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Carvalho RGD, Pinheiro MCC, Damasceno Morais FJ, Galvão RLDF, Barbosa L, Souza Sá SLC, Scherr TF, Bezerra FSDM. Immunochromatographic POC-CCA Test for the diagnosis of intestinal schistosomiasis in a high endemic region in Brazil: Differences in the interpretation of results. Acta Trop 2024; 254:107181. [PMID: 38503365 DOI: 10.1016/j.actatropica.2024.107181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/21/2024]
Abstract
The POC-CCA test is subject to variations in reading interpretations depending on the intensity of its results, and trace test reading have implications for determining prevalence. The aim of this study was to assess whether the readings obtained from the POC-CCA tests, conducted using a semi-quantitative scale (the G-score classification for test determination), exhibited concurrence with the direct visual interpretation (positive, negative, or trace) performed by two distinct analysts, using photographs from previously performed POC-CCA test carried out in the municipality of Maruim, in the state of Sergipe-Brazil, a region of high endemicity. The devices used to read the photographs were smartphones, so as to simulate field usage, and a desktop, a tool with higher image quality that would help the researchers in the evaluation and establishment of the final result at a later. In direct visual interpretation of the POC-CCA photographs, the most discordant results occurred in the identification of the trace response (T). The Kappa index established for the direct visual interpretation between the two analysts, in which T is considered as positive, in the desktop was κ=0.826 and in the smartphone, κ=0.950. When we use the G-score as a reading standardization technique and classify the results according to the manufacturer, with trace being evaluated as positive, the highest level of agreement was obtained. Some disagreement remains between the direct visual interpretation and the G-score when performed on the desktop, with more individuals being classified as negative in the direct visual interpretation, by both analysts. However, this result was not statistically significant. The use of the G-score scale proved to be an excellent tool for standardizing the readings and classifying the results according to the semi-quantitative scale showed greater concordance of results both among analysts and among the different devices used to view the photographs.
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Affiliation(s)
- Roberta Gomes de Carvalho
- Laboratory of Parasitology and Mollusc Biology, Department of Clinical Analysis and Toxicology, Federal University of Ceará, Rua Pastor Samuel Munguba 1210, Fortaleza, Ceará 60.430-272, Brazil
| | - Marta Cristhiany Cunha Pinheiro
- Laboratory of Parasitology and Mollusc Biology, Department of Clinical Analysis and Toxicology, Federal University of Ceará, Rua Pastor Samuel Munguba 1210, Fortaleza, Ceará 60.430-272, Brazil
| | - Francisca Janaína Damasceno Morais
- Laboratory of Parasitology and Mollusc Biology, Department of Clinical Analysis and Toxicology, Federal University of Ceará, Rua Pastor Samuel Munguba 1210, Fortaleza, Ceará 60.430-272, Brazil; Pathology Postgraduate Program, Department of Pathology and Legal Medicine, School of Medicine, Universidade Federal do Ceará, Rua Monsenhor Furtado s/n, Fortaleza, Ceará, 60.441-750, Brazil
| | - Rosangela Lima de Freitas Galvão
- Laboratory of Parasitology and Mollusc Biology, Department of Clinical Analysis and Toxicology, Federal University of Ceará, Rua Pastor Samuel Munguba 1210, Fortaleza, Ceará 60.430-272, Brazil; Pathology Postgraduate Program, Department of Pathology and Legal Medicine, School of Medicine, Universidade Federal do Ceará, Rua Monsenhor Furtado s/n, Fortaleza, Ceará, 60.441-750, Brazil
| | - Luciene Barbosa
- Parasitology and Tropical Entomology Laboratory, Department of Morphology, Federal University of Sergipe, Avenida Marechal Rondon Jardim s/n, São Cristóvão, Sergipe, 49.100-000, Brazil
| | - Sidney Lourdes Cesar Souza Sá
- Epidemiological Monitoring. State's Office for Health of Sergipe. Avenida Augusto Franco 3150, Aracaju, Sergipe 49097-670, Brazil
| | - Thomas Foster Scherr
- Department of Chemistry, Vanderbilt University, 1234 Stevenson Center Lane, Nashville, Tennessee 37240, USA
| | - Fernando Schemelzer de Moraes Bezerra
- Laboratory of Parasitology and Mollusc Biology, Department of Clinical Analysis and Toxicology, Federal University of Ceará, Rua Pastor Samuel Munguba 1210, Fortaleza, Ceará 60.430-272, Brazil; Pathology Postgraduate Program, Department of Pathology and Legal Medicine, School of Medicine, Universidade Federal do Ceará, Rua Monsenhor Furtado s/n, Fortaleza, Ceará, 60.441-750, Brazil; Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Universidade Federal do Ceará, Rua Monsenhor Furtado s/n Fortaleza, Ceará, 60.441-75, Brazil.
