante-Poku A, Darko Otchere I, Asare P, Forson A, Otu J, Antonio M, Yeboah-Manu D.

Abstract

Drug resistance surveillance is crucial for tuberculosis (TB) control. Therefore, our goal was to determine the prevalence of second-line anti-TB drug resistance among diverse primary drug-resistant Mycobacterium tuberculosis complex (MTBC) isolates in Ghana.

 

SECOND-LINE ANTI-TUBERCULOSIS DRUG RESISTANCE TESTING IN GHANA IDENTIFIES THE FIRST EXTENSIVELY DRUG-RESISTANT TUBERCULOSIS CASE

 

Stephen Osei-Wusu, Michael Amo Omari Adwoa Asante-Poku IsaacDarkoOtchere, PrinceAsare1 Audrey Forson3Jacob Otu4Martin Antonio, Dorothy Yeboah-Manu

 

Abstract

Tuberculosis (TB), which has killed more humans than any infectious disease, remains

a global health challenge. Over 10 million people got sick and 1.4 million individuals died of TB in 2015, with most of the affected individuals living in resource-constrained countries.1 The burden of TB is worsened by the emergence of strains that are resistant to standard TB drugs, threatening to make a treatable disease untreatable. Individuals infected with resistant strains have to take anti-TB drugs for longer periods and cure rates are lower compared to infection with susceptible strains.1,2

The standard World Health Organization (WHO)-approved treatment greatly relies on the use of two potent drugs, that is, isoniazid (INH) and rifampicin (RIF).3,4  TB strains that are resistant to these two drugs are classified as multidrug-resistant TB (MDR-TB). More severe forms of TB drug resistance are pre-extensively drug-resistant TB (pre-XDR-TB) and extensively drug-resistant TB (XDR-TB).1,5–9   XDR-TB has been reported in 117 countries worldwide with treatment success of 28%.1

The first key intervention for controlling drug resistance is early detection, for appropriate treatment.1,2 The increased use of new and rapid diagnostic tools such as Infection and Drug Resistance

 

COMPARATIVE EFFICACY OF LOW-DOSE VERSUS STANDARD-DOSE AZITHROMYCIN FOR PATIENTS WITH YAWS: A RANDOMIZED NON-INFERIORITY TRIAL IN GHANA AND PAPUA NEW GUINEA

 

Michael Marks, Oriol Mitjà, Christian Bottomley, Cynthia Kwakye, Wendy Houinei, Mathias Bauri, Paul Adwere, Abdul A Abdulai, Fredrick Dua, Laud Boateng, James Wangi, Sally-Ann Ohene, Regina Wangnapi, Shirley V Simpson, Helen Miag, Kennedy K Addo, Laud A Basing, Damien Danavall,

 

Abstract

Background A dose of 30 mg/kg of azithromycin is recommended for treatment of yaws, a disease targeted for global eradication. Treatment with 20 mg/kg of azithromycin is recommended for the elimination of trachoma as a public health problem. In some settings, these diseases are co-endemic. We aimed to determine the efficacy of 20 mg/kg of azithromycin compared with 30 mg/kg azithromycin for the treatment of active and latent yaws.

 

Kai H Chi, Allan Pillay, Ronald Ballard, Anthony W Solomon, Cheng Y Chen, Sibauk V Bieb, Yaw Adu-Sarkodie, David C W Mabey, Kingsley Asiedu, on behalf of the study team*

 

12.  COMMUNITY PERSPECTIVES ON PERSISTENT TRANSMISSION OF LYMPHATIC FILARIASIS IN THREE HOTSPOT DISTRICTS IN GHANA AFTER 15 ROUNDS OF MASS DRUG ADMINISTRATION: A QUALITATIVE ASSESSMENT

Collins S. K. Ahorlu, Eric Koka, Susan Adu-Amankwah, Joseph Otchere & Dziedzom Komi de Souza 

BMC Public Health volume 18, Article number: 238 (2018)

Abstract

The Global Program for the Elimination of Lymphatic Filariasis (GPELF) started operation in 2000 and aimed at eliminating the disease by the year 2020, following 5–6 rounds of effective annual Mass Drug Administration (MDA). The MDA programme took off in Ghana in 2001 and has interrupted transmission in many areas while it has persisted in some areas after 10 or more rounds of MDA. This study was to appreciate community members’ perspectives on MDA after over 15 years of implementation. Findings will inform strategies to mobilise community members to participate fully in MDA to enhance the disease elimination process.

 

ALTERED IMMUNOGLOBULINS (A AND G) IN GHANAIAN PATIENTS WITH TYPE 2 DIABETES

 

Henry Asare-Anane, Collins Paa Kwesi Botchey, Emmanuel Kwaku Ofori, Isaac Boamah, Sandra Crabbe and Kwadwo Asamoah-Kusi

 

Abstract

Objectives: Elevated immunoglobulin levels have been strongly linked to the development and progression of inflammatory disorders such as type 2 diabetes and obesity. This study aimed to evaluate circulating immunoglobulin levels and to identify

other metabolic factors that influence humoral immune response among Ghanaian subjects with type 2 diabetes.

 

 AN EVALUATION OF TREATMENT OUTCOMES IN A COHORT OF CLIENTS ON THE DOTS STRATEGY, 2012–2016

 

Ato Kwamena Tetteh , Edward Agyarko, Joseph Otchere,

Langbong Bimi, and Irene Ayi

Abstract

We present, for the first time, an evaluation of treatment outcomes in a cohort at a TB referral centre in the Central Region ofGhana. Of the 213 clients placed on DOTS, 59.2% (126/213) were sputum smear-positive. An overall cure rate of 90.2% (51.6% cured + 37.6% completed) and a death rate of 8.5% (18/213) were estimated. Of the number of clients who died, 5.7%  12/213) were males (𝜒2 = 2.891, 𝑝 = 0.699; LR = 3.004, 𝑝 = 0.699). Deaths were only recorded among clients who were > 19 years old (𝜒2 = 40.319, 𝑝 = 0.099; LR = 41.244, 𝑝 = 0.083). Also, 0.9% (2/213) was lost to follow-up, while 1.4% (3/213) had treatment failure. In total,13.6% (7.0%, 15/213 males, and 6.6%, 14/213 females) of clients who were placed on DOTS were HIV seropositive. Ages of 40–49 years had the highest number, 13/213 (6.1%), infected with HIV, though the difference among the remaining age groups was not statistically significant (𝜒2 = 9.621, 𝑝 = 0.142). Furthermore, 7.0% (15/213) had TB/HIV coinfection. Out of them, 9 were cured and 5 died at home, while 1 had treatment failure. Tuberculosis/HIV infection prevention advocacy and interventions that address sociodemographic determinants of unfavourable treatment outcomes are urgently required to augment national efforts towards control.

 

 

ALTERED IMMUNOGLOBULINS (A AND G) IN GHANAIAN PATIENTS WITH TYPE 2 DIABETES

Henry Asare-Anane, Collins Paa Kwesi Botchey, Emmanuel Kwaku Ofori3, Isaac Boamah, Sandra Crabbe and Kwadwo Asamoah-Kusi *********

Abstract

Abstract Objectives: Elevated immunoglobulin levels have been strongly linked to the development and progression of inflammatory disorders such as type 2 diabetes and obesity. This study aimed to evaluate circulating immunoglobulin levels and to identify other metabolic factors that influence humoral immune response among Ghanaian subjects with type 2 diabetes. Methods: A comparative cross-sectional study conducted at the National Diabetes Management and Research Center, Accra. Eighty persons with type 2 diabetes were age-matched with 78 controls. Immunoglobulin A, immunoglobulin G and immunoglobulin M; interleukin 6; fasting blood glucose; glycated hemoglobin; and lipid parameter concentrations were measured. Blood pressure, anthropometry and body composition indices were also assessed. Results: Median immunoglobulin A and immunoglobulin G (g/L) levels were higher in the case group compared with controls (0.89 vs 0.74, p = 0.043; 7.58 vs 7.29, p < 0.001). Immunoglobulin G, immunoglobulin A and interleukin 6 levels in the case cohort, respectively, associated weakly with fasting blood glucose (r = 0.252, p = 0.001; r = 0.170, p = 0.031; r = 0.296, p = 0.001). There were positive correlations within the control group for immunoglobulin A versus interleukin 6 (r = 0.366, p = 0.001) and within the case group for glycated hemoglobin versus interleukin 6 (r = 0.190, p = 0.020). Conclusion: Our data suggest that humoral immune response is altered in subjects with type 2 diabetes and that serum immunoglobulin levels could serve as useful biomarkers in the investigation and management of diabetes mellitus.

Keywords Immunoglobulin, interleukin, type 2 diabetes

 

ESTABLISHMENT OF A QUANTITATIVE AND QUALITATIVE ANALYSIS AND ISOLATION METHOD FOR TETRACYCLIC IRIDOIDS FROM MORINDA LUCIDA BENTHAM LEAVES. &&&&& Authors

Ohta T, Tilkanont T, Ayertey F, Nakagawa M, Tung NH, Bolah P, Blagogee H Jnr, Appiah AA, Ocloo A, Ohashi M, Tanoue K, Yamaguchi Y, Ohta N, Yamaoka S, Iwanaga S, Uto T, Shoyama Y

J Pharm Biomed Anal. 2019 Feb 5;164:475-480. doi: 10.1016/j.jpba.2018.10.044. Epub 2018 Oct 29.

Abstract

A new high performance liquid chromatography (HPLC) method has been established for quantitative and qualitative analysis of three tetracyclic iridoids: ML-2-3 (1), molucidin (2), and ML-F52 (3), which are responsible for anti-trypanosomal and anti-leishmanial activities of Morinda lucida Bentham leaves. Separation of 1-3 from dried 80% aqueous (aq.) ethanol extract was achieved on a reversed-phase cholester column packed with cholesteryl-bonded silica using an acetonitrile-0.1% aq. formic acid mobile phase system. Ultraviolet-visible (UV-VIS) spectroscopy was employed for detection of compounds, and their contents were determined by measuring absorbance at 254 nm. Depending on the above system, several factors potentially affecting the concentration of tetracyclic iridoids were evaluated resulting in several variation on plant organs, seasonality, variation between individual trees, and branch positions within the trees. Moreover, we developed a simple, quick, and effective method for tetracyclic iridoid isolation from M. lucida leaves that consisted of extraction by sonication into 80% aq. ethanol, basic hydrolysis, acid neutralization, liquid-liquid extraction into an organic solvent, and reverse phase open column chromatography. Employing this method, we have succeeded to obtain 1 as a colorless crystal yielding of 0.23%, which was 28 times higher than that of previous isolation method. Setting up methodology in this paper may be important for future in vitro and in vivo studies of tetracyclic iridoids and moreover for their applications in new drug design and development.

 

18. ROTAVIRUS VACCINE TAKE IN INFANTS IS ASSOCIATED WITH SECRETOR STATUS.****** year

Armah GE, Cortese MM , Dennis FE, Yu Y, Morrow AL, McNeal MM, Lewis KDC, Awuni DA, Armachie J, Parashar UD.

J Infect Dis. 2019 Feb 15;219(5):746-749. doi: 10.1093/infdis/jiy573.

 

Abstract

Rotaviruses bind to enterocytes in a genotype-specific manner via histo-blood group antigens (HBGAs), which are also detectable in saliva. We evaluated antirotavirus immunoglobulin A seroconversion ('vaccine take") among 166 Ghanaian infants after 2-3 doses of G1P[8] rotavirus vaccine during a vaccine trial, by HBGA status from saliva collected at age 4.1 years. Only secretor status was associated with seroconversion: 41% seroconversion for secretors vs 13% for nonsecretors; relative risk, 3.2 (95% confidence interval, 1.2-8.1; P = .016). Neither Lewis antigen nor salivary antigen blood type was associated with seroconversion. Likelihood of "take" for any particular rotavirus vaccine may differ across populations based on HBGAs.

Published by Oxford University Press for the Infectious Diseases Society of America 2018.

 

19. Challenges associated with the treatment of Buruli ulcer.

Aboagye SY,  Kpeli G , Tuffour J, Yeboah-Manu D.

J Leukoc Biol. 2019 Feb;105(2):233-242. doi: 10.1002/JLB.MR0318-128. Epub 2018 Aug 31.

Abstract

Buruli ulcer (BU), caused by Mycobacterium ulcerans (MU), is the third most important mycobacterial diseases after tuberculosis and leprosy in immunocompetent individuals. Although the mode of transmission remains an enigma, disease incidence has been strongly linked to disturbed environment and wetlands. The blunt of the diseases is recorded in West African countries along the Gulf of Guinea, and children 15 years and below account for about 48% of all cases globally. Prior to 2004, wide surgical excisions and debridement of infected necrotic tissues followed by skin grafting was the accepted definitive treatment of BU. However, introduction of antibiotic therapy, daily oral rifampicin (10 mg/kg) plus intramuscular injection of streptomycin (15 mg/kg), for 8 weeks by the WHO in 2004 has reduced surgery as an adjunct for correction of deformities and improved wound healing. An all-oral regimen is currently on clinical trial to replace the injectable. It is thought that a protective cloud of the cytotoxic toxin mycolactone kills infiltrating leucocytes leading to local immunosuppression and down-regulation of the systemic immune system. Our studies of lesions from BU patients treated with SR have demonstrated treatment-associated initiation of vigorous immune responses and the development of ectopic lymphoid tissue in the BU lesions. Despite these interventions, there are still challenges that bedevil the management of BU including paradoxical reactions, evolution of lesions after therapy, prolong viability of MU in BU lesions, and development of secondary bacterial infection. In this paper, we will mainly focus on the critical and pertinent challenges that undermine BU treatment toward effective control of BU.

©2018 Society for Leukocyte Biology.

DISTRIBUTION AND RISK OF MYCOLACTONE-PRODUCING MYCOBACTERIA TRANSMISSION WITHIN BURULI ULCER ENDEMIC COMMUNITIES IN CÔTE D'IVOIRE.

Dassi C^,, Mosi L, , Quaye C, Konan DO, Djaman JA, Bonfoh B.

Trop Med Infect Dis. 2017 Feb 26;2(1).

Abstract

In Buruli ulcer (BU) endemic communities, most mycolactone-producing mycobacteria (MPM), including Mycobacterium ulcerans, the causative agent, are present in water bodies used by inhabitants; yet, their mode of transmission is still unclear. This study aimed to assess the distribution of MPM strains, both from human suspected cases and aquatic environments, for identifying possible transmission modes within two BU endemic districts, Daloa and Tiassalé (Taabo), in Côte d'Ivoire. Collected samples were processed using conventional polymerase chain reaction and screened for the presence of non-tuberculous mycobacteria (NTM) and MPMs using 16S rRNA, IS2404 and enoyl reductase (ER) primers. MPM-positive samples were further discriminated using variable number tandem repeat (VNTR) typing and sequencing. 16S rRNA and IS2404 sequences confirmed that 94% of the clinical samples contained MPMs. For environmental samples, 53% were contaminated with NTMs, of which 17% contained MPMs particularly M. ulcerans, suggesting that water-related activities could predispose inhabitants to BU transmission. MPM discrimination by VNTR at four M. ulcerans Agy99 loci identified genotype C, previously reported in Côte d'Ivoire as the most dominant profile. Phylogenetic clustering on the basis of genetic diversity in the MIRU 1 locus showed two main M. ulcerans lineages in Côte d'Ivoire.

21. EVALUATION OF INTUSSUSCEPTION AFTER MONOVALENT ROTAVIRUS VACCINATION IN AFRICA

 

J.E. Tate, J.M. Mwenda, G. Armah, B. Jani, R. Omore, A. Ademe, H. Mujuru, E. Mpabalwani, B. Ngwira, M.M. Cortese, R. Mihigo, H. Glover‑Addy, M. Mbaga, F. Osawa, A. Tadesse, B. Mbuwayesango, J. Simwaka, N. Cunliffe, B.A. Lopman, G. Weldegebriel, D. Ansong, D. Msuya, B. Ogwel, T. Karengera, P. Manangazira, B. Bvulani, C. Yen, F.R. Zawaira, C.T. Narh, L. Mboma, P. Saula, F. Teshager, H. Getachew, R.M. Moeti, C. Eweronu‑Laryea, and U.D. Parashar, for the African Intussusception Surveillance Network

 

Abstract

Postlicensure evaluations have identified an association between rotavirus vaccination

and intussusception in several high- and middle-income countries. We assessed the association between monovalent human rotavirus vaccine and intussusception in lower-income sub-Saharan African countries. lower-income sub-Saharan African countries. (Funded by the GAVI Alliance through the CDC Foundation.)

 

22. P. FALCIPARUM GAMETOCYTE DEVELOPMENT IN PATIENTS WITH MALARIA GAMETOCYTE DEVELOPMENT AND CARRIAGE IN GHANAIAN INDIVIDUALS WITH UNCOMPLICATED PLASMODIUM FALCIPARUM MALARIA

Bismarck Dinko, Felix Ansah, Comfort Agyare-Kwabi, Senyo Tagboto,, Linda Eva Amoah, Britta C. Urban, Colin J. Sutherland, Gordon A. Awandare, Kim C. Williamson, Fred N. Binka and Kirk W. Deitsch

Abstract

Plasmodium falciparum gametocytes develop over 9–12 days while sequestered in deep tissues. On emergence into the bloodstream, they circulate for varied amounts of time during which certain host factors might influence their further development. We aimed to evaluate the potential association of patient clinical parameters with gametocyte development and carriage via in vivo methods. Seventy-two patients were enrolled from three hospitals in the Volta region of Ghana in 2016. Clinical parameters were documented for all patients, and gametocyte prevalence by microscopy was estimated at 12.5%. By measuring RNA transcripts representing two distinct gametocyte developmental stages using reverse transcriptase quantitative PCR (RT-qPCR), we obtained a more precise estimate of gametocyte carriage while also inferring gametocyte maturation. Fifty-three percent of the study participants harbored parasites expressing transcripts of the immature gametocyte-specific gene (PF3D7_1477700), whereas 36% harbored PF3D7_1438800 RNA-positive parasites, which is enriched in mid and mature gametocytes, suggesting the presence of more immature stages. Linear logistic regression showed that patients older than 5 years but less than 16 years were more likely to carry gametocytes expressing both PF3D7_1477700 and PF3D7_1438800 compared with younger participants, and gametocytemia was more likely in mildly anemic individuals compared with those with severe/moderate anemia. These data provide further evidence that a greater number of malaria patients harbor gametocytes than typically estimated by microscopy and suggest a possible association between age, fever, anemia, and gametocytemia.

 

 

MARCH

23. CD4+ AND CD8+ T-CELLS EXPRESSING INTERFERON GAMMA IN ACTIVE PULMONARY TUBERCULOSIS PATIENT ****** JOURNAL AND AUTHORS

 

Betty Agustina Tambunan1*, Hery Priyanto1, Jusak Nugraha1, Soedarsono2

 

Abstract

Background: Tuberculosis (TB) is a global health problem. Immune response through CD4+ and CD8+ T cells is needed to produce Interferon gamma (IFN-γ), a cytokine eliminate Mycobacterium tuberculosis. We aimed to compare the cellular immune response based on the percentage of CD4+ and CD8+ T cells expressing interferon gamma in active pulmonary tuberculosis patients before and after 2 months of tuberculosis treatment.

Methods: It is a longitudinal cohort study included 12 patients with new active pulmonary TB of the Pulmonary Hospital, Surabaya. The CD4+ and CD8+ T cells expressing interferon gamma was measured by flow cytometry method.

Results: The mean CD4+ interferon gamma percentage of new active pulmonary TB before treatment was higher than 2 months after tuberculosis treatment (4.48% vs. 1.52%) and there was a significantly decreased (p = 0.025). The mean CD8+ interferon gamma percentage of new active pulmonary TB before treatment was higher than 2 months after tuberculosis treatment (3.56% vs. 2.89%) but not significantly decreased (p = 0.186).

