1
|
Ariceta G, Liu J, Williams A, Wood S, Schnabel D. POS1155 THE INTERNATIONAL X-LINKED HYPOPHOSPHATAEMIA (XLH) REGISTRY: OVERVIEW OF THE DATA SET. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundX-Linked Hypophosphataemia (XLH) is a rare, progressive, lifelong, hereditary renal tubule phosphate-wasting disorder characterised by a pathological increase in fibroblast growth factor 23 concentration/activity.1 Despite XLH being increasingly recognised as a chronic progressive disease, there are few data documenting its natural history or the impact of treatment on patient outcomes.2 The International XLH Registry was established to address this lack of information on XLH to help inform future clinical management. The Registry will collect data to characterise the treatment, burden of disease, disease progression and long-term outcomes of XLH.ObjectivesTo provide an overview and status update of the International XLH Registry as of 31 December 2021.MethodsThe International XLH Registry (NCT03193476) was initiated in August 2017, aims to recruit 1,200 children and adults with XLH, and will run for 10 years. This Registry is an international, multicentre, non-interventional data collection programme and will provide the largest single dataset representing children and adults with XLH. To be eligible for inclusion in the registry, patients must meet all the following criteria:1) Male or female subjects of all ages; 2) Diagnosis of XLH with clinical, radiological, biochemical and/or genetic findings consistent with XLH. The Registry captures any treatment details and clinical outcome variables in patients with XLH and patients are followed for as long as informed consent (and assent, where applicable) and regulatory permissions are maintained. Only data collected during standard routine examinations are recorded within the Registry, and no specific examinations/data entries are mandated.Parameters collected at baseline included demographics, medical and treatment history, and clinical presentation data. The conduct of the International XLH Registry is overseen by 17 Steering Committee physician members representing the region.ResultsAs of 31 December 2021, 1,043 subjects diagnosed with XLH were enrolled from 88 hospital sites in 19 countries. The geographic distribution of subjects is as follows: Belgium n=29, Bulgaria n=7, Czech Republic n=8, Denmark n=23, France n=267, Germany n=79, Hungary n=11, Ireland n=5, Israel n=21, Italy n=88, The Netherlands n=26, Norway n=23, Portugal n=9, Slovakia n=5, Slovenia n=3, Spain n=55, Sweden n=43, Switzerland n=17, and the UK n=324. A further 30 sites are yet to enrol (including sites in Austria and Latvia). Overall, 400 adults (18–29y, n=116; 30–39y, n=81; 40–49y, n=95; 50–59y, n=58; ≥60y, n=50) and 620 paediatric subjects (<5y, n=138; 5–12y, n=321; 13–17y, n=161) have been enrolled (date of birth not reported, n=23). The majority of enrolled subjects are female (648 (62.1%), with 372 male (35.7%) and 23 for whom sex was not reported (2.2%). The quantity of data from the patients included in this Registry will enable ongoing snapshot and prospective analyses to be conducted over the coming years to answer research questions and inform clinical practice.ConclusionThis International XLH Registry forms the largest dataset of subjects with XLH collected to date. Patients have been recruited from a wide geographical region and baseline demographics are consistent with a hereditary X-linked dominant disease. Information collected during the 10-year Registry duration will generate real-world evidence to help inform clinical practice throughout the region, with the aim of improving the care and quality of life of adults and children living with this debilitating disease.References[1]Haffner D, et al. Nat Rev Nephrol 2019;15(7):435–455.[2]Padidela R, et al. Orphanet J Rare Dis. 2020; 15:172.AcknowledgementsAuthors acknowledge the contribution of all International XLH Registry Steering Committee members, and all the investigators participating in the International XLH Registry.Disclosure of InterestsGema Ariceta Speakers bureau: I have received honoraria for lectures, presentations, or educational events from Alexion Pharmaceuticals, Recordati Rare Disease, Advicenne, Chiesi, Kyowa Kirin, Consultant of: I have participated on Advisory Boards for Alexion Pharmaceuticals, Advicenne, Chiesi, Dicerna, and Alnylam., Jonathan Liu Employee of: Employee of Kyowa Kirin International, Angela Williams Employee of: Employee of Kyowa Kirin International, Sue Wood Employee of: Employee of Kyowa Kirin International, Dirk Schnabel Speakers bureau: I received an honorarium from various companies for scientific lectures (i.e. Ascendis, BioMarin, Ferring Pharma, Hexal / Sandoz, Ipsen Pharma, Kyowa Kirin, Merck Serono, Novo Nordisk), Consultant of: BioMarin, Kyowa Kirin
Collapse
|
2
|
Mngqibisa R, Kendall MA, Dooley K, Wu XS, Firnhaber C, Mcilleron H, Robinson J, Cramer Y, Rosenkranz SL, Roa J, Coughlin K, Mawlana S, Badal-Faesen S, Schnabel D, Omoz-Oarhe A, Samaneka W, Godfrey C, Cohn SE. Pharmacokinetics and Pharmacodynamics of Depot Medroxyprogesterone Acetate in African Women Receiving Treatment for Human Immunodeficiency Virus and Tuberculosis: Potential Concern for Standard Dosing Frequency. Clin Infect Dis 2021; 71:517-524. [PMID: 31504342 DOI: 10.1093/cid/ciz863] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 09/03/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Effective contraception is critical to young women with HIV-associated tuberculosis (TB), as unintended pregnancy is associated with increased perinatal morbidity and mortality. The effects of co-administration of efavirenz and rifampicin on the pharmacokinetics of depot medroxyprogesterone acetate (DMPA) are unknown. We hypothesized that clearance of medroxyprogesterone acetate (MPA) would increase when given with rifampicin and efavirenz, thus increasing risk of ovulation. METHODS This pharmacokinetics (PK) study assessed DMPA among HIV/TB coinfected women on an efavirenz-based antiretroviral treatment and rifampicin-based TB treatment. Plasma MPA concentrations and progesterone were measured predose (MPA only) and 2, 4, 6, 8, 10, and 12 weeks after a single DMPA 150 mg intramuscular injection. The primary outcome measure, MPA concentration (<0.1 ng/mL) at week 12, was assessed using exact 95% Clopper-Pearson confidence intervals. MPA PK parameters were calculated using noncompartmental analysis. RESULTS Among 42 PK-evaluable women from 5 African countries, median age was 32 years and median CD4 was 414 cells/mm3. Five women (11.9%; 95% CI, 4.0-25.6%) had MPA <0.1 ng/mL at week 12; of these, one had MPA <0.1 ng/mL at week 10. The median clearance of MPA was 19 681 L/week compared with 12 118 L/week for historical controls. There were no adverse events related to DMPA, and progesterone concentrations were <1 ng/mL for all women for the study duration. CONCLUSIONS DMPA, when given with rifampicin and efavirenz, was safe. MPA clearance was higher than in women with HIV not on ART, leading to subtherapeutic concentrations of MPA in 12% of women, suggesting that more frequent dosing might be needed. CLINICAL TRIALS REGISTRATION NCT02412436.
Collapse
Affiliation(s)
- Rosie Mngqibisa
- Enhancing Care Foundation, Durban International Clinical Research Site (CRS), Durban, South Africa
| | | | - Kelly Dooley
- Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Xingye Shirley Wu
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Helen Mcilleron
- Division of Clinical Pharmacology, University of Cape Town, Mowbray, South Africa
| | - Jennifer Robinson
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yoninah Cramer
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Jhoanna Roa
- AIDS Clinical Trial Group Network Coordinating Center, Silver Spring, Maryland, USA
| | - Kristine Coughlin
- Frontier Science and Technology Research Foundation, Amherst, New York, USA
| | - Sajeeda Mawlana
- Enhancing Care Foundation, Durban International Clinical Research Site (CRS), Durban, South Africa
| | - Sharlaa Badal-Faesen
- Clinical HIV Research Unit, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | | | - Susan E Cohn
- Northwestern University Feinberg School of Medicine, Infectious Diseases Division, Chicago, Illinois, USA
| | | |
Collapse
|
3
|
Sandfort TGM, L Hamilton E, Marais A, Guo X, Sugarman J, Chen YQ, Cummings V, Dadabhai S, Dominguez K, Panchia R, Schnabel D, Zulu F, Reynolds D, Radebe O, Mbeda C, Kamba D, Kanyemba B, Ogendo A, Stirratt M, Chege W, Lucas J, Fawzy M, McKinstry LA, Eshleman SH. The feasibility of recruiting and retaining men who have sex with men and transgender women in a multinational prospective HIV prevention research cohort study in sub-Saharan Africa (HPTN 075). J Int AIDS Soc 2020; 23 Suppl 6:e25600. [PMID: 33000911 PMCID: PMC7527761 DOI: 10.1002/jia2.25600] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/30/2020] [Accepted: 07/21/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Men who have sex with men (MSM) and transgender women (TGW) in sub-Saharan Africa (SSA) are profoundly affected by HIV with high HIV prevalence and incidence. This population also faces strong social stigma and legal barriers, potentially impeding participation in research. To date, few multi-country longitudinal HIV research studies with MSM/TGW have been conducted in SSA. Primary objective of the HIV Prevention Trials Network (HPTN) 075 study was to assess feasibility of recruiting and retaining a multinational prospective cohort of MSM/TGW in SSA for HIV prevention research. METHODS HPTN 075, conducted from 2015 to 2017, was designed to enroll 400 MSM/TGW at four sites in SSA (100 per site: Kisumu, Kenya; Blantyre, Malawi; Cape Town, South Africa; and Soweto, South Africa). The number of HIV-positive persons was capped at 20 per site; HIV-positive persons already in care were excluded from participation. The one-year study included five biobehavioural assessments. Community-based input and risk mitigation protocols were included in study design and conduct. RESULTS Of 624 persons screened, 401 were enrolled. One in five participants was classified as transgender. Main reasons for ineligibility included: (a) being HIV positive after the cap was reached (29.6%); (b) not reporting anal intercourse with a man in the preceding three months (20.6%); and (c) being HIV positive and already in care (17.5%). Five (1.2%) participants died during the study (unrelated to study participation). 92.9% of the eligible participants (368/396) completed the final study visit and 86.1% participated in all visits. The main, overlapping reasons for early termination included being (a) unable to adhere to the visit schedule, predominantly because of relocation (46.4%), and (b) unable to contact the participant (32.1%). Participants reported strong motivation to participate and few participation barriers. Four participants reported social harms (loss of confidentiality and sexual harassment by study staff) that were successfully addressed. CONCLUSIONS HPTN 075 successfully enrolled a multinational sample of MSM/TGW in SSA in a prospective HIV prevention research study with a high retention rate and few documented social harms. This supports the feasibility of conducting large-scale research trials in this population to address its urgent, unmet HIV prevention needs.