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Oyinloye BE, Shamaki DE, Agbebi EA, Onikanni SA, Ubah CS, Aruleba RT, Dao TNP, Owolabi OV, Idowu OT, Mathenjwa-Goqo MS, Esan DT, Ajiboye BO, Omotuyi OI. In Silico Comparison of Bioactive Compounds Characterized from Azadirachta indica with an FDA-Approved Drug against Schistosomal Agents: New Insight into Schistosomiasis Treatment. Molecules 2024; 29:1909. [PMID: 38731401 PMCID: PMC11084920 DOI: 10.3390/molecules29091909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 05/13/2024] Open
Abstract
The burden of human schistosomiasis, a known but neglected tropical disease in Sub-Saharan Africa, has been worrisome in recent years. It is becoming increasingly difficult to tackle schistosomiasis with praziquantel, a drug known to be effective against all Schistosoma species, due to reports of reduced efficacy and resistance. Therefore, this study seeks to investigate the antischistosomal potential of phytochemicals from Azadirachta indica against proteins that have been implicated as druggable targets for the treatment of schistosomiasis using computational techniques. In this study, sixty-three (63) previously isolated and characterized phytochemicals from A. indica were identified from the literature and retrieved from the PubChem database. In silico screening was conducted to assess the inhibitory potential of these phytochemicals against three receptors (Schistosoma mansoni Thioredoxin glutathione reductase, dihydroorotate dehydrogenase, and Arginase) that may serve as therapeutic targets for schistosomiasis treatment. Molecular docking, ADMET prediction, ligand interaction, MMGBSA, and molecular dynamics simulation of the hit compounds were conducted using the Schrodinger molecular drug discovery suite. The results show that Andrographolide possesses a satisfactory pharmacokinetic profile, does not violate the Lipinski rule of five, binds with favourable affinity with the receptors, and interacts with key amino acids at the active site. Importantly, its interaction with dihydroorotate dehydrogenase, an enzyme responsible for the catalysis of the de novo pyrimidine nucleotide biosynthetic pathway rate-limiting step, shows a glide score and MMGBSA of -10.19 and -45.75 Kcal/mol, respectively. In addition, the MD simulation shows its stability at the active site of the receptor. Overall, this study revealed that Andrographolide from Azadirachta indica could serve as a potential lead compound for the development of an anti-schistosomal drug.