Conclusions: The mean CD4+ IFN-γ percentage of new active pulmonary TB before treatment was higher than 2 months after treatment, suggesting that CD4+ T cells expressing IFN-γ play a role in protection against pulmonary TB infection

 

24. Signatures of competition and strain structure within the major blood-stage antigen of Plasmodium falciparum in a local community in Ghana.

Rorick MM, Artzy-Randrup Y, Ruybal-Pesántez S, Tiedje KE, Rask TS, Oduro A, Ghansah A, Koram K, Day KP, Pascual M.

Abstract

The concept of niche partitioning has received considerable theoretical attention at the interface of ecology and evolution of infectious diseases. Strain theory postulates that pathogen populations can be structured into distinct nonoverlapping strains by frequency-dependent selection in response to intraspecific competition for host immune space. The malaria parasite Plasmodium falciparum presents an opportunity to investigate this phenomenon in nature, under conditions of high recombination rate and extensive antigenic diversity. The parasite's major blood-stage antigen, Pf EMP1, is encoded by the hyperdiverse var genes. With a dataset that includes thousands of var DBLα sequence types sampled from asymptomatic cases within an area of high endemicity in Ghana, we address how var diversity is distributed within isolates and compare this to the distribution of microsatellite allelic diversity within isolates to test whether antigenic and neutral regions of the genome are structured differently. With respect to var DBLα sequence types, we find that on average isolates exhibit significantly lower overlap than expected randomly, but that there also exists frequent pairs of isolates that are highly related. Furthermore, the linkage network of var DBLα sequence types reveals a pattern of nonrandom modularity unique to these antigenic genes, and we find that modules of highly linked DBLα types are not explainable by neutral forces related to var recombination constraints, microsatellite diversity, sampling location, host age, or multiplicity of infection. These findings of reduced overlap and modularity among the var antigenic genes are consistent with a role for immune selection as proposed by strain theory. Identifying the evolutionary and ecological dynamics that are responsible for the nonrandom structure in P. falciparum antigenic diversity is important for designing effective intervention in endemic areas.

25. ELIMINATION OF LYMPHATIC FILARIASIS: CURRENT PERSPECTIVES ON MASS DRUG ADMINISTRATION.

Gyapong JO, Owusu IO , da-Costa Vroom FB, Mensah EO, Gyapong M.

Res Rep Trop Med. 2018 Mar 6;9:25-33. doi: 10.2147/RRTM.S125204

Abstract

Following the London declaration on neglected tropical diseases (NTDs) in 2012 and inspired by the WHO 2020 roadmap to control or eliminate NTDs, the Global Programme to Eliminate Lymphatic Filariasis (GPELF) intensified preventive chemotherapy and management of morbidity as the two main strategies to enhance progress towards the elimination of lymphatic filariasis (LF). This paper focuses on current perspectives of mass drug administration (MDA) towards the elimination of LF. The goal of MDA is to reduce the density of parasites circulating in the blood of infected persons and the intensity of infection in communities to levels where transmission is no longer sustainable by the mosquito vector. Three drugs, diethylcarbamazine, albendazole, and ivermectin are currently available for LF treatment, and their effectiveness and relative safety have opened the possibility of treating the entire population at risk. Currently, almost all LF endemic countries rely on the single-dose two-drug regimen recommended by the GPELF to achieve elimination. The 4th WHO report on NTDs has indicated that considerable progress has been made towards elimination of LF in some countries while acknowledging some challenges. In this review, we conclude that the 2020 elimination goal can be achieved if issues pertaining to the drug distribution, health system and implementation challenges are addressed.

 

26. IN VITRO ANTIOXIDANT POTENTIAL AND EFFECT OF A GLUTATHIONE-ENHANCER DIETARY SUPPLEMENT ON SELECTED RAT LIVER CYTOCHROME P450 ENZYME ACTIVITY

 

Benoit B. N’guessan , Seth K. Amponsah , George J. Dugbartey, Kwabena D. Awuah, Eunice Dotse , Abigail Aning, Kennedy K. E. Kukuia, Isaac J. Asiedu-Gyekye,1 and Regina Appiah-Opong

 

Abstract

Background. There is considerable evidence that many people take dietary supplements including those of herbal origin as an alternative therapy to improve their health. One such supplement, with an amalgam of constituents, is CellGevity_. However, the effect of this dietary supplement on drug-metabolizing enzymes is poorly understood, as it has not been studied extensively. Therefore, we investigated the effect of CellGevity dietary supplement on selected rat liver microsomal cytochrome P450 (CYP) enzymes, the most common drug-metabolizing enzymes. We also determined the total antioxidant potential of this dietary

supplement in vitro. Methods. To determine the antioxidant potential of CellGevity dietary supplement, 2,2-diphenyl-2-picrylhydrazyl (DPPH), total phenolic, and flavonoid assays were used after initial preparation of a solution form of the supplement (low dose, LD; 4mg/kg and high dose, HD; 8mg/kg). Rats received oral administration of these doses of the supplement for 7 days, after which the effect of the supplement on selected liver CYP enzymes was assessed using probe substrates and spectroscopic and high-performance liquid chromatographicmethods. Rats which received daily administration of 80mg/kg of phenobarbitone and distilled water served as positive and negative controls, respectively. Results. The IC50 value of the supplement 0.34 ± 0.07mg/ml compared to 0.076 ± 0.03mg/ml of the BHT (positive control).The total phenolic content of the supplement at a concentration of 2.5mg/ml was 34.97 g gallic acid equivalent (GAE)/100 g while its total flavonoid content at a concentration of 2.5mg/ml was 6 g

quercetin equivalent (QE)/100 g.The supplement significantly inhibited rat CYP2B1/2B2 (LDT 92.4%; HDT 100%), CYP3A4 (LDT 81.2%; HDT 71.7%), and CYP2C9 (LDT 21.7%; HDT 28.5%) while it had no significant inhibitory effect on CYPs 1A1/1A2, CYP1A2,

and CYP2D6. Conclusion. CellGevity dietary supplement possesses moderate antioxidant activity in vitro and has an inhibitory effect on selected rat liver CYP enzymes, suggesting its potential interaction with drugs metabolized by CYP enzymes.

 

27. 27. INSIGHTS INTO THE MODE OF ACTION OF 1,2,6,7-TETRAOXASPIRO [7.11] NONADECANE (N-89) AGAINST ADULT SCHISTOSOMA MANSONI WORMS

 

Rieko Shimogawaraa, Hye-Sook Kimb, Akira Satob, Koichiro Ichimurac, Irene Ayi, Shiroh Emmanuel Awusah Blaya, Takashi Kumagaia, Masafumi Yamabea, Akina Hinoa, Iwanagaa, Nobuo Ohtaa

 

Abstract

Control of morbidity associated with schistosomiasis via chemotherapy largely relies on the drug praziquantel. Repeated therapy with praziquantel has created concerns about the possible selection of resistant worms and necessitated the search for novel drugs to treat schistosomiasis. Here, a murine model was infected with Schistosoma mansoni and treated with oral 1,2,6,7-tetraoxaspiro [7.11] nonadecane (N-89), which caused a significant reduction in fecundity and egg burden and reduced morbidity when administered at 5-weeks postinfection. The analysis showed that the mode of action occurred through the ingestion of activated N-89 by the worms,

and that there was no direct external effect on the S. mansoni worms. Ultrastructural analysis of the treated worms showed disruptions in the gut lumen and the presence of large volumes of material, suggestive of undigested blood meals or red blood cells. In addition, there were reduced vitelline cells in female worms and damage to sub-tegmental musculature in male worms. Eggs recovered from the treated mice showed both damage to the eggs and the production of immature eggs. Expression of mRNA responsible for gut and digestive function and egg production was also significantly affected by N-89 treatment, whereas control genes for musculature showed no significant changes. Thus, N-89 drastically affected the total digestive function and egg production of S. mansoni worms. Physiological processes requiring heme uptake such as egg production and eggshell formation were subsequently affected, suggesting that the compound could be a possible therapeutic drug candidate for schistosomiasis control.

28. T-CELL RESPONSES AGAINST MALARIA: EFFECT OF PARASITE ANTIGEN DIVERSITY AND RELEVANCE FOR VACCINE DEVELOPMENT.

 

Nlinwe ON , Kusi KA,  Adu B, Sedegah M.

 

Abstract

The on-going agenda for global malaria elimination will require the development of additional disease control and prevention measures since currently available tools are showing signs of inadequacy. Malaria vaccines are seen as one such important addition to the control arsenal since vaccines have proven to be highly effective public health tools against important human diseases. Both cell-mediated and antibody responses are generally believed to be important for malaria parasite control, although the exact targets of T and B cell responses against malaria have not been clearly defined. However, our current understanding of the immune response to malaria suggests that T cell responses against multiple antigenic targets may potentially be key for the development of a highly efficacious malaria vaccine. This review takes a comprehensive look at the available literature on T cell-mediated immunity against all human stages of the malaria parasite and the effect of antigen diversity on these responses. The implications of these interrelationships for the development of an effective vaccine for malaria are also highlighted.

 

29. EPIDEMIOLOGY OF SOIL TRANSMITTED HELMINTH INFECTIONS IN THE MIDDLE-BELT OF GHANA, AFRICA.

Adu-Gyasi D, Asante KP, Frempong MT, Gyasi DK, Iddrisu LF, Ankrah L, Dosoo D, Adeniji E, Agyei O, Gyaase S, Amenga-Etego S, Gyan B, Owusu-Agyei S

.

Parasite Epidemiol Control. 2018 Apr 30;3(3):e00071. doi: 10.1016/j.parepi.2018.e00071.

Abstract

Helminths are among the most widespread infectious agents prevalent in tropical and sub-tropical regions of the developing world defined by inadequate sanitation, poverty and unsafe water sources. This study was carried out to describe the distribution of helminth and malaria parasite infections in the middle-belt of Ghana in sub-Saharan Africa where disease burden, including anaemia is rife and helminths are perceived to be significant contributors of the burden.

30. EVALUATION OF INTUSSUSCEPTION AFTER MONOVALENT ROTAVIRUS VACCINATION IN AFRICA

 

J.E. Tate, J.M. Mwenda, G. Armah, B. Jani, R. Omore, A. Ademe, H. Mujuru, E. Mpabalwani, B. Ngwira, M.M. Cortese, R. Mihigo, H. Glover‑Addy, M. Mbaga, F. Osawa, A. Tadesse, B. Mbuwayesango, J. Simwaka, N. Cunliffe, B.A. Lopman, G. Weldegebriel, D. Ansong, D. Msuya, B. Ogwel, T. Karengera, P. Manangazira, B. Bvulani, C. Yen, F.R. Zawaira, C.T. Narh, L. Mboma, P. Saula, F. Teshager, H. Getachew, R.M. Moeti, C. Eweronu‑Laryea, and U.D. Parashar,

 

Abstract

Postlicensure evaluations have identified an association between rotavirus vaccination

and intussusception in several high- and middle-income countries. We assessed the association between monovalent human rotavirus vaccine and intussusception in lower-income sub-Saharan African countries.

 

IN VITRO ANTIOXIDANT POTENTIAL AND EFFECT OF A GLUTATHIONE-ENHANCER DIETARY SUPPLEMENT ON SELECTED RAT LIVER CYTOCHROME P450 ENZYME ACTIVITY

N'guessan BB, Amponsah SK, Dugbartey GJ¹, Awuah KD, Dotse E, Aning A, Kukuia KKE¹, Asiedu-Gyekye IJ, Appiah-Opong R.

 

Evid Based Complement Alternat Med. 2018 May 24;2018:7462839. doi: 10.1155/2018/7462839

Abstract

There is considerable evidence that many people take dietary supplements including those of herbal origin as an alternative therapy to improve their health. One such supplement, with an amalgam of constituents, is CellGevity®. However, the effect of this dietary supplement on drug-metabolizing enzymes is poorly understood, as it has not been studied extensively. Therefore, we investigated the effect of CellGevity dietary supplement on selected rat liver microsomal cytochrome P450 (CYP) enzymes, the most common drug-metabolizing enzymes. We also determined the total antioxidant potential of this dietary supplement in vitro.

 

 

 

32. DETECTION OF DENGUE VIRUS IN SAMPLES FROM SUSPECTED YELLOW FEVER CASES IN GHANA

 

Lawrence H. Ofosu-Appiah, Richard Kutame, Bright Ayensu, Joseph H. K. Bonney, Gifty Boateng, Rexford Bempong Adade, David Opare  and John Kofi Odoom*

 

Abstract

Dengue fever remains a serious public health treat throughout the world. Ghana

shares borders with countries that have reported dengue cases, yet no case has been reported in

Ghana. Dengue infections with its broad range of clinical presentations make it potentially

unrecognized by clinicians. In this study, serological tests were used to detect antigens andantibodies and molecular tests were used to detect viral RNA specific to dengue viruses in archived human serum specimens in Ghana.

EPIDEMIOLOGICAL SURVEY OF ROTAVIRUSES RESPONSIBLE FOR INFANTILE DIARRHEA BY THE IMMUNOMOLECULAR TECHNIQUE IN COTONOU (BENIN, WEST AFRICA)

 

Jijoho Mischa¨el Michel Agbla, Annick Capo-Chichi, Alid´ehou Jerrold Agbankp´e , Tam`egnon Victorien Dougnon , Anges William M. Yadouleton4 Olivia Houngb´egnon Cl´ement Glele- Kakai, George Enyimah Armah, and Honor´e Bankol´e1

 

Abstract

Rotavirus remains the main causative agent of gastroenteritis in young children, in countries that have not yet introduced the vaccine. Benin, in order to implement the WHO recommendations, projects to introduce the rotavirus vaccine in 2018 as part of its Expanded Program on Immunization. But before the introduction of this vaccine, epidemiological data on rotavirus infections and rotavirus genotypes circulating in Benin should be available. -e aim of this study is to generate epidemiological data on infantile rotavirus diarrhea in Benin. In order to determine the epidemiological characteristics and electrophoretypes of rotavirus responsible for gastroenteritis in diarrheic children aged 0 to 5 years, 186 stool samples were collected according to the WHO Rotavirus Laboratory Manual from March 2014 to February 2015 at Suru-Lere University Hospital Center. Detection of rotavirus antigen was performed by the ELISA test, followed by molecular characterization using polyacrylamide gel electrophoresis. 186

stool samples were analyzed for rotavirus, and seventy-three (39.2%) were found to be positive for rotavirus antigen by ELISA. Children aged 3 to 24 months were the most affected by rotavirus diarrhea in this study. Of the seventy-three children affected with rotavirus diarrhea, 27 (37%) had vomiting accompanied by dehydration and fever. Results based on electrophoresis showed that, among the 73 samples tested, 38 yielded typical rotavirus electrophoretic migration profiles.

 

34. HOMOZYGOUS DELETION OF BOTH GSTM1 AND GSTT1 GENES IS ASSOCIATED WITH HIGHER CD4+ T CELL COUNTS IN GHANAIAN HIV PATIENTS

Joshua Agbemefa Kuleape, Emmanuel Ayitey Tagoe, Peter Puplampu, Evelyn

Yayra Bonney, Osbourne Quaye

Abstract

Glutathione S-transferase (GST) family of enzymes are involved in a two-stage detoxification

process of a wide range of environmental toxins, carcinogens and xenobiotics. The GST enzymes play important roles in oxidative stress pathways, and polymorphisms in the

GSTM1 and GSTT1 genes mediate susceptibility and outcome in different diseases.

Human immunodeficiency virus (HIV) infection is associated with oxidative stress, but there

is limited data on the frequency of deleted GSTM1 and GSTT1 genes in HIV/AIDS patients

and their effect on progression among Ghanaians. This study sought to investigate the

association between homozygous deletion of GSTM1 and GSTT1 genes (both null deletion)

with HIV/AIDS disease progression in Ghanaian patients. HIV-infected individuals on antiretroviral therapy (ART), ART-naïve HIV patients, and HIV seronegative individuals were

recruited for the study. HIV/AIDS disease progression was assessed by measuring CD4+

cell count and viral load of the patients, and GST polymorphism was determined by amplifying

the GSTT1 and GSTM1 genes using multiplex PCR, with CYP1A1 gene as an internal

control. The mean CD4+ count of patients that were naïve to ART (298 ± 243 cells/mm3)

was significantly lower than that of patients on ART (604 ± 294 cells/mm3), and viral load

was significantly lower in the ART-experienced group (30379 ± 15073 copies/mm3) compared

to the ART-naïve group (209882 ± 75045 copies/mm3). Frequencies of GSTM1 and

GSTT1 deletions were shown to be 21.9% and 19.8%, respectively, in the HIV patients, and

patients with homozygous deletion of both GSTM1 and GSTT1 were more likely to have

their CD4+ count rising above 350 cells/mm3 (OR = 6.44, 95% CI = 0.81±51.49, p = 0.039)

suggesting that patients with homozygous deletion of GSTM1 and GSTT1 genes have

slower disease progression. The findings of this study show that double deletion of glutathione

S-transferases M1 and T1 is statistically associated with normal CD4+ count in patients

diagnosed with HIV/AIDS. Further study is required to investigate the clinical importance of

the both null deletion in HIV patients.

 

JUNE

ETIOLOGY OF PLACENTAL PLASMODIUM FALCIPARUM MALARIA IN AFRICAN WOMEN.

Ofori MF, Lamptey H, Dickson EK , Kyei-Baafour E, Hviid L.

Abstract

Plasmodium falciparum parasites causing placental malaria express the VAR2CSA type of the clonally variant antigen family erythrocyte membrane protein 1 (PfEMP1). This enables evasion of preexisting immunity and results in placental accumulation of infected erythrocytes. We present data on seasonal variation in levels of VAR2CSA-specific immunoglobulin G (IgG) and IgG specific for a placental malaria-unrelated PfEMP1 protein among Ghanaian women at their first antenatal visit. Our results indicate that placental malaria does not require recent exposure to infected mosquitoes, in contrast to malaria in general. This has implications for the impact of insecticide-treated bed nets on placental malaria incidence and for antenatal care in woman with preexisting immunity.

 

36. SEASONAL VARIATIONS IN PLASMODIUM FALCIPARUM PARASITE PREVALENCE ASSESSED BY VARYING DIAGNOSTIC TESTS IN ASYMPTOMATIC CHILDREN IN SOUTHERN GHANA Author/journal

 

Abstract

Plasmodium falciparum infections presenting either as symptomatic or asymptomatic may

contain sexual stage parasites (gametocytes) that are crucial to malaria transmission. In this

study, the prevalence of microscopic and submicroscopic asexual and gametocyte parasite

stages were assessed in asymptomatic children from two communities in southern Ghana.

Eighty children aged twelve years and below, none of whom exhibited signs of clinical

malaria living in Obom and Cape Coast were sampled twice, one during the rainy (July

2015) and subsequently during the dry (January 2016) season. Venous blood was used to

prepare thick and thin blood smears, spot a rapid malaria diagnostic test (PfHRP2 RDT) as

well as prepare filter paper blood spots. Blood cell pellets were preserved in Trizol for RNA

extraction. Polymerase chain reaction (PCR) and semi-quantitative real time reverse transcriptase

PCR (qRT-PCR) were used to determine submicroscopic parasite prevalence. In

both sites 87% (95% CI: 78±96) of the asymptomatic individuals surveyed were parasites

positive during the 6 month study period. The prevalence of asexual and gametocyte stage

parasites in the rainy season were both significantly higher in Obom than in Cape Coast

(P < 0.001). Submicroscopic gametocyte prevalence was highest in the rainy season in

Obom but in the dry season in Cape Coast. Parasite prevalence determined by PCR was

similar to that determined by qRT-PCR in Obom but significantly lower than that determined

by qRT-PCR in Cape Coast. Communities with varying parasite prevalence exhibit seasonal

variations in the prevalence of gametocyte carriers. Submicroscopic asymptomatic parasite

and gametocyte carriage is very high in southern Ghana, even during the dry season in communities

with low microscopic parasite prevalence and likely to be missed during national

surveillance exercises.