Collapse
Affiliation(s)
- Theodorus GM Sandfort
- HIV Center for Clinical and Behavioral StudiesNew York State Psychiatric Institute and Columbia UniversityNew YorkNYUSA
| | | | - Anita Marais
- Perinatal HIV Research UnitUniversity of the WitwatersrandSoweto HPTN CRSSowetoSouth Africa
| | - Xu Guo
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWAUSA
| | - Jeremy Sugarman
- Berman Institute of BioethicsJohns Hopkins UniversityBaltimoreMDUSA
| | - Ying Q Chen
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWAUSA
| | - Vanessa Cummings
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Sufia Dadabhai
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBlantyreMalawi
| | - Karen Dominguez
- Desmond Tutu HIV CentreUCT Medical SchoolCape TownSouth Africa
| | - Ravindre Panchia
- Perinatal HIV Research UnitUniversity of the WitwatersrandSoweto HPTN CRSSowetoSouth Africa
| | | | - Fatima Zulu
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBlantyreMalawi
| | | | | | - Calvin Mbeda
- Kenya Medical Research Institute (KEMRI) CDCKisumuKenya
| | - Dunker Kamba
- Centre for the Development of People (CEDEP)BlantyreMalawi
| | - Brian Kanyemba
- Desmond Tutu HIV CentreUCT Medical SchoolCape TownSouth Africa
| | - Arthur Ogendo
- Kenya Medical Research Institute (KEMRI) CDCKisumuKenya
| | - Michael Stirratt
- Division of AIDS ResearchNational Institute of Mental HealthBethesdaMDUSA
| | - Wairimu Chege
- Division of AIDNational Institute of Allergy and Infectious DiseaseNational Institutes of HealthBethesdaMDUSA
| | | | | | - Laura A McKinstry
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWAUSA
| | - Susan H Eshleman
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMDUSA
| |
Collapse
|
4
|
Umuhoza T, Bulimo WD, Oyugi J, Schnabel D, Mancuso JD. Prevalence and factors influencing the distribution of influenza viruses in Kenya: Seven-year hospital-based surveillance of influenza-like illness (2007-2013). PLoS One 2020; 15:e0237857. [PMID: 32822390 PMCID: PMC7446924 DOI: 10.1371/journal.pone.0237857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 08/04/2020] [Indexed: 12/03/2022] Open
Abstract
Background Influenza viruses remain a global threat with the potential to trigger outbreaks and pandemics. Globally, seasonal influenza viruses’ mortality range from 291 243–645 832 annually, of which 17% occurs in Sub-Saharan Africa. We sought to estimate the overall prevalence of influenza infections in Kenya, identifying factors influencing the distribution of these infections, and describe trends in occurrence from 2007 to 2013. Methods Surveillance was conducted at eight district hospital sites countrywide. Participants who met the case definition for influenza-like illness were enrolled in the surveillance program. The nasopharyngeal specimens were collected from all participants. We tested all specimens for influenza viruses with quantitative reverse transcriptase real-time polymerase chain reaction (RT-qPCR) assay. Bivariate and multivariate log-binomial regression was performed with a statistically significant level of p<0.005. An administrative map of Kenya was used to locate the geographical distribution of surveillance sites in counties. We visualized the monthly trend of influenza viruses with a graph and chart using exponential smoothing at a damping factor of 0.5 over the study period (2007–2013). Results A total of 17446 participants enrolled in the program. The overall prevalence of influenza viruses was 19% (n = 3230), of which 76% (n = 2449) were type A, 21% (n = 669) type B and 3% (n = 112) A/ B coinfection. Of those with type A, 59% (n = 1451) were not subtyped. Seasonal influenza A/H3N2 was found in 48% (n = 475), influenza A/H1N1/pdm 2009 in 43% (n = 434), and seasonal influenza A/ H1N1 in 9% (n = 88) participants. Both genders were represented, whereas a large proportion of participants 55% were ≤1year age. Influenza prevalence was high, 2 times more in other age categories compared to ≤1year age. Category of occupation other than children and school attendees had a high prevalence of influenza virus (p< <0.001). The monthly trends of influenza viruses’ positivity showed no seasonal pattern. Influenza types A and B co-circulated throughout the annual calendar during seven years of the surveillance. Conclusions Influenza viruses circulate year-round and occur among children as well as the adult population in Kenya. Occupational and school-based settings showed a higher prevalence of influenza viruses. There were no regular seasonal patterns for influenza viruses.
Collapse
Affiliation(s)
- Therese Umuhoza
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Wallace D. Bulimo
- Department of Emerging Infectious Diseases, United State Army Medical Research Directorate – Africa, Nairobi, Kenya
- Department of Biochemistry, School of Medicine, University of Nairobi, Nairobi, Kenya
- * E-mail:
| | - Julius Oyugi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - David Schnabel
- US President’s Malaria Initiative, Freetown, Sierra Leone
| | - James D. Mancuso
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| |
Collapse
|
5
|
Mbeda C, Ogendo A, Lando R, Schnabel D, Gust DA, Guo X, Akelo V, Dominguez K, Panchia R, Mbilizi Y, Chen Y, Chege W. Healthcare-related stigma among men who have sex with men and transgender women in sub-Saharan Africa participating in HIV Prevention Trials Network (HPTN) 075 study. AIDS Care 2020; 32:1052-1060. [PMID: 32500722 DOI: 10.1080/09540121.2020.1776824] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ABSTRACT The inability to access health services when needed is a critical barrier to HIV prevention, treatment and care among men who have sex with men (MSM) and transgender women (TGW). Using data collected in HPTN 075, we explored factors associated with any experienced healthcare-related stigma. HPTN 075 was a cohort study to assess the feasibility of recruiting and retaining MSM and TGW in clinical trials in sub-Saharan Africa. Of 401 MSM and TGW enrolled at four sites (Kisumu, Kenya; Blantyre, Malawi; Cape Town, Soweto, South Africa) 397 contributed to the analysis (79.9% cis-gender and 20.1% TGW). Of these, (45.3%; 180/397) reported one or more of healthcare-related stigma experiences. Most frequently reported experiences included fear to seek healthcare services (36.3%) and avoiding seeking such services because of the discovery of MSM status (29.2%). Few men and TGW (2.5%) reported having been denied health services because of having sex with men. In multivariable analysis, more participants in Soweto [adjusted odds ratio (AOR) = 2.60] and fewer participants in Blantyre (AOR = 0.27) reported any healthcare-related stigma experiences, in comparison to participants in Kisumu. MSM and TGW that did not have a supportive gay community to rely on were more likely to report any healthcare-related stigma experiences (AOR = 1.46), whereas MSM and TGW who reported high social support and who never had engaged in transactional sex were less likely to report such experiences (AOR = 0.76 and AOR = 0.43, respectively). Our results suggest that encouraging support groups for MSM and TGW as well as training and sensitizing healthcare staff, and the general community, on MSM and TGW health issues and cultural competence may reduce stigma, improve access to healthcare, which could ultimately reduce HIV transmission.
Collapse
Affiliation(s)
| | | | | | - David Schnabel
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Deborah A Gust
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xu Guo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Victor Akelo
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Ravindre Panchia
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Yamikani Mbilizi
- Malawi College of Medicine - Johns Hopkins University Research Project, Blantyre, Malawi
| | - Ying Chen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Wairimu Chege
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | -
- Columbia University and New York State Psychiatric Institute, New York, NY, USA
| |
Collapse
|
6
|
Schnabel D, Esposito DH, Gaines J, Ridpath A, Barry MA, Feldman KA, Mullins J, Burns R, Ahmad N, Nyangoma EN, Nguyen DB, Perz JF, Moulton-Meissner HA, Jensen BJ, Lin Y, Posivak-Khouly L, Jani N, Morgan OW, Brunette GW, Pritchard PS, Greenbaum AH, Rhee SM, Blythe D, Sotir M. Multistate US Outbreak of Rapidly Growing Mycobacterial Infections Associated with Medical Tourism to the Dominican Republic, 2013-2014(1). Emerg Infect Dis 2018; 22:1340-1347. [PMID: 27434822 PMCID: PMC4982176 DOI: 10.3201/eid2208.151938] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Infections in 6 states were linked to persons traveling to undergo cosmetic surgical procedures. During 2013, the Maryland Department of Health and Mental Hygiene in Baltimore, MD, USA, received report of 2 Maryland residents whose surgical sites were infected with rapidly growing mycobacteria after cosmetic procedures at a clinic (clinic A) in the Dominican Republic. A multistate investigation was initiated; a probable case was defined as a surgical site infection unresponsive to therapy in a patient who had undergone cosmetic surgery in the Dominican Republic. We identified 21 case-patients in 6 states who had surgery in 1 of 5 Dominican Republic clinics; 13 (62%) had surgery at clinic A. Isolates from 12 (92%) of those patients were culture-positive for Mycobacterium abscessus complex. Of 9 clinic A case-patients with available data, all required therapeutic surgical intervention, 8 (92%) were hospitalized, and 7 (78%) required ≥3 months of antibacterial drug therapy. Healthcare providers should consider infection with rapidly growing mycobacteria in patients who have surgical site infections unresponsive to standard treatment.
Collapse
|
7
|
Müller H, Langer T, Schnabel D. Wachstum und Knochenstoffwechsel nach onkologischer Erkrankung im Kindes- und Jugendalter. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-014-3175-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
8
|
Schnabel D, Gaines J, Nguyen DB, Esposito DH, Ridpath A, Yacisin K, Poy JA, Mullins J, Burns R, Lijewski V, McElroy NP, Ahmad N, Harrison C, Parinelli EJ, Beaudoin AL, Posivak-Khouly L, Pritchard PS, Jensen BJ, Toney NC, Moulton-Meissner HA, Nyangoma EN, Barry MA, Feldman KA, Blythe D, Perz JF, Morgan OW, Kozarsky P, Brunette GW, Sotir M. Notes from the field: rapidly growing nontuberculous Mycobacterium wound infections among medical tourists undergoing cosmetic surgeries in the Dominican Republic--multiple states, March 2013-February 2014. MMWR Morb Mortal Wkly Rep 2014; 63:201-2. [PMID: 24598597 PMCID: PMC4584729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
In August 2013, the Maryland Department of Health and Mental Hygiene (MDHMH) was notified of two persons with rapidly growing nontuberculous mycobacterial (RG-NTM) surgical-site infections. Both patients had undergone surgical procedures as medical tourists at the same private surgical clinic (clinic A) in the Dominican Republic the previous month. Within 7 days of returning to the United States, both sought care for symptoms that included surgical wound abscesses, clear fluid drainage, pain, and fever. Initial antibiotic therapy was ineffective. Material collected from both patients' wounds grew Mycobacterium abscessus exhibiting a high degree of antibiotic resistance characteristic of this organism.
Collapse
Affiliation(s)
- David Schnabel
- Maryland Department of Health and Mental Hygiene,Corresponding author: David Schnabel, , 410-767-7395
| | - Joanna Gaines
- Division for Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Duc B. Nguyen
- Division of Healthcare Quality and Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Douglas H. Esposito
- Division for Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Alison Ridpath
- New York City Department of Health and Mental Hygiene, New York, New York
| | - Kari Yacisin
- New York City Department of Health and Mental Hygiene, New York, New York
| | - Jose A. Poy
- New York City Department of Health and Mental Hygiene, New York, New York
| | | | | | | | | | | | | | | | | | | | | | - Bette J. Jensen
- Division of Healthcare Quality and Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Nadege C. Toney
- Division of Healthcare Quality and Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Heather A. Moulton-Meissner
- Division of Healthcare Quality and Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Edith N. Nyangoma
- Division for Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | | | | | - David Blythe
- Maryland Department of Health and Mental Hygiene
| | - Joseph F. Perz
- Division of Healthcare Quality and Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Oliver W. Morgan
- Dominican Republic Country Office, Center for Global Health, CDC
| | - Phyllis Kozarsky
- Division for Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Gary W. Brunette
- Division for Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Mark Sotir
- Division for Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| |
Collapse
|
9
|
Schnabel D, Letz S, Lankes E, Mayr B, Schöfl C. Severe but not neonatally lethal. A homozygous inactivating CaSR mutation in a 3 year old child. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
10
|
Juma BW, Wadegu M, Makio A, Kirera R, Eyase F, Awinda G, Kamanza J, Schnabel D, Wurapa EK. A Survey of Biosafety and Biosecurity Practices in the United States Army Medical Research Unit-Kenya (USAMRU-K). Appl Biosaf 2014. [DOI: 10.1177/153567601401900104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Meshack Wadegu
- United States Army Medical Research Unit—Kenya, Nairobi, Kenya
| | - Albina Makio
- United States Army Medical Research Unit—Kenya, Nairobi, Kenya
| | - Ronald Kirera
- United States Army Medical Research Unit—Kenya, Nairobi, Kenya
| | - Fredrick Eyase
- United States Army Medical Research Unit—Kenya, Nairobi, Kenya
| | - George Awinda
- United States Army Medical Research Unit—Kenya, Nairobi, Kenya
| | - John Kamanza
- United States Army Medical Research Unit—Kenya, Nairobi, Kenya
| | - David Schnabel
- United States Army Medical Research Unit—Kenya, Nairobi, Kenya
| | - Eyako K. Wurapa
- United States Army Medical Research Unit—Kenya, Nairobi, Kenya
| |
Collapse
|
11
|
Lutomiah J, Musila L, Makio A, Ochieng C, Koka H, Chepkorir E, Mutisya J, Mulwa F, Khamadi S, Miller BR, Bast J, Schnabel D, Wurapa EK, Sang R. Ticks and tick-borne viruses from livestock hosts in arid and semiarid regions of the eastern and northeastern parts of Kenya. J Med Entomol 2014; 51:269-277. [PMID: 24605478 DOI: 10.1603/me13039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Biodiversity and relative abundance of ticks and associated arboviruses in Garissa (northeastern) and Isiolo (eastern) provinces of Kenya were evaluated. Ticks were collected from livestock, identified to species, pooled, and processed for virus isolation. In Garissa, Rhipicephalus pulchellus Gerstacker (57.8%) and Hyalomma truncatum Koch (27.8%) were the most abundant species sampled, whereas R. pulchellus (80.4%) and Amblyomma gemma Donitz (9.6%) were the most abundant in Isiolo. Forty-four virus isolates, comprising Dugbe virus (DUGV; n = 22) and Kupe virus (n = 10; Bunyaviridae: Nirovirus), Dhori virus (DHOV; n = 10; Orthomyxoviridae: Thogotovirus),and Ngari virus (NRIV; n = 2; Bunyaviridae: Orthobunyavirus), were recovered mostly from R. pulchellus sampled in Isiolo. DUGV was mostly recovered from R. pulchellus from sheep and cattle, and DHOV from R. pulchellus from sheep. All Kupe virus isolates were from Isiolo ticks, including R. pulchellus from all the livestock, A. gemma and Amblyomma variegatum F. from cattle, and H. truncatum from goat. NRIV was obtained from R. pulchellus and A. gemma sampled from cattle in Isiolo and Garissa, respectively, while all DHOV and most DUGV (n = 12) were from R. pulchellus sampled from cattle in Garissa. DUGV was also recovered from H. truncatum and Amblyomma hebraeum Koch from cattle and from Rhipicephalus annulatus Say from camel. This surveillance study has demonstrated the circulation of select tick-borne viruses in parts of eastern and northeastern provinces of Kenya, some of which are of public health importance. The isolation of NRIV from ticks is particularly significant because it is usually known to be a mosquito-borne virus affecting humans.