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Affiliation(s)
- Babatunji Emmanuel Oyinloye
- Phytomedicine, Biochemical Toxicology and Biotechnology Research Laboratories, Department of Biochemistry, College of Sciences, Afe Babalola University, PMB 5454, Ado-Ekiti 360001, Nigeria
- Biotechnology and Structural Biology (BSB) Group, Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa
- Institute of Drug Research and Development, S.E. Bogoro Center, Afe Babalola University, PMB 5454, Ado-Ekiti 360001, Nigeria
| | - David Ezekiel Shamaki
- Phytomedicine, Biochemical Toxicology and Biotechnology Research Laboratories, Department of Biochemistry, College of Sciences, Afe Babalola University, PMB 5454, Ado-Ekiti 360001, Nigeria
- Biotechnology and Structural Biology (BSB) Group, Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa
| | - Emmanuel Ayodeji Agbebi
- Institute of Drug Research and Development, S.E. Bogoro Center, Afe Babalola University, PMB 5454, Ado-Ekiti 360001, Nigeria
- Department of Pharmacognosy and Natural Products, College of Pharmacy, Afe Babalola University, Ado-Ekiti 360001, Nigeria
| | - Sunday Amos Onikanni
- Phytomedicine, Biochemical Toxicology and Biotechnology Research Laboratories, Department of Biochemistry, College of Sciences, Afe Babalola University, PMB 5454, Ado-Ekiti 360001, Nigeria
- College of Medicine, Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan
| | - Chukwudi Sunday Ubah
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA 19121, USA
| | | | - Tran Nhat Phong Dao
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Traditional Medicine, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam
| | - Olutunmise Victoria Owolabi
- Medical Biochemistry Unit, College of Medicine and Health Sciences, Afe Babalola University, PMB 5454, Ado-Ekiti 360001, Nigeria
| | - Olajumoke Tolulope Idowu
- Industrial Chemistry Unit, Department of Chemical Sciences, College of Sciences, Afe Babalola University, Ado-Ekiti 360001, Nigeria
| | - Makhosazana Siduduzile Mathenjwa-Goqo
- Biotechnology and Structural Biology (BSB) Group, Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa
| | - Deborah Tolulope Esan
- Faculty of Nursing Sciences, College of Health Sciences, Bowen University, Iwo 232102, Nigeria
| | - Basiru Olaitan Ajiboye
- Institute of Drug Research and Development, S.E. Bogoro Center, Afe Babalola University, PMB 5454, Ado-Ekiti 360001, Nigeria
- Phytomedicine and Molecular Toxicology Research Laboratory, Department of Biochemistry, Federal University Oye-Ekiti, Oye-Ekiti 371104, Nigeria
| | - Olaposi Idowu Omotuyi
- Institute of Drug Research and Development, S.E. Bogoro Center, Afe Babalola University, PMB 5454, Ado-Ekiti 360001, Nigeria
- Department of Pharmacology and Toxicology, College of Pharmacy, Afe Babalola University, PMB 5454, Ado-Ekiti 360001, Nigeria
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Vaillant MT, Philippy F, Neven A, Barré J, Bulaev D, Olliaro PL, Utzinger J, Keiser J, Garba AT. Diagnostic tests for human Schistosoma mansoni and Schistosoma haematobium infection: a systematic review and meta-analysis. THE LANCET. MICROBE 2024; 5:e366-e378. [PMID: 38467130 PMCID: PMC10990967 DOI: 10.1016/s2666-5247(23)00377-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/22/2023] [Accepted: 11/16/2023] [Indexed: 03/13/2024]
Abstract
BACKGROUND Accurate diagnosis is pivotal for implementing strategies for surveillance, control, and elimination of schistosomiasis. Despite their low sensitivity in low-endemicity areas, microscopy-based urine filtration and the Kato-Katz technique are considered as reference diagnostic tests for Schistosoma haematobium and Schistosoma mansoni infections, respectively. We aimed to collate all available evidence on the accuracy of other proposed diagnostic techniques. METHODS In this systematic review and meta-analysis, we searched PubMed, Embase, the Cochrane Library, and LILACS for studies published from database inception to Dec 31, 2022, investigating the sensitivity and specificity of diagnostic tests for S haematobium and S mansoni infections against Kato-Katz thick smears or urine microscopy (reference tests) involving adults (aged ≥18 years), school-aged children (aged 7 to 18 years), or preschool-aged children (aged 1 month to 7 years). We extracted raw data on true positives, true negatives, false positives, and false negatives for the diagnostic tests and data on the number of participants, study authors, publication year, journal, study design, participants' age and sex, prevalence of Schistosoma infection, and treatment status. To