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Campillo JT, Dupasquier V, Lebredonchel E, Rancé LG, Hemilembolo MC, Pion SDS, Boussinesq M, Missamou F, Perez Martin A, Chesnais CB. Association between arterial stiffness and Loa loa microfilaremia in a rural area of the Republic of Congo: A population-based cross-sectional study (the MorLo project). PLoS Negl Trop Dis 2024; 18:e0011915. [PMID: 38241411 PMCID: PMC10830006 DOI: 10.1371/journal.pntd.0011915] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/31/2024] [Accepted: 01/12/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Loa loa filariasis (loiasis) is still considered a relatively benign disease. However, recent epidemiologic data suggest increased mortality and morbidity in L. loa infected individuals. We aimed to examine whether the density of L. loa microfilariae (mfs) in the blood is associated with cardiovascular disease. METHODOLOGY Using a point-of-care device (pOpmètre), we conducted a cross-sectional study to assess arterial stiffness and peripheral arterial disease (PAD) in 991 individuals living in a loiasis-endemic rural area in the Republic of the Congo. Microfilaremic individuals were matched for age, sex and village of residence with 2 amicrofilaremic subjects. We analyzed markers of arterial stiffness (Pulse-Wave Velocity, PWV), PAD (Ankle-Brachial Index, ABI) and cardiovascular health (Pulse Pressure, PP). The analysis considered parasitological results (L. loa microfilarial density [MFD], soil-transmitted helminths infection, asymptomatic malaria and onchocerciasis), sociodemographic characteristics and known cardiovascular risk factors (body mass index, smoking status, creatininemia, blood pressure). PRINCIPAL FINDINGS Among the individuals included in the analysis, 192/982 (19.5%) and 137/976 (14.0%) had a PWV or an ABI considered out of range, respectively. Out of range PWV was associated with younger age, high mean arterial pressure and high L. loa MFD. Compared to amicrofilaremic subjects, those with more than 10,000 mfs/mL were 2.17 times more likely to have an out of range PWV (p = 0.00). Factors significantly associated with PAD were older age, low pulse rate, low body mass index, smoking, and L. loa microfilaremia. Factors significantly associated with an elevation of PP were older age, female sex, high average blood pressure, low pulse rate and L. loa microfilaremia. CONCLUSION A potential link between high L. loa microfilaremia and cardiovascular health deterioration is suggested. Further studies are required to confirm and explore this association.
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Affiliation(s)
- Jérémy T. Campillo
- TransVIHMI, Université de Montpellier, INSERM Unité 1175, Institut de Recherche pour le Développement (IRD), Montpellier, France
| | - Valentin Dupasquier
- Department of Cardiology, Montpellier University Hospital, Montpellier, France
| | - Elodie Lebredonchel
- Département de Biochimie, Hôpitaux Universitaires Paris Nord Val de Seine–site Bichat, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Ludovic G. Rancé
- Department of Anesthesiology and Critical Care Medicine, Montpellier University Hospital, Montpellier, France
| | - Marlhand C. Hemilembolo
- TransVIHMI, Université de Montpellier, INSERM Unité 1175, Institut de Recherche pour le Développement (IRD), Montpellier, France
- Programme National de Lutte contre l’Onchocercose, Direction de l’Épidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo
| | - Sébastien D. S. Pion
- TransVIHMI, Université de Montpellier, INSERM Unité 1175, Institut de Recherche pour le Développement (IRD), Montpellier, France
| | - Michel Boussinesq
- TransVIHMI, Université de Montpellier, INSERM Unité 1175, Institut de Recherche pour le Développement (IRD), Montpellier, France
| | - François Missamou
- Programme National de Lutte contre l’Onchocercose, Direction de l’Épidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo
| | - Antonia Perez Martin
- Vascular Medicine Laboratory, Nîmes University Hospital, Nîmes, France
- IDESP, Université de Montpellier, INSERM, Montpellier, France
| | - Cédric B. Chesnais
- TransVIHMI, Université de Montpellier, INSERM Unité 1175, Institut de Recherche pour le Développement (IRD), Montpellier, France
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Hemilembolo MC, Campillo JT, Niama AC, Pion SDS, Missamou F, Boussinesq M, Bileckot RR, Chesnais CB. Loa loa and Mansonella perstans microfilaremia in the department of Lékoumou, Republic of Congo. Parasit Vectors 2023; 16:451. [PMID: 38071391 PMCID: PMC10710712 DOI: 10.1186/s13071-023-06056-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Loiasis is endemic in the northern and western part of the Republic of Congo. Between 2004 and 2010, surveys were conducted, using the RAPLOA method, in all departments of the Republic of Congo to assess the distribution of loiasis. Prior to 2004, only two parasitological surveys on loiasis had been conducted in Congo and mainly in the Department of Lékoumou, in the southwestern of the country. In 2019, we conducted a parasitological survey in this same department, more than 30 years after the first surveys. METHODS The study was conducted in 21 villages. Loa loa and Mansonella perstans microfilaremia levels were quantified using 50 µl calibrated blood smears. RESULTS A total of 2444 individuals were examined. The median age of the screened individuals was 43 (interquartile range: 30-57, range: 18-91) years old. The overall prevalences of L. loa and M. perstans microfilaremia were 20.0% [95% confidence intervals (CI) 18.0-21.6%] and 1.0% (95% CI 0.6-1.4%) respectively. The proportion of individuals with a microfilarial density of L. loa > 8000 mf/ml and > 30,000 mf/ml were 5.1% (95% CI 4.3-6.1%) and 1.1% (95% CI 0.8-1.7%), respectively. The overall community microfilarial load was 3.4 mf/ml. CONCLUSIONS Prevalences and intensities of L. loa infection remained generally stable between the late 1980s and 2019 in the Lékoumou Department. In contrast, parasitological indicators for M. perstans have declined sharply in the intervening years for an unknown reason.
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Affiliation(s)
- Marlhand C Hemilembolo
- TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175, Montpellier, France
- Programme National de Lutte Contre l'Onchocercose, Ministère de la Santé et de la Population, Brazzaville, République du Congo
| | - Jérémy T Campillo
- TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175, Montpellier, France
| | - Ange Clauvel Niama
- Faculté des Sciences de la santé de l'Université Marien NGOUABI, Brazzaville, République du Congo
| | - Sébastien D S Pion
- TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175, Montpellier, France
| | - François Missamou
- Programme National de Lutte Contre l'Onchocercose, Ministère de la Santé et de la Population, Brazzaville, République du Congo
| | - Michel Boussinesq
- TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175, Montpellier, France
| | - Richard R Bileckot
- Faculté des Sciences de la santé de l'Université Marien NGOUABI, Brazzaville, République du Congo
| | - Cédric B Chesnais
- TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175, Montpellier, France.
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Campillo JT, Hemilembolo MC, Pion SDS, Lebredonchel E, Dupasquier V, Boullé C, Rancé LG, Boussinesq M, Missamou F, Chesnais CB. Association between blood Loa loa microfilarial density and proteinuria levels in a rural area of the Republic of Congo (the MorLo project): a population-based cross-sectional study. Lancet Microbe 2023; 4:e704-e710. [PMID: 37480932 PMCID: PMC10469262 DOI: 10.1016/s2666-5247(23)00142-8] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Case reports have hypothesised that proteinuria, sometimes with glomerulopathy or nephrotic syndromes, might be associated with loiasis. To our knowledge, no study has been done to assess this association. We aimed to investigate the association between Loa loa microfilariae burden and proteinuria. METHODS We did a cross-sectional study between May 16, 2022, and June 11, 2022, to assess the relationship between Loa loa microfilaraemia densities and proteinuria in a rural area of the Republic of Congo. We included all consenting adults living in the target area at study commencement who had L loa microfilarial densities greater than 500 microfilariae per mL during previous screening for a clinical trial in 2019. This study is part of the MorLo project, and used the project's study population of individuals aged 18 years or older who were living near Sibiti. For each microfilaraemic individual, two individuals without L loa microfilarial densities matched on age, sex, and place of residence were included. The association between proteinuria (assessed by dipstick) and L loa microfilarial densities, age, and sex was assessed using an unconstrained ordinal regression model since the parallel-lines assumption was violated for microfilarial densities. FINDINGS 991 participants were included, of whom 342 (35%) were L loa microfilaraemic. The prevalence of microfilaraemia was 38% (122 of 325) among individuals with trace proteinuria (<300 mg/24 h), 51% (45 of 89) among individuals with light proteinuria (300 mg to 1 g/24 h), and 71% (15 of 21) among individuals with high proteinuria (>1 g/24 h). Individuals with high proteinuria had significantly higher L loa microfilarial densities (p<0·0001): mean microfilariae per mL were 1595 (SD 4960) among individuals with no proteinuria, 2691 (7982) for those with trace proteinuria, 3833 (9878) for those with light proteinuria, and 13 541 (20 118) for those with high proteinuria. Individuals with 5000-14 999 microfilariae per mL and individuals with 15 000 microfilariae per mL or greater were, respectively, 5·39 and 20·49 times more likely to have a high proteinuria than individuals with no microfilaraemia. INTERPRETATION The risk of proteinuria increases with L loa microfilaraemia. Further studies are needed to identify renal disorders (eg, tubulopathies, glomerulopathies, or nephrotic syndromes) responsible for loiasis-related proteinuria. FUNDING European Research Council, MorLo project. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Jérémy T Campillo
- TransVIHMI, Université de Montpellier, INSERM Unité 1175, Institut de Recherche pour le Développement, Montpellier, France.
| | - Marlhand C Hemilembolo
- TransVIHMI, Université de Montpellier, INSERM Unité 1175, Institut de Recherche pour le Développement, Montpellier, France; Programme National de Lutte contre l'Onchocercose, Direction de l'Épidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of the Congo
| | - Sébastien D S Pion
- TransVIHMI, Université de Montpellier, INSERM Unité 1175, Institut de Recherche pour le Développement, Montpellier, France
| | - Elodie Lebredonchel
- Département de Biochimie, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Valentin Dupasquier
- Department of Cardiology, Montpellier University Hospital, Montpellier, France
| | - Charlotte Boullé
- TransVIHMI, Université de Montpellier, INSERM Unité 1175, Institut de Recherche pour le Développement, Montpellier, France; Department of Infectious and Tropical Diseases, Montpellier University Hospital, Montpellier, France
| | - Ludovic G Rancé
- Department of Anesthesiology and Critical Care Medicine, Montpellier University Hospital, Montpellier, France
| | - Michel Boussinesq
- TransVIHMI, Université de Montpellier, INSERM Unité 1175, Institut de Recherche pour le Développement, Montpellier, France
| | - François Missamou
- Programme National de Lutte contre l'Onchocercose, Direction de l'Épidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of the Congo
| | - Cédric B Chesnais
- TransVIHMI, Université de Montpellier, INSERM Unité 1175, Institut de Recherche pour le Développement, Montpellier, France
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Checkouri T, Missamou F, Pion SDS, Bikita P, Hemilembolo MC, Boussinesq M, Chesnais CB, Campillo JT. Association between altered cognition and Loa loa microfilaremia: First evidence from a cross-sectional study in a rural area of the Republic of Congo. PLoS Negl Trop Dis 2023; 17:e0011430. [PMID: 37339123 DOI: 10.1371/journal.pntd.0011430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/03/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Individuals with high Loa loa microfilarial densities are at risk of developing severe encephalopathy after administration of antiparasitic drugs. Apart from this finding, loiasis is considered benign with no effect on brain function. However, recent epidemiological data suggest an increased mortality and morbidity in L. loa infected individuals, underscoring the importance of studies on the possible neurological morbidity associated with loiasis. METHODOLOGY Using MoCA tests and neurological ultrasounds, we conducted a cross-sectional study to assess cognitive alteration in a population living in a rural area endemic for loiasis in the Republic of Congo. Fifty individuals with high microfilarial densities (MFD) were matched on sex, age and residency with 50 individuals with low MFD and 50 amicrofilaremic subjects. Analyses focused on individuals with MoCA scores indicating an altered cognition (i.e. < 23/30) and on the total MoCA score according to Loa loa MFD, sociodemographic characteristics and neurological ultrasound results. PRINCIPAL FINDINGS MoCA scores were very low in the studied population (mean of 15.6/30). Individuals with more than 15,000 microfilariae per milliliter of blood (mean predicted score:14.0/30) are more than twenty times more likely to have an altered cognition, compared to individuals with no microfilaremia (mean predicted score: 16.3/30). Years of schooling were strongly associated with better MoCA results. Extracranial and intracranial atheroma were not associated with L. loa MFD. CONCLUSION/SIGNIFICANCE Loaisis microfilaremia is probably involved in cognitive impairment, especially when the MFD are high. These results highlight the urgent need to better understand loaisis-induced morbidity. Further studies investigating neurological morbidity of loiasis are needed.