Collapse
Affiliation(s)
- Joel Lutomiah
- Centre for Virus Research, Kenya Medical Research Institute, P. O. Box 54628, Nairobi 00100, Kenya.
| | - Lillian Musila
- Division of Emerging Infectious Disease, US Army Medical Research Unit, Kenya, P. O.Box 606-00621, Village Market, Nairobi 00621, Kenya
| | - Albina Makio
- Division of Emerging Infectious Disease, US Army Medical Research Unit, Kenya, P. O.Box 606-00621, Village Market, Nairobi 00621, Kenya
| | - Caroline Ochieng
- Division of Emerging Infectious Disease, US Army Medical Research Unit, Kenya, P. O.Box 606-00621, Village Market, Nairobi 00621, Kenya
| | - Hellen Koka
- Division of Emerging Infectious Disease, US Army Medical Research Unit, Kenya, P. O.Box 606-00621, Village Market, Nairobi 00621, Kenya
| | - Edith Chepkorir
- Integrated Vector & Disease Management, International Centre of Insect Physiology and Ecology, P. O. Box 30772-00100, Nairobi 00100, Kenya
| | - James Mutisya
- Division of Emerging Infectious Disease, US Army Medical Research Unit, Kenya, P. O.Box 606-00621, Village Market, Nairobi 00621, Kenya
| | - Francis Mulwa
- Integrated Vector & Disease Management, International Centre of Insect Physiology and Ecology, P. O. Box 30772-00100, Nairobi 00100, Kenya
| | - Samoel Khamadi
- Division of Emerging Infectious Disease, US Army Medical Research Unit, Kenya, P. O.Box 606-00621, Village Market, Nairobi 00621, Kenya
| | - Barry R Miller
- Division of Vector-Borne Infectious Diseases, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 3156 Rampart Road, Foothills Campus, Fort Collins, CO 80521, USA
| | - Joshua Bast
- Department of Entomology, United States Army Medical Research Unit, Kisumu 40100, Kenya
| | - David Schnabel
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Eyako K Wurapa
- Division of Emerging Infectious Disease, US Army Medical Research Unit, Kenya, P. O.Box 606-00621, Village Market, Nairobi 00621, Kenya
| | - Rosemary Sang
- Centre for Virus Research, Kenya Medical Research Institute, P. O. Box 54628, Nairobi 00100, Kenya
| |
Collapse
|
12
|
Lutomiah J, Bast J, Clark J, Richardson J, Yalwala S, Oullo D, Mutisya J, Mulwa F, Musila L, Khamadi S, Schnabel D, Wurapa E, Sang R. Abundance, diversity, and distribution of mosquito vectors in selected ecological regions of Kenya: public health implications. J Vector Ecol 2013; 38:134-142. [PMID: 23701618 DOI: 10.1111/j.1948-7134.2013.12019.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The diversity of mosquito arbovirus vectors was investigated to define regional risk of arbovirus transmission in Kenya. Mosquitoes were sampled between April, 2007 and December, 2010 at thirteen sites across seven administrative provinces and ecological zones. CDC light traps were used to collect mosquitoes while human-landing collection was conducted in five of the sites to target day-feeding Aedes (Stegomyia) species. Over 524,000 mosquitoes were collected and identified into 101 species, 30 of them known vectors of arboviruses endemic to Kenya. Ae. (Neomelaniconion) mcintoshi and Ae. (Aedimorphus) ochraceus were most abundant in Garissa in the arid northeastern province, and Mansonia uniformis and Mn. africana in semi-arid Baringo in the Rift Valley Province. Ae. ochraceus, Mn. africana and Mn. uniformis were also significant in Nyanza Province, while Ae. (Neomelaniconion) circumluteolus predominated in Budalangi, Western Province. Aedes (Stegomyia) aegypti was predominant in Rabai in the Coast Province but insignificant in the western and Nyanza sites. Culex pipiens was abundant in Rift Valley and Nyanza Provinces around the lake shores. This study highlights the potential for emergence and re-emergence of arboviral diseases among vulnerable populations. This calls for comprehensive mapping of vector distribution and abundance for planning focused vector control measures.
Collapse
Affiliation(s)
- Joel Lutomiah
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Voigt M, Schild RL, Mewitz M, Schneider KTM, Schnabel D, Hesse V, Straube S. Maternal Weight Gain during Pregnancy and Somatic Classification of Neonates According to Birth Weight and Duration of Pregnancy Taking Account of Maternal Body Weight and Height. Geburtshilfe Frauenheilkd 2013; 73:318-323. [PMID: 24771917 DOI: 10.1055/s-0032-1328436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/11/2013] [Accepted: 03/11/2013] [Indexed: 10/26/2022] Open
Abstract
Background and Aim: The classification of weight gain during pregnancy and the somatic classification of neonates according to birth weight and duration of pregnancy can be done using percentile values. We aimed to compare such classifications using percentiles of the overall study population with classifications using percentiles that were calculated taking account of maternal height and weight. Material and Methods: Using data from the German Perinatal Survey (1995-2000, over 2.2 million singleton pregnancies) we classified weight gain during pregnancy as low (< 10th percentile), high (> 90th percentile), or medium (10th-90th percentile). Neonates were classified by birth weight as small for gestational age (SGA, < 10th percentile), large for gestational age (LGA, > 90th percentile), or appropriate for gestational age (AGA, 10th-90th percentile). Classifications were performed for 12 groups of women and their neonates formed according to maternal height and weight, either with the percentiles calculated from the total study population or with group-specific percentiles. Results: Using percentiles of the total study population there was large variability between the 12 groups in the proportions with low and high weight gain and in the proportions of SGA and LGA neonates. The variability was much lower when group-specific percentiles were used. Conclusions: Classifications of maternal weight gain during pregnancy and birth weight differ substantially, depending on whether percentiles calculated from the total study population or group-specific percentiles are used. The impact of using percentiles that take account of maternal anthropometric parameters for the medical care and health of neonates needs to be elucidated in future research.
Collapse
Affiliation(s)
- M Voigt
- German Center for Growth, Development and Health Encouragement during Childhood and Youth, Berlin
| | - R L Schild
- Department of Obstetrics and Perinatal Medicine, Diakoniekrankenhaus Friederikenstift, Hanover
| | - M Mewitz
- Department of Obstetrics and Perinatal Medicine, Diakoniekrankenhaus Friederikenstift, Hanover
| | - K T M Schneider
- Section for Perinatal Medicine, Department of Obstetrics and Gynaecology, Technical University of Munich, Munich
| | - D Schnabel
- Department of Pediatric Endocrinology and Diabetology, Charité University Medical Center, Berlin
| | - V Hesse
- German Center for Growth, Development and Health Encouragement during Childhood and Youth, Berlin
| | - S Straube
- Department of Occupational, Social and Environmental Medicine, University Medical Center Göttingen, Göttingen
| |
Collapse
|
14
|
Ochieng C, Lutomiah J, Makio A, Koka H, Chepkorir E, Yalwala S, Mutisya J, Musila L, Khamadi S, Richardson J, Bast J, Schnabel D, Wurapa E, Sang R. Mosquito-borne arbovirus surveillance at selected sites in diverse ecological zones of Kenya; 2007 - 2012. Virol J 2013; 10:140. [PMID: 23663381 PMCID: PMC3669043 DOI: 10.1186/1743-422x-10-140] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 03/22/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increased frequency of arbovirus outbreaks in East Africa necessitated the determination of distribution of risk by entomologic arbovirus surveillance. A systematic vector surveillance programme spanning 5 years and covering 11 sites representing seven of the eight provinces in Kenya and located in diverse ecological zones was carried out. METHODS Mosquitoes were sampled bi-annually during the wet seasons and screened for arboviruses. Mosquitoes were identified to species, pooled by species, collection date and site and screened for arboviruses by isolation in cell culture and/or RT-PCR screening and sequencing. RESULTS Over 450,000 mosquitoes in 15,890 pools were screened with 83 viruses being detected/isolated that include members of the alphavirus, flavivirus and orthobunyavirus genera many of which are known to be of significant public health importance in the East African region. These include West Nile, Ndumu, Sindbis, Bunyamwera, Pongola and Usutu viruses detected from diverse sites. Ngari virus, which was associated with hemorrhagic fever in northern Kenya in 1997/98 was isolated from a pool of Anopheles funestus sampled from Tana-delta and from Aedes mcintoshi from Garissa. Insect only flaviviruses previously undescribed in Kenya were also isolated in the coastal site of Rabai. A flavivirus most closely related to the Chaoyang virus, a new virus recently identified in China and two isolates closely related to Quang Binh virus previously unreported in Kenya were also detected. CONCLUSION Active transmission of arboviruses of public health significance continues in various parts of the country with possible undetermined human impact. Arbovirus activity was highest in the pastoralist dominated semi-arid to arid zones sites of the country where 49% of the viruses were isolated suggesting a role of animals as amplifiers and indicating the need for improved arbovirus disease diagnosis among pastoral communities.