 

37. DETECTION OF NON-INFLUENZA VIRUSES IN ACUTE RESPIRATORY INFECTIONS IN CHILDREN UNDER FIVE-YEAR-OLD IN COTE D'IVOIRE (JANUARY - DECEMBER 2013).

Kadjo HA¹, Adjogoua E¹, Dia N², Adagba M¹, Abdoulaye O¹, Daniel S¹, Kouakou B¹, Ngolo DC¹, Coulibaly D³, Ndahwouh TN⁴, Dosso M¹.

Afr J Infect Dis. 2018 Jun 18;12(2):78-88.

Abstract

Influenza sentinel surveillance in Cote d'Ivoire showed that 70% of Acute Respiratory Infections (ARI) cases remained without etiology. This work aims to describe the epidemiological, clinical, and virological pattern of ARI that tested negative for influenza virus, in children under five years old.

DRUG-RESISTANCE AND POPULATION STRUCTURE OF PLASMODIUMFALCIPARUM ACROSS THE DEMOCRATIC REPUBLIC OF CONGO USING HIGH-THROUGHPUT MOLECULAR INVERSION PROBES

 

Ozkan Aydemir, Mark Janko, Nick J. Hathaway, Robert Verity, Melchior Kashamuka Mwandagalirwa, Antoinette K. Tshefu, Sofonias K. Tessema, Patrick W. Marsh, Alice Tran, Thomas Reimonn,1 Azra C. Ghani, Anita Ghansah, Jonathan J. Juliano,

Bryan R. Greenhouse, Michael Emch, Steven R. Meshnick, and Jeffrey A. Bailey,

PLoS Negl Trop Dis. 2018 Jun 5;12(6):e0006560. doi: 10.1371/journal.pntd.0006560. eCollection 2018 Jun.

LABORATORY CONFIRMATION OF BURULI ULCER CASES IN GHANA, 2008-2016.

Yeboah-Manu D, Aboagye SY, Asare P, Asante-Poku A, Ampah K, Danso E, Owusu-Mireku E, Nakobu Z, Ampadu E.

Abstract

Buruli ulcer (BU), a necrotizing skin infection caused by Mycobacterium ulcerans is the third most important mycobacterial disease globally after tuberculosis and leprosy in immune competent individuals. This study reports on the retrospective analyses of microbiologically confirmed Buruli ulcer (BU) cases in seventy-five health facilities in Ghana.

 

KINETICS OF ANTIBODY RESPONSES TO PFRH5- COMPLEX ANTIGENS IN GHANAIAN CHILDREN WITH PLASMODIUM FALCIPARUM MALARIA ******

journal

 

Frederica D. Partey, Filip C. Castberg, Edem W. Sarbah1¤, Sarah E. Silk, Gordon

1. Awandare, Simon J. Draper, Nicholas Opoku, Margaret Kweku, Michael F. Ofori,

Lars Hviid, Lea Barfod

Abstract

Plasmodium falciparum PfRH5 protein binds Ripr, CyRPA and Pf113 to form a complex that

is essential for merozoite invasion of erythrocytes. The inter-genomic conservation of the

PfRH5 complex proteins makes them attractive blood stage vaccine candidates. However,

little is known about how antibodies to PfRH5, CyRPA and Pf113 are acquired and maintained

in naturally exposed populations, and the role of PfRH5 complex proteins in naturally

acquired immunity. To provide such data, we studied 206 Ghanaian children between the

ages of 1±12 years, who were symptomatic, asymptomatic or aparasitemic and healthy.

Plasma levels of antigen-specific IgG and IgG subclasses were measured by ELISA at several

time points during acute disease and convalescence. On the day of admission with acute P. falciparum malaria, the prevalence of antibodies to PfRH5-complex proteins was low compared to other merozoite antigens (EBA175, GLURP-R0 and GLURP-R2). At convalescence,

the levels of RH5-complex-specific IgG were reduced, with the decay of PfRH5-specific IgG being slower than the decay of IgG specific for CyRPA and Pf113. No correlation between IgG levels and protection against P. falciparum malaria was observed for any of the PfRH5 complex proteins. From this we conclude that specific IgG was induced against proteins from the PfRH5-complex during acute P. falciparum malaria, but the prevalence was low and the IgG levels decayed rapidly after treatment. These data indicate that the levels of IgG specific for PfRH5-complex proteins in natural infections in Ghanaian chil

 

40. Elevated Proangiogenic Markers are Associated with Vascular Complications within Ghanaian Sickle Cell Disease Patients

 

Charles Antwi-Boasiako, Emmanuel Frimpong, Ben Gyan , Eric Kyei-Baafour,

Fredericka Sey , Bartholomew Dzudzor, Mubarak Abdul-Rahman, Gifty B. Dankwah, Kate H. Otu, Tom A. Ndanu, Andrew D. Campbell, Ivy Ekem and Eric S. Donkor

 

Abstract: Sickle cell disease (SCD) is an inherited blood disorder that can result in vasculopathy and end organ damage. Angiogenesis has been implicated as a key contributing factor to vascular mediated tissue injury in SCD. The relative plasma levels of angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), and vascular endothelial growth factor (VEGF) greatly influence angiogenesis. Dysregulation of these growth factors, leading to a pro-angiogenic state in SCD patients, has been documented in the developed world but there is very little data in Africa. There is the need, therefore, for studies in Ghanaian SCD patients. The aim of this study was to assess plasma levels of Ang-1, Ang-2, and VEGF in homozygous (HbSS) SCD patients with or without complications and healthy controls (HbAA) in Ghana. The study was a case-control study involving 544 participants: 396 HbSS SCD patients and 148 HbAA healthy controls. The study was conducted at the Center for Clinical Genetics (Sickle Cell Clinic) and Accra Area Blood Centre for National Blood transfusion at the Korle-Bu Teaching Hospital, Accra, Ghana. The plasma levels of Ang-1, Ang-2, and VEGF of study participants were measured with a double sandwich enzyme-linked immunosorbent assay (ELISA) technique.

Complete blood count (CBC) was measured with an autoanalyser. The mean plasma Ang-1, Ang-2, and VEGF were significantly higher in HbSS SCD patients with or without complications than healthy controls (p < 0.001). The Ang-2/Ang-1 ratio was significantly lower in the controls than the HbSS patients (p < 0.001). The Ang-2/Ang-1 ratio was higher in the HbSS patients with leg ulcers as compared with patients with other complications and healthy controls (p < 0.001). There were higher leucocyte counts in HbSS patients than healthy controls. Overall, there was elevated plasma levels of Ang-1, Ang-2, and VEGF in SCD patients. The higher Ang-2/Ang-1 plasma levels in patients with leg ulcers suggests a possible ongoing angiogenesis and response to inflammatory stimuli. The study provides a first report on plasma levels of angiopoietin-1, angiopoietin-2, and vascular endothelial growth factors in homozygous sickle cell disease patients in Ghana.

 

41. How Can Onchocerciasis Elimination in Africa Be Accelerated? Modeling the Impact of Increased Ivermectin Treatment Frequency and Complementary Vector Control

 

Suzanne Verver,1 Martin Walker,2,3 Young Eun Kim,1,4,a Grace Fobi,5 Afework H. Tekle,6 Honorat G. M. Zouré,6 Samuel Wanji,7 Daniel A. Boakye,8

Annette C. Kuesel,9 Sake J. de Vlas,1 Michel Boussinesq,10 Maria-Gloria Basáñez,3 and Wilma A. Stolk1

Abstract

Background. Great strides have been made toward onchocerciasis elimination by mass drug administration (MDA) of ivermectin.

Focusing on MDA-eligible areas, we investigated where the elimination goal can be achieved by 2025 by continuation of current

practice (annual MDA with ivermectin) and where intensification or additional vector control is required. We did not consider areas

hypoendemic for onchocerciasis with loiasis coendemicity where MDA is contraindicated.

Methods. We used 2 previously published mathematical models, ONCHOSIM and EPIONCHO, to simulate future trends in

microfilarial prevalence for 80 different settings (defined by precontrol endemicity and past MDA frequency and coverage) under

different future treatment scenarios (annual, biannual, or quarterly MDA with different treatment coverage through 2025, with or

without vector control strategies), assessing for each strategy whether it eventually leads to elimination.

Results. Areas with 40%–50% precontrol microfilarial prevalence and ≥10 years of annual MDA may achieve elimination with

a further 7 years of annual MDA, if not achieved already, according to both models. For most areas with 70%–80% precontrol prevalence,

ONCHOSIM predicts that either annual or biannual MDA is sufficient to achieve elimination by 2025, whereas EPIONCHO

predicts that elimination will not be achieved even with complementary vector control.

Conclusions. Whether elimination will be reached by 2025 depends on precontrol endemicity, control history, and strategies

chosen from now until 2025. Biannual or quarterly MDA will accelerate progress toward elimination but cannot guarantee it by 2025

in high-endemicity areas. Long-term concomitant MDA and vector control for high-endemicity areas might be useful.

Keywords. onchocerciasis; modeling; mass drug administration; ivermectin; elimination.

42. In Silico Screening of Isocitrate Lyase for Novel Anti-Buruli Ulcer Natural Products Originating from Africa

 

Samuel K. Kwofie 1,2,*, Bismark Dankwa 1, Emmanuel A. Odame 1, Francis E. Agamah 1 ID ,

Lady P. A. Doe 1, Joshua Teye 1, Odame Agyapong 1,3, Whelton A. Miller III 4,5, Lydia Mosi 2 and Michael D. Wilson

Abstract

: Buruli ulcer (BU) is caused by Mycobacterium ulcerans and is predominant in both tropical

and subtropical regions. The neglected debilitating disease is characterized by chronic necrotizing

skin lesions attributed to a mycolactone, which is a macrolide toxin secreted by M. ulcerans.

The preferred treatment is surgical excision of the lesions followed by a prolonged combination

antibiotic therapy using existing drugs such as rifampicin and streptomycin or clarithromycin. These

antibiotics appear not to be adequately potent and efficacious against persistent and late stage

ulcers. In addition, emerging drug resistance to treatment poses great challenges. There is a need

to identify novel natural product-derived lead compounds, which are potent and efficacious for

the treatment of Buruli ulcer. Natural products present a rich diversity of chemical compounds

with proven activity against various infectious diseases, and therefore, are considered in this study.

This study sought to computationally predict natural product-derived lead compounds with the

potential to be developed further into potent drugs with better therapeutic efficacy than the existing

anti-buruli ulcer compounds. The three-dimensional (3D) structure of Isocitrate lyase (ICL) of

Mycobacterium ulcerans was generated using homology modeling and was further scrutinized with

molecular dynamics simulations. A library consisting of 885 compounds retrieved from the AfroDb

database was virtually screened against the validated ICL model using AutoDock Vina. AfroDb is a

compendium of “drug-like” and structurally diverse 3D structures of natural products originating

from different geographical regions in Africa. The molecular docking with the ICL model was

validated by computing a Receiver Operating Characteristic (ROC) curve with a reasonably good

Area Under the Curve (AUC) value of 0.89375. Twenty hit compounds, which docked firmly within

the active site pocket of the ICL receptor, were assessed via in silico bioactivity and pharmacological

profiling. The three compounds, which emerged as potential novel leads, comprise ZINC38143792

(Euscaphic acid), ZINC95485880, and ZINC95486305 with reasonable binding energies (high affinity)

of 􀀀8.6, 􀀀8.6, and 􀀀8.8 kcal/mol, respectively. Euscaphic acid has been reported to show minimal

inhibition against a drug-sensitive strain of M. tuberculosis. The other two leads were both predicted

43. Power Difference and Risk Perception: Mapping Vulnerability within the Decision Process of Pregnant Women towards Clinical Trial Participation in an Urban Middle-Income Setting.

Den Hollander GC, Browne JL, Arhinful D, van der Graaf R, Klipstein-Grobusch K.

Abstract

To address the burden of maternal morbidity and mortality in low- and middle-income countries (LMICs), research with pregnant women in these settings is increasingly common. Pregnant women in LMIC-context may experience vulnerability related to giving consent to participate in a clinical trial. To recognize possible layers of vulnerability this study aims to identify factors that influence the decision process towards clinical trial participation of pregnant women in an urban middle-income setting. This qualitative research used participant observation, in-depth interviews, and focus group discussion with medical staff and pregnant women eligible for trial participation, at a regional hospital in Accra, Ghana. Besides lack of familiarity with modern scientific concepts, specific factors influencing the decision-making process were identified. These include a wide power difference between health provider and patient, and a different perception of risk through externalization of responsibility of risk management within a religious context as well as a context shaped by authority. Also, therapeutic misconception was observed. The combination of these factors ensued women to rely on the opinion of the medical professional, rather than being guided by their own motivation to participation. Although being a (pregnant) woman per se should not render the label of being vulnerable, this study shows there are factors that influence the decision process of pregnant woman towards trial participation in a LMIC context that can result in vulnerability. The identification of context-specific factors that can create vulnerability facilitates adaptation of the design and conduct of research in a culturally competent manner.

44. Rotavirus strain distribution in Ghana pre- and post- rotavirus vaccine

Introduction

Belinda L. Lartey a, Susan Damanka a, Francis Ekow Dennis a, Christabel C. Enweronu-Laryea b,

Emmanuel Addo-Yobo c, Daniel Ansong c, Sandra Kwarteng-Owusu c, Kwamena W. Sagoe d,

Jason M. Mwenda e, Stanley K. Diamenu f, Clement Narh g, Fred Binka g, Umesh Parashar h, Ben Lopman i,

George E. Armah a,⇑

Abstract

Background: Ghana introduced the monovalent rotavirus vaccine (Rotarix) into its national paediatric

vaccination programme in May2012. Vaccine introduction was initiated nationwide and achieved >85%

coverage within a few months. Rotavirus strain distribution pre- and post-RV vaccine introduction is

reported.

Methods: Stool samples were collected from diarrhoeic children <5 years of age hospitalized between

2009 and 2016 at sentinel sites across Ghana and analyzed for the presence of group A rotavirus by

enzyme immunoassay. Rotavirus strains were characterized by RT-PCR and sequencing.

Results: A total of 1363 rotavirus EIA-positive samples were subjected to molecular characterization.

These were made up of 823 (60.4%) and 540 (39.6%) samples from the pre- and post-vaccine periods

respectively. Rotavirus VP7 genotypes G1, G2 and G3, and VP4 genotypes P[6] and P[8] constituted more

than 65% of circulating G and P types in the pre–vaccine period. The common strains detected were G1P

[8] (20%), G3P[6] (9.2%) and G2P[6] (4.9%).

During the post-vaccine period, G12, G1 and G10 genotypes, constituted more than 65% of the VP7 genotypes

whilst P[6] and P[8] made up more than 75% of the VP4 genotypes. The predominant circulating

strains were G12P[8] (26%), G10P[6] (10%) G3P[6] (8.1%) and G1P[8] (8.0%). We also observed the emergence

of the unusual rotavirus strain G9P[4] during this period.

Conclusion: Rotavirus G1P[8], the major strain in circulation during the pre-vaccination era, was replaced

by G12P[8] as the most predominant strain after vaccine introduction. This strain replacement could be

temporary and unrelated to vaccine introduction since an increase in G12 was observed in countries yet

to introduce the rotavirus vaccine in West Africa. A continuous surveillance programme in the

post-vaccine era is necessary for the monitoring of circulating rotavirus strains and the detection of

unusual/emerging genotypes.

 

JULY

45. OMNIgene SPUTUM: A good transport and decontaminating reagent for tuberculosis testing.

Asandem DA¹, Asante-Poku A¹, Asare P², Aboagye SY², Stephen OW², Danso E², Klevor PM², Hayibor KM², Yeboah-Manu D².

Int J Mycobacteriol. 2018 Jul-Sep;7(3):222-227. doi: 10.4103/ijmy.ijmy_102_18.

Abstract

Background:

Sputum culture is limited to centralized facilities. Thus, samples require transportation from peripheral laboratories to these facilities, compromising specimen quality since it is difficult to maintain cold chain. We evaluated OMNIgene SPUTUM Reagent (OMS) for transporting sputum samples for tuberculosis (TB) testing. The study was carried out at Noguchi Memorial Institute for Medical Research using sputa from Korle Bu Teaching Hospital and La General Hospital in Ghana.

Methods:

In a laboratory-based controlled experiment (CE), sputum contaminants were determined on blood agar before treatment with OMS and N-acetyl-L-cysteine-sodium hydroxide (NALC-NaOH). TB testing included smear microscopy, culture, and Xpert MTB/RIF. Afterward, two peripheral laboratories were trained to transport sputum samples with OMS without cold chain. Positivity, negativity, and contamination rates were compared between both methods using Chi-square and Fisher's exact tests. Cohen's Kappa was also used to determine agreements.

Results:

Among 104 sputum samples analyzed in the CE, 93 (89.4%) had bacterial growth on blood agar before decontamination, while 6 (5.8%) and 5 (4.8%) contaminated after NALC-NaOH and OMS treatment, respectively. Contamination was high with NALC-NaOH (12.8%) than OMS (4.3%) on Lowenstein-Jensen media (P < 0.001), but mycobacterial positivity was comparable: NALC-NaOH of 74.5% and OMS of 78.7%. Smear positivity after NALC-NaOH treatment was 89.4% and OMS was 75.9% (P = 0.491). All except one of the samples tested positive by Xpert MTB/RIF after both treatment. Sixteen samples were evaluated in the field experiment and 81.3% yielded positive culture, and no contamination on LJ was observed.

Conclusion:

Our findings indicate that OMS works well as a transport and decontaminating reagent of samples for TB testing.

KEYWORDS:

Contaminants; OMNIgene SPUTUM; sputum decontamination; sputum transport; tuberculosis

46. Comparative genomics of Mycobacterium africanum Lineage 5 and Lineage 6 from Ghana suggests distinct ecological niches.

Otchere ID^1,2, Coscollá M^3,4, Sánchez-Busó L⁵, Asante-Poku A¹, Brites D^3,4, Loiseau C^3,4, Meehan C⁶, Osei-Wusu S¹, Forson A⁷, Laryea C⁸, Yahayah AI⁹, Baddoo A⁷, Ansa GA¹⁰, Aboagye SY¹, Asare P¹, Borrell S^3,4, Gehre F^6,11, Beckert P^12,13, Kohl TA^12,13, N'dira S¹⁴, Beisel C¹⁵, Antonio M^11,16, Niemann S^12,13, de Jong BC^6,11, Parkhill J⁵, Harris SR⁵, Gagneux S^17,18, Yeboah-Manu D¹⁹.

Sci Rep. 2018 Jul 26;8(1):11269. doi: 10.1038/s41598-018-29620-2.

Abstract

Mycobacterium africanum (Maf) causes a substantial proportion of human tuberculosis in some countries of West Africa, but little is known on this pathogen. We compared the genomes of 253 Maf clinical isolates from Ghana, including N = 175 Lineage 5 (L5) and N = 78 Lineage 6 (L6). We found that the genomic diversity of L6 was higher than in L5 despite the smaller sample size. Regulatory proteins appeared to evolve neutrally in L5 but under purifying selection in L6. Even though over 90% of the human T cell epitopes were conserved in both lineages, L6 showed a higher ratio of non-synonymous to synonymous single nucleotide variation in these epitopes overall compared to L5. Of the 10% human T cell epitopes that were variable, most carried mutations that were lineage-specific. Our findings indicate that Maf L5 and L6 differ in some of their population genomic characteristics, possibly reflecting different selection pressures linked to distinct ecological niches.

47. Characterization of T cell activation and regulation in children with asymptomatic Plasmodium falciparum infection.

Frimpong A^1,2,3, Kusi KA^4,5, Tornyigah B⁵, Ofori MF^4,5, Ndifon W^6,7.

Malar J. 2018 Jul 13;17(1):263. doi: 10.1186/s12936-018-2410-6.

Abstract

BACKGROUND:

Asymptomatic Plasmodium infections are characterized by the absence of clinical disease and the ability to restrict parasite replication. Increasing levels of regulatory T cells (Tregs) in Plasmodium falciparum infections have been associated with the risk of developing clinical disease, suggesting that individuals with asymptomatic infections may have reduced Treg frequency. However, the relationship between Tregs, cellular activation and parasite control in asymptomatic malaria remains unclear.