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Affiliation(s)
- Thomas Checkouri
- AP-HP, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - François Missamou
- Programme National de Lutte contre l'Onchocercose, Direction de l'Épidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of the Congo
| | - Sebastien D S Pion
- UMI 233 TransVIHMI, Université Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité, Montpellier, France
| | - Paul Bikita
- Programme National de Lutte contre l'Onchocercose, Direction de l'Épidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of the Congo
| | - Marlhand C Hemilembolo
- Programme National de Lutte contre l'Onchocercose, Direction de l'Épidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of the Congo
- UMI 233 TransVIHMI, Université Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité, Montpellier, France
| | - Michel Boussinesq
- UMI 233 TransVIHMI, Université Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité, Montpellier, France
| | - Cédric B Chesnais
- UMI 233 TransVIHMI, Université Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité, Montpellier, France
| | - Jérémy T Campillo
- UMI 233 TransVIHMI, Université Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité, Montpellier, France
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Bruschi F, Dupouy-Camet J, Boussinesq M, Pozio E. Comments on 'A case report of Trichinella spiralis pericarditis: an unusual cause of pericardial effusion and cardiac tamponade in an immunocompetent urban black African'. Eur Heart J Case Rep 2023; 7:ytad179. [PMID: 37252205 PMCID: PMC10213713 DOI: 10.1093/ehjcr/ytad179] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Fabrizio Bruschi
- Corresponding author. Tel: +39(050)2218547, Fax: +39(050)2218557,
| | | | - Michel Boussinesq
- UMI 233, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175, Université de Montpellier, Montpellier, France
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Campillo JT, Louya F, Bikita P, Missamou F, Boussinesq M, Pion SDS, Bertout S, Chesnais CB. [Reliability evaluation in rural Congo of the calibrated blood smear technique to assess Loa loa microfilaremia level]. Med Trop Sante Int 2023; 3:mtsi.v3i1.2023.297. [PMID: 37389374 PMCID: PMC10300661 DOI: 10.48327/mtsi.v3i1.2023.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/06/2023] [Indexed: 07/01/2023]
Abstract
Background-Rationale The diagnosis of Loa loa microfilaremia consists in the observation, using a microscope, of microfilariae in a sample of peripheral blood spread on a slide and subsequently stained (the "blood smear technique"). The accurate quantification of Loa loa microfilaremia is important because the choice of the first intention treatment depends on the patient's microfilaremia: severe adverse events can occur in individuals with high microfilarial densities when treated with ivermectin or diethylcarbamazine, the latter drug being the only one which can definitively cure the infection. However, despite the widespread usage of this technique and its role in guiding clinical management of the patient, estimates of its reliability remain scarce. Materials and methods We evaluated the reliability (reproducibility and repeatability) of blood smear technique using several sets of 10 L. loo-positive slides, randomly selected, and considered the results with regard to regulatory requirements. The slides had been prepared as part of a clinical trial conducted in Sibiti, Republic of Congo, a region where loiasis is endemic. Results The estimated and acceptable coefficients of repeatability (NB: the lower, the better) were 13.6% and 16.0%, respectively. The estimated and acceptable coefficients of intermediate reliability (reproducibility) were 15.1% and 22.5%, respectively. The poorest coefficient of intermediate reliability was 19.5% when the tested parameter was related to the technician who performed the readings (10.7% when the reading day was changed). The inter-technician coefficient of variation assessed using 1876 L. loo-positive slides was 13.2%. The coefficient of inter-technician variation considered acceptable was estimated at 18.6%. Discussion-Conclusion. All estimated coefficients of variability were lower than the calculated acceptable coefficients suggesting reliability of the technique, although the lack of laboratory references precludes any conclusion on the quality of this diagnosis. It is imperative to implement a quality system and standardization of procedures for the diagnosis of L. loo microfilaremia, both in endemic countries and in the rest of the world, where the demand for diagnosis has been increasing for years.
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Affiliation(s)
- Jérémy T. Campillo
- TransVIHMI, Université de Montpellier, Institut de recherche pour le développement (IRD), INSERM Unité 1175, 911 avenue Agropolis, 34000 Montpellier, France
| | - Frédéric Louya
- Programme national de lutte contre l'onchocercose, Direction de l’Épidémiologie et de la lutte contre la maladie, Ministère de la Santé et de la population, Brazzaville, République du Congo
| | - Paul Bikita
- Programme national de lutte contre l'onchocercose, Direction de l’Épidémiologie et de la lutte contre la maladie, Ministère de la Santé et de la population, Brazzaville, République du Congo
| | - François Missamou
- Programme national de lutte contre l'onchocercose, Direction de l’Épidémiologie et de la lutte contre la maladie, Ministère de la Santé et de la population, Brazzaville, République du Congo
| | - Michel Boussinesq
- TransVIHMI, Université de Montpellier, Institut de recherche pour le développement (IRD), INSERM Unité 1175, 911 avenue Agropolis, 34000 Montpellier, France
| | - Sébastien D. S. Pion
- TransVIHMI, Université de Montpellier, Institut de recherche pour le développement (IRD), INSERM Unité 1175, 911 avenue Agropolis, 34000 Montpellier, France
| | - Sébastien Bertout
- TransVIHMI, Université de Montpellier, Institut de recherche pour le développement (IRD), INSERM Unité 1175, 911 avenue Agropolis, 34000 Montpellier, France
- Laboratoire de Parasitologie et mycologie médicale, Université de Montpellier, Montpellier, France
| | - Cédric B. Chesnais
- TransVIHMI, Université de Montpellier, Institut de recherche pour le développement (IRD), INSERM Unité 1175, 911 avenue Agropolis, 34000 Montpellier, France
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Hemilembolo MC, Niama AC, Campillo JT, Pion SD, Missamou F, Whittaker C, Kankou JM, Ndziessi G, Bileckot RR, Boussinesq M, Chesnais CB. Excess Mortality Associated With Loiasis: Confirmation by a New Retrospective Cohort Study Conducted in the Republic of Congo. Open Forum Infect Dis 2023; 10:ofad103. [PMID: 36968967 PMCID: PMC10034755 DOI: 10.1093/ofid/ofad103] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/23/2023] [Indexed: 03/25/2023] Open
Abstract
Background Loiasis (Loa loa filariasis) is considered a benign disease and is currently not included in the World Health Organization’s (WHO's) list of Neglected Tropical Diseases, despite mounting evidence suggesting significant disease burden in endemic areas. We conducted a retrospective cohort study to assess the mortality associated with L. loa microfilaremia in the Southwestern Republic of Congo. Methods The cohort included 3329 individuals from 53 villages screened for loiasis in 2004. We compared mortality rates in 2021 for individuals initially diagnosed as with or without L. loa microfilariae 17 years earlier. Data were analyzed at the community level to calculate crude mortality rates. Survival models were used to estimate the effect of L. loa microfilaremia on mortality in the population. Results At baseline, prevalence of microfilaremia was 16.2%. During 17.62 years of cohort follow-up, 751 deaths were recorded, representing a crude mortality rate of 15.36 (95% CI, 14.28–16.50) per 1000 person-years. Median survival time was 58.5 (95% CI, 49.7–67.3) years and 39.2 (95% CI, 32.6–45.8) years for amicrofilaremic and microfilaremic indiviudals, respectively. Conclusions A significant reduction in life expectancy was associated with L. loa microfilaremia, confirming previous observations from Cameroon. This adds to the evidence that loiasis is not a benign disease and deserves to be included in the WHO's list of Neglected Tropical Diseases.
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Affiliation(s)
- Marlhand C Hemilembolo
- UMI 233 TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité, Montpellier, France
- Programme National de Lutte contre l'Onchocercose, Direction de l'Épidémiologie et de la Lutte contre les Maladies, Ministère de la Santé et de la Population, Brazzaville, République du Congo
| | - Ange Clauvel Niama
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, United Kingdom
| | - Jérémy T Campillo
- UMI 233 TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité, Montpellier, France
| | - Sébastien D Pion
- UMI 233 TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité, Montpellier, France
| | - François Missamou
- Programme National de Lutte contre l'Onchocercose, Direction de l'Épidémiologie et de la Lutte contre les Maladies, Ministère de la Santé et de la Population, Brazzaville, République du Congo
| | - Charles Whittaker
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, United Kingdom
| | - Jean-Médard Kankou
- Programme National de Lutte contre l'Onchocercose, Direction de l'Épidémiologie et de la Lutte contre les Maladies, Ministère de la Santé et de la Population, Brazzaville, République du Congo
| | - Gilbert Ndziessi
- Faculté des Sciences de la Santé, Université Marien-Ngouabi, Brazzaville, République du Congo
| | - Richard R Bileckot
- Faculté des Sciences de la Santé, Université Marien-Ngouabi, Brazzaville, République du Congo
| | | | - Cédric B Chesnais
- Correspondence: Cédric B. Chesnais, MD, PhD, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175, 911 avenue Agropolis 34000, Montpellier, France ()
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Boullé C, Chesnais CB, Kamgno J, Gardon J, Chippaux JP, Ranque S, Garcia A, Pion SD, Boussinesq M. Evaluating post-treatment Loa loa microfilarial densities to classify serious adverse events caused by ivermectin: a retrospective analysis. Lancet Microbe 2023; 4:e93-e101. [PMID: 36646105 DOI: 10.1016/s2666-5247(22)00331-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/12/2022] [Accepted: 11/07/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND The elimination of onchocerciasis requires increasing ivermectin treatment coverage in communities hypoendemic for onchocerciasis. In areas where loiasis is co-endemic, this approach is complicated by the risk of serious adverse events following treatment with ivermectin in individuals with a high Loa loa microfilarial density (MFD). We aimed to evaluate the extent to which the pre-treatment MFD can be inferred from post-treatment MFDs. METHODS For this retrospective analysis, we used data from seven clinical or community trials (six were used for the main analysis and one for the secondary analysis) conducted in Cameroon, in which MFDs were measured both before and after (within 14 days) receiving a single dose of ivermectin (150-200 μg/kg bodyweight). The primary objective was to establish the receiver operating characteristic curves and the corresponding area under the curve statistics of MFD measured after treatment to classify pre-treatment MFD (MFDD0) according to common risk thresholds of serious adverse events. We assessed the performance of post-treatment MFD to accurately classify MFDD0 according to commonly used thresholds using bootstrap procedures. FINDINGS 281 individuals with MFD measurements available before and 3-10 days after ivermectin treatment were enrolled. Our results show that an MFD of more than 3500 L loa microfilariae per mL of blood (mf per mL) 3 or 4 days after treatment indicates a 68·6% chance (positive predictive value) of an MFDD0 of more than 20 000 mf per mL. An MFD of more than 3500 mf per mL at day 5-10 corresponds to a 72·2% chance of having an MFDD0 of more than 20 000 mf per mL. Conversely, an MFD of less than 2500 microfilariae per mL at day 3-4 or day 5-10 corresponds to a probability of 92·3% or 92·8% (negative predictive value) of having MFDD0 of less than 20 000 mf per mL. An MFD less than 1500 mf per mL on days 3-4 after treatment was associated with a 78·3% probability of having an MFDD0 less than 8000 mf per mL; this probability increased to 89·6% on days 5-10 after treatment. INTERPRETATION The MFD threshold of 1000 mf per mL within 1 month of treatment, which is commonly used to attribute the occurrence of a serious adverse event to ivermectin, should be revised. In this study, we present tables that can help to assess this attributability as part of mass or individual treatments. FUNDING None.
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Affiliation(s)
- Charlotte Boullé
- UMI 233, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175, Université de Montpellier, Montpellier, France; Services des Maladies Infectieuses et Tropicales, Montpellier University Hospital, Centre Hospitalier Universitaire La Colombière, Montpellier, France.
| | - Cédric B Chesnais
- UMI 233, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175, Université de Montpellier, Montpellier, France
| | - Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon; Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Jacques Gardon
- Hydrosciences Montpellier, IRD, Université de Montpellier, Centre National de la Recherche Scientifique, Montpellier, France
| | | | - Stéphane Ranque
- Aix Marseille University, IRD, Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Santé des Armées (SSA), VITROME, Institut Hospito-Universitaire (IHU)-Méditerranée Infection, Marseille, France
| | - André Garcia
- UMR 261 MERIT, IRD, Paris University, Paris, France
| | - Sébastien D Pion
- UMI 233, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175, Université de Montpellier, Montpellier, France
| | - Michel Boussinesq
- UMI 233, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175, Université de Montpellier, Montpellier, France.
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9
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Campillo JT, Hemilembolo MC, Louya F, Bikita P, Pion SDS, Boussinesq M, Missamou F, Chesnais CB. Temporal variability of Loa loa microfilaraemia. Parasit Vectors 2023; 16:23. [PMID: 36691079 PMCID: PMC9869825 DOI: 10.1186/s13071-022-05612-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/06/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The diurnal periodicity of Loa loa microfilaraemia is well known but few studies have documented the short- and long-term stability of microfilarial density. It seems stable over time at the community level, but significant variations have been observed at the individual level. METHODS We assessed the temporal variability of L. loa microfilaraemia at 5-day, 1-month and 16-month intervals and analyzed the influence of sex, age, level of microfilaraemia, temperatures and time of sampling on this variability. RESULTS At the community level, L. loa microfilaraemia is very stable over time at 5-day, 1-month and 16-month intervals (Pearson correlation coefficients of 0.92, 0.91 and 0.78, respectively, all three with P < 0.001). However, some individuals had significant variations of up to ± 50% of their initial microfilaraemia at 5-day (33.0%), 1-month (36.5%) and 16-month (62.6%) intervals, even in individuals with an initial microfilaraemia density > 20,000 mf/ml (7.7, 23.1 and 41.4%, respectively, for 5 days, 1 month and 16 months). We do not highlight any external factors that have a major impact on this variability. CONCLUSION Although at the community level, microfilaria density is very stable, we highlight some individuals with large variations in both the short and long term, which may have an important impact on onchocerciasis control campaigns and longitudinal studies evaluating the impact of an intervention on L. loa microfilaraemia.