Collapse
Affiliation(s)
- Caroline Ochieng
- Division of Emerging Infectious Disease, United States Army Medical Research Unit, Kenya, P. O. Box 606, Village Market, Nairobi, Kenya
| | - Joel Lutomiah
- Division of Emerging Infectious Disease, United States Army Medical Research Unit, Kenya, P. O. Box 606, Village Market, Nairobi, Kenya
- Centre for Virus Research, Kenya Medical Research Institute, P. O. Box 54628, Nairobi, Kenya
| | - Albina Makio
- Division of Emerging Infectious Disease, United States Army Medical Research Unit, Kenya, P. O. Box 606, Village Market, Nairobi, Kenya
| | - Hellen Koka
- Division of Emerging Infectious Disease, United States Army Medical Research Unit, Kenya, P. O. Box 606, Village Market, Nairobi, Kenya
| | - Edith Chepkorir
- International Centre for Insect Physiology and Ecology, P. O. Box 30772–00100, Nairobi, Kenya
| | - Santos Yalwala
- Division of Emerging Infectious Disease, United States Army Medical Research Unit, Kenya, P. O. Box 606, Village Market, Nairobi, Kenya
| | - James Mutisya
- Division of Emerging Infectious Disease, United States Army Medical Research Unit, Kenya, P. O. Box 606, Village Market, Nairobi, Kenya
| | - Lillian Musila
- Division of Emerging Infectious Disease, United States Army Medical Research Unit, Kenya, P. O. Box 606, Village Market, Nairobi, Kenya
| | - Samoel Khamadi
- Division of Emerging Infectious Disease, United States Army Medical Research Unit, Kenya, P. O. Box 606, Village Market, Nairobi, Kenya
- Centre for Virus Research, Kenya Medical Research Institute, P. O. Box 54628, Nairobi, Kenya
| | | | - Joshua Bast
- Division of Emerging Infectious Disease, United States Army Medical Research Unit, Kenya, P. O. Box 606, Village Market, Nairobi, Kenya
| | - David Schnabel
- Walter Reed Army Institute of Research, Silver Spring, USA
| | - Eyako Wurapa
- Division of Emerging Infectious Disease, United States Army Medical Research Unit, Kenya, P. O. Box 606, Village Market, Nairobi, Kenya
| | - Rosemary Sang
- Division of Emerging Infectious Disease, United States Army Medical Research Unit, Kenya, P. O. Box 606, Village Market, Nairobi, Kenya
- Centre for Virus Research, Kenya Medical Research Institute, P. O. Box 54628, Nairobi, Kenya
| |
Collapse
|
15
|
Ofula VO, Franklin AB, Root JJ, Sullivan HJ, Gichuki P, Makio A, Bulimo W, Abong'o BO, Muchai M, Schnabel D. Detection of avian influenza viruses in wild waterbirds in the Rift Valley of Kenya using fecal sampling. Vector Borne Zoonotic Dis 2013; 13:394-400. [PMID: 23621372 DOI: 10.1089/vbz.2011.0926] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Highly pathogenic avian influenza virus A/H5N1 has been reported in 11 African countries. Migratory waterbirds have the potential of introducing A/H5N1 into east Africa through the Rift Valley of Kenya. We present the results of a wild bird surveillance system for A/H5N1 and other avian influenza viruses based on avian fecal sampling in Kenya. We collected 2630 fecal samples in 2008. Viral RNA was extracted from pools of 3-5 fecal samples and analyzed for presence of avian influenza virus RNA by real-time RT-PCR. Twelve (2.3%) of the 516 sample pools were positive for avian influenza virus RNA, 2 of which were subtyped as H4N6 viruses. This is the first report of avian influenza virus in wild birds in Kenya. This study demonstrates the success of this approach in detecting avian influenza virus in wild birds and represents an efficient surveillance system for avian influenza virus in regions with limited resources.
Collapse
|
16
|
Szczawinska D, Mayr B, Letz S, Rus R, Schnabel D, Schöfl C. Identification and functional characterization of a homozygous, inactivating CaSR mutation in a patient with rickets. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
17
|
Kumagai LB, LeVesque CS, Blomquist CL, Madishetty K, Guo Y, Woods PW, Rooney-Latham S, Rascoe J, Gallindo T, Schnabel D, Polek M. First Report of Candidatus Liberibacter asiaticus Associated with Citrus Huanglongbing in California. Plant Dis 2013; 97:283. [PMID: 30722341 DOI: 10.1094/pdis-09-12-0845-pdn] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Huanglongbing (HLB), also known as citrus greening, is one of the most destructive citrus diseases worldwide and is seen as a major threat to the multimillion dollar citrus industry in California. The vector of the two bacterial species associated with this disease, Candidatus Liberibacter asiaticus and Ca. L. americanus, is the Asian citrus psyllid (ACP), Diaphorina citri (4). ACP was detected in California in August of 2008 and has since been detected in nine counties in southern California. As part of a long term survey and testing program for the ACP carrying the HLB associated bacteria, groups of ACP nymphs and adults were submitted to the Jerry Dimitman Citrus Research Board/Citrus Pest and Disease Prevention Program Laboratory in Riverside, CA. In March 2012, DNA extracted using the Qiagen MagAttract 96 DNA plant kit (QIAGEN Inc., 27220 Turnberry Lane, Suite 200, Valencia, CA 91355) from a group of three ACP adults tested positive for Ca. L. asiaticus with the real-time PCR assay developed by Li et al. (4). ACP adults were collected from a residential citrus tree located in the Hacienda Heights area of Los Angeles County, California. The approximately 1.8 meter tall lemon tree had 23 graft unions, primarily of lemon (Citrus × meyeri) and pomelo (Citrus maxima) varieties. The tree was unthrifty, with yellow shoots and chlorotic leaves. Symptoms on the lemon and pomelo leaves included asymmetrical blotchy mottling, yellowing, and corking of the leaf veins, with the blotchy mottle more prominent in the pomelo leaves. Pomelo leaves appeared crinkled along the thickened veins. Lemon leaves had yellow veins and a few had islands of green tissue completely surrounded by yellow tissue. The entire tree was removed, cut into sections, bagged, and transported to the CDFA Plant Pest Diagnostics Lab for analysis. Two hundred milligrams of petiole and midrib tissue from leaves apical to each graft union was collected, and DNA from each sample was extracted using the Qiagen DNeasy plant mini kit. DNA extracted from both lemon and pomelo leaves tested positive for Ca. L. asiaticus using real-time PCR (4). A 1,160-bp fragment of the 16S ribosomal RNA gene was amplified from the insect and plant DNA extracts using conventional PCR with primers Ol1 and OI2c (2). A 703-bp fragment of the β-operon gene was amplified from the insect and plant extracts with primers A2 and J5 (1). The 16S rDNA fragments from the insect and plant respectively (GenBank Accession Nos. JX430434 and JX455745) and the β-operon fragments (JX430435 and JX455746) showed 100% identity with the corresponding regions of Ca. L. asiaticus (CP001677) strain psy 62. Our 16S rDNA sequence showed 98% identity with Ca. L. africanus (EU921620), 97% identity with Ca. L. solanacearum (HM246509), and 96% with Ca. L. americanus (FJ036892). In response to the detection of HLB, a 241 km2 quarantine area around the detection site was established. Surveys for ACP and symptomatic host plants within the HLB quarantine area are ongoing. To date, there have been no additional positive detections. In the United States, HLB was first detected in Florida in 2005 (4) and in Texas in January of 2012 (3). To our knowledge, this is the first confirmed report of Ca. L. asiaticus associated with HLB in California. References: (1) A. Hocquellet et al. Mol. Cell. Probes 13:373, 1999. (2) S. Jagoueix et al. Mol. Cell. Probes 10:43, 1996. (3) M. Kunta et al. Phytopathology 102:S4.66, 2012. (4) W. Li et al. J. Microbiol. Methods 66:104, 2006.
Collapse
Affiliation(s)
- L B Kumagai
- California Department of Food and Agriculture (CDFA), Sacramento, CA 95832
| | - C S LeVesque
- Jerry Dimitman Citrus Research Board/Citrus Pest Disease Prevention Program Lab, Riverside, CA 92507
| | - C L Blomquist
- California Department of Food and Agriculture (CDFA), Sacramento, CA 95832
| | - K Madishetty
- Jerry Dimitman Citrus Research Board/Citrus Pest Disease Prevention Program Lab, Riverside, CA 92507
| | - Y Guo
- California Department of Food and Agriculture (CDFA), Sacramento, CA 95832
| | - P W Woods
- California Department of Food and Agriculture (CDFA), Sacramento, CA 95832
| | - S Rooney-Latham
- California Department of Food and Agriculture (CDFA), Sacramento, CA 95832
| | - J Rascoe
- USDA APHIS PPQ CPHST, Beltsville, MD 20705
| | - T Gallindo
- California Department of Food and Agriculture, San Gabriel, CA 91776
| | - D Schnabel
- California Department of Food and Agriculture (CDFA), Sacramento, CA 95832
| | - M Polek
- Jerry Dimitman Citrus Research Board/Citrus Pest Disease Prevention Program Lab, Riverside, CA 92507
| |
Collapse
|
18
|
Voigt M, Rochow N, Guthmann F, Hesse V, Schneider KTM, Schnabel D. [Birth weight percentile values for girls and boys under consideration of maternal height]. Z Geburtshilfe Neonatol 2012; 216:212-9. [PMID: 23108965 DOI: 10.1055/s-0032-1316324] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
There is a linear relationship between maternal height and birth weight. For each 1 cm increase in maternal height, birth weight increases by 16.7 g. Birth weight percentiles should be calculated by taking maternal height into account. We present birth weight percentile values for girls and boys born after 23-43 completed weeks of gestation for 5 maternal height groups. With these percentiles "genetically" small and "genetically" large, but healthy, neonates can be classified more adequately. The calculations are based on data of about 2.2 million singleton pregnancies from the German Perinatal Survey of 1995-2000.
Collapse
Affiliation(s)
- M Voigt
- German Center for Growth, Development and Health Encouragement during Childhood and Youth Berlin, Working Group Rostock-Sievershagen.
| | | | | | | | | | | |
Collapse
|
19
|
Wadegu M, Bulimo W, Achilla R, Majanja J, Mukunzi S, Osuna F, Wangui J, Opot B, Njiri J, Mitei K, Nyambura J, Mwangi J, Schnabel D, Wurapa E. Genotypic characterization of antiviral susceptibility of Influenza A viruses isolated in Kenya from 2008 to 2011. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
20
|
Meissner T, Schnabel D. Handlungsempfehlung nach der Leitlinie Vitamin-D-Mangel-Rachitis. Monatsschr Kinderheilkd 2012. [DOI: 10.1007/s00112-012-2674-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
21
|
Hightower A, Kinkade C, Nguku PM, Anyangu A, Mutonga D, Omolo J, Njenga MK, Feikin DR, Schnabel D, Ombok M, Breiman RF. Relationship of climate, geography, and geology to the incidence of Rift Valley fever in Kenya during the 2006-2007 outbreak. Am J Trop Med Hyg 2012; 86:373-380. [PMID: 22302875 PMCID: PMC3269292 DOI: 10.4269/ajtmh.2012.11-0450] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We estimated Rift Valley fever (RVF) incidence as a function of geological, geographical, and climatological factors during the 2006-2007 RVF epidemic in Kenya. Location information was obtained for 214 of 340 (63%) confirmed and probable RVF cases that occurred during an outbreak from November 1, 2006 to February 28, 2007. Locations with subtypes of solonetz, calcisols, solonchaks, and planosols soil types were highly associated with RVF occurrence during the outbreak period. Increased rainfall and higher greenness measures before the outbreak were associated with increased risk. RVF was more likely to occur on plains, in densely bushed areas, at lower elevations, and in the Somalia acacia ecological zone. Cases occurred in three spatial temporal clusters that differed by the date of associated rainfall, soil type, and land usage.