METHODS:

In a cross-sectional study, the levels of Tregs and other T cell activation phenotypes were compared using flow cytometry in symptomatic, asymptomatic and uninfected children before and after stimulation with infected red blood cell lysates (iRBCs). In addition, the association between these T cell phenotypes and parasitaemia were investigated.

RESULTS:

In children with asymptomatic infections, levels of Tregs and activated T cells were comparable to those in healthy controls but significantly lower than those in symptomatic children. After iRBC stimulation, levels of Tregs remained lower for asymptomatic versus symptomatic children. In contrast, levels of activated T cells were higher for asymptomatic children. Strikingly, the pre-stimulation levels of two T cell activation phenotypes (CD8+CD69+ and CD8+CD25+CD69+) and the post-stimulation levels of two regulatory phenotypes (CD4+CD25+Foxp3+ and CD8+CD25+Foxp3+) were significantly positively correlated with and explained 68% of the individual variation in parasitaemia. A machine-learning model based on levels of these four phenotypes accurately distinguished between asymptomatic and symptomatic children (sensitivity = 86%, specificity = 94%), suggesting that these phenotypes govern the observed variation in disease status.

CONCLUSION:

Compared to symptomatic P. falciparum infections, in children asymptomatic infections are characterized by lower levels of Tregs and activated T cells, which are associated with lower parasitaemia. The results indicate that T cell regulatory and activation phenotypes govern both parasitaemia and disease status in paediatric malaria in the studied sub-Saharan African population.

KEYWORDS:

Asymptomatic; Children; Immunity; Malaria; Regulatory T-cells; Symptomatic; T-cell activation; falciparum

48. Effects of lyophilization and storage temperature on Wuchereria bancrofti antigen sensitivity and stability.

Agbozo EY^1,2, Dumashie E², Boakye DA², de Souza DK³.

MC Res Notes. 2018 Jul 11;11(1):454. doi: 10.1186/s13104-018-3586-0.

Abstract

OBJECTIVE:

Antigen-based rapid diagnostic tests for Lymphatic filariasis (LF) do not come with external quality control (QC) materials, and research and disease control programmes rely on stored positive samples. This study was undertaken to evaluate the use of lyophilized Wuchereria bancrofti antigen positive plasma samples to serve as QC materials for LF diagnostic tests. 10 well characterized W. bancrofti positive samples were lyophilized and stored at 4, 28 and 40 °C. The samples were evaluated using the Alere Filariasis Test Strips before lyophilization, and after 1 and 3 months of storage. The sensitivity and stability of the lyophilized samples were evaluated.

RESULTS:

The results revealed a loss of sensitivity and stability with increasing temperature and duration of storage. The results are further discussed in terms of the use of dried blood spot (DBS) in diagnostic studies on LF, and the need for thoughtful DBS preparation and storage.

KEYWORDS:

Dried blood spots; Freeze-drying; Lyophilization; Wuchereria bancrofti antigen

49. Efficacy of two PBO long lasting insecticidal nets against natural populations of Anopheles gambiae s.l. in experimental huts, Kolokopé, Togo.

Ketoh GK¹, Ahadji-Dabla KM¹, Chabi J², Amoudji AD¹, Apetogbo GY¹, Awokou F³, Glitho IA¹.

PLoS One. 2018 Jul 11;13(7):e0192492. doi: 10.1371/journal.pone.0192492. eCollection 2018.

Abstract

LLINs containing an insecticide plus the synergist, piperonyl butoxide (PBO) have been designed for increased efficacy against pyrethroid-resistant malaria vectors. In this study, two LLINs with PBO, PermaNet® 3.0 and Olyset® Plus, and a pyrethroid-only LLIN, Yorkool®, were evaluated in experimental huts against a free-flying, wild population of Anopheles gambiae s.l. in Kolokopé, a cotton cultivated area of Togo. WHO susceptibility tube tests and subsequent molecular assays determine the An. gambiae s.l. populations to be resistant to pyrethroids and DDT with both target site kdr and metabolic resistance mechanisms involved in the resistance observed. Anopheles gambiae s.s. and An. coluzzi were present in sympatry though the kdr (L1014F) mutation was observed at a higher frequency in An. gambiae s.s. The experimental hut results showed that both PermaNet® 3.0 and Olyset® Plus nets induced similar levels of deterrence, exophily, and reduced blood feeding rate against wild An. gambiae s.l. in contrast to the pyrethroid only LLIN, Yorkool®. The proportion of wild An. gambiae s.l. killed by unwashed PermaNet® 3.0 was significantly higher than unwashed Olyset® Plus (corrected mortality 80.5% compared to 66.6%). Similar blood feeding inhibition rates were observed for unwashed PermaNet® 3.0 and Olyset® Plus; however, PermaNet® 3.0 washed 20 times demonstrated significantly higher blood feeding inhibition rate than Olyset® Plus washed 20 times (91.1% compared with 85.6% respectively). Yorkool® performed the worst for all the parameters evaluated. In an area of pyrethroid resistance of An. gambiae s.l involving kdr target site and metabolic resistance mechanisms, LLINs with PBO can provide additional protection in terms of reduction in blood feeding and increase in mosquito mortality compared to a pyrethroid-only net, and should be considered in malaria vector control strategies.

 

50. Plasmodium and intestinal parasite perturbations of the infected host's inflammatory responses: a systematic review.

Lo AC^1,2, Faye B², Gyan BA¹, Amoah LE³.

Parasit Vectors. 2018 Jul 3;11(1):387. doi: 10.1186/s13071-018-2948-8.

Abstract

Co-infection of malaria and intestinal parasites is widespread in sub-Saharan Africa and causes severe disease especially among the poorest populations. It has been shown that an intestinal parasite (helminth), mixed intestinal helminth or Plasmodium parasite infection in a human induces a wide range of cytokine responses, including anti-inflammatory, pro-inflammatory as well as regulatory cytokines. Although immunological interactions have been suggested to occur during a concurrent infection of helminths and Plasmodium parasites, different conclusions have been drawn on the influence this co-infection has on cytokine production. This review briefly discusses patterns of selected cytokine (IL-6, IL-8, IL-10, TNF-α and INF-γ) responses associated with infections caused by Plasmodium, intestinal parasites as well as a Plasmodium-helminth co-infection.

51. Urban sanitation coverage and environmental fecal contamination: Links between the household and public environments of Accra, Ghana.

Berendes DM^1,2, Kirby AE², Clennon JA^2,3, Agbemabiese C⁴, Ampofo JA⁵, Armah GE⁴, Baker KK², Liu P², Reese HE², Robb KA², Wellington N⁶, Yakubu H², Moe CL².

PLoS One. 2018 Jul 3;13(7):e0199304. doi: 10.1371/journal.pone.0199304. eCollection 2018.

Abstract

Exposure to fecal contamination in public areas, especially in dense, urban environments, may significantly contribute to enteric infection risk. This study examined associations between sanitation and fecal contamination in public environments in four low-income neighborhoods in Accra, Ghana. Soil (n = 72) and open drain (n = 90) samples were tested for E. coli, adenovirus, and norovirus. Sanitation facilities in surveyed households (n = 793) were categorized by onsite fecal sludge containment ("contained" vs. "uncontained") using previous Joint Monitoring Program infrastructure guidelines. Most sanitation facilities were shared by multiple households. Associations between spatial clustering of household sanitation coverage and fecal contamination were examined, controlling for neighborhood and population density (measured as enumeration areas in the 2010 census and spatially matched to sample locations). E. coli concentrations in drains within 50m of clusters of contained household sanitation were more than 3 log-units lower than those outside of clusters. Further, although results were not always statistically significant, E. coli concentrations in drains showed consistent trends with household sanitation coverage clusters: concentrations were lower in or near clusters of high coverage of household sanitation facilities-especially contained facilities-and vice versa. Virus detection in drains and E. coli concentrations in soil were not significantly associated with clustering of any type of household sanitation and did not exhibit consistent trends. Population density alone was not significantly associated with any of the fecal contamination outcomes by itself and was a significant, yet inconsistent, effect modifier of the association between sanitation clusters and E. coli concentrations. These findings suggest clustering of contained household sanitation, even when shared, may be associated with lower levels of fecal contamination within drains in the immediate public domain. Further research is needed to better quantify these relationships and examine impacts on health.

52. Domestic animals infected with Mycobacterium ulcerans-Implications for transmission to humans.

Djouaka R¹, Zeukeng F^1,2, Bigoga JD², Kakou-Ngazoa SE³, Akoton R^1,4, Tchigossou G^1,4, Coulibaly DN³, Tchebe SJ⁴, Aboubacar S³, Nguepdjo CN², Tossou E^1,4, Adeoti R¹, Ngo Nsonga TM⁵, Akpo Y⁶, Djegbe I¹, Tamo M¹, Mbacham WF², Ablordey A⁷.

PLoS Negl Trop Dis. 2018 Jul 2;12(7):e0006572. doi: 10.1371/journal.pntd.0006572. eCollection 2018 Jul.

Abstract

BACKGROUND:

The environmental pathogen, Mycobacterium ulcerans (MU) can infect both humans and animals and cause Buruli ulcer (BU) disease. However, its mode(s) of transmission from the colonized environment to human/animal hosts remain unclear. In Australia, MU can infect both wildlife and domestic mammals. Till date, BU-like lesions have only been reported in wildlife in Africa. This warrants a thorough assessment of possible MU in domestic animals in Africa. Here, we screened roaming domesticated animals that share the human microhabitat in two different BU endemic sites, Sedje-Denou in Benin and Akonolinga in Cameroon, for MU lesions.

METHODOLOGY/PRINCIPAL FINDINGS:

We screened roaming mammals and birds across 3 endemic villages of Sedje-Denou in Southern Benin and 6 endemic villages of Akonolinga in Cameroon. After approval from relevant authorities, specimens (wound swabs and tissue fragments) were collected from animals with open or active lesion and systematically screened to detect the presence of MU though the diagnostic DNA targets IS2404, IS2606 and KR-B. Out of 397 animals surveyed in Akonolinga, 44 (11.08%) carried skin lesions and all were negative for MU DNA. For Sedje-Denou, only 25 (6.93%) out of 361 animals surveyed carried external skin lesions of which 2 (8%) were positive for MU DNA targets. These MU infected lesions were found in two different villages on a goat (abdominal part) and on a dog (nape area of the neck). Source-tracking of MU isolates within infected animal lesions was performed using VNTR genotyping and further confirmed with sequencing. One MU VNTR genotype (Z) was successfully typed from the goat lesion. The evolutionary history inferred from sequenced data revealed a clustering of animal MU isolates within isolates from human lesions.

CONCLUSION/SIGNIFICANCE:

This study describes the first report of two MU infected lesions in domestic animals in Africa. Their DNA sequence analyses show close relationship to isolates from human cases. It suggests that MU infection should be suspected in domestic hosts and these could play a role in transmission. The findings further support the hypothesis that MU is a ubiquitous environmental pathogen found in endemic areas, and probably involved in a multiple transmission pathway.

 

 

AUGUST

53. Prevalence of Multidrug-Resistant Escherichia coli Isolated from Drinking Water Sources.

Odonkor ST¹, Addo KK².

Int J Microbiol. 2018 Aug 19;2018:7204013. doi: 10.1155/2018/7204013. eCollection 2018.

Abstract

The control of infectious diseases is badly endangered by the rise in the number of microorganisms that are resistant to antimicrobial agents. This is because infections caused by resistant microorganisms often fail to respond to conventional treatment, resulting in prolonged illness and greater risk of death. Antimicrobial-resistant bacteria are also present in various water sources. This study therefore sought to document the microbiological quality and antibiograms of bacterial isolates (E. coli strains) from six different water sources in order to determine their safety for human consumption and to provide updated antibiotic data for pragmatic treatment of patients. Bacteria isolation and identification was done using API and conventional methods. Antibiotic susceptibility testing was conducted using the Kirby-Bauer method. Results obtained indicated that all the water sources tested were of poor quality. Bacteria isolated included E. coli, Enterobacter spp., Klebsiella spp., Salmonella typhi, Streptococcus spp., Proteus vulgaris, Vibrio cholera, Shigella spp., Pseudomonas aeruginosa, and Enterococcus faecalis. The prevalence of multidrug-resistant E. coli was 49.48%. E. coli isolates showed high resistance patterns to the tested antibiotics. They were most resistant to penicillin (32.99%), cefuroxime (28.87%), erythromycin (23.71%), and tetracycline (21.45%). In contrast, they were susceptible to nitrofurantoin (93.8%), cefotaxime and amikacin (91.75%), gentamicin (90.7%), nalidixic acid (89.65%), ciprofloxacin (74.2%), chloramphenicol (69.07%), pipemidic acid (65.97%), and cefuroxime (52.58%). Sixty-three percent (63%) of the multidrug-resistant E. coli strains recorded a multiple antibiotic resistance (MAR) index value >0.2. The susceptible antibiotics, especially the nitrofurantoin, are hence recommended in the practical treatment of waterborne bacterial diseases.

54. Seasonal variations in Plasmodium falciparum genetic diversity and multiplicity of infection in asymptomatic children living in southern Ghana.

Adjah J¹, Fiadzoe B¹, Ayanful-Torgby R¹, Amoah LE².

BMC Infect Dis. 2018 Aug 29;18(1):432. doi: 10.1186/s12879-018-3350-z.

Abstract

BACKGROUND:

Genetic diversity in Plasmodium falciparum (P. falciparum) parasites is a major hurdle to the control of malaria. This study monitored changes in the genetic diversity and the multiplicity of P. falciparum parasite infection in asymptomatic children living in southern Ghana at 3 month intervals between April 2015 and January 2016.

METHODS:

Filter paper blood spots (DBS) were collected quarterly from children living in Obom, a community with perennial malaria transmission and Abura, a community with seasonal malaria transmission. Genomic DNA was extracted from the DBS and used in polymerase chain reaction (PCR)-based genotyping of the merozoite surface protein 1 (msp 1) and merozoite surface protein 2 (msp 2) genes.

RESULTS:

Out of a total of 787 samples that were collected from the two study sites, 59.2% (466/787) tested positive for P. falciparum. The msp 1 and msp 2 genes were successfully amplified from 73.8% (344/466) and 82.5% (385/466) of the P. falciparum positive samples respectively. The geometric mean MOI in Abura ranged between 1.17 (95% CI: 1.08-1.28) and 1.48 (95% CI: 1.36-1.60) and was significantly lower (p < 0.01, Dunn's multiple comparison test) than that determined in Obom, where the geometric mean MOI ranged between 1.82 (95% CI: 1.58-2.08) and 2.50 (95% CI: 2.33-2.678) over the study period. Whilst the msp 1 R033:MAD20:KI allelic family ratio was dynamic, the msp 2 3D7:FC27 allelic family ratio remained relatively stable across the changing seasons in both sites.

CONCLUSIONS:

This study shows that seasonal variations in parasite diversity in these communities can be better estimated by msp 1 rather than msp 2 due to the constantly changing relative intra allelic frequencies observed in msp 1 and the fact that the dominance of any msp 2 allele was dependent on the transmission setting but not on the season as opposed to the dominance of any msp 1 allele, which was dependent on both the season and the transmission setting.

KEYWORDS:

Allele; Asymptomatic; Genetic diversity; Malaria; Multiplicity of infection; msp 1; msp 2

Int J Infect Dis. 2018 Aug;73:30-42. doi: 10.1016/j.ijid.2018.05.014. Epub 2018 Jun 4.

55. Reduced transmission of Mycobacterium africanum compared to Mycobacterium tuberculosis in urban West Africa.

Asare P¹, Asante-Poku A², Prah DA², Borrell S³, Osei-Wusu S², Otchere ID², Forson A⁴, Adjapong G⁵, Koram KA², Gagneux S³, Yeboah-Manu D⁶.

Author information

Abstract

OBJECTIVE:

Understanding transmission dynamics is useful for tuberculosis (TB) control. A population-based molecular epidemiological study was conducted to determine TB transmission in Ghana.

METHODS:

Mycobacterium tuberculosis complex (MTBC) isolates obtained from prospectively sampled pulmonary TB patients between July 2012 and December 2015 were characterized using spoligotyping and standard 15-locus mycobacterial interspersed repetitive unit variable number tandem repeat (MIRU-VNTR) typing for transmission studies.

RESULTS:

Out of 2309 MTBC isolates, 1082 (46.9%) unique cases were identified, with 1227 (53.1%) isolates belonging to one of 276 clusters. The recent TB transmission rate was estimated to be 41.2%. Whereas TB strains of lineage 4 belonging to M. tuberculosis showed a high recent transmission rate (44.9%), reduced recent transmission rates were found for lineages of Mycobacterium africanum (lineage 5, 31.8%; lineage 6, 24.7%).

CONCLUSIONS:

The study findings indicate high recent TB transmission, suggesting the occurrence of unsuspected outbreaks in Ghana. The observed reduced transmission rate of M. africanum suggests other factor(s) (host/environmental) may be responsible for its continuous presence in West Africa.

Int J Infect Dis. 2018 Aug;73:30-42. doi: 10.1016/j.ijid.2018.05.014. Epub 2018 Jun 4.

 

56. Molecular investigations of viral meningitis among HIV-infected adults in Accra, Ghana.

Adjei EF^1,2, Adiku TK², Mawuli G¹, Bonney JHK³.

BMC Res Notes. 2018 Aug 28;11(1):615. doi: 10.1186/s13104-018-3720-z.

Abstract

OBJECTIVE:

Meningitis is one of the leading causes of death among patients living with the human immunodeficiency virus (HIV) in sub-Saharan Africa. Based on clinical presentations alone, the different types of meningitis may not be distinguished from each other, consequently accurate laboratory diagnosis is extremely essential. Viruses such as Enteroviruses (EV), Mumps virus (MuV) and Herpes Simplex Virus-1 (HSV-1) are implicated in cases of meningitis. We sought to detect and characterize viral aetiologies of meningitis among HIV-infected adults with the use of molecular tools.

RESULTS:

As a subset of a main research work, cerebrospinal fluid specimens were collected from a cross-section of HIV patients at the Fevers Unit of the Korle Bu Teaching Hospital with clinical features suggestive of meningitis but without laboratory confirmation. Laboratory investigations were performed with the use of the real time polymerase chain reaction for pan EV, MuV and HSV-1. None of the viruses investigated in this study was found to be positive for meningitis. However, lymphocytic pleocytosis, normal glucose and elevated protein levels were observed in some of the study participants.

KEYWORDS:

Cerebrospinal fluid; Human immunodeficiency virus; Meningitis; Viral aetiology

57. Inducible nitric oxide synthase 2 promoter polymorphism and malaria disease severity in children in Southern Ghana.

Dzodzomenyo M¹, Ghansah A², Ensaw N³, Dovie B⁴, Bimi L⁵, Quansah R¹, Gyan BA², Gyakobo M⁶, Amoani B⁷.

PLoS One. 2018 Aug 17;13(8):e0202218. doi: 10.1371/journal.pone.0202218. eCollection 2018.

Abstract

OBJECTIVE:

We assessed the association of mutant allele frequencies of nitric oxide synthase 2 (NOS2) gene at two SNPs (-954 and -1173) with malaria disease severity in children from a malaria endemic area in Southern Ghana.

METHOD:

Using children recruited at the hospital, assigned into clinical subgroups of uncomplicated and severe malaria and matching with their "healthy control" counterparts, we designed a case control study. Genomic DNA was extracted and genotyping using Restriction Fragment Polymorphism was done.

RESULT:

A total of 123 malaria cases (91 uncomplicated, 32 severe) and 100 controls were sampled. Their corresponding mean Hbs were 9.6, 9.3 and 11.2g/dl and geometric mean parasite densities of 32097, 193252 and 0 parasites/ml respectively. Variant allele frequencies varied from 0.09 through 0.03 to 0.12 for G-954C and 0.06 through 0.03 to 0.07 for C-1173T in the uncomplicated, severe and healthy control groups respectively. There was a strong linkage disequilibrium between the two alleles (p<0.001). For the -954 position, the odds of developing severe malaria was found to be 2.5 times lower with the carriage of a C allele compared to those without severe malaria (χ2; p< 0.05) though this isn't the case with -1173.