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Affiliation(s)
- Jérémy T. Campillo
- grid.121334.60000 0001 2097 0141TransVIHMI, INSERM Unité 1175, Institut de Recherche pour le Développement (IRD), Université de Montpellier, Montpellier, France
| | - Marlhand C. Hemilembolo
- grid.121334.60000 0001 2097 0141TransVIHMI, INSERM Unité 1175, Institut de Recherche pour le Développement (IRD), Université de Montpellier, Montpellier, France ,Programme National de Lutte contre l’Onchocercose, Direction de l’Épidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo
| | - Frédéric Louya
- Programme National de Lutte contre l’Onchocercose, Direction de l’Épidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo
| | - Paul Bikita
- Programme National de Lutte contre l’Onchocercose, Direction de l’Épidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo
| | - Sébastien D. S. Pion
- grid.121334.60000 0001 2097 0141TransVIHMI, INSERM Unité 1175, Institut de Recherche pour le Développement (IRD), Université de Montpellier, Montpellier, France
| | - Michel Boussinesq
- grid.121334.60000 0001 2097 0141TransVIHMI, INSERM Unité 1175, Institut de Recherche pour le Développement (IRD), Université de Montpellier, Montpellier, France
| | - François Missamou
- Programme National de Lutte contre l’Onchocercose, Direction de l’Épidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo
| | - Cédric B. Chesnais
- grid.121334.60000 0001 2097 0141TransVIHMI, INSERM Unité 1175, Institut de Recherche pour le Développement (IRD), Université de Montpellier, Montpellier, France
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10
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Domche A, Nwane PB, Nana Djeunga HC, Njitchouang GR, Pion SD, Boussinesq M, Njiokou F, Kamgno J. Status of Onchocerca volvulus (Spirurida: Onchocercidae) Transmission and Effect of Climatic Variables on the Vector Population Dynamics After Two Decades of Ivermectin-based Preventive Chemotherapy in the Mbam Valley (Centre Region, Cameroon). J Med Entomol 2022; 59:2130-2138. [PMID: 36111691 DOI: 10.1093/jme/tjac133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Indexed: 06/15/2023]
Abstract
Entomological indicators of onchocerciasis transmission and the effect of climatic variables on the vector population dynamics were investigated in two first-line villages after more than two decades of mass drug administration with ivermectin. Female blackflies were collected in two villages (Bayomen and Biatsota) using human landing method for a period of 12 months. Blackflies were dissected and entomological indices were computed. Monthly temperature, precipitation, and humidity were collected and the Spearman correlation rank test was used to assess the relationship between biting rates and climatic variables. The highest biting rates (62,280 bites/human/month in Bayomen and 42,090 bites/human/month in Biatsota) were recorded during the long rainy season (November). The Onchocerca volvulus transmission was greater during the long dry season in both villages, with a peak at the beginning of the long dry season in Biatsota (100 infective larvae/human/month), and at the middle of the long dry season in Bayomen (92 infective larvae/human/month). No correlation was found between biting rates and selected climatic variables in the two villages. This study revealed that onchocerciasis transmission is ongoing in the study area despite almost 25 years of Community-Directed Treatment with Ivermectin. In accordance with WHO recommendations, vector control should be used in combination with mass drug administration to accelerate transmission interruption of onchocerciasis. To be optimal, this vector control should be implemented during the long dry season (November to March) when water volumes are low and transmission potentials are high.
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Affiliation(s)
- André Domche
- Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
- Parasitology and Ecology Laboratory, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé 1, Yaoundé, Cameroon
| | - Philippe B Nwane
- Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
- Parasitology and Ecology Laboratory, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé 1, Yaoundé, Cameroon
| | - Hugues C Nana Djeunga
- Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Guy R Njitchouang
- Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Sébastien D Pion
- TransVIHMI, University of Montpellier, Institut de Recherche pour le Développement (IRD), Institut National de la Santé et de la Recherche Médicale (INSERM), Montpellier, France
| | - Michel Boussinesq
- TransVIHMI, University of Montpellier, Institut de Recherche pour le Développement (IRD), Institut National de la Santé et de la Recherche Médicale (INSERM), Montpellier, France
| | - Flobert Njiokou
- Parasitology and Ecology Laboratory, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé 1, Yaoundé, Cameroon
| | - Joseph Kamgno
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
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11
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Veletzky L, Eberhardt KA, Hergeth J, Stelzl DR, Zoleko Manego R, Mombo-Ngoma G, Kreuzmair R, Burger G, Adegnika AA, Agnandji ST, Matsiegui PB, Boussinesq M, Mordmüller B, Ramharter M. Distinct loiasis infection states and associated clinical and hematological manifestations in patients from Gabon. PLoS Negl Trop Dis 2022; 16:e0010793. [PMID: 36121900 PMCID: PMC9521832 DOI: 10.1371/journal.pntd.0010793] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/29/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background Loiasis–a filarial disease endemic in Central and West Africa–is increasingly recognized as significant individual and public health concern. While the understanding of the disease characteristics remains limited, significant morbidity and excess mortality have been demonstrated. Here, we characterize clinical and hematological findings in a large cohort from Gabon. Methods Loiasis-related clinical manifestations and microfilaremia, hemoglobin and differential blood counts were recorded prospectively during a cross-sectional survey. For analysis, participants were categorized into distinct infection states by the diagnostic criteria of eye worm history and microfilaremia. Results Analysis of data from 1,232 individuals showed that occurrence of clinical and hematological findings differed significantly between the infection states. Eye worm positivity was associated with a wide range of clinical manifestations while microfilaremia by itself was not. Loa loa infection was associated with presence of eosinophilia and absolute eosinophil counts were associated with extent of microfilaremia (p-adj. = 0.012, ß-estimate:0.17[0.04–0.31]). Conclusions Loiasis is a complex disease, causing different disease manifestations in patients from endemic regions. The consequences for the affected individuals or populations as well as the pathophysiological consequences of correlating eosinophilia are largely unknown. High-quality research on loiasis should be fostered to improve patient care and understanding of the disease. Loiasis is a parasitic disease, endemic in parts of Western and Central Africa. While the disease has traditionally been considered to be benign, only recently significant disease morbidity and mortality have been shown. Most of the knowledge about loiasis, however, stems from reports on returning travelers, while comprehensive data from patients living in endemic areas are missing. Blood microfilaremia and reported eye worm are important diagnostic manifestations of the disease, but they can occur independent of each other in affected individuals. We analyzed hematological and clinical findings according to loiasis infection states, comprising reported eye worm and microfilaremia positivity, in a large group of individuals from a highly endemic area. While we found that all loiasis infection states were significantly associated with absolute blood eosinophilia, the eosinophilia was more pronounced in microfilaremic loiasis. Further, there was an association between the extent of microfilaremia and absolute eosinophilia. Analyzing the frequency of clinical disease manifestations, we found that eye worm positive loiasis was associated with a range of symptoms, but microfilaremic loiasis was not. Summarizing, even in highly endemic populations different loiasis infection states are associated with distinct disease manifestations, underlining that loiasis is a versatile and indeed relevant disease.
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Affiliation(s)
- Luzia Veletzky
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Dep. of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- German Center For Infection Research (DZIF), Hamburg-Borstel-Riems, Germany
- * E-mail: (LV); (MR)
| | - Kirsten Alexandra Eberhardt
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Dep. of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Daniel Robert Stelzl
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rella Zoleko Manego
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Dep. of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany & German Center for Infection Research, partner site Tübingen, Tübingen, Germany
| | - Ghyslain Mombo-Ngoma
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Dep. of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany & German Center for Infection Research, partner site Tübingen, Tübingen, Germany
| | - Ruth Kreuzmair
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Gerrit Burger
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany & German Center for Infection Research, partner site Tübingen, Tübingen, Germany
| | - Ayôla Akim Adegnika
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany & German Center for Infection Research, partner site Tübingen, Tübingen, Germany
| | - Selidji Todagbe Agnandji
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany & German Center for Infection Research, partner site Tübingen, Tübingen, Germany
| | | | - Michel Boussinesq
- Institut de Recherche pour le Développement (IRD), UMI 233-TransVIHMI-Inserm U1175-University of Montpellier, Montpellier, France
| | - Benjamin Mordmüller
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany & German Center for Infection Research, partner site Tübingen, Tübingen, Germany
- Radboud University Medical Center, Department of Medical Microbiology, Nijmegen, The Netherlands
| | - Michael Ramharter
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Dep. of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- German Center For Infection Research (DZIF), Hamburg-Borstel-Riems, Germany
- * E-mail: (LV); (MR)
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12
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Nana-Djeunga HC, Sicard CM, Mogoung-Wafo AE, Chesnais CB, Deléglise H, Touka-Nounkeu R, Domche A, Golden A, Klion AD, Nutman TB, Boussinesq M, Kamgno J, Pion SD. Changes in Onchocerciasis Ov16 IgG4 Rapid Diagnostic Test Results Over One-Month Follow-up: Lessons for Reading Timeframe and Decision-Making. Am J Trop Med Hyg 2022; 107:tpmd211201. [PMID: 35914689 PMCID: PMC9490668 DOI: 10.4269/ajtmh.21-1201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 11/17/2021] [Accepted: 04/30/2022] [Indexed: 11/14/2022] Open
Abstract
The SD Bioline® IgG4 rapid diagnostic test (RDT) detects IgG4 antibodies induced by the Onchocerca volvulus-specific antigen Ov16. We evaluated the stability of the RDT results over 1 month, at different time points after completion of each assay, using eluted dried blood spots collected in central Cameroon. Agreement coefficients regarding positivity between 30 minutes and 24 hours, 1, 2, 3, and 4 weeks were, 96.4%, 93.4%, 93.3%, 93.2%, and 93.2%, respectively. Between 30 minutes and 24 hours, 3.6% of the 15,444 tests showed inconsistent results with 81.2% of these tests changing from negative to positive, increasing O. volvulus antibody prevalence from 23.9% to 26.2% (P < 0.0001). This change from negative to positive outcome was confirmed at the subsequent timepoints. Depending on the desired accuracy of prevalence estimates, reading time may have to be redefined more strictly.
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Affiliation(s)
| | - Capucine M. Sicard
- Institut de Recherche pour le Développement, UMI 233-Inserm U1175-Montpellier University, Montpellier, France
| | - Aude E. Mogoung-Wafo
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
| | - Cédric B. Chesnais
- Institut de Recherche pour le Développement, UMI 233-Inserm U1175-Montpellier University, Montpellier, France
| | - Hugo Deléglise
- Institut de Recherche pour le Développement, UMI 233-Inserm U1175-Montpellier University, Montpellier, France
| | - Rufine Touka-Nounkeu
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
| | - André Domche
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
- Parasitology and Ecology Laboratory, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé 1, Yaoundé, Cameroon
| | | | - Amy D. Klion
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Thomas B. Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Michel Boussinesq
- Institut de Recherche pour le Développement, UMI 233-Inserm U1175-Montpellier University, Montpellier, France
| | - Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Sébastien D. Pion
- Institut de Recherche pour le Développement, UMI 233-Inserm U1175-Montpellier University, Montpellier, France
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Ngatse JA, Ndziessi G, Missamou F, Kinouani R, Hemilembolo M, Pion SD, Bork KA, Abena AA, Boussinesq M, Chesnais CB. Historical overview and geographical distribution of neglected tropical diseases amenable to preventive chemotherapy in the Republic of the Congo: A systematic review. PLoS Negl Trop Dis 2022; 16:e0010560. [PMID: 35816549 PMCID: PMC9302787 DOI: 10.1371/journal.pntd.0010560] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 07/21/2022] [Accepted: 06/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background Neglected Tropical Diseases amenable to Preventive Chemotherapy (PC-NTDs) affect the poorest populations around the world, especially in Africa. Scientific information on the distribution and level of endemicity of these diseases in the Republic of the Congo (RoC) is scarce in the published literature. We sought to collect all available epidemiological data on PC-NTDs in the RoC to document the historical and current situation and identify challenges in reaching the elimination of NTDs. Methods We searched Medline and Horizon databases for studies published until to July 4th, 2019, on onchocerciasis, lymphatic filariasis, soil-transmitted helminth infections, schistosomiasis, and trachoma in the RoC. Unpublished reports were also reviewed. We included all epidemiological studies containing community data and excluded case reports. Location, prevalence data, and dates of the studies were extracted. Principal findings We identified 933 records, of which 56 met the inclusion criteria. The articles published before 1960 mainly concerned onchocerciasis and schistosomiasis. Despite a low number over the studied period, since 2005 there has been a steady increase in the number of publications. Most of the studies were cross-sectional and conducted in the general population. Trachoma is endemic in the Sangha and Likouala departments (prevalence of trachomatous inflammation-follicular > 5% in some villages), and further mapping is essential to properly assess the burden of this disease in the country. While the prevalence of soil-transmitted helminths is still high (over 20%) in a large part of Congo, cases of lymphatic filariasis (based on Wuchereria bancrofti antigenaemia and/or microfilaraemia) and onchocerciasis are becoming rare and very focused. To achieve the elimination of PC-NTDs, further intervention is required. Conclusions Except for trachoma, whose epidemiological situation should be better evaluated, PC-NTDs are endemic in the RoC, and actions to control them have been taken by health authorities. To eliminate PC-NTDs, which are still present in some locations, new mapping surveys are needed, and increased investment in scientific research should be encouraged in the country. For many years, the Republic of the Congo has implemented control programs to combat neglected tropical diseases that cause severe disabilities. By tracing the past and recent distribution of these diseases through the analysis of epidemiological studies, we show that most remaining NTDs are located in defined foci of infection, maintained depending on ecology and lifestyle habits. However, the small number of recent studies limits the production of new knowledge, which would be useful for a better understanding of epidemiological patterns and to accelerate NTD elimination.
