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Kim MJ, Chu KB, Yoon KW, Kang HJ, Lee DH, Moon EK, Quan FS. Virus-like particles expressing microneme-associated antigen of Plasmodium berghei confer better protection than those expressing apical membrane antigen 1. PARASITES, HOSTS AND DISEASES 2024; 62:193-204. [PMID: 38835260 DOI: 10.3347/phd.24017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/18/2024] [Indexed: 06/06/2024]
Abstract
Malaria is a global disease affecting a large portion of the world's population. Although vaccines have recently become available, their efficacies are suboptimal. We generated virus-like particles (VLPs) that expressed either apical membrane antigen 1 (AMA1) or microneme-associated antigen (MIC) of Plasmodium berghei and compared their efficacy in BALB/c mice. We found that immune sera acquired from AMA1 VLP- or MIC VLP-immunized mice specifically interacted with the antigen of choice and the whole P. berghei lysate antigen, indicating that the antibodies were highly parasite-specific. Both VLP vaccines significantly enhanced germinal center B cell frequencies in the inguinal lymph nodes of mice compared with the control, but only the mice that received MIC VLPs showed significantly enhanced CD4+ T cell responses in the blood following P. berghei challenge infection. AMA1 and MIC VLPs significantly suppressed TNF-α and interleukin-10 production but had a negligible effect on interferon-γ. Both VLPs prevented excessive parasitemia buildup in immunized mice, although parasite burden reduction induced by MIC VLPs was slightly more effective than that induced by AMA1. Both VLPs were equally effective at preventing body weight loss. Our findings demonstrated that the MIC VLP was an effective inducer of protection against murine experimental malaria and should be the focus of further development.
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Affiliation(s)
- Min-Ju Kim
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul 02447, Korea
| | - Ki Back Chu
- Department of Parasitology, Inje University College of Medicine, Busan 47392, Korea
- Department of Infectious Disease and Malaria, Paik Institute of Clinical Research, Inje University, Busan 47392, Korea
| | - Keon-Woong Yoon
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul 02447, Korea
| | - Hae-Ji Kang
- Department of Microbiology, Dongguk University College of Medicine, Gyeongju 38066, Korea
| | - Dong-Hun Lee
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul 02447, Korea
| | - Eun-Kyung Moon
- Department of Medical Zoology, Kyung Hee University School of Medicine, Seoul 02447, Korea
| | - Fu-Shi Quan
- Department of Medical Zoology, Kyung Hee University School of Medicine, Seoul 02447, Korea
- Medical Research Center for Bioreaction to Reactive Oxygen Species and Biomedical Science Institute, School of Medicine, Graduate School, Kyung Hee University, Seoul 02447, Korea
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Awasthi KR, Jancey J, Clements ACA, Rai R, Leavy JE. Community engagement approaches for malaria prevention, control and elimination: a scoping review. BMJ Open 2024; 14:e081982. [PMID: 38365295 PMCID: PMC10875526 DOI: 10.1136/bmjopen-2023-081982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/25/2024] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION Globally malaria programmes have adopted approaches to community engagement (ACE) to design and deliver malaria interventions. This scoping review aimed to understand, map, and synthesise intervention activities guided by ACE and implemented by countries worldwide for the prevention, control and elimination of malaria. METHODS Three databases (Web of Science, Proquest, and Medline) were searched for peer-reviewed, primary studies, published in English between 1 January 2000 and 31 December 2022. Advanced Google was used to search for grey literature. The five levels of the International Association for Public Participation were used to categorise ACE - (1) Inform, (2) Consult, (3) involve, (4) Collaborate, and (5) Co-lead. Intervention activities were categorised as health education (HE), and/or health services (HS), and/or environmental management (EM). Outcomes were collected as knowledge, attitude, behaviour, help-seeking, health and HS and environment. Enablers and barriers were identified. Malaria intervention phases were categorised as (1) prevention (P), or (2) control (C), or (3) prevention and control (PC) or prevention, control and elimination (PCE). RESULTS Seventy-five studies were included in the review. Based on ACE levels, most studies were at the inform (n=37) and involve (n=26) level. HE (n=66) and HS (n=43) were the common intervention activities. HE informed communities about malaria, its prevention and vector control. EM activities were effective when complemented by HE. Community-based HS using locally recruited health workers was well-accepted by the community. Involvement of local leaders and collaboration with local stakeholders can be enablers for malaria intervention activities. CONCLUSION Involving local leaders and community groups in all stages of malaria prevention programmes is vital for successful interventions. Key elements of successful ACE, that is, consult, collaborate, and co-lead were under-represented in the literature and require attention. National programes must consult and collaborate with community stakeholders to develop ownership of the interventions and eventually co-lead them.