CONCLUSION:

The carriage of a mutant allele in the -954 NOS2 gene may have a protective effect on malaria among Southern Ghanaian children.

58. Effects of lyophilization and storage temperature on Wuchereria bancrofti antigen sensitivity and stability.

Agbozo EY^1,2, Dumashie E², Boakye DA², de Souza DK³.

MC Res Notes. 2018 Jul 11;11(1):454. doi: 10.1186/s13104-018-3586-0.

Abstract

OBJECTIVE:

Antigen-based rapid diagnostic tests for Lymphatic filariasis (LF) do not come with external quality control (QC) materials, and research and disease control programmes rely on stored positive samples. This study was undertaken to evaluate the use of lyophilized Wuchereria bancrofti antigen positive plasma samples to serve as QC materials for LF diagnostic tests. 10 well characterized W. bancrofti positive samples were lyophilized and stored at 4, 28 and 40 °C. The samples were evaluated using the Alere Filariasis Test Strips before lyophilization, and after 1 and 3 months of storage. The sensitivity and stability of the lyophilized samples were evaluated.

RESULTS:

The results revealed a loss of sensitivity and stability with increasing temperature and duration of storage. The results are further discussed in terms of the use of dried blood spot (DBS) in diagnostic studies on LF, and the need for thoughtful DBS preparation and storage.

KEYWORDS:

Dried blood spots; Freeze-drying; Lyophilization; Wuchereria bancrofti antigen

59. Cytophilic Antibodies Against Key Plasmodium falciparum Blood Stage Antigens Contribute to Protection Against Clinical Malaria in a High Transmission Region of Eastern India.

Kana IH^1,2, Garcia-Senosiain A², Singh SK^1,2, Tiendrebeogo RW^1,2, Chourasia BK^1,2, Malhotra P³, Sharma SK⁴, Das MK⁵, Singh S⁶, Adu B⁷, Theisen M^1,2.

J Infect Dis. 2018 Aug 14;218(6):956-965. doi: 10.1093/infdis/jiy258.

Abstract

Background:

The collection of clinical data from a tribal population in a malaria-endemic area of India suggests the occurrence of naturally acquired immunity (NAI) against Plasmodium falciparum malaria.

Methods:

Quantity and functionality of immunoglobulin G (IgG) antibodies against intact merozoites and recombinant proteins were assessed in a 13-month longitudinal cohort study of 121 individuals, 3-60 years of age.

Results:

Opsonic phagocytosis of merozoites activity was strongly associated (hazard ratio [HR] = 0.34; 95% confidence interval [CI] = .18-.66; P = .0013) with protection against febrile malaria. Of the different IgG subclasses, only IgG3 antibodies against intact whole merozoites was significantly associated with protection against febrile malaria (HR = 0.47; 95% CI = .26-.86; P = .01). Furthermore, a combination of IgG3 antibody responses against Pf12, MSP3.7, MSP3.3, and MSP2FC27 was strongly associated with protection against febrile malaria (HR = 0.15; 95% CI, .06-.37; P = .0001).

Conclusions:

These data suggest that NAI may, at least in part, be explained by opsonic phagocytosis of merozoites and IgG3 responses against whole merozoites, and in particular to a combination of 4 antigens is critical in this population. These results may have implications in the development of a subunit malaria vaccine. Opsonic phagocytosis of Plasmodium falciparum merozoites was associated with protection against clinical malaria in an India population. Antibody profiling identified four merozoite antigens (Pf12, MSP3.7, MSP3.3, and MSP2) as targets of protective Immunoglobuline G3 antibodies.

 

 

SEPTEMBER

60. Buruli Ulcer: a Review of the Current Knowledge

Rie R. Yotsu, Koichi Suzuki, Rachel E. Simmonds,⁵ Roger Bedimo,^6,7 Anthony Ablordey,⁸ Dorothy Yeboah-Manu,⁸ Richard Phillips,⁹ and Kingsley Asiedu¹⁰

Abstract

Purpose of the Review

Buruli ulcer (BU) is a necrotizing and disabling cutaneous disease caused by Mycobacterium ulcerans, one of the skin-related neglected tropical diseases (skin NTDs). This article aims to review the current knowledge of this disease and challenges ahead.

Recent Findings

Around 60,000 cases of BU have been reported from over 33 countries between 2002 and 2017. Encouraging findings for development of point-of-care tests for BU are being made, and its treatment is currently in the transition period from rifampicin plus streptomycin (injection) to all-oral regimen. A major recent advance in our understanding of its pathogenesis has been agreement on the mechanism of action of the major virulence toxin mycolactone in host cells, targeting the Sec61 translocon during a major step in protein biogenesis.

Summary

BU is distributed mainly in West Africa, but cases are also found in other parts of the world. We may be underestimating its true disease burden, due to the limited awareness of this disease. More awareness and more understanding of BU will surely contribute in enhancing our fight against this skin NTD.

Keywords: Buruli ulcer, Mycobacterium ulcerans, Mycolactone, Non-tuberculous mycobacterial disease, Skin neglected tropical diseases, Skin NTDs

Curr Trop Med Rep. 2018; 5(4): 247–256.

Published online 2018 Sep 28. doi: 10.1007/s40475-018-0166-2

 

61. Socio-Behavioral Risk Factors Associated with Cryptosporidiosis in HIV/AIDS Patients Visiting the HIV Referral Clinic at Cape Coast Teaching Hospital, Ghana.

Opoku YK^1,2, Boampong JN¹, Ayi I³, Kwakye-Nuako G¹, Obiri-Yeboah D⁴, Koranteng H⁵, Ghartey-Kwansah G^1,6, Asare KK^1,7,8.

Open AIDS J. 2018 Sep 12;12:106-116. doi: 10.2174/1874613601812010106. eCollection 2018.

Abstract

Objective:

To identify the socio-behavioral risk factors associated with cryptosporidiosis among HIV/AIDS patients with chronic diarrhea symptoms visiting the HIV referral clinic at Cape Coast Teaching Hospital, Ghana.

Methods:

A cross-sectional study was conducted among 50 HIV/AIDS patients with recurrent diarrhea. Questionnaires were administered to collect social and behavioral risk factors associated with Cryptosporidium and other opportunistic protozoan parasitic infections in HIV patients. Stool samples were collected for the diagnosis of enteric protozoan pathogens using modified Ziehl-Neelsen and acid-fast staining methods. CD4⁺ cells counts of study subjects were obtained from patients clinical records. The data obtained were analyzed using Pearson chi-square and multivariate-adjusted statistics tool on SPSS 16 for Windows.

Results:

Twenty-seven (54%) of the subjects were infected with enteric protozoan pathogens. The prevalences of Cryptosporidium, Cyclospora and Microsporidium infections were 46%, 32% and 16%, respectively. Cryptosporidium infection was significantly associated with drinking water (ײ=13.528, p<0.001), Cyclospora was associated with the type of drinking water (ײ=14.931, p<0.001) and toilet facilities used by the study subjects (ײ=12.463, p<0.01), whiles Microsporidium infection was associated with hand washing behavior (ײ=12.463, p<0.01). Enteric protozoans were frequently encountered among subjects with CD4+ T-cell count <200 cells/mm³. However, coinfection of Cyclospora spp & Cryptosporidium spp was not observed in CD4⁺ cell count <200 and >500 cells/mm^3. Multivariate analysis showed that the risk factor for Cryptosporidium infection among HIV/AIDS patients was the source of drinking water (pipe borne water 76.2% prevalence: sachet water 25%; OR=0.10, 95%CI: 0.03-0.39, p<0.001).

Conclusion:

We report the risk factor for exposure of Cryptosporidium infection among HIV/AIDS patients for the first time in Ghana. The contamination of drinking water by protozoan parasites should be a public health concern. These results provide the stepping block to understand the transmission dynamics of Cryptosporidium and other opportunistic pathogens in HIV/AIDS infected patients in Ghana.

KEYWORDS:

CD4+; Cape Coast; Chronic diarrhea; Cryptosporidium oocyst; Ghana; HIV referral clinic; HIV/AIDS; Risk factors; Sachet water

62. Low Microfilaremia Levels in Three Districts in Coastal Ghana with at Least 16 Years of Mass Drug Administration and Persistent Transmission of Lymphatic Filariasis.

de Souza DK¹, Otchere J², Ahorlu CS³, Adu-Amankwah S⁴, Larbi IA⁵, Dumashie E⁶, McCarthy FA⁷, King SA⁸, Otoo S⁹, Osabutey D¹⁰, Osei JHN¹¹, Sedzro KM¹², Asiedu O¹³, Dadzie SK¹⁴, Ayi I¹⁵, Marfo B¹⁶, Biritwum NK¹⁷, Boakye DA¹⁸.

Trop Med Infect Dis. 2018 Sep 26;3(4). pii: E105. doi: 10.3390/tropicalmed3040105.

 

Abstract

Ghana has been implementing mass drug administration (MDA) of ivermectin and albendazole for the elimination of lymphatic filariasis (LF) since the year 2000, as part of the Global Programme to Eliminate Lymphatic Filariasis (GPELF). It was estimated that 5⁻6 years of treatment would be sufficient to eliminate the disease. Tremendous progress has been made over the years, and treatment has stopped in many disease endemic districts. However, despite the successful implementation of MDA, there are districts with persistent transmission. In this study we assessed the epidemiology of LF in three adjoining districts that have received at least 16 years of MDA. The assessments were undertaken one year after the last MDA. 1234 adults and 182 children below the age of 10 years were assessed. The overall prevalence of circulating filarial antigen in the study participants was 8.3% (95% CI: 6.9⁻9.9), with an estimated microfilaria prevalence of 1.2%. The microfilarial intensity in positive individuals ranged from 1 to 57 microfilariae/mL of blood. Higher antigen prevalence was detected in males (13.0%; 95% CI: 10.3⁻16.2) compared to females (5.5%; 95% CI: 4.1⁻7.2). The presence of infection was also highest in individuals involved in outdoor commercial activities, with the risks of infection being four- to five-fold higher among farmers, fishermen, drivers and artisans, compared to all other occupations. Using bednets or participating in MDA did not significantly influence the risk of infection. No children below the age of 10 years were found with infection. Detection of Wb123 antibodies for current infections indicated a prevalence of 14.4% (95% CI: 8.1⁻23.0) in antigen-positive individuals above 10 years of age. No antibodies were detected in children 10 years or below. Assessment of infection within the An. gambiae vectors of LF indicated an infection rate of 0.9% (95% CI: 0.3⁻2.1) and infectivity rate of 0.5% (95% CI: 0.1⁻1.6). These results indicate low-level transmission within the districts, and suggest that it will require targeted interventions in order to eliminate the infection.

KEYWORDS:

Ghana; Wuchereria bancrofti; control; elephantiasis; lymphatic filariasis; transmission

 

63. Detecting local risk factors for residual malaria in northern Ghana using Bayesian model averaging.

Millar J¹, Psychas P², Abuaku B³, Ahorlu C³, Amratia P², Koram K³, Oppong S⁴, Valle D².

Malar J. 2018 Sep 29;17(1):343. doi: 10.1186/s12936-018-2491-2.

 

Abstract

BACKGROUND:

There is a need for comprehensive evaluations of the underlying local factors that contribute to residual malaria in sub-Saharan Africa. However, it is difficult to compare the wide array of demographic, socio-economic, and environmental variables associated with malaria transmission using standard statistical approaches while accounting for seasonal differences and nonlinear relationships. This article uses a Bayesian model averaging (BMA) approach for identifying and comparing potential risk and protective factors associated with residual malaria.

RESULTS:

The relative influence of a comprehensive set of demographic, socio-economic, environmental, and malaria intervention variables on malaria prevalence were modelled using BMA for variable selection. Data were collected in Bunkpurugu-Yunyoo, a rural district in northeast Ghana that experiences holoendemic seasonal malaria transmission, over six biannual surveys from 2010 to 2013. A total of 10,022 children between the ages 6 to 59 months were used in the analysis. Multiple models were developed to identify important risk and protective factors, accounting for seasonal patterns and nonlinear relationships. These models revealed pronounced nonlinear associations between malaria risk and distance from the nearest urban centre and health facility. Furthermore, the association between malaria risk and age and some ethnic groups was significantly different in the rainy and dry seasons. BMA outperformed other commonly used regression approaches in out-of-sample predictive ability using a season-to-season validation approach.

CONCLUSIONS:

This modelling framework offers an alternative approach to disease risk factor analysis that generates interpretable models, can reveal complex, nonlinear relationships, incorporates uncertainty in model selection, and produces accurate predictions. Certain modelling applications, such as designing targeted local interventions, require more sophisticated statistical methods which are capable of handling a wide range of relevant data while maintaining interpretability and predictive performance, and directly characterize uncertainty. To this end, BMA represents a valuable tool for constructing more informative models for understanding risk factors for malaria, as well as other vector-borne and environmentally mediated diseases.

KEYWORDS:

Bayesian model averaging; Nonlinear patterns; Risk factors; Statistical methods

64. Amplification of GTP-cyclohydrolase 1 gene in Plasmodium falciparum isolates with the quadruple mutant of dihydrofolate reductase and dihydropteroate synthase genes in Ghana.

Osei M^1,2, Ansah F¹, Matrevi SA^1,3, Asante KP², Awandare GA¹, Quashie NB^3,4, Duah NO³.

LoS One. 2018 Sep 28;13(9):e0204871. doi: 10.1371/journal.pone.0204871. eCollection 2018.

Abstract

Sulfadoxine-pyrimethamine (SP) is used as malaria chemoprophylaxis for pregnant women and children in Ghana. Plasmodium falciparum resistance to SP is linked to mutations in the dihydropteroate synthase gene (pfdhps), dihydrofolate reductase gene (pfdhfr) and amplification of GTP cyclohydrolase 1 (pfgch1) gene. The pfgch1 duplication is associated with pfdhfr L164, a crucial mutant for high level pyrimethamine resistance which is rare in Ghana. The presence of amplified pfgch1 in Ghanaian isolates could be an indicator of the evolution of the L164 mutant. This study therefore determined the pfgch1 copy number variations and SP resistance mutations in clinical isolates from Ghana. One hundred and ninety-two (192) blood samples collected from children aged ≤14 years with uncomplicated malaria in 2013-14 and 2015-16 were used. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect the pfgch1 copy number and nested PCR-Sanger sequencing used to detect mutations in pfdhps and pfdhfr genes. Twelve parasites (6.3%) harbored double copies of the pfgch1 gene out of the 192 samples. Of the 12, 75% had the pfdhfr I51-R59-N108, 92% had the pfdhps G437 mutant, 8% had the pfdhps E540 and 67% had the SP resistance haplotype IRNG. No L164 was detected in samples with amplified pfgch1. The rare T108 mutant associated with cycloguanil resistance showed predominance (60%) over N108 in the 2015-16 isolates. The observation of parasites with increased copy number of pfgch1 gene is indicative of the future evolution of the rare quadruple pfdhfr mutant, I51-R59-N108-L164, in Ghanaian parasites. Mutant pfdhps isolates also had increased gch1 copy number suggestive that it may also facilitate sulphadoxine resistance. The selection of parasites with pfgch1 gene amplification will enhance the sustenance and persistence of parasites with SP resistance in the country. Policy makers need to begin the search for a replac ement chemoprophylaxis drug for malaria vulnerable groups in Ghana.

 

65. Emergence of HIV-1 drug resistance mutations in mothers on treatment with a history of prophylaxis in Ghana.

Martin-Odoom A¹, Brown CA², Odoom JK³, Bonney EY³, Ntim NAA³, Delgado E⁴, Lartey M⁵, Sagoe KW², Adiku T², Ampofo WK³

. Virol J. 2018 Sep 17;15(1):143. doi: 10.1186/s12985-018-1051-2.

 

Abstract

BACKGROUND:

Antiretrovirals have been available in Ghana since 2003 for HIV-1 positive pregnant women for prevention of mother-to-child transmission (PMTCT). Suboptimal responses to treatment observed post-PMTCT interventions necessitated the need to investigate the profile of viral mutations generated. This study investigated HIV-1 drug resistance profiles in mothers in selected centres in Ghana on treatment with a history of prophylaxis.

METHODS:

Genotypic Drug Resistance Testing for HIV-1 was carried out. Subtyping was done by phylogenetic analysis and Stanford HIV Database programme was used for drug resistance analysis and interpretation. To compare the significance between the different groups and the emergence of drug resistance mutations, p values were used.

RESULTS:

Participants who had prophylaxis before treatment, those who had treatment without prophylaxis and those yet to initiate PMTCT showed 32% (8), 5% (3) and 15% (4) HIV-1 drug resistance associated mutations respectively. The differences were significant with p value < 0.05. Resistance Associated Mutations (RAMs) were seen in 14 participants (35%) to nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs). The most common NRTI mutation found was M184 V; K103 N and A98G were the most common NNRTI mutations seen. Thymidine Analogue Mutations (TAMs) such as M41 L, K70R and T215Y were found in all the groups; the most common of the TAMs found were M41 L and T215Y. Majority of the subtypes were CRF02_AG (82%).

CONCLUSION:

In Ghana initiation of uninterrupted treatment upon diagnosis, coupled with drug resistance testing, would produce a better treatment outcome for HIV-1 positive pregnant women.

KEYWORDS:

Antiretroviral therapy; Drug resistance profiles; Phylogenetic analysis; Treatment outcome

66. The prevalence of submicroscopic Plasmodium falciparum gametocyte carriage and multiplicity of infection in children, pregnant women and adults in a low malaria transmission area in Southern Ghana.

Lamptey H¹, Ofori MF², Kusi KA², Adu B², Owusu-Yeboa E², Kyei-Baafour E², Arku AT², Bosomprah S³, Alifrangis M^4,5, Quakyi IA⁶.

Malar J. 2018 Sep 17;17(1):331. doi: 10.1186/s12936-018-2479-y.

Abstract

BACKGROUND:

The gametocyte stage of Plasmodium falciparum is considered an important target for disrupting malaria transmission. Indications are that various demographic groups, such as children and pregnant women may differ in risk of harbouring gametocytes, which may be crucial for targeted control. In this study, the relationship between the prevalence and multiplicity of P. falciparum, asexual parasite infections and gametocytaemia was assessed in three different demographic groups in an area of southern Ghana with low malaria endemicity. Levels of antibody responses to Pfs230 were also assessed as a proxy for the presence of gametocytes.

METHODS:

The study involved multiple cross-sectional sampling of children (N = 184, aged 2-15 years), male and non-pregnant female adults (N = 154, aged 16-65 years) and pregnant women (N = 125, aged 18-45 years) from Asutsuare in the Shai Osudoku District of Greater Accra Region in Ghana. Asexual parasitaemia was detected by microscopy and PCR, and gametocytaemia was assessed by Pfs25-real time PCR. Multiclonal P. falciparum infections were estimated by msp2 genotyping and an indirect ELISA was used to measure plasma IgG antibodies to Pfs230 antigen.

RESULTS:

Overall, children and pregnant women had higher prevalence of submicroscopic gametocytes (39.5% and 29.7%, respectively) compared to adults (17.4%). Multiplicity of infection observed amongst children (3.1) and pregnant women (3.9) were found to be significantly higher (P = 0.006) compared with adults (2.7). Risk of gametocyte carriage was higher in individuals infected with P. falciparum having both Pfmsp2 3D7 and FC27 parasite types (OR = 5.92, 95% CI 1.56-22.54, P = 0.009) compared with those infected with only 3D7 or FC27 parasite types. In agreement with the parasite prevalence data, anti-Pfs230 antibody levels were lower in gametocyte positive adults (β = - 0.57, 95% CI - 0.81, - 0.34, P < 0.001) compared to children.