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Affiliation(s)
- Joseph A. Ngatse
- Faculté des Sciences de la Santé, Université Marien NGOUABI, Brazzaville, République du Congo
- UMI233, Institut de Recherche pour le Développement (IRD)-INSERM U1175-Université de Montpellier, Montpellier, France
- * E-mail: (JAN); (CBC)
| | - Gilbert Ndziessi
- Faculté des Sciences de la Santé, Université Marien NGOUABI, Brazzaville, République du Congo
| | - François Missamou
- Programme National de Lutte contre l’Onchocercose, Brazzaville, République du Congo
| | - Rodrigue Kinouani
- Centre de Recherche Géographique et de Production Cartographique, Brazzaville, République du Congo
| | - Marlhand Hemilembolo
- Programme National de Lutte contre l’Onchocercose, Brazzaville, République du Congo
| | - Sébastien D. Pion
- UMI233, Institut de Recherche pour le Développement (IRD)-INSERM U1175-Université de Montpellier, Montpellier, France
| | - Kirsten A. Bork
- UMI233, Institut de Recherche pour le Développement (IRD)-INSERM U1175-Université de Montpellier, Montpellier, France
| | - Ange A. Abena
- Faculté des Sciences de la Santé, Université Marien NGOUABI, Brazzaville, République du Congo
| | - Michel Boussinesq
- UMI233, Institut de Recherche pour le Développement (IRD)-INSERM U1175-Université de Montpellier, Montpellier, France
| | - Cédric B. Chesnais
- UMI233, Institut de Recherche pour le Développement (IRD)-INSERM U1175-Université de Montpellier, Montpellier, France
- * E-mail: (JAN); (CBC)
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Pion SDS, Chesnais CB, Weil GJ, Louya F, Boussinesq M, Missamou F. Impact of Semi-Annual Albendazole on Lymphatic Filariasis and Soil-Transmitted Helminth Infection: Parasitological Assessment after 14 Rounds of Community Treatment. Am J Trop Med Hyg 2021; 106:729-731. [PMID: 34929673 PMCID: PMC8832930 DOI: 10.4269/ajtmh.21-0731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 06/28/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022] Open
Abstract
Between October 2012 and October 2015, we conducted a community trial to assess the impact of semi-annual (twice yearly) community treatment with albendazole on lymphatic filariasis in Seke Pembe, a village in the Republic of the Congo. Semi-annual community treatment with albendazole has been continued in the community since October 2015. We conducted an additional parasitological assessment survey in October 2019, 6 months after the 14th round of semi-annual treatment. Between October 2012 and October 2015, Wuchereria bancrofti antigenemia and microfilaremia rates in the community had decreased from 17.3% to 4.7% and from 5.3% to 0.3%, respectively. In October 2019, the antigenemia rate had decreased further to 2.8% (19 of 687). No microfilariae were found in night blood smears from persons with circulating filarial antigenemia (0 of 16), suggesting that W. bancrofti transmission has been interrupted in Seke Pembe. Semi-annual albendazole treatments also reduced significantly infection rates with soil-transmitted helminths.
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Affiliation(s)
- Sébastien D S Pion
- Institut de Recherche pour le Développement, UMI233/INSERM U1175/Université de Montpellier, Montpellier, France
| | - Cédric B Chesnais
- Institut de Recherche pour le Développement, UMI233/INSERM U1175/Université de Montpellier, Montpellier, France
| | - Gary J Weil
- Infectious Diseases Division, Washington University School of Medicine, St. Louis, Missouri
| | - Frédéric Louya
- Programme National de Lutte contre l'Onchocercose, Direction de l'Epidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo
| | - Michel Boussinesq
- Institut de Recherche pour le Développement, UMI233/INSERM U1175/Université de Montpellier, Montpellier, France
| | - François Missamou
- Programme National de Lutte contre l'Onchocercose, Direction de l'Epidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo
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15
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Hendy A, Krit M, Pfarr K, Laemmer C, De Witte J, Nwane P, Kamgno J, Nana-Djeunga HC, Boussinesq M, Dujardin JC, Post R, Colebunders R, O'Neill S, Enyong P, Njamnshi AK. Onchocerca volvulus transmission in the Mbam valley of Cameroon following 16 years of annual community-directed treatment with ivermectin, and the description of a new cytotype of Simulium squamosum. Parasit Vectors 2021; 14:563. [PMID: 34727965 PMCID: PMC8561987 DOI: 10.1186/s13071-021-05072-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The onchocerciasis focus surrounding the lower Mbam and Sanaga rivers, where Onchocerca volvulus is transmitted by Simulium damnosum s.l. (Diptera: Simuliidae), was historically the largest in the southern regions of Cameroon. Annual community-directed treatment with ivermectin (CDTI) has been taking place since 2000, but recent studies have shown that new infections are occurring in children. We aimed to investigate blackfly biting and O. volvulus transmission rates along the lower Mbam river 16 years after the formal onset of annual CDTI. METHODS Black flies were collected for three consecutive days each month between July 2016 and June 2017 at two riverside villages and two inland sites situated 4.9 km and 7.9 km from the riverside. Specimens collected at each site were dissected on one of the three collection days each month to estimate parity rates and O. volvulus infection rates, while the remaining samples were preserved for pool screening. RESULTS In total, 93,573 S. damnosum s.l. black flies were recorded biting humans and 9281 were dissected. Annual biting rates of up to 606,370 were estimated at the riverside, decreasing to 20,540 at 7.9 km, while, based on dissections, annual transmission potentials of up to 4488 were estimated at the riverside, decreasing to 102 and 0 at 4.9 km and 7.9 km, respectively. However, pool screening showed evidence of infection in black flies at the furthest distance from the river. Results of both methods demonstrated the percentage of infective flies to be relatively low (0.10-0.36%), but above the WHO threshold for interruption of transmission. In addition, a small number of larvae collected during the dry season revealed the presence of Simulium squamosum E. This is the first time S. squamosum E has been found east of Lake Volta in Ghana, but our material was chromosomally distinctive, and we call it S. squamosum E2. CONCLUSIONS Relatively low O. volvulus infection rates appear to be offset by extremely high densities of biting black flies which are sustaining transmission along the banks of the lower Mbam river.
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Affiliation(s)
- Adam Hendy
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium. .,Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA.
| | - Meryam Krit
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kenneth Pfarr
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany.,German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Christine Laemmer
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany.,German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Jacobus De Witte
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Philippe Nwane
- Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Joseph Kamgno
- Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), Yaoundé, Cameroon.,Department of Public Health, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
| | - Hugues C Nana-Djeunga
- Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Michel Boussinesq
- Institut de Recherche pour le Développement (IRD), Montpellier, France
| | - Jean-Claude Dujardin
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Rory Post
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.,School of Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, UK
| | | | - Sarah O'Neill
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,CR 5, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Peter Enyong
- Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| | - Alfred K Njamnshi
- Neuroscience Lab, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon.,Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon.,Brain Research Africa Initiative (BRAIN), Geneva, Switzerland.,Neurology Department, Central Hospital Yaoundé, Yaoundé, Cameroon
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16
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Campillo JT, Bikita P, Hemilembolo M, Louya F, Missamou F, Pion SDS, Boussinesq M, Chesnais CB. Safety and efficacy of levamisole in loiasis: a randomized, placebo-controlled, double-blind clinical trial. Clin Infect Dis 2021; 75:19-27. [PMID: 34651190 PMCID: PMC9402607 DOI: 10.1093/cid/ciab906] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Individuals with high microfilarial densities (MFD) of Loa loa are at risk of developing serious adverse events (SAEs) after ivermectin treatment. Pretreatment with drugs progressively reducing Loa MFD below the risk threshold might help prevent these SAEs. We assessed the safety and efficacy of levamisole for this purpose. METHODS A double-blind, randomized, placebo-controlled, MFD-ascending trial was conducted in the Republic of the Congo. Participants were treated in 3 cohorts defined by pretreatment MFD and levamisole dose (Cohort 1: 1.0 kg and 1.5 mg/kg, Cohorts 2 and 3: 2.5 mg/kg). Safety outcomes were occurrence of SAE and AE frequency during the first week. The efficacy outcomes were MFD reduction from baseline and proportions of individuals with at least 40% and 80% MFD reduction at day 2 (D2), D7 and D30. RESULTS The two lowest doses (1.0 mg/kg and 1.5 mg/kg) caused no SAE but were ineffective. Compared to placebo, 2.5 mg/kg levamisole caused more mild AEs (10/85 vs. 3/85, P = .018), a higher median reduction from baseline to D2 (-12.9% vs. + 15.5%, P < .001), D7 (-4.9% vs. +18.7%, P < .001) and D30 (-0.5% vs. +13.5%, P = .036) and a higher percentage of participants with >40% MFD reduction at D2 (17.5% vs. 1.2%, P < .001), D7 (11.8% vs. 6.3%, P = .269) and D30 (18.5% vs. 9.6%, P = .107). CONCLUSIONS A single 2.5 mg/kg levamisole dose induces a promising transient reduction in Loa loa MFD and should encourage testing different regimens.
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Affiliation(s)
- Jérémy T Campillo
- UMI 233 TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175, Montpellier, France
| | - Paul Bikita
- Programme National de Lutte contre l'Onchocercose, Direction de l'Épidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of the Congo
| | - Marlhand Hemilembolo
- Programme National de Lutte contre l'Onchocercose, Direction de l'Épidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of the Congo
| | - Frédéric Louya
- Programme National de Lutte contre l'Onchocercose, Direction de l'Épidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of the Congo
| | - François Missamou
- Programme National de Lutte contre l'Onchocercose, Direction de l'Épidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of the Congo
| | - Sébastien D S Pion
- UMI 233 TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175, Montpellier, France
| | - Michel Boussinesq
- UMI 233 TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175, Montpellier, France
| | - Cédric B Chesnais
- UMI 233 TransVIHMI, Université de Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175, Montpellier, France
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17
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Morin A, Guillaume M, Ngarka L, Tatah GY, Siewe Fodjo JN, Wyart G, Nokam G, Tchoumi T, Nkinin MB, Njamnshi WY, Chokote E, Boussinesq M, Colebunders R, Chesnais CB, Gargala G, Parain D, Njamnshi AK. Epilepsy in the Sanaga-Mbam valley, an onchocerciasis-endemic region in Cameroon: electroclinical and neuropsychological findings. Epilepsia Open 2021; 6:513-527. [PMID: 35138694 PMCID: PMC8408605 DOI: 10.1002/epi4.12510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/14/2020] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Epilepsy is highly prevalent in onchocerciasis-endemic African regions. Various types of epilepsy have been described in such regions based essentially on clinical characteristics. METHODS We conducted a clinical, neurophysiological and neuropsychological study of epilepsy in the onchocerciasis-endemic region of Ntui, Sanaga-Mbam area, Cameroon. RESULTS One hundred and eighty-seven persons with presumed epilepsy were recruited in an epilepsy clinic in Ntui. Epilepsy was clinically confirmed in 144 (79%) subjects, 69 (46.0%) of them met the onchocerciasis-associated epilepsy (OAE) criteria, and 51 of 106 tested (48.1%) presented Ov16 antibodies. Electroencephalograms (EEG) were recorded in 91 participants, of which 36 (33%) were considered abnormal and 27 of 36 (75%) revealed bifrontotemporal spike and slow waves. Concerning the neuropsychological evaluation, 29% showed severe global cognitive impairment, 28% severe episodic memory impairment, and 66% severe frontal cognitive impairment. Half of the persons with epilepsy (PWE) suffered from a mental disorder. SIGNIFICANCE In PWE in the Sanaga-Mbam area in Cameroon, we observed EEG patterns similar to those described among persons with OAE, including nodding syndrome in other onchocerciasis-endemic areas. Most PWE presented with severe cognitive impairment. We hypothesize that onchocerciasis may induce neurocognitive disorders and epilepsy via a mechanism that involves mainly the frontal and temporal regions of the brain.
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Affiliation(s)
| | | | - Leonard Ngarka
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Department of NeurologyYaoundé Central Hospital/Faculty of Medicine and Biomedical SciencesThe University of Yaoundé 1YaoundéCameroon
| | - Godwin Y. Tatah
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Department of NeurologyCH Saint‐NazaireSaint‐NazaireFrance
| | - Joseph Nelson Siewe Fodjo
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Global Health InstituteUniversity of AntwerpAntwerpBelgium
| | | | | | | | - Mary Bello Nkinin
- Department of NeurologyYaoundé Central Hospital/Faculty of Medicine and Biomedical SciencesThe University of Yaoundé 1YaoundéCameroon
| | - Wepnyu Y. Njamnshi
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Department of NeurologyYaoundé Central Hospital/Faculty of Medicine and Biomedical SciencesThe University of Yaoundé 1YaoundéCameroon
| | - Eric‐Samuel Chokote
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
| | - Michel Boussinesq
- UMI 233Institut de Recherche pour le Développement (IRD)/Research and Development InstituteMontpellierFrance
- Montpellier UniversityMontpellierFrance
- INSERM Unit 1175MontpellierFrance
| | | | - Cédric B. Chesnais
- UMI 233Institut de Recherche pour le Développement (IRD)/Research and Development InstituteMontpellierFrance
- Montpellier UniversityMontpellierFrance
- INSERM Unit 1175MontpellierFrance
| | - Gilles Gargala
- Laboratory of Parasitology‐Mycology & EA7510Rouen University HospitalRouenFrance
| | | | - Alfred K. Njamnshi
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Department of NeurologyYaoundé Central Hospital/Faculty of Medicine and Biomedical SciencesThe University of Yaoundé 1YaoundéCameroon
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18
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Campillo JT, Eiden C, Boussinesq M, Pion SDS, Faillie JL, Chesnais CB. Adverse reactions with levamisole vary according to its indications and misuse: a systematic pharmacovigilance study. Br J Clin Pharmacol 2021; 88:1094-1106. [PMID: 34390273 PMCID: PMC9293185 DOI: 10.1111/bcp.15037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022] Open
Abstract
AIM Levamisole was initially prescribed for the treatment of intestinal worms. Because of immunomodulatory properties, levamisole has been used in inflammatory pathologies and in cancers in association with 5-fluorouracil. Levamisole is misused as a cocaine adulterant. Post-marketing reports have implicated levamisole in the occurrence of adverse drug reactions (ADRs) and its use is now limited in Europe and North America. In contrast, all other parts of the World continue to use single-dose as an anthelmintic. The aim of this study was to identify ADRs reported after levamisole exposure in VigiBase, the WHO's pharmacovigilance database, and analyze their frequency compared to other drugs and according to levamisole type of use. METHODS All levamisole-related ADRs were extracted from VigiBase®. Disproportionality analyses were conducted to investigate psychiatric, hepatobiliary, renal, vascular, nervous, blood, skin, cardiac, musculoskeletal and general ADRs associated with levamisole and other drugs exposure. In secondary analyses, we compared the frequency of ADRs between levamisole and mebendazole and between levamisole type of use. RESULTS Among the 1763 levamisole-related ADRs identified, psychiatric disorders (Reporting Odds-Ratio with 95% confidence intervals: 1.4 [1.2-2.6]), hepatobiliary disorders (2.4 [1.9-4.3]), vasculitis (6.5 [4.1-10.6]), encephalopathy (22.5 [17.4-39.9]), neuropathy (4.3 [2.9-7.1]), hematological disorders, mild rashes and musculoskeletal disorders were more frequently reported with levamisole than with other drug. The majority of levamisole-related ADRs occurred when the drug was administrated for a non-anti-infectious indication. CONCLUSION The great majority of the levamisole-related ADRs concerned its immunomodulatory indication and multiple doses regimen. Our results suggest that single-dose treatments for anthelmintic action have a good safety profile.