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Affiliation(s)
- Kiran Raj Awasthi
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Jonine Jancey
- Western Australian Centre for Health Promotion Research, School of Public Health, Curtin University, Perth, Western Australia, Australia
| | | | - Rajni Rai
- School of Population Health, Curtin University, Perth, Western Australia, Australia
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The High Potency of Green Synthesized Copper Nanoparticles to Prevent the Toxoplasma gondii Infection in Mice. Acta Parasitol 2021; 66:1472-1479. [PMID: 34050875 DOI: 10.1007/s11686-021-00421-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Nowadays, due to the lack of an effective vaccine to prevent the toxoplasmosis, chemotherapy with the combination of pyrimethamine and sulfadiazine is considered as the "gold standard" treatment for toxoplasmosis. Recent reports have exhibited that these synthesized chemical drugs are associated with some serious side effects. The present study aims to evaluate the prophylactic effects of copper nanoparticles (CuNPs) green synthesized by Capparis spinosa fruit methanolic extract alone and combined with atovaquone against chronic toxoplasmosis induced by the Tehran strain of Toxoplasma gondii in mice METHODS: Mice were then orally administrated with CuNPs at the doses of 2 and 4 mg/kg/day and in combined with atovaquone 50 mg/kg for 14 days. Male BALB/c mice were divided into two seven groups include C1 (non-treated non-infected); C2 (treated with normal saline); C3 (Infected mice treated with atovaquone 100 mg/kg/day); Ex1 (treated with CuNPs 2 mg/kg/day); Ex2 (treated with CuNPs 4 mg/kg/day); Ex3 (treated with CuNPs 2 mg/kg/day + atovaquone 50 mg/kg/day); Ex3 (treated with CuNPs 4 mg/kg/day + atovaquone 50 mg/kg/day). On the 15th day, the mice were infected with the intraperitoneal inoculation of 20-25 tissue cysts from the Tehran strain of T. gondii. The mean numbers of brain tissue cysts and the mRNA levels of IL-12, IFN-γ, and inducible nitric oxide synthase (iNOS) in mice of each tested group were measured. RESULTS CuNPs were green synthesized by C. spinosa methanolic extract. Scanning electron microscopy showed that the particle size of CuNPs was 17 and 41 nm with maximum peak at the wavelength of 414 nm. The mean number of T. gondii tissue cysts in mice of tested groups of Ex1, Ex2, Ex3, and Ex4, significantly decreased as a dose-dependent response compared with control group. Moreover, in similar to the control group C3, no T. gondii tissue cysts was observed in mice of experimental group Ex3 and Ex4. The mRNA levels of IFN-γ, IL-12, and iNO was measured in mice of all tested groups. The mRNA levels of IFN-γ, IL-12, and iNO was increased in all mice of experimental groups in comparison with the control group C2; however, a significant enhancement was detected in mRNA level of IFN-γ, IL-12, and iNO in the tested groups of Ex3 and Ex4 when compared with control group C3. CONCLUSION The obtained results revealed the high potency of CuNPs alone and combined with atovaquone to prevent toxoplasmosis in mice. Although, the prophylactic effects of CuNPs and other properties, such as improved cellular immunity and low toxicity, are positive topics; however, more studies are required to approve these findings especially in clinical settings.
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Awasthi KR, Jancey J, Clements ACA, Leavy JE. Community engagement approaches for malaria prevention, control and elimination: a scoping review protocol. BMJ Open 2021; 11:e049812. [PMID: 34610938 PMCID: PMC8493896 DOI: 10.1136/bmjopen-2021-049812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Community engagement (CE) is important for malaria prevention, control and ultimately elimination. As the decline of malaria has plateaued over the last 5 years, strengthening CE approaches will be necessary to enhance health promotion practice and policy to drive malaria transmission down further. Countries have adopted a wide range of public health intervention approaches for malaria prevention and control that best suit their context. This review will examine the existing evidence on the various CE approaches adopted by malaria programmes across the world and their outcomes. METHODOLOGY AND ANALYSIS: The review methodology will follow the updated Joanna Briggs Institute guide for scoping review, 2017, which is based on the framework developed by Arksey and O'Malley and further developed by Levac Colquhoun and O'Brien. Proquest, Web of Knowledge and Medline will be searched for publications from January 2000 to 31 March 2021 while Google search engine will be used to find any grey literature. The eligibility criteria will be as follows: review will include primary studies written in the English language using appropriate study designs and methods, including quantitative, qualitative and mixed methods designs; and case, programme or project reports. Information on CE approaches designed specifically for malaria prevention, control, elimination and their outcomes will be explored. Subheadings and free text terms for 'community engagement' and 'malaria' will be used for the search. The article screening and data extraction will be examined by two reviewers after the initial search, and any disputes will be resolved by a third reviewer through discussion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guide will be used to present the review methods and the results from the search. The scoping review results will identify and map the available evidences, sources of information and research gaps in the area of CE as one approach for malaria prevention, control and/or elimination. ETHICS AND DISSEMINATION: This study only aims to review secondary sources and does not require human research ethics committee approval. The findings of the scoping review will be submitted to a peer-reviewed journal for wider dissemination.