CONCLUSIONS:

These findings suggest that children and pregnant women are particularly important as P. falciparum submicroscopic gametocyte reservoirs and represent important focus groups for control interventions. The number of clones increased in individuals carrying gametocytes compared to those who did not carry gametocytes. The higher anti-gametocyte antibody levels in children suggests recent exposure and may be a marker of gametocyte carriage.

KEYWORDS:

Gametocyte prevalence; Ghana; Multiplicity of infection; Pfs230; Plasmodium falciparum; Seroprevalence; Submicroscopic infections

.

67. Molecular strain typing of the yaws pathogen, Treponema pallidum subspecies pertenue.

Katz SS¹, Chi KH¹, Nachamkin E¹, Danavall D¹, Taleo F², Kool JL², Addo KK³, Ampofo W³, Simpson SV³, Ye T⁴, Asiedu KB⁵, Ballard RC⁴, Chen CY¹, Pillay A¹.

PLoS One. 2018 Sep 12;13(9):e0203632. doi: 10.1371/journal.pone.0203632. eCollection 2018

Abstract

Yaws is a neglected tropical disease caused by the bacterium Treponema pallidum subspecies pertenue. The disease primarily affects children under 15 years of age living in low socioeconomic conditions in tropical areas. As a result of a renewed focus on the disease owing to a recent eradication effort initiated by the World Health Organization, we have evaluated a typing method, adapted from and based on the enhanced Centers for Disease Control and Prevention typing method for T. pallidum subsp. pallidum, for possible use in epidemiological studies. Thirty DNA samples from yaws cases in Vanuatu and Ghana, 11 DNA samples extracted from laboratory strains, and 3 published genomic sequences were fully typed by PCR/RFLP analysis of the tpr E, G, and J genes and by determining the number of 60-bp repeats within the arp gene. Subtyping was performed by sequencing a homonucleotide "G" tandem repeat immediately upstream of the rpsA gene and an 84-bp region of tp0548. A total of 22 complete strain types were identified; two strain types in clinical samples from Vanuatu (5q11/ak and 5q12/ak), nine strain types in clinical samples from Ghana (3q12/ah, 4r12/ah, 4q10/j, 4q11/ah, 4q12/ah, 4q12/v, 4q13/ah, 6q10/aj, and 9q10/ai), and twelve strain types in laboratory strains and published genomes (2q11/ae, 3r12/ad, 4q11/ad, 4q12/ad, 4q12/ag, 4q12/v, 5r12/ad, 6r12/x, 6q11/af, 10q9/r, 10q12/r, and 12r12/w). The tpr RFLP patterns and arp repeat sizes were subsequently verified by sequencing analysis of the respective PCR amplicons. This study demonstrates that the typing method for subsp. pallidum can be applied to subsp. pertenue strains and should prove useful for molecular epidemiological studies on yaws.

68. Aetiology of viral hepatitis among jaundiced patients presenting to a tertiary hospital in Ghana.

Owusu M¹, Bonney JK², Annan AA^1,3, Mawuli G², Okyere K⁴, Mutocheluh M⁴, Aryeequaye J², Adjei NK⁵, Afihene M⁶, Spangenberg K⁷, Sylverken J⁵, Owusu-Dabo E^1,8, Drosten C⁹, Adu-Sarkodie Y⁴.

PLoS One. 2018 Sep 12;13(9):e0203699. doi: 10.1371/journal.pone.0203699. eCollection 2018.

 

Abstract

BACKGROUND:

Viral hepatitis continues to play significant role in causing morbidity and mortality in sub-Saharan Africa. Apart from the few population based studies available, not many have investigated the burden of these viruses in jaundiced patients. Among the few studies, hepatitis E is the least studied among jaundiced patients. This study was aimed at describing the frequency, distribution and risk of the different hepatitis viruses among jaundiced patients reporting to the second largest teaching hospital in Ghana.

METHODS:

From November, 2015 to April, 2016, a cross-sectional study was conducted among jaundiced patients attending the Komfo Anokye Teaching Hospital. Between 3-5 ml of blood was collected from each patient and screened for viral hepatitis agents using both serologic and molecular-based assays.

RESULTS:

In the 155 patients recruited, hepatitis B was the most prevalent [54.2% (95% CI = 46.0%-62.2%)] followed by hepatitis E [32.9% (95% CI = 25.6-40.9%)]. Most cases of hepatitis E occurred as co-infections with hepatitis B (18%), with the predominant clinical feature being hepatocellular carcinoma. Risk factor variable analysis showed middle and older aged individuals were more at risk of hepatitis B exposure whereas younger age groups (<18 years) were more at risk of hepatitis E virus infection.

CONCLUSION:

Hepatitis viruses are still important in the viral aetiology of jaundice in Ghana. Hepatitis B and hepatitis E co-infections could play significant roles in causing severe disease. A more aggressive approach needs to be adopted in order to reduce the morbidity and mortality associated with hepatitis causing viruses in Ghana and other developing countries.

69. Implementing active community-based surveillance-response system for Buruli ulcer early case detection and management in Ghana.

Ahorlu CSK¹, Okyere D¹, Ampadu E².

PLoS Negl Trop Dis. 2018 Sep 12;12(9):e0006776. doi: 10.1371/journal.pntd.0006776. eCollection 2018 Sep.

Abstract

BACKGROUND:

Buruli Ulcer (BU) is one of the most neglected debilitating tropical diseases caused by Mycobacterium ulcerans, which causes considerable morbidity and disability. Building on earlier findings that community-based interventions could enhance case detection and reduce treatment dropout and defaulter rates, we established an active surveillance-response system in an endemic sub-district in the Ga West municipality of Ghana to enhance early case detection, diagnosis and treatment to reduce or eliminate severe ulcers and its related disabilities.

METHODS:

We established surveillance response system, implemented in collaboration with the sub-district disease control officers, selected clinical staff and trained community-based volunteers. The active community-based surveillance- response system was implemented for 12 months. Also, pre and post intervention surveys were conducted to document any change in perceptions on BU in the study population over the period. The baseline and endline surveys were conducted in August 2016 and August 2017 respectively.

RESULTS:

On average, each person was seen 11 times in 12 months. In all 75 skin lesions were detected during surveillance rounds, out of which 17 were suspected to be BU and 12 out of the 17 were confirmed as BU using Polymerase chain reaction (PCR). Out of the 12, five, three and four were categories I, II and III lesions respectively. Physical examination was done on 94% of the people seen during the surveillance rounds. Knowledge on BU has also increased in the communities at the end of the study.

CONCLUSION:

The findings from this study have demonstrated that it is possible to establish surveillance-response system for BU and by extension, other neglected tropical diseases to enhance control and elimination efforts through the use of community-based volunteers.

 

70. The significance of human respiratory syncytial virus (HRSV) in children from Ghana with acute lower respiratory tract infection: A molecular epidemiological analysis, 2006 and 2013-2014.

Obodai E^1,2, Odoom JK¹, Adiku T³, Goka B⁴, Wolff T², Biere B², Schweiger B², Reiche J².

PLoS One. 2018 Sep 10;13(9):e0203788. doi: 10.1371/journal.pone.0203788. eCollection 2018.

Erratum in

• Correction: The significance of human respiratory syncytial virus (HRSV) in children from Ghana with acute lower respiratory tract infection: A molecular epidemiological analysis, 2006 and 2013-2014. [PLoS One. 2019]

Abstract

BACKGROUND:

Acute lower respiratory tract infection (ALRI) is a leading cause of childhood morbidity and mortality in developing countries. Globally, human respiratory syncytial virus (HRSV) is the most common pathogen of ALRI in infants and children. However, age-stratified HRSV disease burden data are largely absent from Africa, which is a key gap in informing an evidence-based recommendation for the introduction of an HRSV vaccine by the WHO.

METHODS:

This study investigated the presence of HRSV in respiratory specimens from 552 children <5 years old with ALRI from Accra, Ghana in 2006 and 2013-2014 by real-time PCR. Of HRSV-positive samples the second hypervariable region of the viral G protein gene was sequenced and analyzed for phylogeny, characteristic amino acid substitutions, and potential glycosylation patterns. Further, HRSV infections have been characterized by age, symptoms and timely occurrence.

RESULTS:

HRSV was observed in 23% (127/552) of the children with ALRI, with the highest incidence in infants younger than one year (33%, 97/295, p = 0.013). Within the observed seasonal circulation time of HRSV from June (mid-wet season) to December (beginning of the dry season) the incidence of ALRI due to HRSV was as high as 46% (125/273). HRSV disease was significantly associated with (broncho-) pneumonia, bronchiolitis, LRTI, and difficulty in breathing. Phylogenetic characterization of HRSV strains from Ghana identified the circulation of the currently worldwide prevailing genotypes ON1 and BA9, and shows evidence of an independent molecular evolution of ON1 and BA9 strains in Ghana resulting in potentially new subgenotypes within ON1 and BA9, provisionally named ON1.5, ON1.6, and BA9-IV.

CONCLUSION:

This study addresses important knowledge gaps in the forefront of introducing the HRSV vaccine by providing information on the molecular evolution and incidence of HRSV in Accra (Ghana, Africa).

71. A Multiplex PCR/LDR Assay for Viral Agents of Diarrhea with the Capacity to Genotype Rotavirus.

Mirza AH¹, Das S¹, Pingle MR¹, Rundell MS¹, Armah G², Gyan B², Hodinka RL³, Larone DH¹, Spitzer ED⁴, Barany F¹, Golightly LM⁵.

Sci Rep. 2018 Sep 4;8(1):13215. doi: 10.1038/s41598-018-30301-3.

Abstract

Rotavirus and noroviruses are major causes of diarrhea. Variable rotavirus vaccination efficacy in Africa and Asia is multifactorial, including the diversity of circulating strains and viral co-infection. We describe a multiplexed assay that detects and genotypes viruses from stool specimens. It includes a one-step reverse transcriptase PCR reaction, a ligase detection reaction (LDR), then hybridization of fluorescent products to micro-beads. In clinical samples it detects rotavirus, caliciviruses (sapovirus and norovirus), mixed infections, and genotypes or genogroups of rotaviruses and noroviruses, respectively. The assay also has the capacity to detect hepatitis A. The assay was validated on reference isolates and 296 stool specimens from the US and Ghana. The assay was 97% sensitive and 100% specific. The genogroup was concordant in 100% of norovirus, and the genotype in 91% and 89% of rotavirus G- and P-types, respectively. Two rare rotavirus strains, G6P[6] and G6P[8], were detected in stool specimens from Ghana. The high-throughput assay is sensitive, specific, and may be of utility in the epidemiological surveillance for rare and emerging viral strains post-rotavirus vaccine implementation.

 

 

 

OCTOBER

72. Meta-narrative review of molecular methods for diagnosis and monitoring of multidrug-resistant tuberculosis treatment in adults.

Mbelele PM¹, Mohamed SY², Sauli E³, Mpolya EA³, Mfinanga SG⁴, Addo KK⁵, Heysell SK², Mpagama SG¹.

Int J Mycobacteriol. 2018 Oct-Dec;7(4):299-309. doi: 10.4103/ijmy.ijmy_135_18.

Abstract

Early and accurate diagnosis and rigorous clinical and microbiological monitoring of multidrug-resistant tuberculosis (MDR-TB) treatment can curb morbidity and mortality. While others are still under evaluation, the World Health Organization has recommended few novel molecular methods for MDR-TB diagnosis only. We present current molecular methods for diagnosis and monitoring of MDR-TB treatment in TB-endemic settings. A systematic meta-narrative review was conducted according to the RAMESES recommendations. Electronic databases were searched for relevant articles published in English language from January 2013 to June 2018. Based on predefined criteria, two independent reviewers extracted the key messages from relevant articles. Disagreement between them was resolved through discussion and the involvement of a third reviewer, if needed. Key messages were synthesized to create the meta-narratives for method's accuracy, drug-susceptibility capability, and laboratory infrastructure required. We included 33 articles out of 1213 records retrieved, of which 16 (48%) and 12 (36%) were conducted in high- and low-TB-endemic settings, respectively. Xpert^® MTB/RIF, GenoType MTBDRplus, GenoType MTBDRsl, FlouroType™ MTBDR, TB TaqMan^® array card, and DNA sequencers can accurately guide effective treatment regimens. Molecular bacterial load assay quantifies mycobactericidal impact of these regimens. Although they present inherent advantages compared to the current standard of care, they carry important limitations to implementation and/or scale-up. Therefore, considerable effort must now be directed to implementation and health systems research to maximize these forecasted benefits for individual patient's health outcomes.

KEYWORDS:

Anti-tuberculosis therapy; diagnosis; drug-resistant tuberculosis; molecular methods; monitoring

73. Impact of indoor residual spraying on malaria parasitaemia in the Bunkpurugu-Yunyoo District in northern Ghana.

Abuaku B¹, Ahorlu C², Psychas P³, Ricks P⁴, Oppong S⁵, Mensah S², Sackey W², Koram KA².

Parasit Vectors. 2018 Oct 23;11(1):555. doi: 10.1186/s13071-018-3130-z.

 

Abstract

BACKGROUND:

Since 2008 indoor residual spraying (IRS) has become one of the interventions for malaria control in Ghana. Key partners in the scale-up of IRS have been the US President's Malaria Initiative (PMI) and AngloGold Ashanti (AGA). This study was designed to assess the impact of IRS on malaria parasitaemia among children less than 5 years-old in Bunkpurugu-Yunyoo, one of PMI-sponsored districts in northern Ghana, where rates of parasitaemia significantly exceeded the national average.

METHODS:

Two pre-IRS cross-sectional surveys using microscopy were conducted in November 2010 and April 2011 to provide baseline estimates of malaria parasitaemia for the high and low transmission seasons, respectively. IRS for the entire district was conducted in May/June to coincide with the beginning of the rains. Alpha-cypermethrin was used in 2011 and 2012, and changed to pirimiphos-methyl in 2013 and 2014 following declining susceptibility of local vectors to pyrethroids. Post-IRS cross-sectional surveys were conducted between 2011 and 2014 to provide estimates for the end of high (2011-2014) and the end of low (2012-2013) transmission seasons.

RESULTS:

The end of high transmission season prevalence of asexual parasitaemia declined marginally from 52.4% (95% CI: 50.0-54.7%) to 47.7% (95% CI: 45.5-49.9%) following 2 years of IRS with alpha-cypermethrin. Prevalence declined substantially to 20.6% (95% CI: 18.4-22.9%) following one year of IRS with pirimiphos-methyl.

CONCLUSIONS:

The use of a more efficacious insecticide for IRS can reduce malaria parasitaemia among children less than 5 years-old in northern Ghana.

KEYWORDS:

Indoor residual spraying; Malaria parasitaemia; Northern Ghana

74. A genomic infection control study for Staphylococcus aureus in two Ghanaian hospitals.

Donkor ES¹, Jamrozy D², Mills RO^3,4, Dankwah T³, Amoo PK⁵, Egyir B⁶, Badoe EV⁷, Twasam J⁸, Bentley SD².

nfect Drug Resist. 2018 Oct 11;11:1757-1765. doi: 10.2147/IDR.S167639. eCollection 2018.

 

Abstract

Background:

Whole genome sequencing analysis (WGSA) provides the best resolution for typing of bacterial isolates and has the potential for identification of transmission pathways. The aim of the study was to apply WGSA to elucidate the possible transmission events involved in two suspected Staphylococcus aureus hospital outbreaks in Ghana and describe genomic features of the S. aureus isolates sampled in the outbreaks.

Methods:

The study was carried out at Korle-Bu Teaching Hospital and Lekma Hospital where the suspected outbreaks occurred in 2012 and 2015, respectively. The S. aureus isolates collected from the two hospitals were from three sources including carriage, invasive disease, and the environment. Whole genome sequencing of the S. aureus isolates was performed and the sequence reads were mapped to the S. aureus reference genome of strain USA300_FPR3757. A maximum-likelihood phylogenetic tree was reconstructed. Multilocus sequence typing together with the analysis of antimicrobial resistance and virulence genes were performed by short read mapping using the SRST2.

Results:

The S. aureus isolates belonged to diverse sequence types (STs) with ST15 and ST152 most common. All isolates carried the blaZ gene, with low prevalence of tetK and dfrG genes also observed. All isolates were mecA negative. The pvl genes were common and observed in distinct lineages that revealed diverse Sa2int phages. At Korle-Bu Teaching Hospital, the genomics data indicated several transmission events of S. aureus ST15 involving contamination of various surfaces in the pediatric emergency ward where the outbreak occurred.

Conclusion:

The pattern of dissemination of the ST15 clone in the emergency ward of Korle-Bu Teaching Hospital highlights a basic problem with disinfection of environmental surfaces at the hospital. Diverse phage population rather than a single highly transmissible phage type likely mediates the high prevalence of pvl genes among the S. aureus isolates.

KEYWORDS:

Ghana; Staphylococcus aureus; outbreak; sequencing; transmission

75. Significant induction of soluble TNFR2 compared with TNFR1 in serum samples of HIV patients with or without antiretroviral medication

Sarfo B¹, Haile Z², Deletsu S³, Mensah EA³, Bonney EY⁴.

Infect Disord Drug Targets. 2018 Oct 16. doi: 10.2174/1871526518666181016110409. [Epub ahead of print]

 

Abstract

Background Tumor necrosis factor and its receptors (sTNFR1 and sTNFR2) have been implicated in many infectious diseases. Identification of the key receptor (sTNFR1 or sTNFR2) which drives the immunopathogenesis of HIV infection is crucial in developing adjunctive therapy for HIV. Objective This study determined the expression levels of sTNFR1 and sTNFR2 in antiretroviral therapy (ART) - experienced and naïve HIV patients. Method: A total of 40 HIV patients comprising 30 with ART and 10 without ART were enrolled from the Pantang Hospital located in the Greater Accra Region of Ghana for data and blood collection. Serum concentrations of sTNFR1 and sTNFR2 was determined by ELISA. Mann-Whitney U test was used to examine differences in serum levels of sTNFR1 and sTNFR2 between patients on ART and ART naïve patients. Wilcoxon Signed-Rank Test was performed to determine the difference between sTNFR1 and sTNFR2, and Kruskal Wallis test was conducted to compare the effect of different antiretroviral drugs on levels of sTNFR1 and sTNFR2. . P< 0.05 was considered statistically significant. Results A Wilcoxon Signed-Ranks Test indicated serum levels of sTNFR2 was statistically significantly higher than sTNFR1 (Z=-5.51; p<0.001). Levels of sTNFR1 and sTNFR2 did not differ by ART status U =91.00 (Z = -1.84), p = 0.065 and U = 131.50 (Z = -0.58, p =0.560), respectively. .. There were not significant differences in levels ofsTNFR2 H(2) = 1.86, p=0.395 and sTNFR1 (H (2) = 4.37, p=0.113 across different ART combinations. Conclusion Compared to sTNFR1, the level of sTNFR2 is significantly increasedduring HIV infection irrespective of ART status. The high sTNFR2 level is not associated with antiretroviral drugs and may be another potential target for therapuetic development. This is the first study of sTNFRs in African population.

Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

KEYWORDS:

HIV; TNF receptors; adjunctive therapy; antiretroviral; immunopathogenesis

76. Dynamics of Plasmodium falciparum gametocyte carriage in pregnant women under intermittent preventive treatment with sulfadoxine-pyrimethamine in Benin.

Jafari-Guemouri S^1,2, Dhiab J^3,4, Massougbodji A⁵, Deloron P^3,4, Tuikue NN^3,6.

Malar J. 2018 Oct 11;17(1):356. doi: 10.1186/s12936-018-2498-8.

Abstract

BACKGROUND:

In sub-Saharan Africa, malaria is a major cause of morbidity and mortality, in particular in children and pregnant women. During pregnancy, Plasmodium falciparum infected red blood cells expressing VAR2CSA are selected from circulation by selective cytoadherence to chondroitin sulfate proteoglycan receptors expressed in the placenta, leading to an increased susceptibility to malaria, long-lasting infections and poor pregnancy outcome. Partly because of these long-lasting infections, women were reported to have a higher density of gametocytes in their peripheral blood, and are considered as a potential reservoir for malaria transmission. To improve pregnancy outcome in areas of high malaria transmission, The WHO recommends intermittent preventive treatment with sulfadoxine/pyrimethamine (IPTp-SP) during antenatal care visits. The effect of IPTp-SP on gametocyte carriage in infected pregnant women was studied.