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Affiliation(s)
- Jérémy T Campillo
- UMI 233, Institut de Recherche pour le Développement (IRD), Montpellier, France.,Université de Montpellier, Montpellier, France.,INSERM Unité 1175, Montpellier, France
| | - Céline Eiden
- Department of medical pharmacology and toxicology, CHU Montpellier, Montpellier, France
| | - Michel Boussinesq
- UMI 233, Institut de Recherche pour le Développement (IRD), Montpellier, France.,Université de Montpellier, Montpellier, France.,INSERM Unité 1175, Montpellier, France
| | - Sébastien D S Pion
- UMI 233, Institut de Recherche pour le Développement (IRD), Montpellier, France.,Université de Montpellier, Montpellier, France.,INSERM Unité 1175, Montpellier, France
| | - Jean-Luc Faillie
- Department of medical pharmacology and toxicology, CHU Montpellier, Montpellier, France.,Desbrest Institute of Epidemiology and Public Health UMR UA11 INSERM, University of Montpellier, Montpellier, France
| | - Cédric B Chesnais
- UMI 233, Institut de Recherche pour le Développement (IRD), Montpellier, France.,Université de Montpellier, Montpellier, France.,INSERM Unité 1175, Montpellier, France
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Campillo J, Missamou F, Pion S, Montavon C, Boussinesq M, Chesnais C. Évaluation de l’efficacité et de la tolérance du lévamisole chez des patients microfilarémiques à Loa loa : essai clinique contrôlé randomisé à dose et intensité d’infection croissantes. Infect Dis Now 2021. [DOI: 10.1016/j.idnow.2021.06.172] [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: 11/30/2022]
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20
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Campillo J, Eiden C, Boussinesq M, Pion S, Faillie J, Chesnais C. Les effets indésirables associés au lévamisole varient en fonction de ses indications et de son mésusage : une étude systématique de pharmacovigilance. Infect Dis Now 2021. [DOI: 10.1016/j.idnow.2021.06.251] [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: 11/29/2022]
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21
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Campillo J, Boussinesq M, Bertout S, Faillie J, Chesnais C. Effets indésirables graves associés à l’ivermectine : une étude systématique de pharmacovigilance en Afrique subsaharienne et dans le reste du monde. Infect Dis Now 2021. [DOI: 10.1016/j.idnow.2021.06.266] [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: 11/25/2022]
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22
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Niamsi-Emalio Y, Nana-Djeunga HC, Chesnais CB, Pion SDS, Tchatchueng-Mbougua JB, Boussinesq M, Basáñez MG, Kamgno J. Unusual Localization of Blood-Borne Loa loa Microfilariae in the Skin Depends on Microfilarial Density in the Blood: Implications for Onchocerciasis Diagnosis in Coendemic Areas. Clin Infect Dis 2021; 72:S158-S164. [PMID: 33909066 PMCID: PMC8201578 DOI: 10.1093/cid/ciab255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The diagnostic gold standard for onchocerciasis relies on identification and enumeration of (skin-dwelling) Onchocerca volvulus microfilariae (mf) using the skin snip technique (SST). In a recent study, blood-borne Loa loa mf were found by SST in individuals heavily infected with L. loa, and microscopically misidentified as O. volvulus due to their superficially similar morphology. This study investigates the relationship between L. loa microfilarial density (Loa MFD) and the probability of testing SST positive. Methods A total of 1053 participants from the (onchocerciasis and loiasis coendemic) East Region in Cameroon were tested for (1) Loa MFD in blood samples, (2) O. volvulus presence by SST, and (3) Immunoglobulin (Ig) G4 antibody positivity to Ov16 by rapid diagnostic test (RDT). A Classification and Regression Tree (CART) model was used to perform a supervised classification of SST status and identify a Loa MFD threshold above which it is highly likely to find L. loa mf in skin snips. Results Of 1011 Ov16-negative individuals, 28 (2.8%) tested SST positive and 150 (14.8%) were L. loa positive. The range of Loa MFD was 0–85 200 mf/mL. The CART model subdivided the sample into 2 Loa MFD classes with a discrimination threshold of 4080 (95% CI, 2180–12 240) mf/mL. The probability of being SST positive exceeded 27% when Loa MFD was >4080 mf/mL. Conclusions The probability of finding L. loa mf by SST increases significantly with Loa MFD. Skin-snip polymerase chain reaction would be useful when monitoring onchocerciasis prevalence by SST in onchocerciasis–loiasis coendemic areas.
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Affiliation(s)
- Yannick Niamsi-Emalio
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Hugues C Nana-Djeunga
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Cédric B Chesnais
- Institut de Recherche pour le Développement (IRD), UMI233/INSERM U1175, Université de Montpellier , Montpellier, France
| | - Sébastien D S Pion
- Institut de Recherche pour le Développement (IRD), UMI233/INSERM U1175, Université de Montpellier , Montpellier, France
| | - Jules B Tchatchueng-Mbougua
- Service d'Epidémiologie, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun
| | - Michel Boussinesq
- Institut de Recherche pour le Développement (IRD), UMI233/INSERM U1175, Université de Montpellier , Montpellier, France
| | - María-Gloria Basáñez
- MRC Centre for Global Infectious Disease Analysis and London Centre for Neglected Tropical Disease Research, Dep artment of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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Sirima C, Bizet C, Hamou H, Červená B, Lemarcis T, Esteban A, Peeters M, Mpoudi Ngole E, Mombo IM, Liégeois F, Petrželková KJ, Boussinesq M, Locatelli S. Soil-transmitted helminth infections in free-ranging non-human primates from Cameroon and Gabon. Parasit Vectors 2021; 14:354. [PMID: 34225777 PMCID: PMC8259424 DOI: 10.1186/s13071-021-04855-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/22/2021] [Accepted: 06/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Zoonotic diseases are a serious threat to both public health and animal conservation. Most non-human primates (NHP) are facing the threat of forest loss and fragmentation and are increasingly living in closer spatial proximity to humans. Humans are infected with soil-transmitted helminths (STH) at a high prevalence, and bidirectional infection with NHP has been observed. The aim of this study was to determine the prevalence, genetic diversity, distribution and presence of co-infections of STH in free-ranging gorillas, chimpanzees and other NHP species, and to determine the potential role of these NHP as reservoir hosts contributing to the environmental sustenance of zoonotic nematode infections in forested areas of Cameroon and Gabon. METHODS A total of 315 faecal samples from six species of NHPs were analysed. We performed PCR amplification, sequencing and maximum likelihood analysis of DNA fragments of the internal transcribed spacer 2 (ITS2) nuclear ribosomal DNA to detect the presence and determine the genetic diversity of Oesophagostomum spp., Necator spp. and Trichuris spp., and of targeted DNA fragments of the internal transcribed spacer 1 (ITS1) to detect the presence of Ascaris spp. RESULTS Necator spp. infections were most common in gorillas (35 of 65 individuals), but also present in chimpanzees (100 of 222 individuals) and in one of four samples from greater spot-nosed monkeys. These clustered with previously described type II and III Necator spp. Gorillas were also the most infected NHP with Oesophagostomum (51/65 individuals), followed by chimpanzees (157/222 individuals), mandrills (8/12 samples) and mangabeys (7/12 samples), with O. stephanostomum being the most prevalent species. Oesophagostomum bifurcum was detected in chimpanzees and a red-capped mangabey, and a non-classified Oesophagostomum species was detected in a mandrill and a red-capped mangabey. In addition, Ternidens deminutus was detected in samples from one chimpanzee and three greater spot-nosed monkeys. A significant relative overabundance of co-infections with Necator and Oesophagostomum was observed in chimpanzees and gorillas. Trichuris sp. was detected at low prevalence in a gorilla, a chimpanzee and a greater spot-nosed monkey. No Ascaris was observed in any of the samples analysed. CONCLUSIONS Our results on STH prevalence and genetic diversity in NHP from Cameroon and Gabon corroborate those obtained from other wild NHP populations in other African countries. Future research should focus on better identifying, at a molecular level, the species of Necator and Oesophagostomum infecting NHP and determining how human populations may be affected by increased proximity resulting from encroachment into sylvatic STH reservoir habitats.
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Affiliation(s)
- C. Sirima
- Institut de Recherche Pour Le Développement (IRD), UMI 233-TransVIHMI-INSERM U1175–University of Montpellier, Montpellier, France
| | - C. Bizet
- Institut de Recherche Pour Le Développement (IRD), UMI 233-TransVIHMI-INSERM U1175–University of Montpellier, Montpellier, France
| | - H. Hamou
- Institut de Recherche Pour Le Développement (IRD), UMI 233-TransVIHMI-INSERM U1175–University of Montpellier, Montpellier, France
| | - B. Červená
- Institute of Vertebrate Biology, Czech Academy of Sciences, Květná 8, 603 65 Brno, Czech Republic
- Department of Pathology and Parasitology, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Brno, Czech Republic
| | - T. Lemarcis
- Institut de Recherche Pour Le Développement (IRD), UMI 233-TransVIHMI-INSERM U1175–University of Montpellier, Montpellier, France
| | - A. Esteban
- Institut de Recherche Pour Le Développement (IRD), UMI 233-TransVIHMI-INSERM U1175–University of Montpellier, Montpellier, France
| | - M. Peeters
- Institut de Recherche Pour Le Développement (IRD), UMI 233-TransVIHMI-INSERM U1175–University of Montpellier, Montpellier, France
| | - E. Mpoudi Ngole
- Projet Prévention du Sida Au Cameroun (PRESICA) and Virology Laboratory IMPM/IRD, Yaoundé, Cameroon
| | - I. M. Mombo
- Centre Interdisciplinaire de Recherches Médicales de Franceville, BP 769, Franceville, Gabon
| | - F. Liégeois
- Present Address: Institut de Recherche Pour Le Développement (IRD), Maladies Infectieuses Et Vecteurs : Écologie, Génétique, Évolution et Contrôle (MIVEGEC), IRD 224-CNRS 5290–University of Montpellier, Montpellier, France
| | - K. J. Petrželková
- Institute of Vertebrate Biology, Czech Academy of Sciences, Květná 8, 603 65 Brno, Czech Republic
- Biology Centre, Institute of Parasitology, Czech Academy of Sciences, Ceske Budejovice, Czech Republic
| | - M. Boussinesq
- Institut de Recherche Pour Le Développement (IRD), UMI 233-TransVIHMI-INSERM U1175–University of Montpellier, Montpellier, France
| | - S. Locatelli
- Institut de Recherche Pour Le Développement (IRD), UMI 233-TransVIHMI-INSERM U1175–University of Montpellier, Montpellier, France
- Present Address: Institut de Recherche Pour Le Développement (IRD), Maladies Infectieuses Et Vecteurs : Écologie, Génétique, Évolution et Contrôle (MIVEGEC), IRD 224-CNRS 5290–University of Montpellier, Montpellier, France
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Campillo JT, Awaca-Uvon NP, Missamou F, Tambwe JP, Kuyangisa-Simuna G, Weil GJ, Louya F, Boussinesq M, Pion SDS, Chesnais CB. Results From 2 Cohort Studies in Central Africa Show That Clearance of Wuchereria bancrofti Infection After Repeated Rounds of Mass Drug Administration With Albendazole Alone Is Closely Linked to Individual Adherence. Clin Infect Dis 2021; 73:e176-e183. [PMID: 32856050 PMCID: PMC8246789 DOI: 10.1093/cid/ciaa1232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background Two community trials conducted from 2012 to 2018 in the Republic of Congo and the Democratic Republic of the Congo demonstrated the efficacy of semiannual mass drug administration (MDA) with albendazole (ALB) alone on lymphatic filariasis (LF). However, a high interindividual heterogeneity in the clearance of infection was observed. Methods We analyzed trial data to assess the effect of individual adherence to ALB MDA on clearance of circulating filarial antigenemia (CFA) and microfilaremia. Community residents were offered a single dose of ALB every 6 months and tested for LF with a rapid test for CFA at baseline and then annually. CFA test results were scored on a semiquantitative scale. At each round, microfilaremia was assessed in CFA-positive individuals. All CFA-positive individuals for whom at least 1 follow-up measure was available were included in the analyses. Parametric survival models were used to assess the influence of treatment adherence on LF infection indicators. Results Of 2658 individuals enrolled in the trials, 394 and 129 were eligible for analysis of CFA and microfilaremia clearance, respectively. After adjusting for age, sex, and initial CFA score, the predicted mean time for clearing CFA was shorter in persons who had taken 2 doses of ALB per year (3.9 years) than in persons who had taken 1 or 0 dose (4.4 and 5.3 years; P < .001 for both). A similar pattern was observed for microfilaremia clearance. Conclusions These results demonstrate a clear dose-response relationship for the effect of ALB on clearance of CFA and microfilaremia.