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Affiliation(s)
- Kiran Raj Awasthi
- Curtin School of Population Health, Curtin University-Perth Bentley Campus, Perth, Western Australia, Australia
| | - Jonine Jancey
- Curtin School of Population Health, Curtin University-Perth Bentley Campus, Perth, Western Australia, Australia
| | - Archie C A Clements
- Curtin School of Population Health, Curtin University-Perth Bentley Campus, Perth, Western Australia, Australia
| | - Justine E Leavy
- Curtin School of Population Health, Curtin University-Perth Bentley Campus, Perth, Western Australia, Australia
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Peixoto JF, Ramos YJ, de Lima Moreira D, Alves CR, Gonçalves-Oliveira LF. Potential of Piper spp. as a source of new compounds for the leishmaniases treatment. Parasitol Res 2021; 120:2731-2747. [PMID: 34245362 DOI: 10.1007/s00436-021-07199-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Abstract
Current treatment guidelines for leishmaniasis is based on chemotherapy with drugs that show a set of limitations such as high cost, toxicity, difficult route of administration, and lack of efficacy in endemic areas. In this context, phytopharmaceutical products and herbal medicines emerge as promising alternatives for developing new treatment against leishmaniasis. This review discusses the perspectives of leishmaniasis treatment based on natural products and phytotherapy highlighting the Piper genus, especially P. aduncun and P. mollicomum Kunth covering the period of 1998 to 2020. Leishmanicidal activity of pure compounds of Piper spp. [3-(3,4,5-trimethoxyphenyl) propanoic acid, 3-chlorosintenpyridone, 2'-hydroxy-3',4',6'-trimethoxy-chalcone, cardamonin, conocarpan, cubebin, eupomatenoid, flavokavain B, ( +)-(7R,8S)-epoxy-5,6-didehydrokavain, N-[7-(3',4'-methylenedioxypheny l-2(E),4(E)-heptadienoyl-pyrrolidine, N-[7-(3',4'-methylenedioxyphenyl)-2(Z),4(Z)-heptadienoyl-pyrrolidine, piperovatine, pellitorine, and piplartine (piperlongumine)] were proved against the promastigote and amastigote forms of parasite related with cutaneous (L. (L.) amazonensis, L. (V.) braziliensis, and L. (V.) guyanensis) and visceral (L. (L.) donovani, L. (L.) chagasi, and L. (L.) infantum). We also discussed the perspective of leishmaniasis treatment, considering the potential synergism between different promising species of Piper, presenting some interesting interaction possibilities for future studies between plants. Finally, the necessary steps for technological development of phytomedicines and herbal medicines with the desirable quality requirements for medicines are highlighted. The data presented here highlight the use of Piper spp. as source of pharmacological compounds that can lead to effective, safe, and inexpensive treatments for leishmaniasis.
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Affiliation(s)
- Juliana Figueiredo Peixoto
- Laboratório de Biologia Molecular e Doenças Endêmicas, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Av Brasil 4365, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ygor Jessé Ramos
- Departamento de Produtos Naturais, Instituto de Tecnologia em Fármacos (Farmanguinhos), Fundação Oswaldo Cruz (Fiocruz), Av Brasil 4365, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Davyson de Lima Moreira
- Departamento de Produtos Naturais, Instituto de Tecnologia em Fármacos (Farmanguinhos), Fundação Oswaldo Cruz (Fiocruz), Av Brasil 4365, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Roberto Alves
- Laboratório de Biologia Molecular e Doenças Endêmicas, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Av Brasil 4365, Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Luiz Filipe Gonçalves-Oliveira
- Laboratório de Biologia Molecular e Doenças Endêmicas, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Av Brasil 4365, Rio de Janeiro, Rio de Janeiro, Brazil.
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Léger A, Lambraki I, Graells T, Cousins M, Henriksson PJG, Harbarth S, Carson C, Majowicz S, Troell M, Parmley EJ, Jørgensen PS, Wernli D. AMR-Intervene: a social-ecological framework to capture the diversity of actions to tackle antimicrobial resistance from a One Health perspective. J Antimicrob Chemother 2021; 76:1-21. [PMID: 33057678 DOI: 10.1093/jac/dkaa394] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The global threat of antimicrobial resistance (AMR) requires coordinated actions by and across different sectors. Increasing attention at the global and national levels has led to different strategies to tackle the challenge. The diversity of possible actions to address AMR is currently not well understood from a One Health perspective. AMR-Intervene, an interdisciplinary social-ecological framework, describes interventions to tackle AMR in terms of six components: (i) core information about the publication; (ii) social system; (iii) bio-ecological system; (iv) triggers and goals; (v) implementation and governance; and (vi) assessment. AMR-Intervene provides a broadly applicable framework, which can inform the design, implementation, assessment and reporting of interventions to tackle AMR and, in turn, enable faster uptake of successful interventions to build societal resilience to AMR.