Collapse
Affiliation(s)
- Allen Hightower
- *Address correspondence to Allen Hightower, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Mailstop F22, 4770 Buford Highway, Atlanta, GA 30341. E-mail:
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Sang WK, Oundo V, Schnabel D. Prevalence and antibiotic resistance of bacterial pathogens isolated from childhood diarrhoea in four provinces of Kenya. J Infect Dev Ctries 2012; 6:572-8. [DOI: 10.3855/jidc.2196] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 01/22/2012] [Accepted: 01/24/2012] [Indexed: 10/31/2022] Open
Abstract
Introduction: Diarrhoea is one of the main causes of morbidity and mortality among children in sub-Saharan Africa, and one of the main causes of hospital admissions in rural areas of Kenya. In Kenya, antimicrobial resistance surveillance has been conducted only at the institutional levels, with limited sharing of information and analysis of data. As a result, the actual scale of regional or national antimicrobial drug resistance is not well defined. Methodology: Stool samples were collected between 1 October 2007 and 30 September 2008 from a total of 651 outpatients with diarrhoea who were under five years of age in four provinces of Kenya. Conventional, biochemical methods, multiplex PCR and antimicrobial susceptibility were conducted to identify the bacterial causes and virulence factors in the isolates, respectively. Results: Of the 651 patients screened, we identified the causes of 115 cases (17.7%) as follows: Pathogenic E. coli (11.2%) [enteroaggregative (8.9%), enterotoxigenic (1.2%), enteroinvasive (0.6%), shigatoxigenic (0.5%)], Salmonella (3.5%), Shigella (2%) and Vibrio cholera O1 (0.7%). The highest levels of resistance among the E. coli isolates were observed in ampicillin and trimethoprim/sulphamethoxazole each at 95% followed by tetracycline at 81%. Shigella isolate levels of resistance ranged from 80% to 100% for ampicillin, tetracycline and trimethoprim/sulphamethoxazole. Conclusion: The highest prevalence of antimicrobial resistance was to ampicillin followed by trimethoprim/sulphamethoxazole and tetracycline. Though still at low levels, the major concern from our findings is the emerging resistance of enteric pathogens that was observed to quinolones (ciprofloxacin, nalidixic acid, norfloxacin) and gentamycin.
Collapse
|
23
|
Sang WK, Boga HI, Waiyaki PG, Schnabel D, Wamae NC, Kariuki SM. Prevalence and genetic characteristics of Shigatoxigenic Escherichia coli from patients with diarrhoea in Maasailand, Kenya. J Infect Dev Ctries 2012; 6:102-8. [PMID: 22337837 DOI: 10.3855/jidc.1750] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 05/26/2011] [Accepted: 05/30/2011] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Shigatoxigenic Escherichia coli strains are food-borne bacterial pathogens that may cause haemorrhagic colitis (HC) in humans which can lead to life-threatening systemic complication, including haemolytic uremic syndrome (HUS). This study aimed to characterize and analyze virulence properties of pathogenic E. coli isolates among patients with diarrhoea from a Maasai community in Kenya. METHODOLOGY Stool samples from 380 patients of all ages from the Kajiado and Narok districts of Kenya were investigated for the presence of enteric bacterial pathogens by conventional and molecular methods. RESULTS Bacterial diarrhoea was diagnosed in 141/380 (37.1%) cases, of which enterotoxigenic E. coli (ETEC) compromised 29.8%, shigatoxigenic E. coli (STEC) 24.1%, enteroaggregative E. coli (EAEC) 14.2%, enteroinvasive E. coli (EIEC) 12.8% and enteropathogenic E. coli (EPEC) 3.5%. Gene analysis for STEC virulence factors showed that 52.9% isolates carried stx1, 29.4% possessed stx2, 14.7% carried both stx1 and stx2, and 2.9% had stx2e. 23.5% isolates carried enterohaemolysin and 20.5% isolates possessed the Intimin gene. From 9 strains that exhibited adherence, 7 contained both Intimin and Haemolysin genes. Infections with Intimin-positive STEC strains (46%) were more frequent in patients with bloody diarrhoea, especially in children under 5 years of age, whereas Intimin-negative STEC infections dominated in adults. CONCLUSION Although STEC infection as a cause of bloody diarrhoea has not attracted much attention as a medical problem in Kenya, our findings indicate that this is a problem that must be investigated. The 24.1% isolation rate of STEC among the Maasai is one of the highest reported rates worldwide.
Collapse
Affiliation(s)
- Willie K Sang
- Center for Microbiology Research Laboratory, Kenya Medical Research Institute, 54840-00200, Nairobi, Kenya.
| | | | | | | | | | | |
Collapse
|
24
|
Sang R, Lutomiah J, Koka H, Makio A, Chepkorir E, Ochieng C, Yalwala S, Mutisya J, Musila L, Richardson JH, Miller BR, Schnabel D. Crimean-Congo hemorrhagic fever virus in Hyalommid ticks, northeastern Kenya. Emerg Infect Dis 2011; 17:1502-5. [PMID: 21801635 PMCID: PMC3381575 DOI: 10.3201/eid1708.102064] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
As part of ongoing arbovirus surveillance, we screened ticks obtained from livestock in northeastern Kenya in 2008 to assess the risk for human exposure to tick-borne viruses. Of 1,144 pools of 8,600 Hyalomma spp. ticks screened for Congo-Crimean hemorrhagic fever virus by reverse transcription PCR, 23 pools were infected, demonstrating a potential for human exposure.
Collapse
Affiliation(s)
- Rosemary Sang
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Živičnjak M, Schnabel D, Staude H, Even G, Marx M, Beetz R, Holder M, Billing H, Fischer DC, Rabl W, Schumacher M, Hiort O, Haffner D. Three-year growth hormone treatment in short children with X-linked hypophosphatemic rickets: effects on linear growth and body disproportion. J Clin Endocrinol Metab 2011; 96:E2097-105. [PMID: 21994957 DOI: 10.1210/jc.2011-0399] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Children with X-linked hypophosphatemic rickets (XLH) are prone to progressive disproportionate stunting despite oral phosphate and vitamin D treatment. OBJECTIVE Our objective was to analyze the effects of GH treatment on stature and lengths of linear body segments in short children with XLH. DESIGN, SETTINGS, AND PATIENTS A 3-yr randomized controlled open-label GH study in short prepubertal children with XLH (n = 16) on phosphate and calcitriol treatment was conducted. A cohort of XLH patients (n = 76) on conservative treatment served as an XLH reference population. MAIN OUTCOME MEASURES Changes in SD scores (SDS) of stature and linear body segments, i.e. sitting height, leg and arm length, and sitting height index (i.e. ratio between sitting height and stature) were the main outcome measures. RESULTS XLH patients presented at time of enrollment with significant impairments of stature (-3.3 SDS) and linear body segments compared with healthy children. Leg length (-3.8 SDS) was most impaired, whereas sitting height (-1.7 SDS) was best preserved. The markedly elevated mean sitting height index (+3.3 SDS) reflected severe body disproportion. GH resulted in a sustained increase in linear growth (stature, +1.1 SDS; sitting height, +1.3 SDS; leg length, +0.8 SDS; arm length, +1.1 SDS; each P < 0.05 vs. baseline), whereas no significant changes were observed in controls. Mean height SDS at 3 yr did not significantly differ between groups. Sitting height index remained stable in both the GH-treated patients and in study controls but increased further in the XLH-reference population. CONCLUSIONS The 3-yr GH treatment improved linear growth without progression of body disproportion in short children with XLH.
Collapse
Affiliation(s)
- M Živičnjak
- Department of Pediatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Lutomiah JL, Koka H, Mutisya J, Yalwala S, Muthoni M, Makio A, Limbaso S, Musila L, Clark JW, Turell MJ, Kioko E, Schnabel D, Sang RC. Ability of selected Kenyan mosquito (Diptera: Culicidae) species to transmit West Nile virus under laboratory conditions. J Med Entomol 2011; 48:1197-1201. [PMID: 22238879 DOI: 10.1603/me11062] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
West Nile virus (WNV) is currently active in Kenya as evidenced by the detection of antibodies in birds bled as part of an avian influenza surveillance program in 2009. Although WNV has been isolated from several mosquito species in Kenya, no studies have ever been conducted to determine which of these species are competent vectors of this virus. Therefore, we allowed Kenyan mosquitoes to feed on 2- or 3-d-old chickens that had been infected with a Lineage one strain of WNV 24-48 h earlier. These mosquitoes were tested approximately 2 wk later to determine infection, dissemination, and transmission rates. All five species [Culex quinquefasciatus Say, Culex univittatus Theobald, Culex vansomereni Edwards, Mansonia africana (Theobald), and Mansonia uniformis (Theobald)] were susceptible to infection, but disseminated infections were detected only in the three Culex, and not the two Mansonia species. Culex mosquitoes with a disseminated infection readily transmitted virus by bite, but even when inoculated with WNV, the two Mansonia failed to transmit virus, indicating a salivary gland barrier. These studies indicate that the three Culex species may play a role in the transmission of WNV in Kenya.
Collapse
|
27
|
Money NN, Maves RC, Sebeny P, Kasper MR, Riddle MS, Wu M, Lee JE, Schnabel D, Bowden R, Oaks EV, Ocaña V, Acosta L, Gotuzzo E, Lanata C, Ochoa T, Aguayo N, Bernal M, Meza R, Canal E, Gregory M, Cepeda D, Listiyaningsih E, Putnam SD, Young S, Mansour A, Nakhla I, Moustafa M, Hassan K, Klena J, Bruton J, Shaheen H, Farid S, Fouad S, El-Mohamady H, Styles T, Shiau LCDRD, Espinosa B, McMullen K, Reed E, Neil D, Searles D, Nevin R, Von Thun A, Sessions C. Enteric disease surveillance under the AFHSC-GEIS: current efforts, landscape analysis and vision forward. BMC Public Health 2011; 11 Suppl 2:S7. [PMID: 21388567 PMCID: PMC3092417 DOI: 10.1186/1471-2458-11-s2-s7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The mission of the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) is to support global public health and to counter infectious disease threats to the United States Armed Forces, including newly identified agents or those increasing in incidence. Enteric diseases are a growing threat to U.S. forces, which must be ready to deploy to austere environments where the risk of exposure to enteropathogens may be significant and where routine prevention efforts may be impractical. In this report, the authors review the recent activities of AFHSC-GEIS partner laboratories in regards to enteric disease surveillance, prevention and response. Each partner identified recent accomplishments, including support for regional networks. AFHSC/GEIS partners also completed a Strengths, Weaknesses, Opportunities and Threats (SWOT) survey as part of a landscape analysis of global enteric surveillance efforts. The current strengths of this network include excellent laboratory infrastructure, equipment and personnel that provide the opportunity for high-quality epidemiological studies and test platforms for point-of-care diagnostics. Weaknesses include inconsistent guidance and a splintered reporting system that hampers the comparison of data across regions or longitudinally. The newly chartered Enterics Surveillance Steering Committee (ESSC) is intended to provide clear mission guidance, a structured project review process, and central data management and analysis in support of rationally directed enteric disease surveillance efforts.
Collapse
Affiliation(s)
- Nisha N Money
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Burke RL, Vest KG, Eick AA, Sanchez JL, Johns MC, Pavlin JA, Jarman RG, Mothershead JL, Quintana M, Palys T, Cooper MJ, Guan J, Schnabel D, Waitumbi J, Wilma A, Daniels C, Brown ML, Tobias S, Kasper MR, Williams M, Tjaden JA, Oyofo B, Styles T, Blair PJ, Hawksworth A, Montgomery JM, Razuri H, Laguna-Torres A, Schoepp RJ, Norwood DA, MacIntosh VH, Gibbons T, Gray GC, Blazes DL, Russell KL. Department of Defense influenza and other respiratory disease surveillance during the 2009 pandemic. BMC Public Health 2011; 11 Suppl 2:S6. [PMID: 21388566 PMCID: PMC3092416 DOI: 10.1186/1471-2458-11-s2-s6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The Armed Forces Health Surveillance Center's Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) supports and oversees surveillance for emerging infectious diseases, including respiratory diseases, of importance to the U.S. Department of Defense (DoD). AFHSC-GEIS accomplishes this mission by providing funding and oversight to a global network of partners for respiratory disease surveillance. This report details the system's surveillance activities during 2009, with a focus on efforts in responding to the novel H1N1 Influenza A (A/H1N1) pandemic and contributions to global public health. Active surveillance networks established by AFHSC-GEIS partners resulted in the initial detection of novel A/H1N1 influenza in the U.S. and several other countries, and viruses isolated from these activities were used as seed strains for the 2009 pandemic influenza vaccine. Partners also provided diagnostic laboratory training and capacity building to host nations to assist with the novel A/H1N1 pandemic global response, adapted a Food and Drug Administration-approved assay for use on a ruggedized polymerase chain reaction platform for diagnosing novel A/H1N1 in remote settings, and provided estimates of seasonal vaccine effectiveness against novel A/H1N1 illness. Regular reporting of the system's worldwide surveillance findings to the global public health community enabled leaders to make informed decisions on disease mitigation measures and controls for the 2009 A/H1N1 influenza pandemic. AFHSC-GEIS's support of a global network contributes to DoD's force health protection, while supporting global public health.