METHODS:

The levels of transcription of three gametocytes stage-specific genes Pfs16 (expressed by sexually-committed ring stage parasites and fully matured gametocytes), Pfs25 (expressed by female mature gametocytes) and Pfs230 (expressed by male mature gametocytes) were assessed by real-time PCR in 50 P. falciparum infected women at early pregnancy (before implementation of IPTp-SP), and in 50 infected women at delivery. Sex ratios of male and female gametocytes were determined in these women to assess the effect of IPTp-SP on the gametocyte populations.

RESULTS:

The data show that the three transcript types specific to Pfs16, Pfs25 and Pfs230 were detected in all samples, both at inclusion and delivery. Levels of Pfs25 and Pfs230 transcripts were higher at delivery than at inclusion (p = 0.042 and p = 0.003), while the opposite was observed for Pfs16 (p = 0.048). The ratio of male/female gametocyte transcript levels was higher at delivery than at inclusion (p = 0.018). Since a mixed gender late stage gametocyte culture was used as a positive control, male and female gametocytes could not be quantified in an absolute way in the samples. However, the amplification reliability of the Pfs25 and Pfs230 markers in the samples could be checked. A relative quantity of each type of Pfs transcript was, therefore, used to calculate the sex ratio proxy.

CONCLUSION:

This study demonstrates that IPTp-SP treatment contributes to modify the parasite populations' structure during pregnancy. In line with previous studies, we suggest that the continued use of SP in pregnant women as IPTp, despite having a beneficial effect on the pregnancy outcome, could be a risk factor for increased transmission. This reinforces the need for an alternative to the SP drug for malaria prevention during pregnancy.

KEYWORDS:

Gametocytes; Intermittent preventive treatment; Malaria; Malaria transmission; Plasmodium falciparum; Pregnant women

 

77. Blood outgrowth endothelial cells (BOECs) as a novel tool for studying adhesion of Plasmodium falciparum-infected erythrocytes.

Ecklu-Mensah G^1,2, Olsen RW², Bengtsson A², Ofori MF¹, Hviid L^2,3, Jensen ATR², Adams Y².

PLoS One. 2018 Oct 9;13(10):e0204177. doi: 10.1371/journal.pone.0204177. eCollection 2018.

Abstract

The lack of suitable animal models for the study of cytoadhesion of P. falciparum-infected erythrocytes (IEs) has necessitated in vitro studies employing a range of cell lines of either human tumour origin (e.g., BeWo and C32 cells) or non-human origin (e.g., CHO cells). Of the human cells available, many were isolated from adults, or derived from a pool of donors (e.g., HBEC-5i). Here we demonstrate, for the first time, the successful isolation of blood outgrowth endothelial cells (BOECs) from frozen stabilates of peripheral blood mononuclear cells obtained from small-volume peripheral blood samples from paediatric malaria patients. BOECs are a sub-population of human endothelial cells, found within the peripheral blood. We demonstrate that these cells express receptors such as Intercellular Adhesion Molecule 1 (ICAM-1/CD54), Endothelial Protein C Receptor (EPCR/CD201), platelet/endothelial cell adhesion molecule 1 (PECAM-1/CD31), Thrombomodulin (CD141), and support adhesion of P. falciparum IEs.

 

78. Safe mass drug administration for neglected tropical diseases RSS Download PDF

Dziedzom K de Souza and Thomas P C Dorlo

Abstract

Lancet Global Health, 2018-10-01, Volume 6, Issue 10, Pages e1054-e1055, Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license

The use of mass drug administration for the control of diseases dates back to the early 1900s, with campaigns for the control of soil-transmitted helminths in the USA,

and worldwide malaria eradication attempts for more than 70 years. However, mass drug administration for neglected tropical diseases gained particular prominence in the 1990s. Diseases such as onchocerciasis, lymphatic filariasis, trachoma, schistosomiasis, and soil-transmitted helminths are amenable to mass treatment and control as a result of the availability of safe and affordable drugs. These neglected diseases also tend to overlap in their geographical distribution, typically affecting the poorest of the poor, and therefore concomitant administration of free or low-cost drugs against multiple neglected tropical diseases has been recommended to optimise the use of resources, save operational costs, and increase the impact of health interventions. Nonetheless, co-administration of multiple drugs requires for rigorous assessments of safety and drug interactions.

 

79. Rotavirus Vaccination and the Global Burden of Rotavirus Diarrhea Among Children Younger Than 5 Years.

Troeger C¹, Khalil IA¹, Rao PC¹, Cao S¹, Blacker BF¹, Ahmed T², Armah G³, Bines JE^4,5, Brewer TG⁶, Colombara DV¹, Kang G⁷, Kirkpatrick BD⁸, Kirkwood CD⁹, Mwenda JM¹⁰, Parashar UD¹¹, Petri WA Jr¹², Riddle MS¹³, Steele AD⁹, Thompson RL¹, Walson JL^14,15,16,17, Sanders JW¹⁸, Mokdad AH¹, Murray CJL¹, Hay SI^1,19, Reiner RC Jr¹.

JAMA Pediatr. 2018 Oct 1;172(10):958-965. doi: 10.1001/jamapediatrics.2018.1960.

Abstract

Importance:

Rotavirus infection is the global leading cause of diarrhea-associated morbidity and mortality among children younger than 5 years.

Objectives:

To examine the extent of rotavirus infection among children younger than 5 years by country and the number of deaths averted because of the rotavirus vaccine.

Design, Setting, and Participants:

This report builds on findings from the Global Burden of Disease Study 2016, a cross-sectional study that measured diarrheal diseases and their etiologic agents. Models were used to estimate burden in data-sparse locations.

Exposure:

Diarrhea due to rotavirus infection.

Main Outcomes and Measures:

Rotavirus-associated mortality and morbidity by country and year and averted deaths attributable to the rotavirus vaccine by country.

Results:

Rotavirus infection was responsible for an estimated 128 500 deaths (95% uncertainty interval [UI], 104 500-155 600) among children younger than 5 years throughout the world in 2016, with 104 733 deaths occurring in sub-Saharan Africa (95% UI, 83 406-128 842). Rotavirus infection was responsible for more than 258 million episodes of diarrhea among children younger than 5 years in 2016 (95% UI, 193 million to 341 million), an incidence of 0.42 cases per child-year (95% UI, 0.30-0.53). Vaccine use is estimated to have averted more than 28 000 deaths (95% UI, 14 600-46 700) among children younger than 5 years, and expanded use of the rotavirus vaccine, particularly in sub-Saharan Africa, could have prevented approximately 20% of all deaths attributable to diarrhea among children younger than 5 years.

Conclusions and Relevance:

Rotavirus-associated mortality has decreased markedly over time in part because of the introduction of the rotavirus vaccine. This study suggests that prioritizing vaccine introduction and interventions to reduce diarrhea-associated morbidity and mortality is necessary in the continued global reduction of rotavirus infection

80. Gastrointestinal helminths in farmers and their ruminant livestock from the Coastal Savannah zone of Ghana.

Squire SA^1,2, Yang R³, Robertson I^3,4, Ayi I⁵, Squire DS^3,6, Ryan U³.

Parasitol Res. 2018 Oct;117(10):3183-3194. doi: 10.1007/s00436-018-6017-1. Epub 2018 Jul 21.

Abstract

To identify the gastrointestinal helminths of veterinary, zoonotic and public health importance in farmers and their ruminant livestock in Ghana, faecal samples were collected from 95 farmers and their livestock (cattle = 328, sheep = 285 and goats = 217) and examined by microscopy and/or molecular techniques. Overall, 21 farmers tested positive for at least one gastrointestinal helminth, 80.9% of which were single infections and 19.0% co-infections. The parasites identified in the farmers consisted of hookworms (n = 13) (9 were Necator americanus and the other 4 could not be amplified by PCR), Trichostrongylus spp. (n = 9), Schistosoma mansoni (n = 1), Schistosoma haematobium (n = 1) and Diphyllobothrium latum (n = 1). In livestock, strongylid nematodes were dominant (56.6%), followed by Paramphistomum spp. (16.9%), Dicrocoelium spp. (7.1%), Thysaniezia spp. (5.8%), Trichuris spp. (3.3%), Moniezia spp. (3.1%), Fasciola spp. (2.8%), Toxocara spp. (1.1%) and Schistosoma spp. (0.2%). Genotyping of Trichostrongylus spp. in the farmer's stools identified six T. colubriformis similar to T. colubriformis detected in cattle, sheep and goats in the study, two Trichostrongylus spp. with 98.3% and 99.2% genetic similarity to T. probolurus respectively and one Trichostrongylus spp. which showed 96.6% similarity to both T. probolurus and T. rugatus. Trichostrongylus axei was also identified in cattle, sheep and goats. This is the first molecular characterisation of Trichostrongylus spp. in Ghana and the species identified in the present study suggests zoonotic transmission from cattle, sheep and goats. Further studies involving larger numbers of farmers and their household members are essential to understand the transmission dynamics and impact of these parasites on farming communities in Ghana.

KEYWORDS:

Farmers; Gastrointestinal helminths; Ghana; Molecular characterisation; Ruminant livestock

 

 

 

 

 

NOVEMBER

81. Novel Strategies for Malaria Vaccine Design.

Frimpong A^1,2,3, Kusi KA^1,2, Ofori MF^1,2, Ndifon W^3,4.

Front Immunol. 2018 Nov 29;9:2769. doi: 10.3389/fimmu.2018.02769. eCollection 2018.

 

Abstract

The quest for a licensed effective vaccine against malaria remains a global priority. Even though classical vaccine design strategies have been successful for some viral and bacterial pathogens, little success has been achieved for Plasmodium falciparum, which causes the deadliest form of malaria due to its diversity and ability to evade host immune responses. Nevertheless, recent advances in vaccinology through high throughput discovery of immune correlates of protection, lymphocyte repertoire sequencing and structural design of immunogens, provide a comprehensive approach to identifying and designing a highly efficacious vaccine for malaria. In this review, we discuss novel vaccine approaches that can be employed in malaria vaccine design.

KEYWORDS:

Plasmodium falciparum; immunoinformatics; lymphocyte repertoire sequencing; malaria; structure-based; vaccine

82. Characterization of anti-EBA175RIII-V in asymptomatic adults and children living in communities in the Greater Accra Region of Ghana with varying malaria transmission intensities
83. E. Amoah, ¹ H. B. Abagna,¹ K. Akyea-Mensah,¹ A. C. Lo,^1,2 K. A. Kusi,¹ and B. A. Gyan¹

BMC Immunol. 2018; 19: 34.

Published online 2018 Nov 19. doi: 10.1186/s12865-018-0271-y

Associated Data

Supplementary Materials

Data Availability Statement

 

Abstract

Background

Antibodies against Region III-V of the erythrocyte binding antigen (EBA) 175 (EBA175RIII-V) have been suggested to provide protection from malaria in a natural infection. However, the quality and quantity of naturally induced antibodies to EBA175RIII-V has not been fully characterized in different cohorts of Ghanaians. This study sought to determine the characteristics of antibodies against EBA175RIII-V in asymptomatic adults and children living in two communities of varying P. falciparum parasite prevalence in southern Ghana.

Methods

Microscopic evaluation of thick and thin blood smears was used to identify asymptomatic Plasmodium falciparum carriage and indirect enzyme linked immunosorbent (ELISA) used to assess antibody concentrations and avidity.

Results

Parasite carriage estimated by microscopy in Obom was 35.6% as opposed to 3.5% in Asutsuare. Levels of IgG, IgG1, IgG2, IgG3 and IgG4 against EBA175RIII-V in the participants from Obom were significantly higher (P < 0.05, Dunn’s Multiple Comparison test) than those in Asutsuare. However the relative avidity of IgG antibodies against EBA175RIII-V was significantly higher (P < 0.0001, Mann Whitney test) in Asutsuare than in Obom.

Conclusions

People living in communities with limited exposure to P. falciparum parasites have low quantities of high avidity antibodies against EBA175RIII-V whilst people living in communities with high exposure to the parasites have high quantities of age-dependent but low avidity antibodies against EBA175RIII-V.

Electronic supplementary material

The online version of this article (10.1186/s12865-018-0271-y) contains supplementary material, which is available to authorized users.

83. Organizational capacities of national pharmacovigilance centres in Africa: assessment of resource elements associated with successful and unsuccessful pharmacovigilance experiences
84. Hilda Ampadu, ^1,2 Jarno Hoekman,³ Daniel Arhinful,⁴ Marilyn Amoama-Dapaah,¹ Hubert G. M. Leufkens,² and Alex N. O. Dodoo¹

 

Associated Global Health. 2018; 14: 109.

Published online 2018 Nov 16. doi: 10.1186/s12992-018-0431-0

 

Abstract

Background

National pharmacovigilance centres (national centres) are gradually gaining visibility as part of the healthcare delivery system in Africa. As does happen in high-income countries, it is assumed that national centres can play a central coordinating role in their national pharmacovigilance (PV) systems. However, there are no studies that have investigated whether national centres in Africa have sufficient organizational capacity to deliver on this mandate and previous studies have reported challenges such as lack of funding, political will and adequate human resources.

We conducted interviews with strategic leaders in national centres in 18 African countries, to examine how they link the capacity of their organization to the outcomes of activities coordinated by their centres. Strategic leaders were asked to describe three situations in which activities conducted by their centre were deemed successful and unsuccessful. We analyzed these experiences for common themes and examined whether strategic leaders attributed particular types of resources and relationships with stakeholders to successful or unsuccessful activities.

Results

We found that strategic leaders most often attributed successful experiences to the acquisition of political (e.g. legal mandate) or technical (e.g. active surveillance database) resources, while unsuccessful experiences were often attributed to the lack of financial and human resources. Stakeholders that were most often mentioned in association with successful experiences were national government and development partners, whereas national government and public health programmes (PHPs) were often mentioned in unsuccessful experiences. All 18 centres, regardless of maturity of their PV systems had similar challenges.

Conclusions

The study concludes that national centres in Africa are faced with 3 core challenges: (1) over-reliance on development partners, (2) seeming indifference of national governments to provide support after national centres have gained membership of the World Health Organization (WHO) Programme for International Drug Monitoring (PIDM) and (3) engaging public health programmes in a sustainable way.

Keywords: National pharmacovigilance centres, Organizational capacity, Resource elements, Stakeholders, Outcomes, National governments, Development partners, Public health Programmes

 

84. On-going transmission of human onchocerciasis in the Massangam health district in the West Region of Cameroon: Better understanding transmission dynamics to inform changes in programmatic interventions

Didier Bakajika , Laura Senyonjo , Peter Enyong, Joseph Oye, Benjamin Biholong, Elizabeth Elhassan, Daniel Boakye, Ruth Dixon, Elena Schmidt

PLoS Negl Trop Dis. 2018 Nov; 12(11): e0006904.

Published online 2018 Nov 14. doi: 10.1371/journal.pntd.0006904

Abstract

Background

Massangam health district (HD), in the West Region of Cameroon, has received ivermectin mass drug administration (MDA) for 20 years, however there is evidence of continued high transmission of Onchocerca volvulus. In order to better understand the transmission dynamics in the HD and inform intervention strategies there is a need to delineate the boundaries of the suspected area of high transmission within the wider transmission zone.

Methodology/Principal findings

Parasitological and entomological surveys were conducted to map out the breeding sites of Simulium damnosum and evaluate the prevalence of onchocerciasis in neighbouring communities, including Makouopsap sentinel community. Potential rapids were prospected for identification of S. damnosum larvae and black flies collected to determine infectivity rates. Adults were assessed for the presence of O. volvulus microfilariae through a skin snip biopsy and examined for the presence of nodules. Anti Ov-16 antibodies were tested for in children. Four perennial breeding sites were identified on the Rivers Mbam and Nja. Large number of flies were collected along the River Mbam, especially in the rainy season, with up to 955 flies per day, suggesting this river is a perennial source of black flies. A total of 0.8% of parous flies were infective across the study area. Parasitological studies provided evidence of high rates of infection in the sentinel community and three neighbouring communities, with 37.1% of adults microfilariae positive in Makouopsap. High Ov-16 seropositivity in children also provided evidence of recent on-going transmission. In comparison, communities sampled further away from the sentinel community and neighbouring breeding sites were much closer to reaching onchocerciasis elimination targets.

Conclusions/Significance

This study provides evidence of a particular geographic area of high transmission in an approximate 12 km range around the sentinel community of Makouopsap and the neighbouring breeding sites on the River Nja. To eliminate onchocerciasis by 2025, there is a need to explore alternative intervention strategies in this area of high transmission.

Author summary

The global goal is to eliminate onchocerciasis by 2025. However, not all areas are on track to do so, as is the case for Massangam health district (HD) in the West Region of Cameroon. A new strategy is required in order to accelerate efforts to reach elimination targets. This study aimed to better understand the transmission dynamics of Onchocerca volvulus in Massangam HD through the identification of black fly (Simulium damnosum) breeding sites, parasitological and entomological studies. The study was able to define an approximate 12 km area of high transmission encompassing four communities with very high levels of infection and evidence of on-going transmission in humans. This area is facilitated by perennial productive black fly breeding sites in the neighbouring rivers of the Nja and Mbam. Multi-faceted interventions are required to target the reservoir of infection facilitating transmission. We suggest the need for a new test and treat strategy in the area of high transmission (with a drug that kills the adult O. volvulus worm living in humans) and larviciding of the breeding sites of the black fly. In areas surrounding the area, increase distribution of ivermectin from annual to twice yearly distribution, whilst also using innovative strategies to improve compliance.

 

85. Splicing Factor 3B Subunit 1 Interacts with HIV Tat and Plays a Role in Viral Transcription and Reactivation from Latency

George B. Kyei, ^a,b,c Shanshan Meng,^a Rashmi Ramani,^a Austin Niu,^a Chandraiah Lagisetti,^d Thomas R. Webb,^d and Lee Ratner^a,b

mBio. 2018 Nov-Dec; 9(6): e01423-18.

Published online 2018 Nov 6. doi: 10.1128/mBio.01423-18

 

ABSTRACT

The main obstacle to an HIV cure is the transcriptionally inert proviruses that persist in resting CD4 T cells and other reservoirs. None of the current approaches has significantly reduced the size of the viral reservoir. Hence, alternative approaches, such as permanent blocking of viral transcription, to achieve a sustained remission, need urgent attention. To identify cellular factors that may be important for this approach, we sought for host targets that when altered could block HIV transcription and reactivation. Here, we identified splicing factor 3B subunit 1 (SF3B1) as a critical HIV dependency factor required for viral replication. SF3B1 is a splicing factor involved in directing chromatin and nascent gene transcripts to appropriate splice sites. Inhibitors of SF3B1 are currently in development for cancer and have been found to be nontoxic to normal cells compared to malignant cells. Knockdown of SF3B1 abrogated HIV replication in all cell types tested. SF3B1 interacted with viral protein Tat in vitro and in vivo. Genetic or pharmacologic inhibition of SF3B1 prevented Tat-mediated HIV transcription and RNA polymerase II association with the HIV promoter. In addition, an inhibitor of SF3B1 prevented HIV reactivation from latency irrespective of the latency-reversing agent used. The data show that SF3B1 is involved in viral transcription and reactivation from latency and may serve as a therapeutic target in the HIV cure efforts.

KEYWORDS: HIV cure, HIV transcription, block and lock, human immunodeficiency virus, latency, reactivation

86. Symptoms of toxicity and plasma cytochrome c levels in human immunodeficiency virus-infected patients receiving anti-retroviral therapy in Ghana: A cross-sectional study.