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Affiliation(s)
- Anaïs Léger
- Global Studies Institute, University of Geneva, Sciences II, Quai Ernest-Ansermet 30, CH -1211 Genève 4, Switzerland
| | - Irene Lambraki
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Tiscar Graells
- Global Economic Dynamics and the Biosphere, The Royal Swedish Academy of Sciences, Box 50005, 104 05 Stockholm, Sweden.,Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, 10691 Stockholm, Sweden
| | - Melanie Cousins
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Patrik J G Henriksson
- Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, 10691 Stockholm, Sweden.,Beijer Institute of Ecological Economics, The Royal Swedish Academy of Sciences, PO Box 50005, SE-104 05 Stockholm, Sweden.,WorldFish, Jalan Batu Maung, 11960 Bayan Lepas, Penang, Malaysia
| | - Stephan Harbarth
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Carolee Carson
- Canadian Integrated Program for Antimicrobial Resistance Surveillance; Public Health Agency of Canada, Guelph, Canada
| | - Shannon Majowicz
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Max Troell
- Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, 10691 Stockholm, Sweden.,Beijer Institute of Ecological Economics, The Royal Swedish Academy of Sciences, PO Box 50005, SE-104 05 Stockholm, Sweden
| | - E Jane Parmley
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada
| | - Peter S Jørgensen
- Global Economic Dynamics and the Biosphere, The Royal Swedish Academy of Sciences, Box 50005, 104 05 Stockholm, Sweden.,Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, 10691 Stockholm, Sweden
| | - Didier Wernli
- Global Studies Institute, University of Geneva, Sciences II, Quai Ernest-Ansermet 30, CH -1211 Genève 4, Switzerland
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Therapeutic Potential of Green Synthesized Copper Nanoparticles Alone or Combined with Meglumine Antimoniate (Glucantime ®) in Cutaneous Leishmaniasis. NANOMATERIALS 2021; 11:nano11040891. [PMID: 33807273 PMCID: PMC8065924 DOI: 10.3390/nano11040891] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/20/2021] [Accepted: 03/27/2021] [Indexed: 02/06/2023]
Abstract
Background: In recent years, the focus on nanotechnological methods in medicine, especially in the treatment of microbial infections, has increased rapidly. Aim: The present study aims to evaluate in vitro and in vivo antileishmanial effects of copper nanoparticles (CuNPs) green synthesized by Capparis spinosa fruit extract alone and combined with meglumine antimoniate (MA). Methods: CuNPs were green synthesized by C. spinosa methanolic extract. The in vitro antileishmanial activity of CuNPs (10–200 µg/mL) or MA alone (10–200 µg/mL), and various concentrations of MA (10–200 μg/mL) along with 20 μg/mL of CuNPs, was assessed against the Leishmania major (MRHO/IR/75/ER) amastigote forms and, then tested on cutaneous leishmaniasis induced in male BALB/c mice by L. major. Moreover, infectivity rate, nitric oxide (NO) production, and cytotoxic effects of CuNPs on J774-A1 cells were evaluated. Results: Scanning electron microscopy showed that the particle size of CuNPs was 17 to 41 nm. The results demonstrated that CuNPs, especially combined with MA, significantly (p < 0.001) inhibited the growth rate of L. major amastigotes and triggered the production of NO (p < 0.05) in a dose-dependent manner. CuNPs also had no significant cytotoxicity in J774 cells. The mean number of parasites was significantly (p < 0.05) reduced in the infected mice treated with CuNPs, especially combined with MA in a dose-dependent response. The mean diameter of the lesions decreased by 43 and 58 mm after the treatment with concentrations of 100 and 200 mg/mL of CuNPs, respectively. Conclusion: The findings of the present study demonstrated the high potency and synergistic effect of CuNPs alone and combined with MA in inhibiting the growth of amastigote forms of L. major, as well as recovery and improving cutaneous leishmaniasis (CL) induced by L. major in BALB/c mice. Additionally, supplementary studies, especially in clinical settings, are required.
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Banfi FF, Krombauer GC, da Fonseca AL, Nunes RR, Andrade SN, de Rezende MA, Chaves MH, Monção EDS, Taranto AG, Rodrigues DDJ, Vieira GM, de Castro WV, Varotti FDP, Sanchez BAM. Dehydrobufotenin extracted from the Amazonian toad Rhinella marina (Anura: Bufonidae) as a prototype molecule for the development of antiplasmodial drugs. J Venom Anim Toxins Incl Trop Dis 2021; 27:e20200073. [PMID: 33519927 PMCID: PMC7812938 DOI: 10.1590/1678-9199-jvatitd-2020-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/28/2020] [Indexed: 11/22/2022] Open
Abstract
Background: The resistance against antimalarial drugs represents a global challenge in the fight and control of malaria. The Brazilian biodiversity can be an important tool for research and development of new medicinal products. In this context, toxinology is a multidisciplinary approach on the development of new drugs, including the isolation, purification, and evaluation of the pharmacological activities of natural toxins. The present study aimed to evaluate the cytotoxicity, as well as the antimalarial activity in silico and in vitro of four compounds isolated from Rhinella marina venom as potential oral drug prototypes. Methods: Four compounds were challenged against 35 target proteins from P. falciparum and screened to evaluate their physicochemical properties using docking assay in Brazilian Malaria Molecular Targets (BraMMT) software and in silico assay in OCTOPUS® software. The in vitro antimalarial activity of the compounds against the 3D7 Plasmodium falciparum clones were assessed using the SYBR Green I based assay (IC50). For the cytotoxic tests, the LD50 was determined in human pulmonary fibroblast cell line using the [3(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] (MTT) assay. Results: All compounds presented a ligand-receptor interaction with ten Plasmodium falciparum-related protein targets, as well as antimalarial activity against chloroquine resistant strain (IC50 = 3.44 μM to 19.11 μM). Three of them (dehydrobufotenine, marinobufagin, and bufalin) showed adequate conditions for oral drug prototypes, with satisfactory prediction of absorption, permeability, and absence of toxicity. In the cell viability assay, only dehydrobufotenin was selective for the parasite. Conclusions: Dehydrobufotenin revealed to be a potential oral drug prototype presenting adequate antimalarial activity and absence of cytotoxicity, therefore should be subjected to further studies.