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Affiliation(s)
- Jérémy T Campillo
- UMI 233, Institut de Recherche pour le Développement, Montpellier, France.,Université de Montpellier, Montpellier, France.,INSERM Unité 1175, Montpellier, France
| | - Naomi P Awaca-Uvon
- Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo
| | - Francois Missamou
- Programme National de Lutte contre l'Onchocercose, Direction de l'Epidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo
| | - Jean-Paul Tambwe
- Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo
| | | | - Gary J Weil
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Frédéric Louya
- Programme National de Lutte contre l'Onchocercose, Direction de l'Epidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo
| | - Michel Boussinesq
- UMI 233, Institut de Recherche pour le Développement, Montpellier, France.,Université de Montpellier, Montpellier, France.,INSERM Unité 1175, Montpellier, France
| | - Sébastien D S Pion
- UMI 233, Institut de Recherche pour le Développement, Montpellier, France.,Université de Montpellier, Montpellier, France.,INSERM Unité 1175, Montpellier, France
| | - Cédric B Chesnais
- UMI 233, Institut de Recherche pour le Développement, Montpellier, France.,Université de Montpellier, Montpellier, France.,INSERM Unité 1175, Montpellier, France
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25
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Blok DJ, Kamgno J, Pion SD, Nana-Djeunga HC, Niamsi-Emalio Y, Chesnais CB, Mackenzie CD, Klion AD, Fletcher DA, Nutman TB, de Vlas SJ, Boussinesq M, Stolk WA. Feasibility of Onchocerciasis Elimination Using a "Test-and-not-treat" Strategy in Loa loa Co-endemic Areas. Clin Infect Dis 2021; 72:e1047-e1055. [PMID: 33289025 PMCID: PMC8204788 DOI: 10.1093/cid/ciaa1829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Indexed: 12/29/2022] Open
Abstract
Background Mass drug administration (MDA) with ivermectin is the main strategy for onchocerciasis elimination. Ivermectin is generally safe, but is associated with serious adverse events in individuals with high Loa loa microfilarial densities (MFD). Therefore, ivermectin MDA is not recommended in areas where onchocerciasis is hypo-endemic and L loa is co-endemic. To eliminate onchocerciasis in those areas, a test-and-not-treat (TaNT) strategy has been proposed. We investigated whether onchocerciasis elimination can be achieved using TaNT and the required duration. Methods We used the individual-based model ONCHOSIM to predict the impact of TaNT on onchocerciasis microfilarial (mf) prevalence. We simulated precontrol mf prevalence levels from 2% to 40%. The impact of TaNT was simulated under varying levels of participation, systematic nonparticipation, and exclusion from ivermectin resulting from high L loa MFD. For each scenario, we assessed the time to elimination, defined as bringing onchocerciasis mf prevalence below 1.4%. Results In areas with 30% to 40% precontrol mf prevalence, the model predicted that it would take between 14 and 16 years to bring the mf prevalence below 1.4% using conventional MDA, assuming 65% participation. TaNT would increase the time to elimination by up to 1.5 years, depending on the level of systematic nonparticipation and the exclusion rate. At lower exclusion rates (≤2.5%), the delay would be less than 6 months. Conclusions Our model predicts that onchocerciasis can be eliminated using TaNT in L loa co-endemic areas. The required treatment duration using TaNT would be only slightly longer than in areas with conventional MDA, provided that participation is good.
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Affiliation(s)
- David J Blok
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Sebastien D Pion
- IRD UMI 233-INSERM U1175-Montpellier University, Montpellier, France
| | - Hugues C Nana-Djeunga
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Yannick Niamsi-Emalio
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Cedric B Chesnais
- IRD UMI 233-INSERM U1175-Montpellier University, Montpellier, France
| | | | - Amy D Klion
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States
| | - Daniel A Fletcher
- Department of Bioengineering and the Biophysics Program, University of California, Berkeley, California, United States
| | - Thomas B Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States
| | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Michel Boussinesq
- IRD UMI 233-INSERM U1175-Montpellier University, Montpellier, France
| | - Wilma A Stolk
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Campillo JT, Awaca-Uvon NP, Tambwe JP, Kuyangisa-Simuna G, Vlaminck J, Weil GJ, Boussinesq M, Chesnais CB, Pion SDS. A strong effect of individual compliance with mass drug administration for lymphatic filariasis on sustained clearance of soil-transmitted helminth infections. Parasit Vectors 2021; 14:310. [PMID: 34103096 PMCID: PMC8186172 DOI: 10.1186/s13071-021-04814-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The impact of semiannual mass drug administration (MDA) with albendazole (ALB; 400 mg) alone on lymphatic filariasis (LF) and soil-transmitted helminth (STH) infections was assessed during two trials conducted from 2012 to 2018 in the Republic of Congo and the Democratic Republic of Congo. The collected data were analyzed to evaluate the effect of compliance with ALB treatment on STH infections. METHODS STH infections were diagnosed with duplicate Kato-Katz thick smears and the results are reported as eggs per gram of stool. All subjects with at least two STH infection assessments were included in the analyses. We used parametric survival models to assess the influence of compliance with ALB treatment on the probability of (i) achieving sustained clearance of an STH infection, and (ii) acquiring an STH infection during the follow-up. RESULTS Out of 2658 subjects included in the trials, data on 202 participants (701 person-years; PY) with hookworm infection, 211 (651 PY) with Ascaris lumbricoides infection and 270 (1013 PY) with Trichuris trichiura infection were available to calculate the probability of achieving sustained clearance of infection. The effect of ALB was dose related for all three STH. For hookworm, the time required for sustained clearance was longer (4.3 years, P < 0.001) for participants who took zero doses per year and shorter (3.4 years, P = 0.112) for participants who took two doses per year compared to those who took one dose per year (3.7 years). For Ascaris, the time required to obtain sustained clearance followed the same pattern: 6.1 years (P < 0.001) and 3.2 years (P = 0.004) vs 3.6 years for, zero, two and one dose per year, respectively. For Trichuris, less time was required for sustained clearance (4.2 years, P < 0.001) for fully compliant participants, i.e. those who took two doses per year, than for those who only took one dose per year (5.0 years). ALB was more effective in achieving sustained clearance of STH infection in subjects with light baseline infection intensities compared to those with higher egg counts. CONCLUSION Our results illustrate the importance of MDA compliance at the level of the individual with respect to the STH benefit provided by semiannual ALB MDA, which is used for the elimination of LF in Central Africa.
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Affiliation(s)
- Jérémy T Campillo
- TransVIHMI, Université Montpellier, Institut de Recherche pour le Développement (IRD), INSERM, Montpellier, France
| | - Naomi P Awaca-Uvon
- Ministère de La Santé Publique, Kinshasa, Democratic Republic of the Congo
| | - Jean-Paul Tambwe
- Ministère de La Santé Publique, Kinshasa, Democratic Republic of the Congo
| | | | - Johnny Vlaminck
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Gary J Weil
- Washington University School of Medicine, St. Louis, MO, USA
| | - Michel Boussinesq
- TransVIHMI, Université Montpellier, Institut de Recherche pour le Développement (IRD), INSERM, Montpellier, France
| | - Cédric B Chesnais
- TransVIHMI, Université Montpellier, Institut de Recherche pour le Développement (IRD), INSERM, Montpellier, France
| | - Sébastien D S Pion
- TransVIHMI, Université Montpellier, Institut de Recherche pour le Développement (IRD), INSERM, Montpellier, France.
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Doret MPM, Nana-Djeunga HC, Nzune-Toche N, Pion SDS, Chesnais CB, Boussinesq M, Kamgno J, Varlet-Marie E, Locatelli S. Limitations of PCR detection of filarial DNA in human stools from subjects non-infected with soil-transmitted helminths. ACTA ACUST UNITED AC 2021; 28:47. [PMID: 34047694 PMCID: PMC8162058 DOI: 10.1051/parasite/2021046] [Citation(s) in RCA: 1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/11/2021] [Indexed: 11/22/2022]
Abstract
The standard techniques for diagnosis of human filariasis are the microscopic examination of blood smears or skin biopsies, which are relatively invasive and poorly sensitive at low levels of infection. Recently, filarial DNA has been detected in fecal samples from non-human primates in Central Africa. The aim of this study was to demonstrate proof-of-concept of a non-invasive molecular diagnosis technique for human filariasis by targeting fragments of 12S rDNA, Cox1, ITS1 and LL20-15kDa ladder antigen-gene by conventional PCR in DNA extracted from stool samples of 52 people infected with Mansonella perstans and/or Loa loa. Of these, 10 patients were infected with soil-transmitted helminths (Trichuris trichiura and/or Ascaris lumbricoides), and none were positive for Necator americanus. Interestingly, no filarial gene fragments were detected in the stools of any of the 52 patients. Future studies should evaluate whether a co-infection with soil-transmitted helminths causing gastrointestinal bleeding and likely allowing (micro)filaria exit into the digestive tract, may facilitate the molecular detection of filarial DNA fragments in stool samples.
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Affiliation(s)
- Maxime P M Doret
- Institut de Recherche pour le Développement (IRD), UMI 233-INSERM U1175-University of Montpellier, 34394 Montpellier Cedex 5, France
| | - Hugues C Nana-Djeunga
- Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), PO Box 5797 Yaoundé, Cameroon
| | - Narcisse Nzune-Toche
- Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), PO Box 5797 Yaoundé, Cameroon
| | - Sébastien D S Pion
- Institut de Recherche pour le Développement (IRD), UMI 233-INSERM U1175-University of Montpellier, 34394 Montpellier Cedex 5, France
| | - Cédric B Chesnais
- Institut de Recherche pour le Développement (IRD), UMI 233-INSERM U1175-University of Montpellier, 34394 Montpellier Cedex 5, France
| | - Michel Boussinesq
- Institut de Recherche pour le Développement (IRD), UMI 233-INSERM U1175-University of Montpellier, 34394 Montpellier Cedex 5, France
| | - Joseph Kamgno
- Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), PO Box 5797 Yaoundé, Cameroon - Department of Public Health, Faculty of Medicine and Biomedical Sciences (FMBS), PO Box 1364 Yaoundé, Cameroon
| | - Emmanuelle Varlet-Marie
- Department of Parasitology-Mycology, Centre Hospitalier Universitaire (CHU) of Montpellier, University of Montpellier, 34295 Montpellier Cedex 5, France
| | - Sabrina Locatelli
- Institut de Recherche pour le Développement (IRD), UMI 233-INSERM U1175-University of Montpellier, 34394 Montpellier Cedex 5, France
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Campillo JT, Chabot EB, Awaca-Uvon NP, Tambwe JP, Kuyangisa-Simuna G, Boussinesq M, Chesnais CB, Pion SD. Effect of Lymphatic Filariasis and Hookworm Infection on Pregnancy Course and Outcome in Women Living in the Democratic Republic of the Congo. Am J Trop Med Hyg 2021; 104:2074-2081. [PMID: 33939636 PMCID: PMC8176502 DOI: 10.4269/ajtmh.20-1422] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/29/2021] [Indexed: 11/26/2022] Open
Abstract
Little is known about the effect of helminth infections on the natural gynecological and pregnancy course. Our goal was to assess the relationship between Wuchereria bancrofti and hookworm (HW) infections with pregnancy course and outcome in a group of 82 women living in a rural area of the Democratic Republic of the Congo. Demographics and information on gynecological and obstetrical histories were collected retrospectively with standardized questionnaires. Wuchereria bancrofti and HW infections were diagnosed using a filarial antigen-detection test and the Kato-Katz method, respectively. Analyses consisted of multivariable logistic regressions adjusting for age, number of deliveries, and history of anthelmintic treatment (HAHT). The median age of study participants was 35 (interquartile range [IQR]: 30-44) years, and the median number of deliveries was five (IQR: 3-7). Wuchereria bancrofti and HW infection rates were 44.5% and 43.3%, respectively. Filarial antigenemia and HW infection were not significantly associated with the number of deliveries. The proportions of women with a history of pregnancy resulting in neonatal death, miscarriage, premature birth, and postpartum hemorrhage were 56%, 44%, 23%, and 36%, respectively. History of pregnancy associated with neonatal death was less frequent in women with HAHT, tended to be more frequent in women with filarial antigenemia, and was not associated with HW infection. None of the three other pregnancy events studied (miscarriage, premature birth, and postpartum hemorrhage) were associated with filarial antigenemia or HW infection. The positive association found between HAHT and lower risk of neonatal death warrants investigation in larger groups of women.
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Affiliation(s)
- Jérémy T Campillo
- 1UMI 233, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175 and University of Montpellier, Montpellier, France
| | - Emmanuel B Chabot
- 1UMI 233, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175 and University of Montpellier, Montpellier, France
- 2UMR1027, Institut National de la Santé et de la Recherche Nationale (Inserm) and University of Toulouse, Toulouse, France
| | - Naomi-Pitchouna Awaca-Uvon
- 3Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive, Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo
| | - Jean-Paul Tambwe
- 3Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive, Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo
| | - Godefroy Kuyangisa-Simuna
- 3Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive, Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo
| | - Michel Boussinesq
- 1UMI 233, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175 and University of Montpellier, Montpellier, France
| | - Cédric B Chesnais
- 1UMI 233, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175 and University of Montpellier, Montpellier, France
| | - Sébastien D Pion
- 1UMI 233, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175 and University of Montpellier, Montpellier, France
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Campillo JT, Boussinesq M, Bertout S, Faillie JL, Chesnais CB. Serious adverse reactions associated with ivermectin: A systematic pharmacovigilance study in sub-Saharan Africa and in the rest of the World. PLoS Negl Trop Dis 2021; 15:e0009354. [PMID: 33878105 PMCID: PMC8087035 DOI: 10.1371/journal.pntd.0009354] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Received: 01/23/2021] [Revised: 04/30/2021] [Accepted: 04/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ivermectin is known to cause severe encephalopathies in subjects infected with loiasis, an endemic parasite in Sub-Saharan Africa (SSA). In addition, case reports have described ivermectin-related serious adverse drug reactions (sADRs) such as toxidermias, hepatic and renal disorders. The aim of this study was to identify suspected sADRs reported after ivermectin administration in VigiBase, the World Health Organization's global individual case safety reports database and analyze their frequency relative to the frequency of these events after other antinematodal drugs reported in SSA and other areas of the world (ROW). METHODS All antinematodal-related sADRs were extracted from VigiBase. Disproportionality analyses were conducted to investigate nervous, cutaneous, psychiatric, respiratory, renal, hepatic and cardiac suspected sADRs reported after ivermectin and benzimidazole drug administration across the world, in SSA and RoW. PRINCIPAL FINDINGS 2041 post-ivermectin or post-benzimidazole suspected sADRs were identified including 667 after ivermectin exposure (208 in SSA and 459 in the RoW). We found an increased reporting for toxidermias, encephalopathies, confusional disorders after ivermectin compared to benzimidazole drug administration. Encephalopathies were not only reported from SSA but also from the RoW (adjusted reporting odds ratios [aROR] 6.30, 95% confidence interval: 2.68-14.8), highlighting the fact these types of sADR occur outside loiasis endemic regions. CONCLUSION We described for the first time suspected sADRs associated with ivermectin exposure according to geographical origin. While our results do not put in question ivermectin's excellent safety profile, they show that as for all drugs, appropriate pharmacovigilance for adverse reactions is indicated.