Mensah EA¹, Sarfo B², Bonney EY³, Parbie PK³, Ocloo A¹.

nfect Disord Drug Targets. 2018 Nov 2. doi: 10.2174/1871526518666181102112010. [Epub ahead of print]

Abstract

BACKGROUND:

Side effects and toxicity have posed a threat to the positive contribution of antiretroviral therapy (ART) in the management of human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS). Symptoms of mitochondrial toxicity including myopathy, pancreatitis, hyperlipidaemia and lactic acidosis are found among HIV-infected patients on ART. To date, there is not a reliable biomarker for monitoring ART-related mitochondrial toxicity. Plasma level of Cytochrome c (Cyt-c) has been proposed as a potential biomarker for ART-related toxicity due to its strong association with apoptosis.

OBJECTIVE:

The present study assessed toxicity and level of plasma Cyt-c among HIV-infected patients receiving ART in Ghana.

METHOD:

A total of eighty (80) HIV patients were recruited into the study. Demographic data were obtained from personal interview and medical records. Plasma samples were screened for toxicity from sixty (60) participants due to limited resources, and plasma Cyt-c levels were determined using ELISA. Data were analysed using Stata version 13.

RESULT:

Out of the 60 participants, 11 (18.3%) were found with symptoms of myopathy, 12 (20%) with pancreatitis, 21 (35%) with hyperlipidaemia and 36 (60%) with at least one of the symptoms. Concentration of plasma Cyt-c was higher (0.122 ng/ml) in patients with toxicity than in those without toxicity (0.05 ng/ml) though the difference was not statistically significant (p = 0.148). There was a weak correlation between plasma Cyt-c level and duration of ART (Spearman rho = 0.02, p = 0.89).

CONCLUSION:

This study therefore demonstrated high prevalence of ART-related toxicity and high levels of Cyt-c in HIV-infected patients in support of the argument that plasma Cyt-c levels are potential biomarkers for determining ART-related toxicity in HIV patients.

Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

KEYWORDS:

ART; Toxicity; plasma cytochrome c

87. Identification of Amino Acid Substitutions Within the VP7 Genes of G2 Rotavirus Strains in Ghana.

Damanka SA¹, Agbemabiese CA, Lartey BL, Dennis FE, Asamoah FK, Adiku TK, Enweronu-Laryea CC, Sagoe KW, Ofori MF, Armah GE.

Pediatr Infect Dis J. 2018 Nov;37(11):1172-1174. doi: 10.1097/INF.0000000000002037.

Abstract

We used the dideoxynucleotide chain termination method to determine the strains of nine non-typeable rotavirus enzyme immunoassay-positive samples, which were identified as G2. We detected nucleotide changes in the primer-binding region and amino acid substitutions within the VP7 protein of the G2 rotavirus strains. Genotyping primers need to be updated regularly.

 

88. Why we need epidemiologic studies of polycystic ovary syndrome in Africa.

Maya ET^1,2, Guure CB¹, Adanu RMK¹, Sarfo B¹, Ntumy M², Bonney EY³, Lizneva D^4,5, Walker W⁴, Azziz R^4,6,7,8.

Int J Gynaecol Obstet. 2018 Nov;143(2):251-254. doi: 10.1002/ijgo.12642. Epub 2018 Aug 27.

Abstract

The primary objective of the Ghana Polycystic Ovary Syndrome Epidemiology and Phenotype (Ghana-PEP) study will be to assess the relevance and phenotypic distribution of polycystic ovarian syndrome (PCOS) in a medically unbiased population of reproductive-aged women. In addition, the study will also attempt to identify sociodemographic, environmental, and psychological factors that may play a role in the development of PCOS phenotype. The study aims to recruit 990 randomly selected women aged 18-45 years living in Nsawam, the district capital of the Nsawam-Adoagyiri Municipality, in the Eastern region of Ghana. Participants will complete a questionnaire with the aid of trained personnel, undergo a physical examination, and undergo ultrasonography and biochemical evaluations relevant to PCOS. It is anticipated that the study will provide the population prevalence and phenotypes, and distribution of PCOS.

© 2018 International Federation of Gynecology and Obstetrics.

KEYWORDS:

Ghana; PCOS; Phenotypes; Polycystic ovarian syndrome; Prevalence

 

 

 

 

DECEMBER

89. Refocusing vector assessment towards the elimination of onchocerciasis from Africa: a review of the current status in selected countries

Daniel Boakyea, Jamie Tallantb, Aime Adjamia, Samfo Moussac, Afework Tekled, Magda Robaloc, Maria Rebolloc,

Pauline Mwinzac, Laston Sitimae, Paul Canteyd and Charles Mackenzief,*

Abstract

Introduction

Human onchocerciasis is transmitted through the bite of the

infected Simulium black fly vector. Onchocerciasis is a disfiguring

and economically detrimental disease that causes skin and eye disease.

Infection in the black fly is a direct indicator of the presence

of transmission, and the demonstration of complete breaking of

transmission requires demonstration of a lack of infective black flies

by O150 polymerase chain reaction (PCR). Fly evaluations have to

be completed in addition to human serological evaluations, in order

to satisfy WHO criteria for stopping mass drug administration and

verification of elimination of human onchocerciasis.1

Attempts to break transmission by eliminating the vector were

the first internationally supported action aimed at controlling the

blindness and debilitating skin disease caused by the parasite that

the vector transmits. Larvacidal spraying of the riverine vector

breeding sites was used in West Africa in the early 1970s, but

failed to completely eliminate the transmission of disease in these

areas, although there were major reductions in disease and focal

areas of elimination.2 The introduction of the chemotherapeutic

agent, ivermectin, donated by MSD, also known as Merck & Co., Inc.,

Kenilworth, NJ, USA, in 1987, and its use over the past 30 years has

significantly reduced clinical disease.3 This success has catalyzed the

global effort against this disease to focus on a goal of elimination.4,5

Indeed, the elimination of transmission has been demonstrated in

some African onchocerciasis foci, where assessments in humans and

the vector have shown that transmission has ceased.6,7

The elimination of onchocerciasis in Africa was not felt to be

feasible until relatively recently.8 However, after some successes

in the Americas, interest grew in Africa and work began to

determine if the disease could be eliminated in Africa as well.

The African Programme for Onchocerciasis Control (APOC) began

 

90. Small-scale field evaluation of the efficacy and residual effect of Fludora^® Fusion (mixture of clothianidin and deltamethrin) against susceptible and resistant Anopheles gambiae populations from Benin, West Africa.

Agossa FR¹, Padonou GG^2,3, Fassinou AJYH^2,4, Odjo EM², Akuoko OK⁵, Salako A^2,4, Koukpo ZC^2,4, Nwangwu UC⁶, Akinro B², Sezonlin M^2,3, Akogbeto MC^2,3.

Malar J. 2018 Dec 29;17(1):484. doi: 10.1186/s12936-018-2633-6.

Abstract

BACKGROUND:

In recognition of the threat of insecticide resistance in vectors of malaria, the WHO Global Malaria Programme recommends the development of an appropriate and comprehensive response to insecticide resistance. In principle, good resistance management practice requires the application of multiple insecticides of different modes of action, for example, in rotations and mixtures. Insecticides recommended by the World Health Organization for indoor residual spraying and long-lasting insecticide nets are limited. It is, therefore, judicious to prevent the rapid spread of insecticide resistance by evaluating new insecticides formulations with different modes of action and long residual effect.

METHODS:

Fludora^® Fusion, a new neonicotinoid IRS formulation (a mixture of 500 g/kg clothianidin and 62.5 g/kg deltamethrin applied 200 mg ai/sqm + 25 mg ai/sqm, respectively) was tested. Small scale field evaluation of this product was conducted in the district of Dangbo in Benin, to compare its efficacy and residual effect on cement and mud walls against those of clothianidin 200 mg ai/sqm (WG 70) alone, and of deltamethrin 25 mg ai/sqm (WG 250) alone. WHO wall cone bioassays were conducted monthly with laboratory susceptible Anopheles "Kisumu" and wild Anopheles gambiae sensu stricto (s.s.) population from Dangbo. The induced mortality by each treatment per wall substrate for 24 h, 48 h, and 72 h post exposure were recorded every month and analysed.

RESULTS:

Fludora^® Fusion and clothianidin WG 70 showed mortality rates over 80% WHO bio-efficacy threshold on cement walls either with susceptible or resistant An. gambiae s.s. over a period of 10 and 9 months, respectively. Treatment with Fludora^® Fusion and clothianidin WG 70 on the mud walls showed residual effect for 6 months and 5 months respectively against both susceptible and resistant mosquitoes. During the whole evaluation period, deltamethrin WG 250 showed mortality rates below 80% against resistant Anopheles population. Furthermore, the knock down rates observed with the Fludora^® Fusion combination were significantly higher (p < 5%) than those induced by Clothiandin WG 70.

CONCLUSION:

Both the Fludora^® Fusion combination and clothianidin alone showed very good and lasting efficacy for IRS against resistant Anopheles with some residual benefit provided by the combination. The residual efficacy of the Fludora^® Fusion combination evaluated at 10 months shows this product is a good candidate for IRS interventions.

KEYWORDS:

Benin; Clothianidin; Deltamethrin Anopheles gambiae; Efficacy; Fludora® Fusion

 

91. Implementing a community vector collection strategy using xenomonitoring for the endgame of lymphatic filariasis elimination.

Pi-Bansa S^1,2,3, Osei JHN^4,5, Joannides J⁴, Woode ME⁶, Agyemang D⁷, Elhassan E⁷, Dadzie SK⁴, Appawu MA⁴, Wilson MD⁴, Koudou BG^6,8, de Souza DK⁴, Utzinger J^9,10, Boakye DA⁴.

Parasit Vectors. 2018 Dec 27;11(1):672. doi: 10.1186/s13071-018-3260-3.

 

Abstract

BACKGROUND:

The global strategy for elimination of lymphatic filariasis is by annual mass drug administration (MDA). Effective implementation of this strategy in endemic areas reduces Wuchereria bancrofti in the blood of infected individuals to very low levels. This minimises the rate at which vectors successfully pick microfilariae from infected blood, hence requiring large mosquito numbers to detect infections. The aim of this study was to assess the feasibility of using trained community vector collectors (CVCs) to sample large mosquito numbers with minimal supervision at low cost for potential scale-up of this strategy.

METHODS:

CVCs and supervisors were trained in mosquito sampling methods, i.e. human landing collections, pyrethrum spray collections and window exit traps. Mosquito sampling was done over a 13-month period. Validation was conducted by a research team as quality control for mosquitoes sampled by CVCs. Data were analyzed for number of mosquitoes collected and cost incurred by the research team and CVCs during the validation phase of the study.

RESULTS:

A total of 31,064 and 8720 mosquitoes were sampled by CVCs and the research team, respectively. We found a significant difference (F_(1,13) = 27.1606, P = 0.0001) in the total number of mosquitoes collected from southern and northern communities. Validation revealed similar numbers of mosquitoes sampled by CVCs and the research team, both in the wet (F_(1,4) = 1.875, P = 0.309) and dry (F_(1,4) = 2.276, P = 0.258) seasons in the southern communities, but was significantly different for both wet (F_(1,4) = 0.022, P = 0.005) and dry (F_{(1,4 )} = 0.079, P = 0.033) seasons in the north. The cost of sampling mosquitoes per season was considerably lower by CVCs compared to the research team (15.170 vs 53.739 USD).

CONCLUSIONS:

This study revealed the feasibility of using CVCs to sample large numbers of mosquitoes with minimal supervision from a research team at considerably lower cost than a research team for lymphatic filariasis xenomonitoring. However, evaluation of the selection and motivation of CVCs, acceptability of CVCs strategy and its epidemiological relevance for lymphatic filariasis xenomonitoring programmes need to be assessed in greater detail.

KEYWORDS:

Community vector collectors; Lymphatic filariasis; Validation; Wuchereria bancrofti; Xenomonitoring

92. Paenidigyamycin A, Potent Antiparasitic Imidazole Alkaloid from the Ghanaian Paenibacillus sp. DE2SH.

Osei E¹, Kwain S², Mawuli GT³, Anang AK⁴, Owusu KB⁵, Camas M⁶, Camas AS⁷, Ohashi M⁸, Alexandru-Crivac CN⁹, Deng H¹⁰, Jaspars M¹¹, Kyeremeh K¹².

Mar Drugs. 2018 Dec 24;17(1). pii: E9. doi: 10.3390/md17010009

Author information

Abstract

A new alkaloid paenidigyamycin A (1) was obtained from the novel Ghanaian Paenibacillus sp. isolated from the mangrove rhizosphere soils of the Pterocarpus santalinoides tree growing in the wetlands of the Digya National Park, Ghana. Compound 1 was isolated on HPLC at t_R = 37.0 min and its structure determined by MS, 1D, and 2D-NMR data. When tested against L. major, 1 (IC₅₀ 0.75 µM) was just as effective as amphotericin B (IC₅₀ 0.31 µM). Against L. donovani, 1 (IC₅₀ 7.02 µM) was twenty-two times less active than amphotericin B (IC₅₀ 0.32 µM), reinforcing the unique effectiveness of 1 against L. major. For T. brucei brucei, 1 (IC₅₀ 0.78 µM) was ten times more active than the laboratory standard Coptis japonica (IC₅₀ 8.20 µM). The IC₅₀ of 9.08 µM for 1 against P. falciparum 3d7 compared to artesunate (IC₅₀ 36 nM) was not strong, but this result suggests the possibility of using the paenidigyamycin scaffold for the development of potent antimalarial drugs. Against cercariae, 1 showed high anticercaricidal activity compared to artesunate. The minimal lethal concentration (MLC) and minimal effective concentration (MEC) of the compound were 25 and 6.25 µM, respectively, while artesunate was needed in higher quantities to produce such results. However, 1 (IC₅₀ > 100 µM) was not active against T. mobilensis.

KEYWORDS:

leishmania; paenidigyamycin; plasmodium; schistosome; trichomonas; trypanosome

93. Molecular characterisation of the NDM-1-encoding plasmid p2189-NDM in an Escherichia coli ST410 clinical isolate from Ghana.

Ayibieke A¹, Sato W¹, Mahazu S², Prah I², Addow-Thompson J², Ohashi M³, Suzuki T⁴, Iwanaga S³, Ablordey A², Saito R¹.

PLoS One. 2018 Dec 21;13(12):e0209623. doi: 10.1371/journal.pone.0209623. eCollection 2018.

Abstract

Global dissemination of New Delhi metallo-β-lactamase (NDM)-producing bacteria has become a major health threat. However, there are few reports regarding the identification and characterisation of NDM-producing bacteria from West Africa, including Ghana. An Escherichia coli strain with resistance to meropenem was isolated from the Tamale Teaching Hospital in Ghana. Its identification and determination of antibiotic susceptibility profile were carried out using commercial systems. The antibiotic resistance mechanism was analysed by phenotypic detection kits, PCR, and DNA sequencing. Conjugation experiments, S1 nuclease pulsed field gel electrophoresis, and Southern blotting were performed. Finally, the NDM-1-harbouring plasmid was characterised using next-generation sequencing and phylogenetic analysis. The meropenem-resistant Escherichia coli strain EC2189 harboured blaNDM-1 and belonged to sequence type 410. blaNDM-1 was located on the IncHI type transferrable plasmid p2189-NDM (248,807 bp long), which co-carried multiple resistance genes, such as blaCTX-M-15, aadA1, aac(6')-Ib, sul3, dfrA12, and cmlA1. p2189-NDM phylogenetically differed from previously identified blaNDM-1-positive IncHI type plasmids. A truncated Tn125 containing blaNDM-1 was bracketed by an ISSm-1-like insertion sequence upstream and by a site-specific integrase downstream. To the best of our knowledge, we have, for the first time identified and molecularly characterised an NDM-1-producing Enterobacteriaceae strain in Ghana with blaNDM-1 that had a novel genetic structure. Our findings indicate a possibility of NDM-1 dissemination in Ghana and underscore the need for constant monitoring of carbapenemase-producing bacteria.

94. Serological and PCR-based markers of ocular Chlamydia trachomatis transmission in northern Ghana after elimination of trachoma as a public health problem.

Senyonjo LG^1,2, Debrah O³, Martin DL⁴, Asante-Poku A⁵, Migchelsen SJ², Gwyn S⁴, deSouza DK⁶, Solomon AW², Agyemang D⁷, Biritwum-Kwadwo N⁸, Marfo B⁸, Bakajika D⁷, Mensah EO⁹, Aboe A⁷, Koroma J⁹, Addy J³, Bailey R².

PLoS Negl Trop Dis. 2018 Dec 14;12(12):e0007027. doi: 10.1371/journal.pntd.0007027. eCollection 2018 Dec.

Abstract

BACKGROUND:

Validation of elimination of trachoma as a public health problem is based on clinical indicators, using the WHO simplified grading system. Chlamydia trachomatis (Ct) infection and anti-Ct antibody responses (anti-Pgp3) have both been evaluated as alternative indicators in settings with varying levels of trachoma. There is a need to evaluate the feasibility of using tests for Ct infection and anti-Pgp3 antibodies at scale in a trachoma-endemic country and to establish the added value of the data generated for understanding transmission dynamics in the peri-elimination setting.

METHODOLOGY/PRINCIPAL FINDINGS:

Dried blood spots for serological testing and ocular swabs for Ct infection testing (taken from children aged 1-9 years) were integrated into the pre-validation trachoma surveys conducted in the Northern and Upper West regions of Ghana in 2015 and 2016. Ct infection was detected using the GeneXpert PCR platform and the presence of anti-Pgp3 antibodies was detected using both the ELISA assay and multiplex bead array (MBA). The overall mean cluster-summarised TF prevalence (the clinical indicator) was 0.8% (95% CI: 0.6-1.0) and Ct infection prevalence was 0.04% (95%CI: 0.00-0.12). Anti-Pgp3 seroprevalence using the ELISA was 5.5% (95% CI: 4.8-6.3) compared to 4.3% (95%CI: 3.7-4.9) using the MBA. There was strong evidence from both assays that seropositivity increased with age (p<0.001), although the seroconversion rate was estimated to be very low (between 1.2 to 1.3 yearly events per 100 children).

CONCLUSIONS/SIGNIFICANCE:

Infection and serological data provide useful information to aid in understanding Ct transmission dynamics. Elimination of trachoma as a public health problem does not equate to the absence of ocular Ct infection nor cessation in acquisition of anti-Ct antibodies.

95. Malaria causes long-term effects on markers of iron status in children: a critical assessment of existing clinical and epidemiological tools.

Castberg FC^1,2, Sarbah EW³, Koram KA³, Opoku N^4,5, Ofori MF³, Styrishave B⁶, Hviid L^1,7, Kurtzhals JAL^8,9.

Malar J. 2018 Dec 11;17(1):464. doi: 10.1186/s12936-018-2609-6.

Abstract

BACKGROUND:

Most epidemiological studies on the interplay between iron deficiency and malaria risk classify individuals as iron-deficient or iron-replete based on inflammation-dependent iron markers and adjustment for inflammation by using C-reactive protein (CRP) or α-1-acid glycoprotein (AGP). The validity of this approach and the usefulness of fibroblast growth factor 23 (FGF23) as a proposed inflammation-independent iron marker were tested.

METHODS:

Conventional iron markers and FGF23 were measured in children with acute falciparum malaria and after 1, 2, 4, and 6 weeks. Children, who were transfused or received iron supplementation in the follow-up period, were excluded, and iron stores were considered to be stable throughout. Ferritin levels 6 weeks after admission were used as a reference for admission iron status and compared with iron markers at different time points.

RESULTS:

There were long-term perturbations in iron markers during convalescence from acute malaria. None of the tested iron parameters, including FGF23, were independent of inflammation. CRP and AGP normalized faster than ferritin after malaria episodes.

CONCLUSION:

Malaria may bias epidemiological studies based on inflammation-dependent iron markers. Better markers of iron status during and after inflammation are needed in order to test strategies for iron supplementation in populations at risk of malaria.

KEYWORDS:

FGF23; Ferritin; Hepcidin; Iron deficiency; Malaria