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Affiliation(s)
- Felipe Finger Banfi
- Laboratory of Immunopathology and Tropical Diseases, Health Education and Research Center (NUPADS), Institute of Health Sciences, Federal University of Mato Grosso, Sinop, MT, Brazil
| | - Gabriela Camila Krombauer
- Laboratory of Immunopathology and Tropical Diseases, Health Education and Research Center (NUPADS), Institute of Health Sciences, Federal University of Mato Grosso, Sinop, MT, Brazil
| | - Amanda Luisa da Fonseca
- Research Center on Biological Chemistry (NQBio), Federal University of São João Del Rei, Divinópolis, MG, Brazil
| | - Renata Rachide Nunes
- Research Center on Biological Chemistry (NQBio), Federal University of São João Del Rei, Divinópolis, MG, Brazil
| | - Silmara Nunes Andrade
- Research Center on Biological Chemistry (NQBio), Federal University of São João Del Rei, Divinópolis, MG, Brazil
| | - Millena Alves de Rezende
- Research Center on Biological Chemistry (NQBio), Federal University of São João Del Rei, Divinópolis, MG, Brazil
| | | | | | - Alex Guterres Taranto
- Research Center on Biological Chemistry (NQBio), Federal University of São João Del Rei, Divinópolis, MG, Brazil
| | - Domingos de Jesus Rodrigues
- Center for Biodiversity Studies in the Amazon Region of Mato Grosso (NEBAM), Federal University of Mato Grosso, MT, Brazil
| | | | | | - Fernando de Pilla Varotti
- Research Center on Biological Chemistry (NQBio), Federal University of São João Del Rei, Divinópolis, MG, Brazil
| | - Bruno Antonio Marinho Sanchez
- Laboratory of Immunopathology and Tropical Diseases, Health Education and Research Center (NUPADS), Institute of Health Sciences, Federal University of Mato Grosso, Sinop, MT, Brazil
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Barton I, Avanceña ALV, Gounden N, Anupindi R. Unintended Consequences and Hidden Obstacles in Medicine Access in Sub-Saharan Africa. Front Public Health 2019; 7:342. [PMID: 31803707 PMCID: PMC6873739 DOI: 10.3389/fpubh.2019.00342] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/30/2019] [Indexed: 01/09/2023] Open
Abstract
Many life-saving drugs are still inaccessible and unaffordable in low- and middle-income countries, particularly in Sub-Saharan Africa. This contributes to poor health outcomes, wider health and socioeconomic inequities, and higher patient spending on healthcare. While resource limitations facing national regulatory authorities (NRAs) contribute to the problem, we believe that (1) fragmented and complex drug regulations, (2) suboptimal enforcement of existing regulations, and (3) poorly designed disincentives for non-compliance play a larger role. These "unintended consequences" that are a direct result of our current regulatory regimes limit competition, keep drug costs high, and lead to shortages and the proliferation of illegitimate and unregistered drugs. While NRAs can gain a lot from increased investment in their work, regulatory harmonization and innovation can arrest and reverse the regulatory failures we still see today and improve medicine access in Africa. Unfortunately, harmonization initiatives in Sub-Saharan Africa have made modest impact and have done so slowly. We encourage greater attention and investment in harmonization and other downstream functions of NRAs. We also urge increased participation of national governments-particularly executive agencies in health and the treasury-and patient advocacy groups in advancing harmonization across the subcontinent.