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Affiliation(s)
- Jérémy T. Campillo
- TransVIHMI, Université Montpellier, Institut de Recherche pour le Développement (IRD), INSERM, Montpellier, France
- Department of medical pharmacology and toxicology, CHU Montpellier, Montpellier, France
| | - Michel Boussinesq
- TransVIHMI, Université Montpellier, Institut de Recherche pour le Développement (IRD), INSERM, Montpellier, France
| | - Sébastien Bertout
- TransVIHMI, Université Montpellier, Institut de Recherche pour le Développement (IRD), INSERM, Montpellier, France
- Laboratoire de Parasitologie et Mycologie Médicale, Université de Montpellier, Montpellier, France
| | - Jean-Luc Faillie
- Department of medical pharmacology and toxicology, CHU Montpellier, Montpellier, France
- EA 2415, IDESP, University of Montpellier, Montpellier, France
| | - Cédric B. Chesnais
- TransVIHMI, Université Montpellier, Institut de Recherche pour le Développement (IRD), INSERM, Montpellier, France
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Vinkeles Melchers NVS, Coffeng LE, Boussinesq M, Pedrique B, Pion SDS, Tekle AH, Zouré HGM, Wanji S, Remme JH, Stolk WA. Projected Number of People With Onchocerciasis-Loiasis Coinfection in Africa, 1995 to 2025. Clin Infect Dis 2021; 70:2281-2289. [PMID: 31304961 PMCID: PMC7245158 DOI: 10.1093/cid/ciz647] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/12/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Onchocerciasis elimination through mass drug administration (MDA) is hampered by coendemicity of Loa loa, as people with high L. loa microfilariae (mf) density can develop serious adverse events (SAEs) after ivermectin treatment. We assessed the geographical overlap of onchocerciasis and loiasis prevalence and estimated the number of coinfected individuals at risk of post-ivermectin SAEs in West and Central Africa from 1995 to 2025. METHODS Focusing on regions with suspected loiasis transmission in 14 countries, we overlaid precontrol maps of loiasis and onchocerciasis prevalence to calculate precontrol prevalence of coinfection by 5 km2 × 5 km2 pixel, distinguishing different categories of L. loa mf intensity. Using statistical and mathematical models, we predicted prevalence of both infections and coinfection for 2015 and 2025, accounting for the impact of MDA with ivermectin. RESULTS The number of people infected with onchocerciasis was predicted to decline from almost 19 million in 1995 to 4 million in 2025. Of these, 137 000 people were estimated to also have L. loa hypermicrofilaremia (≥20 000 L. loa mf/mL) in 1995, declining to 31 000 in 2025. In 2025, 92.8% of coinfected cases with loiasis hypermicrofilaremia are predicted to live in hypoendemic areas currently not targeted for MDA. CONCLUSIONS Loiasis coinfection is a major concern for onchocerciasis elimination in Africa. We predict that under current strategies, at least 31 000 coinfected people still require treatment for onchocerciasis in 2025 while being at risk of SAEs, justifying continued efforts in research and development for safer drugs and control strategies.
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Affiliation(s)
| | - Luc E Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Michel Boussinesq
- Unité Mixte Internationale 233 TransVIHMI, Institut de Recherche pour le Développement (IRD), INSERM U1175, University of Montpellier, Montpellier, France
| | - Belén Pedrique
- Research & Development Department, Drugs for Neglected Diseases initiative, and, Geneva, Switzerland
| | - Sébastien D S Pion
- Unité Mixte Internationale 233 TransVIHMI, Institut de Recherche pour le Développement (IRD), INSERM U1175, University of Montpellier, Montpellier, France
| | - Afework H Tekle
- Preventive Chemotherapy and Transmission Control Unit, Control of Neglected Tropical Diseases Department, World Health Organization, Geneva, Switzerland
| | - Honorat G M Zouré
- Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN), World Health Organization, Regional Office for Africa, Cité du Djoué, Brazzaville, Republic of Congo
| | - Samuel Wanji
- Parasites and Vectors Research Unit, Department of Microbiology and Parasitology, University of Buea, Cameroon
| | | | - Wilma A Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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Lenk EJ, Moungui HC, Boussinesq M, Kamgno J, Nana-Djeunga HC, Fitzpatrick C, Peultier ACMM, Klion AD, Fletcher DA, Nutman TB, Pion SD, Niamsi-Emalio Y, Redekop WK, Severens JL, Stolk WA. A Test-and-Not-Treat Strategy for Onchocerciasis Elimination in Loa loa-coendemic Areas: Cost Analysis of a Pilot in the Soa Health District, Cameroon. Clin Infect Dis 2021; 70:1628-1635. [PMID: 31165855 PMCID: PMC7146010 DOI: 10.1093/cid/ciz461] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/03/2019] [Indexed: 11/24/2022] Open
Abstract
Background Severe adverse events after treatment with ivermectin in individuals with high levels of Loa loa microfilariae in the blood preclude onchocerciasis elimination through community-directed treatment with ivermectin (CDTI) in Central Africa. We measured the cost of a community-based pilot using a test-and-not-treat (TaNT) strategy in the Soa health district in Cameroon. Methods Based on actual expenditures, we empirically estimated the economic cost of the Soa TaNT campaign, including financial costs and opportunity costs that will likely be borne by control programs and stakeholders in the future. In addition to the empirical analyses, we estimated base-case, less intensive, and more intensive resource use scenarios to explore how costs might differ if TaNT were implemented programmatically. Results The total costs of US$283 938 divided by total population, people tested, and people treated with 42% coverage were US$4.0, US$9.2, and US$9.5, respectively. In programmatic implementation, these costs (base-case estimates with less and more intensive scenarios) could be US$2.2 ($1.9–$3.6), US$5.2 ($4.5–$8.3), and US$5.4 ($4.6–$8.6), respectively. Conclusions TaNT clearly provides a safe strategy for large-scale ivermectin treatment and overcomes a major obstacle to the elimination of onchocerciasis in areas coendemic for Loa loa. Although it is more expensive than standard CDTI, costs vary depending on the setting, the implementation choices made by the institutions involved, and the community participation rate. Research on the required duration of TaNT is needed to improve the affordability assessment, and more experience is needed to understand how to implement TaNT optimally.
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Affiliation(s)
- Edeltraud J Lenk
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam.,Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, The Netherlands
| | - Henri C Moungui
- Centre for Research on Filariasis and Other Tropical Diseases, Yaounde, Cameroon
| | - Michel Boussinesq
- Unité Mixte Internationale, TransVIHMI, Institut de Recherche pour le Développement, University of Montpellier, France
| | - Joseph Kamgno
- Centre for Research on Filariasis and Other Tropical Diseases, Yaounde, Cameroon
| | | | | | | | - Amy D Klion
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Thomas B Nutman
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Sébastien D Pion
- Unité Mixte Internationale, TransVIHMI, Institut de Recherche pour le Développement, University of Montpellier, France
| | | | - William K Redekop
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam
| | - Johan L Severens
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam
| | - Wilma A Stolk
- Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, The Netherlands
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Chesnais CB, Pion SD, Boullé C, Gardon J, Gardon-Wendel N, Fokom-Domgue J, Kamgno J, Boussinesq M. Individual risk of post-ivermectin serious adverse events in subjects infected with Loa loa. EClinicalMedicine 2020; 28:100582. [PMID: 33294807 PMCID: PMC7700892 DOI: 10.1016/j.eclinm.2020.100582] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Implementation of onchocerciasis elimination programmes has been delayed in Central Africa because of the risk of ivermectin-related serious adverse events (SAEs) in individuals with high Loa loa microfilarial densities (MFD). We developed the first statistical models enabling prediction of SAE risk in individuals with a given MFD. METHODS We used individual participant data from two trials conducted in loiasis-onchocerciasis co-endemic areas in Cameroon. among the 10 506 ivermectin-treated subjects included in the analysis, 38 (0·36%) developed an ivermectin-related SAE. To predict individual-level risk of SAE, we developed mixed multivariate logistic models including subjects' sex, age, pre-treatment L loa and Mansonella perstans MFDs, and study region. FINDINGS The models predicted that regardless of sex, about 1% of people with 20 000 L loa microfilariae per millilitre of blood (mf/mL), 10% of people with 50 000 mf/mL and about one third of those with 100 000 mf/mL will develop an SAE. For a given MFD, males have a three-fold higher risk of developing an SAE than females. INTERPRETATION By enabling the prediction of post-ivermectin SAE risk in communities with known distribution of L loa MFDs, our results can guide decisions on the choice of ivermectin-based treatment strategies. They also predict that 37 SAEs were prevented in 2015 by using a Test-and-Treat strategy in the Okola District of Cameroon. FUNDING UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases; Institut de Recherche pour le Développement; Mectizan Donation Program; Bill & Melinda Gates Foundation.
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Affiliation(s)
- Cédric B. Chesnais
- UMI 233, Institut de Recherche pour le Développement (IRD), Montpellier, France
- Université Montpellier, Montpellier, France
- INSERM Unité 1175, Montpellier, France
| | - Sébastien D. Pion
- UMI 233, Institut de Recherche pour le Développement (IRD), Montpellier, France
- Université Montpellier, Montpellier, France
- INSERM Unité 1175, Montpellier, France
| | - Charlotte Boullé
- Université Montpellier, Montpellier, France
- INSERM Unité 1175, Montpellier, France
- Infectious Disease Department, Montpellier University Hospital, Montpellier, France
- Institut de Recherche pour le Développement (IRD), Montpellier, France
| | - Jacques Gardon
- HSM, IRD, CNRS, University of Montpellier, Montpellier, France
| | | | - Joël Fokom-Domgue
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph Kamgno
- Professor, Centre for Research on Filariasis and other Tropical Diseases, Yaounde, Cameroon
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Michel Boussinesq
- UMI 233, Institut de Recherche pour le Développement (IRD), Montpellier, France
- Université Montpellier, Montpellier, France
- INSERM Unité 1175, Montpellier, France
- Corresponding author at: Institut de Recherche pour le Développement (UMI 233), 911 avenue Agropolis, BP 64501, 34394 Montpellier cedex 5, France.
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Lemarcis T, Chesnais CB, Pion SDS, Boussinesq M, Locatelli S. Detection of a Larva of Armillifer armillatus in a Potto (Perodicticus potto) from the Republic of the Congo. J Parasitol 2020; 106:654-662. [PMID: 33079999 DOI: 10.1645/20-51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/14/2023] Open
Abstract
We determined the complete sequence of the mitochondrial DNA (mtDNA) of a parasite discovered between the subcutaneous tissue and the peritoneum of an African nocturnal non-human primate (NHP). The parasite and host sequences were obtained by a combination of Sanger sequencing and nanopore MinION techniques. Analyses of mtDNA gene arrangements and sequences unambiguously showed that the parasite investigated was the pentastomid Armillifer armillatus, also commonly named the tongue worm. The full-length mitochondrial genome of A. armillatus, measuring 16,706 bp in length, contains 13 protein-coding genes, 2 ribosomal RNA genes, and 22 transfer RNA genes, an arrangement identical to that of previously described pentastomid mitochondrial genomes. We describe here the second full mitochondrial genome of A. armillatus to date. To identify the NHP host, maximum likelihood phylogenetic analyses of a 441-bp fragment on the 12S rDNA gene and of a 1,140-bp fragment of the mitochondrial cytochrome b strongly support clustering with the African lorisid Perodicticus potto, a species that has rarely been reported as an intermediate host of this parasite.