Collapse
Affiliation(s)
- Ronald L Burke
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Kelly G Vest
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Angelia A Eick
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Jose L Sanchez
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Matthew C Johns
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Julie A Pavlin
- Armed Forces Research Institute of Medical Sciences, 315/6 Rajavithi Road, Bangkok, Thailand 10400
| | - Richard G Jarman
- Armed Forces Research Institute of Medical Sciences, 315/6 Rajavithi Road, Bangkok, Thailand 10400
| | - Jerry L Mothershead
- Center for Disaster and Humanitarian Assistance Medicine, Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Miguel Quintana
- Public Health Region-South, Building 2472, Schofield Road, Fort Sam Houston, TX 78234, USA
| | - Thomas Palys
- Landstuhl Regional Medical Center, Department of Pathology and Area Laboratory Services, CMR 402, APO AE 09180, USA
| | | | - Jian Guan
- Public Health Region-Pacific, Unit 45006, APO AE 96343, USA
| | - David Schnabel
- U.S. Embassy, Attention: MRU, United Nations Avenue, Post Office Box 606, Village Market 00621 Nairobi, Kenya
| | - John Waitumbi
- U.S. Embassy, Attention: MRU, United Nations Avenue, Post Office Box 606, Village Market 00621 Nairobi, Kenya
| | - Alisa Wilma
- Department of Defense Veterinary Food Analysis & Diagnostic Laboratory, 2472 Schofield Road, Suite 2630, Fort Sam Houston, TX 78234, USA
| | - Candelaria Daniels
- Department of Defense Veterinary Food Analysis & Diagnostic Laboratory, 2472 Schofield Road, Suite 2630, Fort Sam Houston, TX 78234, USA
| | - Matthew L Brown
- USAMEDDAC-Korea, Microbiology Section, Unit 15244, Box 459, APO AP 96205, USA
| | - Steven Tobias
- Naval Medical Research Unit Number 2, Kompleks Pergudangan DEPKES R.I., JI. Percetakan Negara II No. 23, Jakarta 10560, Indonesia
| | - Matthew R Kasper
- Naval Medical Research Unit Number 2, Kompleks Pergudangan DEPKES R.I., JI. Percetakan Negara II No. 23, Jakarta 10560, Indonesia
| | - Maya Williams
- Naval Medical Research Unit Number 2, Kompleks Pergudangan DEPKES R.I., JI. Percetakan Negara II No. 23, Jakarta 10560, Indonesia
| | - Jeffrey A Tjaden
- Naval Medical Research Unit No. 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
| | - Buhari Oyofo
- Naval Medical Research Unit No. 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
| | - Timothy Styles
- U.S. Navy Environmental Preventive Medicine Unit No. 2, 1887 Powhatan Street, Norfolk, VA 23511, USA
| | - Patrick J Blair
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA
| | - Anthony Hawksworth
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA
| | - Joel M Montgomery
- Naval Medical Research Center Detachment, Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
| | - Hugo Razuri
- Naval Medical Research Center Detachment, Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
| | - Alberto Laguna-Torres
- Naval Medical Research Center Detachment, Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
| | - Randal J Schoepp
- U.S. Army Medical Research Institute of Infectious Diseases, Diagnostic Systems Division, 1425 Porter Street, Fort Detrick, MD 21702, USA
| | - David A Norwood
- U.S. Army Medical Research Institute of Infectious Diseases, Diagnostic Systems Division, 1425 Porter Street, Fort Detrick, MD 21702, USA
| | - Victor H MacIntosh
- U.S. Air Force School of Aerospace Medicine, 2513 Kennedy Circle, Building 180, Brooks City Base, TX 78235, USA
| | - Thomas Gibbons
- U.S. Air Force School of Aerospace Medicine, 2513 Kennedy Circle, Building 180, Brooks City Base, TX 78235, USA
| | - Gregory C Gray
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Post Office Box 100188, Gainesville, FL 32610, USA
| | - David L Blazes
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Kevin L Russell
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - AFHSC-GEIS Influenza Surveillance Writing Group
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
- Armed Forces Research Institute of Medical Sciences, 315/6 Rajavithi Road, Bangkok, Thailand 10400
- Center for Disaster and Humanitarian Assistance Medicine, Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
- Landstuhl Regional Medical Center, Department of Pathology and Area Laboratory Services, CMR 402, APO AE 09180, USA
- U.S. Embassy, Attention: MRU, United Nations Avenue, Post Office Box 606, Village Market 00621 Nairobi, Kenya
- Naval Medical Research Unit Number 2, Kompleks Pergudangan DEPKES R.I., JI. Percetakan Negara II No. 23, Jakarta 10560, Indonesia
- Naval Medical Research Unit No. 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
- U.S. Navy Environmental Preventive Medicine Unit No. 2, 1887 Powhatan Street, Norfolk, VA 23511, USA
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA
- Naval Medical Research Center Detachment, Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
- U.S. Air Force School of Aerospace Medicine, 2513 Kennedy Circle, Building 180, Brooks City Base, TX 78235, USA
- Walter Reed Army Institute of Research, Emerging Infectious Diseases Research Unit, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
- Australian Army Malaria Institute, Gallipoli Barracks, Enoggera, QLD 4051, Australia
- Johns Hopkins University Applied Physics Laboratory, 11100 Johns Hopkins Road, Laurel, MD 20723, USA
- U.S. Navy and Marine Corps Public Health Center, 620 John Paul Jones Circle, Suite 1100, Portsmouth, VA 23708, USA
- Laboratory for Emerging Infectious Diseases, University of Buea, Post Office Box 63, Buea, Cameroon
- Global Viral Forecasting Initiative, 1 Sutter, Suite 600, San Francisco, CA 94104, USA
| |
Collapse
|
29
|
Nguku PM, Sharif SK, Mutonga D, Amwayi S, Omolo J, Mohammed O, Farnon EC, Gould LH, Lederman E, Rao C, Sang R, Schnabel D, Feikin DR, Hightower A, Njenga MK, Breiman RF. An investigation of a major outbreak of Rift Valley fever in Kenya: 2006-2007. Am J Trop Med Hyg 2010; 83:5-13. [PMID: 20682900 DOI: 10.4269/ajtmh.2010.09-0288] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
An outbreak of Rift Valley fever (RVF) occurred in Kenya during November 2006 through March 2007. We characterized the magnitude of the outbreak through disease surveillance and serosurveys, and investigated contributing factors to enhance strategies for forecasting to prevent or minimize the impact of future outbreaks. Of 700 suspected cases, 392 met probable or confirmed case definitions; demographic data were available for 340 (87%), including 90 (26.4%) deaths. Male cases were more likely to die than females, Case Fatality Rate Ratio 1.8 (95% Confidence Interval [CI] 1.3-3.8). Serosurveys suggested an attack rate up to 13% of residents in heavily affected areas. Genetic sequencing showed high homology among viruses from this and earlier RVF outbreaks. Case areas were more likely than non-case areas to have soil types that retain surface moisture. The outbreak had a devastatingly high case-fatality rate for hospitalized patients. However, there were up to 180,000 infected mildly ill or asymptomatic people within highly affected areas. Soil type data may add specificity to climate-based forecasting models for RVF.
Collapse
Affiliation(s)
- Patrick M Nguku
- Division of Communicable Disease Control, Kenya Ministry of Public Health and Sanitation, Nairobi, Kenya.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Sang R, Kioko E, Lutomiah J, Warigia M, Ochieng C, O'Guinn M, Lee JS, Koka H, Godsey M, Hoel D, Hanafi H, Miller B, Schnabel D, Breiman RF, Richardson J. Rift Valley fever virus epidemic in Kenya, 2006/2007: the entomologic investigations. Am J Trop Med Hyg 2010; 83:28-37. [PMID: 20682903 DOI: 10.4269/ajtmh.2010.09-0319] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In December 2006, Rift Valley fever (RVF) was diagnosed in humans in Garissa Hospital, Kenya and an outbreak reported affecting 11 districts. Entomologic surveillance was performed in four districts to determine the epidemic/epizootic vectors of RVF virus (RVFV). Approximately 297,000 mosquitoes were collected, 164,626 identified to species, 72,058 sorted into 3,003 pools and tested for RVFV by reverse transcription-polymerase chain reaction. Seventy-seven pools representing 10 species tested positive for RVFV, including Aedes mcintoshi/circumluteolus (26 pools), Aedes ochraceus (23 pools), Mansonia uniformis (15 pools); Culex poicilipes, Culex bitaeniorhynchus (3 pools each); Anopheles squamosus, Mansonia africana (2 pools each); Culex quinquefasciatus, Culex univittatus, Aedes pembaensis (1 pool each). Positive Ae. pembaensis, Cx. univittatus, and Cx. bitaeniorhynchus was a first time observation. Species composition, densities, and infection varied among districts supporting hypothesis that different mosquito species serve as epizootic/epidemic vectors of RVFV in diverse ecologies, creating a complex epidemiologic pattern in East Africa.
Collapse
Affiliation(s)
- Rosemary Sang
- Arbovirology/Hemorrhagic Fevers Laboratory, Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Anyamba A, Linthicum KJ, Small J, Britch SC, Pak E, de La Rocque S, Formenty P, Hightower AW, Breiman RF, Chretien JP, Tucker CJ, Schnabel D, Sang R, Haagsma K, Latham M, Lewandowski HB, Magdi SO, Mohamed MA, Nguku PM, Reynes JM, Swanepoel R. Prediction, assessment of the Rift Valley fever activity in East and Southern Africa 2006-2008 and possible vector control strategies. Am J Trop Med Hyg 2010; 83:43-51. [PMID: 20682905 DOI: 10.4269/ajtmh.2010.09-0289] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Historical outbreaks of Rift Valley fever (RVF) since the early 1950s have been associated with cyclical patterns of the El Niño/Southern Oscillation (ENSO) phenomenon, which results in elevated and widespread rainfall over the RVF endemic areas of Africa. Using satellite measurements of global and regional elevated sea surface temperatures, elevated rainfall, and satellite derived-normalized difference vegetation index data, we predicted with lead times of 2-4 months areas where outbreaks of RVF in humans and animals were expected and occurred in the Horn of Africa, Sudan, and Southern Africa at different time periods from September 2006 to March 2008. Predictions were confirmed by entomological field investigations of virus activity and by reported cases of RVF in human and livestock populations. This represents the first series of prospective predictions of RVF outbreaks and provides a baseline for improved early warning, control, response planning, and mitigation into the future.
Collapse
Affiliation(s)
- Assaf Anyamba
- NASA Goddard Space Flight Center, Biospheric Sciences Branch, Greenbelt, Maryland 20771, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Woodring JV, Ogutu B, Schnabel D, Waitumbi JN, Olsen CH, Walsh DS, Heppner DG, Polhemus ME. Evaluation of recurrent parasitemia after artemether-lumefantrine treatment for uncomplicated malaria in children in western Kenya. Am J Trop Med Hyg 2010; 83:458-64. [PMID: 20810804 DOI: 10.4269/ajtmh.2010.09-0403] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
From April 2005 to April 2006, a phase 2 malaria vaccine trial in Kenya enrolled 400 children aged 12-47 months. Each received mixed supervised and unsupervised artemether-lumefantrine for uncomplicated malaria, using a standard six-dose regimen, by weight. Children were followed for detection of parasitemia and clinical malaria. A median of two negative malaria blood films occurred during every recurrent parasitemia (RP) episode, suggesting reinfection over late recrudescence. Median time to RP after starting artemether-lumefantrine was 37 days (36-38). Of 2,020 evaluable artemether-lumefantrine treatments, there were no RPs in 99% by day 14, 71% by day 28, and 41% by day 42. By World Health Organization standards, 71% of treatment courses had adequate responses. Although recrudescence in some cannot be ruled out, our cohort had a shorter median time to RP compared with other artemether-lumefantrine treatment studies. This underscores patient counseling on completing all treatment doses for optimal protection from RP.