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Affiliation(s)
| | - Anton L V Avanceña
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | | | - Ravi Anupindi
- Stephen M. Ross School of Business, University of Michigan, Ann Arbor, MI, United States
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Gonçalves-Oliveira LF, Souza-Silva F, de Castro Côrtes LM, Veloso LB, Santini Pereira BA, Cysne-Finkelstein L, Lechuga GC, Bourguignon SC, Almeida-Souza F, da Silva Calabrese K, Ferreira VF, Alves CR. The combination therapy of meglumine antimoniate and oxiranes (epoxy-α-lapachone and epoxymethyl-lawsone) enhance the leishmanicidal effect in mice infected by Leishmania (Leishmania) amazonensis. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2019; 10:101-108. [PMID: 31430693 PMCID: PMC6712286 DOI: 10.1016/j.ijpddr.2019.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/26/2019] [Accepted: 08/11/2019] [Indexed: 12/14/2022]
Abstract
Current treatment of cutaneous leishmaniasis includes pentavalent antimonials as first-line drugs, but this therapy has shown severe adverse effects. An alternative to minimize this issue is based on combination therapy scheme with other drugs. In this study we analyzed the potential of the association of meglumine antimoniate (MA) with the oxiranes epoxy-α-lapachone (LAP) or epoxymethyl-lawsone (LAW). Results demonstrated that association between these drugs enhanced leishmanicidal activity on Leishmania (Leishmania) amazonensis infection. The compounds were tested in monotherapy or in combinations (3:1; 1:1 and 1:3) and reduced intracellular parasite numbers, measured by the endocytic index, in all tested conditions. The most effective combination regimens were MA/LAP or MA/LAW in 3:1 ratio, which achieved a reduction of 98.3% and 93.6% in the endocytic index, respectively. BALB/c mice challenged with L. (L.) amazonensis showed significant reduction in lesion size and parasite load in both footpad and lymph nodes, after four weeks of treatment. Although, MA, LAP or LAW monotherapy were able to control the evolution of lesions when compared to untreated animals (30%, 40% and 40% of reduction, respectively), the combination of MA/LAP and LAW in 3:1 ratio showed better results reducing 61.7 and 54.4%, respectively. The results indicate that the association of meglumine antimoniate to oxiranes lead to an increment in the antileishmanial activity and represent a promising approach for the cutaneous leishmaniasis treatment. Meglumine antimoniate with oxiranes enhanced effect against Leishmania infection. The most effective treatment in vitro infection was observed in a 3:1 ratio. Mice treatment with drugs caused reductions in lesion size and parasite load. Antimony-based combination has the potential for leishmaniasis treatment.
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Affiliation(s)
- Luiz Filipe Gonçalves-Oliveira
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Biologia Molecular e Doenças Endêmicas, Avenida Brasil n(o) 4365 - Manguinhos, Rio de Janeiro, 21040-900, RJ, Brazil.
| | - Franklin Souza-Silva
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Biologia Molecular e Doenças Endêmicas, Avenida Brasil n(o) 4365 - Manguinhos, Rio de Janeiro, 21040-900, RJ, Brazil; Fundação Oswaldo Cruz, Centro de Desenvolvimento Tecnológico em Saúde, Avenida Brasil n(o) 4365 - Manguinhos, 21040-900, Rio de Janeiro, RJ, Brazil.
| | - Luzia Monteiro de Castro Côrtes
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Biologia Molecular e Doenças Endêmicas, Avenida Brasil n(o) 4365 - Manguinhos, Rio de Janeiro, 21040-900, RJ, Brazil.
| | - Laura Barral Veloso
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Biologia Molecular e Doenças Endêmicas, Avenida Brasil n(o) 4365 - Manguinhos, Rio de Janeiro, 21040-900, RJ, Brazil.
| | - Bernardo Acácio Santini Pereira
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Biologia Molecular e Doenças Endêmicas, Avenida Brasil n(o) 4365 - Manguinhos, Rio de Janeiro, 21040-900, RJ, Brazil.
| | - Lea Cysne-Finkelstein
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Imunoparasitologia, Avenida Brasil n(o) 4365 - Manguinhos, 21040-900, Rio de Janeiro, RJ, Brazil.
| | - Guilherme Curty Lechuga
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Ultraestrutura Celular, Av. Brasil n(o) 4365 - Manguinhos, 21040-900, Rio de Janeiro, RJ, Brazil.
| | - Saulo Cabral Bourguignon
- Universidade Federal Fluminense, Departamento de Biologia Celular e Molecular, Laboratório de Interação Celular e Molecular, Outeiro São João Batista s/n, Centro, 24020-141, Niterói, RJ, Brazil.
| | - Fernando Almeida-Souza
- Universidade Estadual do Maranhão, Pós-graduação em Ciência Animal, Cidade Universitária Paulo VI, Av. Lourenço Vieira da Silva no 1000, Jardim São Cristóvão, 65055-310, São Luís, MA, Brazil; Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Imunomodulação e Protozoologia, Avenida Brasil n(o) 4365 - Manguinhos, 21040-900, Rio de Janeiro, RJ, Brazil.
| | - Kátia da Silva Calabrese
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Imunomodulação e Protozoologia, Avenida Brasil n(o) 4365 - Manguinhos, 21040-900, Rio de Janeiro, RJ, Brazil.
| | - Vitor Francisco Ferreira
- Universidade Federal Fluminense, Faculdade de Farmácia, Departamento de Tecnologia Farmacêutica, Rua Doutor Mário Viana n(o) 523- Santa Rosa, 24241-002, Niterói, RJ, Brazil.
| | - Carlos Roberto Alves
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Biologia Molecular e Doenças Endêmicas, Avenida Brasil n(o) 4365 - Manguinhos, Rio de Janeiro, 21040-900, RJ, Brazil.