account for imperfect reference tests, we used a hierarchical Bayesian latent class meta-analysis to model test accuracy. FINDINGS Overall, we included 121 studies, assessing 28 different diagnostic techniques. Most studies (103 [85%] of 121) were done in Africa, 14 (12%) in South America, one (1%) in Asia, and one (1%) in an unknown country. Compared with the reference test, Kato-Katz thick smears, circulating cathodic antigen urine cassette assay version 1 (CCA1, 36 test comparisons) had excellent sensitivity (95% [95% credible interval 88-99]) and reasonable specificity (74% [63-83]) for S mansoni. ELISA-based tests had a performance comparable to circulating cathodic antigen, but there were few available test comparisons. For S haematobium, proteinuria (42 test comparisons, sensitivity 73% [62-82]; specificity 94% [89-98]) and haematuria (75 test comparisons, sensitivity 85% [80-90]; specificity 96% [92-99]) reagent strips showed high specificity, with haematuria reagent strips having better sensitivity. Despite limited data, nucleic acid amplification tests (NAATs; eg, PCR or loop-mediated isothermal amplification [LAMP]) showed promising results with sensitivity estimates above 90%. We found an unclear risk of bias of about 70% in the use of the reference or index tests and of 50% in patient selection. All analyses showed substantial heterogeneity (I2>80%). INTERPRETATION Although NAATs and immunological diagnostics show promise, the limited information available precludes drawing definitive conclusions. Additional research on diagnostic accuracy and cost-effectiveness is needed before the replacement of conventional tests can be considered. FUNDING WHO and Luxembourg Institute of Health.
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Affiliation(s)
- Michel T Vaillant
- Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg.
| | - Fred Philippy
- Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg; Zortify, Luxembourg City, Luxembourg
| | - Anouk Neven
- Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Jessica Barré
- Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg; Luxembourg National Office of Health, Luxembourg City, Luxembourg
| | - Dmitry Bulaev
- Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Piero L Olliaro
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute and Medical Parasitology and Infection Biology Department, University of Basel, Basel, Switzerland
| | - Amadou T Garba
- Department of Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland
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Tawana-Ndolo SM, Zachariah M, Phaladze NA, Sichilongo KF. A solid-phase microextraction gas chromatography-mass spectrometry technique for urinary metabolomics of human samples infected with schistosomiasis-Case of the Okavango Delta, Botswana. Biomed Chromatogr 2023; 37:e5718. [PMID: 37632284 DOI: 10.1002/bmc.5718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/01/2022] [Accepted: 07/24/2023] [Indexed: 08/27/2023]
Abstract
We present a GC-MS metabolomics workflow for analyzing metabolites in urine samples infected with schistosomiasis. Schistosomiasis, a neglected tropical disease, affects 85% of the global population, with the majority residing in Sub-Saharan Africa. The workflow utilized in this study involved the utilization of the AMDIS freeware, Metab R for pre-processing, and multivariate statistical classification through partial least squares-discriminant analysis (PLS-DA). This classification aimed to categorize volatile metabolites found in urine samples from humans infected with schistosomiasis. All samples were collected from individuals in Botswana. A solid-phase microextraction-fused silica fiber was used to adsorb volatile metabolites from the urine samples and inserted into the GC-MS injection port for data acquisition. The acquired data were then subjected to AMDIS auto-deconvolution, Metab R pre-processing, and statistical evaluation for metabolite mining. A total of 12 metabolites, including 3-chloropropionic acid and heptadecyl ester with an AMDIS match factor of 96% at an approximated amount of 0.35% and cyclohexylamine with an AMDIS match factor of 100% and approximated amount of 0.39%, were identified. PLS-DA was used for the classification of the metabolites. The method showed good sensitivity and specificity as indicated by the receiver operating characteristic measured by the areas under the curves. Results indicated that metabolomics is a useful tool for mining metabolites because of the variance in metabolite composition of infected and non-infected urine samples.