Collapse
Affiliation(s)
- Joseph V Woodring
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Anyangu AS, Gould LH, Sharif SK, Nguku PM, Omolo JO, Mutonga D, Rao CY, Lederman ER, Schnabel D, Paweska JT, Katz M, Hightower A, Njenga MK, Feikin DR, Breiman RF. Risk factors for severe Rift Valley fever infection in Kenya, 2007. Am J Trop Med Hyg 2010; 83:14-21. [PMID: 20682901 PMCID: PMC2913492 DOI: 10.4269/ajtmh.2010.09-0293] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A large Rift Valley fever (RVF) outbreak occurred in Kenya from December 2006 to March 2007. We conducted a study to define risk factors associated with infection and severe disease. A total of 861 individuals from 424 households were enrolled. Two hundred and two participants (23%) had serologic evidence of acute RVF infection. Of these, 52 (26%) had severe RVF disease characterized by hemorrhagic manifestations or death. Independent risk factors for acute RVF infection were consuming or handling products from sick animals (odds ratio [OR] = 2.53, 95% confidence interval [CI] = 1.78-3.61, population attributable risk percentage [PAR%] = 19%) and being a herds person (OR 1.77, 95% CI = 1.20-2.63, PAR% = 11%). Touching an aborted animal fetus was associated with severe RVF disease (OR = 3.83, 95% CI = 1.68-9.07, PAR% = 14%). Consuming or handling products from sick animals was associated with death (OR = 3.67, 95% CI = 1.07-12.64, PAR% = 47%). Exposures related to animal contact were associated with acute RVF infection, whereas exposures to mosquitoes were not independent risk factors.
Collapse
|
34
|
Huppmann S, Lankes E, Verstege A, Czernik C, Varnholt V, Schnabel D. Ausgeprägtes Salzverlustsyndrom bei Pseudohyperaldosteronismus Typ 1 eines männlichen Frühgeborenen. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1223140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
35
|
Achilla R, Bulimo W, Schnabel D. An Evaluation of the Epidemiology of Adenovirus Infections in Kenya Using a Sustained Laboratory-Based Sentinel Surveillance System. Int J Infect Dis 2008. [DOI: 10.1016/j.ijid.2008.05.813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
36
|
Grasemann C, Ratjen F, Schnabel D, Reutershahn E, Vester U, Grasemann H. Effect of growth hormone therapy on nitric oxide formation in cystic fibrosis patients. Eur Respir J 2008; 31:815-21. [DOI: 10.1183/09031936.00103907] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
37
|
Roth J, Wust M, Rawer R, Schnabel D, Armbrecht G, Beller G, Rembitzki I, Wahn U, Felsenberg D, Staab D. Whole body vibration in cystic fibrosis--a pilot study. J Musculoskelet Neuronal Interact 2008; 8:179-187. [PMID: 18622087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION In cystic fibrosis (CF), bone mass deficits as well as a lack of muscle mass and force have been described. The bone mass deficits are thought to be at least in part secondary to the reduced muscle mass. Whole body vibration has recently been suggested as an effective technique to increase muscle force and power. The aim of this pilot study was to evaluate the compliance and safety of a side-alternating, whole body vibration platform in patients with CF and to assess its effects on muscle force, muscle power, bone mass and lung function. PATIENTS AND METHODS Eleven adult CF patients participated in a six-months home-based training programme on a whole body vibration platform. Muscle force and power were assessed with three standard manoeuvres on a ground reaction force plate at regular intervals. Bone densitometry was performed at the spine, the radius and the tibia using quantitative computerized tomography. RESULTS Regular cardiovascular monitoring did not show any critical drop in oxygen saturation or blood pressure. Lung function remained relatively constant with a median FEV1 change [% of norm] of -3.1% (range -7-20). Trabecular density at the spine and parameters of bone density and geometry at the radius and tibia did not show consistent changes. A median decrease of -0.3% (-31.0-17.9) for muscle force and a median increase of 4.7% (-16.4-74.5) for muscle power and 6.6% (-0.9-48.3) for velocity was noted in the two-leg jump. In the one-leg jump, a median increase of 6.7% (-8.5-24.3) for muscle force was measured. CONCLUSIONS Whole body vibration was well tolerated in the majority of the study participants. Most patients were able to increase peak force in the one-leg jump. In the two-leg jump, velocity and muscle power increased with equal or decreased muscle force. This may indicate an improvement in neuromuscular and intramuscular co-ordination (and therefore efficiency) with less muscle force necessary to generate the same power.
Collapse
Affiliation(s)
- J Roth
- Children's Hospital of Eastern Ontario, Ottawa, Canada.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
Rickets is caused by deficient mineralization at the level of growth plate and is usually due to a decreased serum calcium/phosphate product. Although the diagnosis of rickets can usually be suspected on the basis of a clinical examination (bone deformities in legs, impaired growth), radiological examination and detailed biochemical work-up are necessary to elucidate the etiology of the underlying disease. It is important to differentiate between calcipenic/vitamin deficient and phosphopenic rickets. The former is due to vitamin D deficiency, and the ultimate cause of this usually lies in altered vitamin D supply; however, impaired synthesis of or resistance to the actions of vitamin D can also be a cause. Phosphopenic rickets is usually related to impaired phosphate reabsorption in the proximal renal tubule. Both calcipenic and phosphopenic rickets can be acquired or hereditary in origin.
Collapse
Affiliation(s)
- D Schnabel
- Pädiatrische Endokrinologie und Diabetologie, Otto-Huebner-Centrum für Kinder- und Jugendmedizin, Charité, CVK--Universitätsmedizin Berlin.
| | | |
Collapse
|
39
|
|
40
|
von Heppe JH, Krude H, L'Allemand D, Schnabel D, Grüters A. The use of L-T4 as liquid solution improves the practicability and individualized dosage in newborns and infants with congenital hypothyroidism. J Pediatr Endocrinol Metab 2004; 17:967-74. [PMID: 15301044 DOI: 10.1515/jpem.2004.17.7.967] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED Dosage recommendations for the initial therapy of congenital hypothyroidism (CH) in newborns vary between 8 microg/kg/d and 10-15 microg/kg/d. AIM To evaluate the practicability of LT4 in liquid form and to define the initial dosage for optimal treatment. METHODS Liquid LT4 solution was administered to 28 consecutive newborns with primary CH. We measured TSH, T3, T4, free T3 and free T4 before therapy and during follow-up up to 2 years. After 2 years a standardized developmental test (Griffith) was performed. RESULTS The median dosage at start of therapy was 12.3 microg LT4/kg/d and decreased to about 5 microg LT4/kg/d after 9 months. The median time of normalization of TSH (< or =6 mU/l) was 2 weeks. In 21 patients, who received a median starting dosage of 12.7 microg LT4/kg (range 9.8-17.1 microg/kg), TSH levels normalized within a median of 1 week. Seven patients receiving only 10.1 microg LT4/kg normalized their TSH only after a median of 2 months. CONCLUSIONS Newborns with CH should normalize their TSH within 1-2 weeks. The initial dose necessary to normalize TSH is not lower when a liquid solution is used. The higher dose used in tablets is not due to inefficient absorption, but rather reflects the increased demand for thyroid hormone in the first weeks of life.
Collapse
Affiliation(s)
- J H von Heppe
- Charité, Humboldt-Universität, Pediatric Endocrinology, Otto-Heubner Centrum für Kinder- und Jugendmedizin, Berlin, Germany
| | | | | | | | | |
Collapse
|
41
|
Elmlinger MW, Mayer I, Schnabel D, Schuett BS, Diesing D, Romalo G, Wollmann HA, Weidemann W, Spindler KD, Ranke MB, Schweikert HU. Decreased expression of IGF-II and its binding protein, IGF-binding protein-2, in genital skin fibroblasts of patients with complete androgen insensitivity syndrome compared with normally virilized males. J Clin Endocrinol Metab 2001; 86:4741-6. [PMID: 11600534 DOI: 10.1210/jcem.86.10.7883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The action of androgen by way of the AR is required for the development of male gonads and external genitalia. The interplay between androgens and the somatotropic axis, in particular the IGFs in sexual development, is currently under thorough investigation. The IGF system is thought to mediate the androgen action in androgen-responsive cells. To investigate the interaction of androgens with the IGF system, we compared the expression of IGFs and IGF-binding proteins in cultured genital skin fibroblasts from nine patients with the syndrome of complete androgen insensitivity with that in genital skin fibroblasts from 10 normally virilized males. Mutations in the AR gene and/or abnormalities of the AR protein in the immunoblot were detected in all complete androgen insensitivity genital skin fibroblast strains. They caused a complete failure of DHT binding. RIA and RT-PCR demonstrated that the genital skin fibroblast strains expressed IGF-II, IGF-binding protein-2, and IGF-binding protein-3, but no IGF-I. Most strikingly, complete androgen insensitivity genital skin fibroblast strains produced significantly lower IGF-II (P < 0.001; 42.2 +/- 9.7 vs. 106.9 +/- 11.8 ng/mg protein) and IGF-II mRNA (P < 0.01, by RT-PCR) than control genital skin fibroblast strains. The production of IGF-binding protein-2 was also decreased (P < 0.03) in complete androgen insensitivity genital skin fibroblasts, whereas that of IGF-binding protein-3 did not differ. Furthermore, high levels of IGF-binding protein-5 mRNA were detected in all genital skin fibroblast strains, whereby the 28-kDa band in the ligand blot, probably representing IGF-binding protein-5, was more abundant in complete androgen insensitivity genital skin fibroblasts. Exposure of the genital skin fibroblasts to T (5 x 10(-8) M) had only weak effects on the expression of IGFs and IGF-binding proteins. In conclusion, although the mechanism underlying these differences requires further study, it is conceivable that in addition to the endocrine actions of IGF-I, IGF-II and IGF-binding protein-2, as local growth factors, are involved in the mediation of androgen action and growth of genital tissues.
Collapse
Affiliation(s)
- M W Elmlinger
- Pediatric Endocrinology, University Children's Hospital, Hoppe Seyler Strasse 1, D-72076 Tubingen, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Musebeck J, Mohnike K, Beye P, Tönnies H, Neitzel H, Schnabel D, Grüters A, Wieacker PF, Stumm M. Short stature homeobox-containing gene deletion screening by fluorescence in situ hybridisation in patients with short stature. Eur J Pediatr 2001; 160:561-5. [PMID: 11585080 DOI: 10.1007/s004310100790] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED The short stature homeobox-containing gene (SHOX) on the short arm of the X and Y chromosomes is an important determining factor of stature phenotype. Absence of the SHOX gene is a main cause for short stature in patients with Turner syndrome. Mutations of the SHOX gene can also be responsible for Léri-Weill syndrome (dyschondrosteosis). The aim of this study was to determine the frequency of SHOX deletions in short stature children and to delineate indications for SHOX deletion screening. Out of 50 probands, 35 had idiopathic short stature, 12 cases showed additional anomalies of the forearms (in particular Madelung deformity) and three patients were affected by a congenital heart defect. Chromosomal investigations with fluoresence in situ hybridisation did not reveal a SHOX deletion in any patient with idiopathic short stature. In five of the 12 patients (41.7%) with anomalies of the forearms, a SHOX deletion on one sex chromosome could be detected. No deletion was observed in the three cases with additional heart defects. CONCLUSION The frequency of short stature homeobox-containing gene deletions in patients with idiopathic short stature appears to be very low and does not require a fluorescence in situ hybridisation analysis. Short stature in association with anomalies of the forearms such as Madelung deformity makes a deletion more probable and therefore screening for such deletions is recommended in these cases.