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11
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Althaus T, Greer RC, Swe MMM, Cohen J, Tun NN, Heaton J, Nedsuwan S, Intralawan D, Sumpradit N, Dittrich S, Doran Z, Waithira N, Thu HM, Win H, Thaipadungpanit J, Srilohasin P, Mukaka M, Smit PW, Charoenboon EN, Haenssgen MJ, Wangrangsimakul T, Blacksell S, Limmathurotsakul D, Day N, Smithuis F, Lubell Y. Effect of point-of-care C-reactive protein testing on antibiotic prescription in febrile patients attending primary care in Thailand and Myanmar: an open-label, randomised, controlled trial. Lancet Glob Health 2019; 7:e119-e131. [PMID: 30554748 PMCID: PMC6293968 DOI: 10.1016/s2214-109x(18)30444-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/27/2018] [Accepted: 09/15/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND In southeast Asia, antibiotic prescription in febrile patients attending primary care is common, and a probable contributor to the high burden of antimicrobial resistance. The objective of this trial was to explore whether C-reactive protein (CRP) testing at point of care could rationalise antibiotic prescription in primary care, comparing two proposed thresholds to classify CRP concentrations as low or high to guide antibiotic treatment. METHODS We did a multicentre, open-label, randomised, controlled trial in participants aged at least 1 year with a documented fever or a chief complaint of fever (regardless of previous antibiotic intake and comorbidities other than malignancies) recruited from six public primary care units in Thailand and three primary care clinics and one outpatient department in Myanmar. Individuals were randomly assigned using a computer-based randomisation system at a ratio of 1:1:1 to either the control group or one of two CRP testing groups, which used thresholds of 20 mg/L (group A) or 40 mg/L CRP (group B) to guide antibiotic prescription. Health-care providers were masked to allocation between the two intervention groups but not to the control group. The primary outcome was the prescription of any antibiotic from day 0 to day 5 and the proportion of patients who were prescribed an antibiotic when CRP concentrations were above and below the 20 mg/L or 40 mg/L thresholds. The primary outcome was analysed in the intention-to-treat and per-protocol populations. The trial is registered with ClinicalTrials.gov, number NCT02758821, and is now completed. FINDINGS Between June 8, 2016, and Aug 25, 2017, we recruited 2410 patients, of whom 803 patients were randomly assigned to CRP group A, 800 to CRP group B, and 807 to the control group. 598 patients in CRP group A, 593 in CRP group B, and 767 in the control group had follow-up data for both day 5 and day 14 and had been prescribed antibiotics (or not) in accordance with test results (per-protocol population). During the trial, 318 (39%) of 807 patients in the control group were prescribed an antibiotic by day 5, compared with 290 (36%) of 803 patients in CRP group A and 275 (34%) of 800 in CRP group B. The adjusted odds ratio (aOR) of 0·80 (95% CI 0·65-0·98) and risk difference of -5·0 percentage points (95% CI -9·7 to -0·3) between group B and the control group were significant, although lower than anticipated, whereas the reduction in prescribing in group A compared with the control group was not significant (aOR 0·86 [0·70-1·06]; risk difference -3·3 percentage points [-8·0 to 1·4]). Patients with high CRP concentrations in both intervention groups were more likely to be prescribed an antibiotic than in the control group (CRP ≥20 mg/L: group A vs control group, p<0·0001; CRP ≥40 mg/L: group B vs control group, p<0·0001), and those with low CRP concentrations were more likely to have an antibiotic withheld (CRP <20 mg/L: group A vs control group, p<0·0001; CRP <40 mg/L: group B vs control group, p<0·0001). 24 serious adverse events were recorded, consisting of 23 hospital admissions and one death, which occurred in CRP group A. Only one serious adverse event was thought to be possibly related to the study (a hospital admission in CRP group A). INTERPRETATION In febrile patients attending primary care, testing for CRP at point of care with a threshold of 40 mg/L resulted in a modest but significant reduction in antibiotic prescribing, with patients with high CRP being more likely to be prescribed an antibiotic, and no evidence of a difference in clinical outcomes. This study extends the evidence base from lower-income settings supporting the use of CRP tests to rationalise antibiotic use in primary care patients with an acute febrile illness. A key limitation of this study is the individual rather than cluster randomised study design which might have resulted in contamination between the study groups, reducing the effect size of the intervention. FUNDING Wellcome Trust Institutional Strategic Support Fund grant (105605/Z/14/Z) and Foundation for Innovative New Diagnostics (FIND) funding from the Australian Government.