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Affiliation(s)
- Sedireng M Tawana-Ndolo
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
- College of Open Schooling, Botswana Open University, Gaborone Regional Campus, Gaborone, Botswana
| | - Matshediso Zachariah
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Nthabiseng A Phaladze
- School of Nursing, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Kwenga F Sichilongo
- Chemistry Department, Faculty of Science, University of Botswana, Gaborone, Botswana
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Galvão RLDF, Meneses GC, Pinheiro MCC, Martins AMC, Daher EDF, Bezerra FSM. Kidney injury biomarkers and parasitic loads of Schistosoma mansoni in a highly endemic area in northeastern Brazil. Acta Trop 2022; 228:106311. [PMID: 35038425 DOI: 10.1016/j.actatropica.2022.106311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 12/21/2021] [Accepted: 01/12/2022] [Indexed: 01/20/2023]
Abstract
Schistosomiasis affects approximately 240 million people worldwide. In Brazil, it is estimated that 1.5 million people are infected with Schistosoma mansoni and up to 15% of diagnosed individuals develop kidney damage. Renal involvement in schistosomiasis mansoni is characterized by glomerular lesions, with a high incidence, especially in chronically infected patients living in areas of high endemicity. Renal damage occurs slowly and is often asymptomatic, with a long-term manifestation of chronic kidney disease, with progressive loss of kidney functions, and early detection of subclinical kidney disease is of great importance. The aim of this study was to investigate kidney damage in patients infected with S. mansoni through urinary biomarkers of kidney injury and their association with the different parasite loads found. The patients were divided into two groups based on the diagnosis of infection by S. mansoni by the Kato-Katz and IgG-ELISA-SEA method: group of individuals infected by S. mansoni, Kato-Katz positive (PG); and group of individuals not infected by S. mansoni, Kato-Katz-negative (NG). Urinary creatinine and albuminuria were determined by immunoturbidimetry and proteinuria by the colorimetric method. The urinary biomarkers of podocyte injury (VEGF and Nephrin) and glomerular inflammation (MCP-1) were quantified by immunoassay and expressed by the urinary creatinine ratio. Urinary VEGF showed significantly higher levels in PG compared to NG (p = 0.004), increasing at all intensities of infection including low parasite load (p = 0.020). Our results show increased signs of podocyte damage in patients with schistosomiasis mansoni regardless of the parasite load, evidenced by increased urinary VEGF levels. However, further studies are needed since data related to schistosomiasis glomerulopathy and its association with new urinary biomarkers of kidney injury are scarce in the literature.
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Favre TC, Beck LCNH, Bezerra FSM, Graeff-Teixeira C, Coelho PMZ, Enk MJ, Katz N, Oliveira RR, Reis MGD, Pieri OS. Reliability of point-of-care circulating cathodic antigen assay for diagnosing schistosomiasis mansoni in urine samples from an endemic area of Brazil after one year of storage at -20 degrees Celsius. Rev Soc Bras Med Trop 2022; 55:e0389. [PMID: 35239906 PMCID: PMC8909435 DOI: 10.1590/0037-8682-0389-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/24/2021] [Indexed: 11/22/2022] Open
Abstract
Background The World Health Organization recommends reliable point-of-care (POC) diagnostic testing to eliminate schistosomiasis. Lateral flow immunoassay that detects schistosome circulating cathodic antigen (CCA) in urine to establish prevalence thresholds for intervention in endemic areas is recommended. Stored urine may be useful if surveying at-risk populations is delayed or interrupted by unforeseen circumstances, such as the current COVID-19 pandemic. This study evaluated the manufacturer’s claim that Schistosoma mansoni infection can be reliably diagnosed in urine samples stored at -20°C for one year. Methods Two-hundred-forty-two subjects from an endemic site in Brazil provided one urine sample each for testing with URINE CCA (SCHISTO) ECO TESTE® (POC-ECO) and one stool sample each for testing with Kato-Katz (KK) and Helmintex® (HTX) as a robust reference standard for infection status. At least 2 ml of urine from each participant was stored at -20°C; after one year, 76 samples were randomly selected for POC-ECO retesting. Results: The POC-ECO agreement between freshly collected and stored urine was inadequate considering trace results as positive (Cohen’s kappa coefficient κ = 0.08) and negative (κ = 0.36). POC-ECO accuracy was not significantly greater than that of routine KK (54%; 95% confidence interval: 42.1%-65.5%). Conclusions The precision and accuracy of POC-ECO have to be optimized in both freshly collected and stored urine before it can be recommended for use in control programs in Brazil.