Collapse
Affiliation(s)
- J Musebeck
- Institut für Humangenetik, Otto-von-Guericke-Universität, Magdeburg, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
In patients with congenital hypothyroidism (CH), the autosomal recessive inheritance of mutations of thyroid peroxidase, thyroglobulin and the NIS and pendrin genes encoding for sodium iodide transporters has been identified. CH due to thyroid dysgenesis was considered to be a sporadic disease, but recently, inheritable defects of thyroid development have been described. The autosomal recessive inheritance of mutations of the thyroid-stimulating hormone receptor gene was recognized in patients with CH and thyroid hypoplasia, while autosomal dominant mutations of the Pax-8 gene were described in patients with thyroid dysgenesis. In addition, analysis of mutations of the beta-thyrotropin gene has resulted in a new understanding of the pathogenesis of central CH. Molecular genetic studies in patients with CH detected by newborn screening will provide the information necessary for genetic counselling and may help to explain the less favourable outcome present in 5-10% of the patients.
Collapse
Affiliation(s)
- H Krude
- Department of Pediatrics, Charité University Hospital, Humboldt University, Berlin, Germany
| | | | | | | | | |
Collapse
|
44
|
L'Allemand D, Tardy V, Grüters A, Schnabel D, Krude H, Morel Y. How a patient homozygous for a 30-kb deletion of the C4-CYP 21 genomic region can have a nonclassic form of 21-hydroxylase deficiency. J Clin Endocrinol Metab 2000; 85:4562-7. [PMID: 11134109 DOI: 10.1210/jcem.85.12.7018] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
A case of nonclassic (NC) 21-hydroxylase deficiency, with a moderately elevated 17-hydroxyprogesterone level (145 nmol/L in filter paper blood spot), was detected in newborn screening. The newborn's phenotype was female, with no sign of virilization. Confirmatory diagnosis revealed elevated serum levels of 17-hydroxyprogesterone and of 21-desoxycortisol, whereas cortisol, PRA, and electrolytes were normal. Hydrocortisone substitution was considered at the age of 6 months, when virilization became obvious. For clinical reasons, this case had to be classified as late-onset congenital adrenal hyperplasia (CAH) with unusually early manifestation. However, the diagnosis of classic 21-hydroxylase deficiency was obtained by Southern blotting studies, showing that she was homozygous for the 30-kb deletion, including the 3' end of CYP21P pseudogene, the C4B gene, and the 5' end of the functional CYP21 gene. Further studies, using PCR and sequencing, were conducted to explain the discrepancy between this genotype, usually associated with a classic salt-wasting form, and the girl's phenotype. Typically, patients homozygous for the 30-kb deletion encoding classic CAH possess a unique CYP21P/21 hybrid gene with the junction site located after the third exon, yielding a nonfunctional pseudogene. The girl in question, however, was heterozygous for the 8-bp deletion, suggesting that the chimeric pseudogene on one allele had a junction site before the third exon. She was compound heterozygous for a 30-kb deletion encoding classic CAH on the paternal allele, and a 30-kb deletion encoding NC CAH on the maternal allele. This novel maternal CYP21P/21 hybrid gene is characterized by a junction site before intron 2 and differs from the normal CYP21 gene only by the P30L mutation in exon 1 and the promoter region of the CYP21P pseudogene. Because the P30L mutation has been described to result in an enzyme with 30-60% activity of the normal P450c21 enzyme, and the CYP21P promoter reduced the transcription to 20% of normal, this puzzling phenotype of a NC CAH with early onset may be fully explained by the genotype of the patient and considered as an intermediate form between the simple virilizing and NC form.
Collapse
Affiliation(s)
- D L'Allemand
- Department of Pediatrics, Virchow-Klinikum, Charité, Humboldt University, 13353 Berlin, Germany
| | | | | | | | | | | |
Collapse
|
45
|
Schnabel D, l'Allemand D, Krude H, Keller E, Grüters A. Ergebnisse des Neugeborenenscreenings zur Früherkennung des Adrenogenitalen Syndroms in Berlin (1992-1999). Monatsschr Kinderheilkd 2000. [DOI: 10.1007/s001120050684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
46
|
Netchine I, Sobrier ML, Krude H, Schnabel D, Maghnie M, Marcos E, Duriez B, Cacheux V, Moers AV, Goossens M, Grüters A, Amselem S. Mutations in LHX3 result in a new syndrome revealed by combined pituitary hormone deficiency. Nat Genet 2000; 25:182-6. [PMID: 10835633 DOI: 10.1038/76041] [Citation(s) in RCA: 274] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Combined pituitary hormone deficiency (CPHD) has been linked with rare abnormalities in genes encoding transcription factors necessary for pituitary development. We have isolated LHX3, a gene involved in a new syndrome, using a candidate-gene approach developed on the basis of documented pituitary abnormalities of a recessive lethal mutation in mice generated by targeted disruption of Lhx3 (ref. 2). LHX3, encoding a member of the LIM class of homeodomain proteins, consists of at least six exons located at 9q34. We identified a homozygous LHX3 defect in patients of two unrelated consanguineous families displaying a complete deficit in all but one (adrenocorticotropin) anterior pituitary hormone and a rigid cervical spine leading to limited head rotation. Two of these patients also displayed a severe pituitary hypoplasia, whereas one patient presented secondarily with an enlarged anterior pituitary. These LHX3 mutations consist of a missense mutation (Y116C) in the LIM2 domain at a phylogenetically conserved residue and an intragenic deletion predicting a severely truncated protein lacking the entire homeodomain. These data are consistent with function of LHX3 in the proper development of all anterior pituitary cell types, except corticotropes, and extrapituitary structures.
Collapse
MESH Headings
- Abnormalities, Multiple/genetics
- Abnormalities, Multiple/pathology
- Abnormalities, Multiple/physiopathology
- Amino Acid Sequence
- Base Sequence
- Cervical Vertebrae/abnormalities
- Cervical Vertebrae/physiopathology
- Chromosomes, Human, Pair 9/genetics
- Cloning, Molecular
- Consanguinity
- DNA Mutational Analysis
- Exons/genetics
- Female
- Homeodomain Proteins/chemistry
- Homeodomain Proteins/genetics
- Humans
- LIM-Homeodomain Proteins
- Male
- Molecular Sequence Data
- Mutation/genetics
- Mutation, Missense/genetics
- Pedigree
- Physical Chromosome Mapping
- Pituitary Gland, Anterior/abnormalities
- Pituitary Gland, Anterior/physiopathology
- Pituitary Hormones, Anterior/analysis
- Pituitary Hormones, Anterior/deficiency
- Rotation
- Sequence Alignment
- Sequence Deletion/genetics
- Syndrome
- Transcription Factors
Collapse
Affiliation(s)
- I Netchine
- [1] Laboratoire de Génétique et de Physiopathologie, Institut National de la Santé et de la Recherche Médicale (INSERM) U.468, Hôpital Henri-Mondor, Créteil, France
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Brabant G, Horn R, von zur Mühlen A, Mayr B, Wurster U, Heidenreich F, Schnabel D, Grüters-Kieslich A, Zimmermann-Belsing T, Feldt-Rasmussen U. Free and protein bound leptin are distinct and independently controlled factors in energy regulation. Diabetologia 2000; 43:438-42. [PMID: 10819236 DOI: 10.1007/s001250051326] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS/HYPOTHESIS Leptin exerts important regulating effects on energy homeostasis and could have a central role in our understanding of obesity, diabetes mellitus and the metabolic syndrome. Leptin circulates in a free and protein bound form. The aim of the present study was to test whether both fractions of the leptin system can be selectively regulated and thus serve independent physiological roles. METHODS Using specific radioimmunoassays we measured both leptin components in relation to BMI in healthy subjects before and after weight reduction and in hyperthyroid patients during correction of thyrotoxicosis. In the latter group body composition and resting energy expenditure was monitored. In addition, we measured serum and cerebrospinal fluid concentrations of free and bound leptin in patients with neurological disorders. RESULTS Under all conditions free leptin concentrations reflected body fat mass. Bound leptin concentrations decreased during weight reduction but also after treatment of hyperthyroidism despite an increase in fat mass. Direct measurement of resting energy expenditure and bound leptin in hyperthyroid patients and under thyrostatic treatment showed a significant positive correlation of both variables. In contrast to free leptin whose transport into the cerebrospinal fluid appears to be saturated at low physiological concentrations of serum free leptin, bound leptin concentrations in the cerebrospinal fluid increased in parallel to serum concentrations over the whole physiologically relevant range. CONCLUSION/INTERPRETATION Our data indicate a distinct role of free and bound leptin in the feedback regulating energy intake and expenditure and could have important implications for our understanding of the physiology and pathophysiology of leptin-dependent signalling.
Collapse
Affiliation(s)
- G Brabant
- Department of Clinical Endocrinology, School of Medicine, Hannover, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Affiliation(s)
- H Krude
- Kinderpoliklinik, Humboldtuniversität zu Berlin, Germany
| | | | | | | |
Collapse
|
49
|
Thiele B, Weidemann W, Schnabel D, Romalo G, Schweikert HU, Spindler KD. Complete androgen insensitivity caused by a new frameshift deletion of two base pairs in exon 1 of the human androgen receptor gene. J Clin Endocrinol Metab 1999; 84:1751-3. [PMID: 10323411 DOI: 10.1210/jcem.84.5.5664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We describe a novel mutation in exon 1 of the androgen receptor gene in a patient with complete androgen insensitivity (CAIS). Endocrine findings were typical for androgen insensitivity (testosterone serum levels in the upper limit of normal males and increased LH serum concentrations). Biochemical investigations in cultured genital skin fibroblasts of the patient showed a normal 5alpha-reductase activity but a complete absence of androgen binding. Western blot analysis revealed no detectable protein product. Sequence analysis of the entire coding region of the androgen receptor gene resulted in the identification of a 2-bp deletion in codon 472, causing frameshift and introduction of a premature stop codon 27 codons downstream of the mutation.
Collapse
Affiliation(s)
- B Thiele
- Institute of Zoophysiology, Department of Endocrinology and Developmental Biology, University of Düsseldorf, Germany
| | | | | | | | | | | |
Collapse
|
50
|
Abstract
Expression of CD44 is involved in the maturation as well as the homing of haemopoietic progenitor cells. Whether these processes are mediated by CD44 standard (CD44s) or variant (CD44v) isoforms is unknown. To assign functional activities of CD44 in haemopoiesis of the rat to distinct isoforms, ligand binding of haemopoietic progenitor cells was inhibited by monoclonal antibodies recognizing an epitope on CD44s (Ox50) or CD44 exon v6, (1.1ASML). The vast majority of rat bone marrow cells (BMC) as well as stromal cells and non-adherent cells in long-term bone marrown culture (LTBMC) expressed CD44s. Bone marrow cells and non-adherent cells in LTBMC, but not the stromal cells, also contained a population of large and granulated cells, which stained with anti-CD44v6. In vivo and in vitro reconstitution experiments revealed that homing of BMC as well as settlement on stromal elements was influenced exclusively by anti-CD44s, which also inhibited proliferation of progenitor cells. Anti-CD44v6 had no influence on homing and seeding, but interfered with stroma formation and progenitor maturation. Finally, restoration of functional activity of T-lineage cells was impaired in the presence of anti-CD44v6. The data indicate that CD44s and CD44v6 fulfilled distinct functions in haemopoiesis of the rat. Although CD44s facilitated homing and expansion of stem cells, progenitor cells, CD44v6 was involved in differentiation processes, particularly of lymphoid progenitor cells.
Collapse
Affiliation(s)
- S Khaldoyanidi
- Department of Tumour Progression and Immune Defence, German Cancer Research Centre, Heidelberg, Germany
| | | | | | | |
Collapse
|