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Affiliation(s)
- Thomas Althaus
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Rachel C Greer
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Myo Maung Maung Swe
- Myanmar-Oxford Clinical Research Unit, Yangon, Myanmar; Medical Action Myanmar, Yangon, Myanmar
| | - Joshua Cohen
- Myanmar-Oxford Clinical Research Unit, Yangon, Myanmar; Medical Action Myanmar, Yangon, Myanmar
| | - Ni Ni Tun
- Myanmar-Oxford Clinical Research Unit, Yangon, Myanmar; Medical Action Myanmar, Yangon, Myanmar
| | - James Heaton
- Myanmar-Oxford Clinical Research Unit, Yangon, Myanmar; Medical Action Myanmar, Yangon, Myanmar
| | - Supalert Nedsuwan
- Primary Care Department, Chiangrai Prachanukroh Hospital, Chiangrai, Thailand
| | - Daranee Intralawan
- Primary Care Department, Chiangrai Prachanukroh Hospital, Chiangrai, Thailand
| | - Nithima Sumpradit
- Thai Food and Drug Administration, Ministry of Public Health, Bangkok, Thailand
| | - Sabine Dittrich
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Zoë Doran
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Naomi Waithira
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | - Han Win
- Department of Medical Research, Yangon, Myanmar
| | - Janjira Thaipadungpanit
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Prapaporn Srilohasin
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mavuto Mukaka
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Pieter W Smit
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ern Nutcha Charoenboon
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Marco Johannes Haenssgen
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Tri Wangrangsimakul
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Stuart Blacksell
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Direk Limmathurotsakul
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Nicholas Day
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Frank Smithuis
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Yoel Lubell
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
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12
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McIntosh AI, Jenkins HE, White LF, Barnard M, Thomson DR, Dolby T, Simpson J, Streicher EM, Kleinman MB, Ragan EJ, van Helden PD, Murray MB, Warren RM, Jacobson KR. Using routinely collected laboratory data to identify high rifampicin-resistant tuberculosis burden communities in the Western Cape Province, South Africa: A retrospective spatiotemporal analysis. PLoS Med 2018; 15:e1002638. [PMID: 30130377 PMCID: PMC6103505 DOI: 10.1371/journal.pmed.1002638] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/13/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND South Africa has the highest tuberculosis incidence globally (781/100,000), with an estimated 4.3% of cases being rifampicin resistant (RR). Control and elimination strategies will require detailed spatial information to understand where drug-resistant tuberculosis exists and why it persists in those communities. We demonstrate a method to enable drug-resistant tuberculosis monitoring by identifying high-burden communities in the Western Cape Province using routinely collected laboratory data. METHODS AND FINDINGS We retrospectively identified cases of microbiologically confirmed tuberculosis and RR-tuberculosis from all biological samples submitted for tuberculosis testing (n = 2,219,891) to the Western Cape National Health Laboratory Services (NHLS) between January 1, 2008, and June 30, 2013. Because the NHLS database lacks unique patient identifiers, we performed a series of record-linking processes to match specimen records to individual patients. We counted an individual as having a single disease episode if their positive samples came from within two years of each other. Cases were aggregated by clinic location (n = 302) to estimate the percentage of tuberculosis cases with rifampicin resistance per clinic. We used inverse distance weighting (IDW) to produce heatmaps of the RR-tuberculosis percentage across the province. Regression was used to estimate annual changes in the RR-tuberculosis percentage by clinic, and estimated average size and direction of change was mapped. We identified 799,779 individuals who had specimens submitted from mappable clinics for testing, of whom 222,735 (27.8%) had microbiologically confirmed tuberculosis. The study population was 43% female, the median age was 36 years (IQR 27-44), and 10,255 (4.6%, 95% CI: 4.6-4.7) cases had documented rifampicin resistance. Among individuals with microbiologically confirmed tuberculosis, 8,947 (4.0%) had more than one disease episode during the study period. The percentage of tuberculosis cases with rifampicin resistance documented among these individuals was 11.4% (95% CI: 10.7-12.0). Overall, the percentage of tuberculosis cases that were RR-tuberculosis was spatially heterogeneous, ranging from 0% to 25% across the province. Our maps reveal significant yearly fluctuations in RR-tuberculosis percentages at several locations. Additionally, the directions of change over time in RR-tuberculosis percentage were not uniform. The main limitation of this study is the lack of unique patient identifiers in the NHLS database, rendering findings to be estimates reliant on the accuracy of the person-matching algorithm. CONCLUSIONS Our maps reveal striking spatial and temporal heterogeneity in RR-tuberculosis percentages across this province. We demonstrate the potential to monitor RR-tuberculosis spatially and temporally with routinely collected laboratory data, enabling improved resource targeting and more rapid locally appropriate interventions.
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Affiliation(s)
- Avery I. McIntosh
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Helen E. Jenkins
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Laura F. White
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | | | - Dana R. Thomson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Tania Dolby
- National Health Laboratory Service, Cape Town, South Africa
| | - John Simpson
- National Health Laboratory Service, Cape Town, South Africa
| | - Elizabeth M. Streicher
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Mary B. Kleinman
- Section of Infectious Diseases, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States of America
| | - Elizabeth J. Ragan
- Section of Infectious Diseases, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States of America
| | - Paul D. van Helden
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Megan B. Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Robin M. Warren
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Karen R. Jacobson
- Section of Infectious Diseases, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States of America
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