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Affiliation(s)
| | | | | | - Carlos Graeff-Teixeira
- Universidade Federal do Espírito Santo, Brasil; Pontifícia Universidade Católica do Rio Grande do Sul, Brasil
| | | | | | | | | | - Mitermayer Galvão dos Reis
- Fundação Oswaldo Cruz, Brasil; Universidade Federal da Bahia, Brasil; Yale University, United States of America
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Anantharam P, Emerson LE, Bilcha KD, Fairley JK, Tesfaye AB. Undernutrition, food insecurity, and leprosy in North Gondar Zone, Ethiopia: A case-control study to identify infection risk factors associated with poverty. PLoS Negl Trop Dis 2021; 15:e0009456. [PMID: 34166403 PMCID: PMC8277044 DOI: 10.1371/journal.pntd.0009456] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 07/13/2021] [Accepted: 05/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background Ethiopia has over 3,200 new cases of leprosy diagnosed every year. Prevention remains a challenge as transmission pathways are poorly understood. Susceptibility and disease manifestations are highly dependent on individual host-immune response. Nutritional deficiencies, such as protein-energy malnutrition, have been linked to reduced cell-mediated immunity, which in the case of leprosy, could lead to a higher chance of active leprosy and thus an increased reservoir of transmissible infection. Methodology/Principal findings Between June and August 2018, recently diagnosed patients with leprosy and individuals without known contact with cases were enrolled as controls in North Gondar regional health centers. Participants answered survey questions on biometric data, demographics, socioeconomic situation, and dietary habits. Descriptive statistics, univariate, and multivariate logisitic regression examined associations between undernutrition, specifically body mass index (BMI), middle upper arm circumference (MUAC), and leprosy. Eighty-one participants (40 cases of leprosy, 41 controls) were enrolled (75% male) with an average age of 38.6 years (SD 18.3). The majority of cases were multibacillary (MB) (90%). There was a high prevalence of undernutrition with 24 (29.6%) participants underweight (BMI <18.5) and 17 (21%) having a low MUAC. On multivariate analysis, underweight was significantly associated with leprosy (aOR = 9.25, 95% CI 2.77, 30.81). Also found to be associated with leprosy was cutting the size of meals/skipping meals (OR = 2.9, 95% CI 1.0, 8.32) or not having enough money for food (OR = 10, 95% CI 3.44 29.06). Conclusions/Significance The results suggest a strong association between leprosy and undernutrition, while also supporting the framework that food insecurity may lead to undernutrition that then could increase susceptibility to leprosy. In conclusion, this study highlights the need to study the interplay of undernutrition, food insecurity, and the manifestations of leprosy. Understanding the effect that nutritional deficiencies, dietary habits, and undernutrition exert on leprosy transmission can improve our ability to better develop strategies and control programs to prevent this debilitating disease. While there is evidence that leprosy and undernutrition are associated, overall the literature is sparse. The authors here provide evidence for the possible role of undernutrition and low BMI on leprosy susceptibility. Additional questions about dietary habits and socioeconomic status support the framework that food insecurity may lead to undernutrition causing an increase in susceptibility to active leprosy disease. Although the study focuses on the leprosy susceptibility, as it relates to undernutrition, in North Gondar Zone, Ethiopia, the outcomes of the study may inform risks in other areas where the dual burden of undernutrition and neglected tropical diseases exist.
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Affiliation(s)
- Puneet Anantharam
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Lisa E. Emerson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Kassahun D. Bilcha
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Jessica K. Fairley
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
- * E-mail:
| | - Annisa B. Tesfaye
- University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
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