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Affiliation(s)
- Thomas Lemarcis
- IRD, UMI 233-TransVIHMI-INSERM U1175, University de Montpellier, 911 Avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
| | - Cédric Benjamin Chesnais
- IRD, UMI 233-TransVIHMI-INSERM U1175, University de Montpellier, 911 Avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
| | - Sébastien David Serge Pion
- IRD, UMI 233-TransVIHMI-INSERM U1175, University de Montpellier, 911 Avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
| | - Michel Boussinesq
- IRD, UMI 233-TransVIHMI-INSERM U1175, University de Montpellier, 911 Avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
| | - Sabrina Locatelli
- IRD, UMI 233-TransVIHMI-INSERM U1175, University de Montpellier, 911 Avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France.,Current address: IRD, UMR 224-CNRS5290-MIVEGEC, University de Montpellier, MIVEGEC, 911, Avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
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Pion SDS, Chesnais CB, Awaca-Uvon NP, Vlaminck J, Abdou A, Kunyu-Shako B, Kuyangisa Simuna G, Tambwe JP, Weil GJ, Boussinesq M. The impact of four years of semiannual treatments with albendazole alone on lymphatic filariasis and soil-transmitted helminth infections: A community-based study in the Democratic Republic of the Congo. PLoS Negl Trop Dis 2020; 14:e0008322. [PMID: 32574160 PMCID: PMC7337406 DOI: 10.1371/journal.pntd.0008322] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 07/06/2020] [Accepted: 04/24/2020] [Indexed: 02/03/2023] Open
Abstract
Background The World Health Organization now recommends semiannual mass drug administration (MDA) of albendazole with integrated vector management as an option for eliminating lymphatic filariasis (LF) in areas of loiasis-endemic countries where it may not be safe to use diethylcarbamazine or ivermectin in MDA programs. However, the published evidence base to support this policy is thin, and uptake by national programs has been slow. Methodology/Principal findings We conducted a community trial to assess the impact of semiannual MDA on lymphatic filariasis and soil-transmitted helminth infections (STH) in two villages in the Bandundu province of the Democratic Republic of the Congo with moderately high prevalences for LF and hookworm infections. MDA with albendazole was provided every six months from June 2014 to December 2017 with treatment coverages of the eligible population (all ≥ 2 year of age) that ranged between 56% and 88%. No adverse effects were reported during the trial. Evaluation at 48 months, (i.e. 6 months after the 8th round of MDA), showed that W. bancrofti microfilaremia (Mf) prevalence in the study communities had decreased between 2014 to 2018 from 12% to 0.9% (p<0.001). The prevalence of W. bancrofti antigenemia was also significantly reduced from 31.6% to 8.5% (p<0.001). MDA with albendazole also reduced hookworm, Ascaris lumbricoides and Trichuris trichiura infection prevalences in the community from 58.6% to 21.2% (p<0.001), from 14.0% to 1.6% and 4.1% to 2.9%, respectively. Hookworm and Ascaris infection intensities were reduced by 93% (p = 0.02) and 57% (p = 0.03), respectively. In contrast, Trichuris infection intensity was not significantly reduced by MDA (p = 0.61) over this time period. Conclusion/Significance These results provide strong evidence that semiannual MDA with albendazole alone is a safe and effective strategy for LF elimination in Central Africa. Community MDA also had a major impact on STH infections. In low-income rural settings of Africa, populations are commonly affected by multiple parasitic diseases. Some of these diseases have been targeted for elimination through dedicated national or international programs. In 2012, the World Health Organization (WHO) defined a specific strategy to eliminate lymphatic filariasis, the disease responsible for elephantiasis, in central Africa. This strategy consists in treating the whole population living in endemic areas every six months with a single donated drug—albendazole. Together with the use of the night bed nets distributed as part of malaria programs, it was expected that this strategy could interrupt the transmission and eliminate lymphatic filariasis locally within period of 4 to 7 years. Here, we evaluated this strategy in two endemic communities near Bandundu in the Democratic Republic of the Congo. We also assessed the impact of the semiannual community treatments on three species of gastrointestinal parasitic worms. Our results suggest that semiannual MDA with albendazole is effective for LF elimination in Central Africa, but they also indicate that drug-based only intervention is not enough to eliminate gastrointestinal worm infections in areas with high transmission.
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Affiliation(s)
- Sébastien D. S. Pion
- French National Research Institute for Sustainable Development, Montpellier, France
- * E-mail:
| | - Cédric B. Chesnais
- French National Research Institute for Sustainable Development, Montpellier, France
| | | | - Johnny Vlaminck
- Ministry of health, Kinshasa, Democratic Republic of the Congo
- Ghent University, Merelbeke, Belgium
| | - Anlimou Abdou
- French National Research Institute for Sustainable Development, Montpellier, France
| | - Billy Kunyu-Shako
- National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | | | | | - Gary J. Weil
- Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Michel Boussinesq
- French National Research Institute for Sustainable Development, Montpellier, France
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Gaillard CM, Pion SD, Hamou H, Sirima C, Bizet C, Lemarcis T, Rodrigues J, Esteban A, Peeters M, Mpoudi Ngole E, Mombo I, Liégeois F, Martin C, Boussinesq M, Locatelli S. Detection of DNA of filariae closely related to Mansonella perstans in faecal samples from wild non-human primates from Cameroon and Gabon. Parasit Vectors 2020; 13:313. [PMID: 32546281 PMCID: PMC7298833 DOI: 10.1186/s13071-020-04184-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/12/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The Onchocercidae is a family of filarial nematodes with several species of medical or veterinary importance. Microfilariae are found in the blood and/or the dermis and are usually diagnosed in humans by microscopy examination of a blood sample or skin biopsy. The main objectives of this study were to evaluate whether filariae DNA can be detected in faecal samples of wild non-human primates (NHPs), whether the detected parasites were closely related to those infecting humans and whether filarial DNA detection in faeces is associated with co-infections with nematodes (Oesophagostumum sp. and Necator sp.) known to cause blood loss while feeding on the host intestinal mucosa. METHODS A total of 315 faecal samples from 6 species of NHPs from Cameroon and Gabon were analysed. PCRs targeted DNA fragments of cox1 and 12S rDNA genes, to detect the presence of filariae, and the internal transcribed spacer 2 (ITS2), to detect the presence of Oesophagostomum sp. and Necator sp. infections. RESULTS Among the 315 samples analysed, 121 produced sequences with > 90% homology with Onchocercidae reference sequences. However, 63% of the 12S rDNA and 78% of the cox1 gene sequences were exploitable for phylogenetic analyses and the amplification of the 12S rDNA gene showed less discriminating power than the amplification of the cox1 fragment. Phylogenetic analyses showed that the cox1 sequences obtained from five chimpanzee DNA faecal samples from Gabon and two from Cameroon cluster together with Mansonella perstans with high bootstrap support. Most of the remaining sequences clustered together within the genus Mansonella, but the species could not be resolved. Among the NHP species investigated, a significant association between filarial DNA detection and Oesophagostomum sp. and Necator sp. infection was observed only in gorillas. CONCLUSIONS To our knowledge, this is the first study reporting DNA from Mansonella spp. in faecal samples. Our results raise questions about the diversity and abundance of these parasites in wildlife, their role as sylvatic reservoirs and their potential for zoonotic transmission. Future studies should focus on detecting variants circulating in both human and NHPs, and improve the molecular information to resolve or support taxonomy classification based on morphological descriptions.
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Affiliation(s)
| | | | - Hadjira Hamou
- IRD UMI 233-INSERM U1175, University of Montpellier, Montpellier, France
| | - Constant Sirima
- IRD UMI 233-INSERM U1175, University of Montpellier, Montpellier, France
| | - Charlotte Bizet
- IRD UMI 233-INSERM U1175, University of Montpellier, Montpellier, France
| | - Thomas Lemarcis
- IRD UMI 233-INSERM U1175, University of Montpellier, Montpellier, France
| | - Jules Rodrigues
- Unité Molécules de Communication et Adaptation des Microorganismes (MCAM UMR7245), Muséum national d'Histoire naturelle, CNRS, Paris, France
| | - Amandine Esteban
- IRD UMI 233-INSERM U1175, University of Montpellier, Montpellier, France
| | - Martine Peeters
- IRD UMI 233-INSERM U1175, University of Montpellier, Montpellier, France
| | - Eitel Mpoudi Ngole
- Projet Prévention du Sida au Cameroun (PRESICA) and Virology Laboratory IMPM/IRD, Yaoundé, Cameroon
| | - Illich Mombo
- Centre International de Recherches Médicales, BP 769, Franceville, Gabon
| | - Florian Liégeois
- Laboratoire Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution, Contrôle, UMR 224 IRD/CNRS/UM1, 34394, Montpellier, France
| | - Coralie Martin
- Unité Molécules de Communication et Adaptation des Microorganismes (MCAM UMR7245), Muséum national d'Histoire naturelle, CNRS, Paris, France
| | - Michel Boussinesq
- IRD UMI 233-INSERM U1175, University of Montpellier, Montpellier, France
| | - Sabrina Locatelli
- IRD UMI 233-INSERM U1175, University of Montpellier, Montpellier, France.
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Kamgno J, Tchatchueng-Mbougua JB, Nana-Djeunga HC, Esso L, Zouré HG, Mackenzie CD, Boussinesq M. Community-based door to door census of suspected people living with epilepsy: empowering community drug distributors to improve the provision of care to rural communities in Cameroon. BMC Public Health 2020; 20:871. [PMID: 32503495 PMCID: PMC7275343 DOI: 10.1186/s12889-020-08997-8] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 05/27/2020] [Indexed: 11/12/2022] Open
Abstract
Background Epilepsy is a severe neurological disorder with huge psychological, social, and economic consequences, including premature deaths and loss of productivity. Sub-Saharan Africa carries the highest burden of epilepsy. The management of epilepsy in Cameroon remains unsatisfactory due to poor identification of cases and a limited knowledge of the distribution of the disease. The objective of this study was to determine whether community drug distributors (CDDs) - volunteers selected by their communities to distribute ivermectin against onchocerciasis and who have been proven efficient to deliver other health interventions such as insecticide-treated bed nets to prevent malaria, vitamin A tablets, and albendazole to treat soil transmitted helminthiasis - can be used to reliably identify people living with epilepsy to promote better management of cases. Methods This study was carried out in three health Districts in Cameroon. An exhaustive house to house census was carried out by trained CDDs under the supervision of local nurses. In each household, all suspected cases of epilepsy were identified. In each health district, five communities were randomly selected for a second census by trained health personnel (research team). The results of the two censuses were compared for verification purposes. Results A total of 53,005 people was registered in the 190 communities surveyed with 794 (1.4%) individuals identified as suspected cases of epilepsy (SCE) by the CDDs. In the 15 communities where the SCE census was verified, the average ratio between the number of suspected cases of epilepsy reported in a community by the research team and that reported by the CDDs was 1.1; this ratio was < 0.8 and > 1.2 in 6 communities. Conclusions The results of this study suggest that CDDs, who are present in about 200,000 communities in 31 Sub Saharan African countries where onchocerciasis is endemic, can be successfully used to assess epilepsy prevalence, and therefore map epilepsy in many African countries.
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Affiliation(s)
- Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaoundé, Cameroon. .,Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
| | - Jules B Tchatchueng-Mbougua
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Service d'épidémiologie, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroon
| | - Hugues C Nana-Djeunga
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaoundé, Cameroon
| | - Lynda Esso
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaoundé, Cameroon
| | - Honorat G Zouré
- Expanded Special Project for Elimination of NTDs (ESPEN), World Health Organization, African Regional Office, Brazzaville, Republic of Congo
| | - Charles D Mackenzie
- Filarial Programmes Support Unit (FPSU), Liverpool School of Tropical Medicine, Pembroke Place Liverpool, Liverpool, L3 5QA, UK
| | - Michel Boussinesq
- Institut de Recherche pour le Développement (IRD), UMI233/ INSERM U1175/ Université de Montpellier, 911 Avenue Agropolis, 34394, Montpellier Cedex 5, France
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Chesnais CB, Bizet C, Campillo JT, Njamnshi WY, Bopda J, Nwane P, Pion SD, Njamnshi AK, Boussinesq M. A Second Population-Based Cohort Study in Cameroon Confirms the Temporal Relationship Between Onchocerciasis and Epilepsy. Open Forum Infect Dis 2020; 7:ofaa206. [PMID: 32587878 PMCID: PMC7304933 DOI: 10.1093/ofid/ofaa206] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/28/2020] [Indexed: 11/13/2022] Open
Abstract
To confirm our earlier evidence of a temporal and dose–response relationship between onchocerciasis and epilepsy, we conducted another cohort study in a different setting in Cameroon. Individuals whose Onchocerca volvulus microfilarial density (Ov-MFD) was measured in 1992–1994 when they were children were revisited in 2019 to determine if they acquired epilepsy. With reference to individuals with no microfilariae in 1992–1994, the relative risks of acquiring epilepsy were 0.96, 2.76, 3.67, and 11.87 in subjects with initial Ov-MFD of 1–7, 8–70, 71–200, and > 200 microfilariae per skin snip, respectively. This study further demonstrates reproducibility using the Bradford Hill’s criteria for causality.
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Affiliation(s)
- Cédric B Chesnais
- UMI 233, Institut de Recherche pour le Développement (IRD), Université Montpellier, INSERM Unité 1175, Montpellier, France
| | - Charlotte Bizet
- UMI 233, Institut de Recherche pour le Développement (IRD), Université Montpellier, INSERM Unité 1175, Montpellier, France.,Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Jérémy T Campillo
- UMI 233, Institut de Recherche pour le Développement (IRD), Université Montpellier, INSERM Unité 1175, Montpellier, France
| | - Wepnyu Y Njamnshi
- Neurology Department, Central Hospital/Faculty of Medicine & Biomedical Sciences, The University of Yaoundé I, (FMBS-UYI), Yaoundé, Cameroon.,Brain Research Africa Initiative, BRAIN, Geneva, Switzerland/Yaoundé, Cameroon
| | - Jean Bopda
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Philippe Nwane
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Sébastien D Pion
- UMI 233, Institut de Recherche pour le Développement (IRD), Université Montpellier, INSERM Unité 1175, Montpellier, France
| | - Alfred K Njamnshi
- Neurology Department, Central Hospital/Faculty of Medicine & Biomedical Sciences, The University of Yaoundé I, (FMBS-UYI), Yaoundé, Cameroon.,Brain Research Africa Initiative, BRAIN, Geneva, Switzerland/Yaoundé, Cameroon
| | - Michel Boussinesq
- UMI 233, Institut de Recherche pour le Développement (IRD), Université Montpellier, INSERM Unité 1175, Montpellier, France
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Gobbi F, Buonfrate D, Boussinesq M, Chesnais CB, Pion SD, Silva R, Moro L, Rodari P, Tamarozzi F, Biamonte M, Bisoffi Z. Performance of two serodiagnostic tests for loiasis in a Non-Endemic area. PLoS Negl Trop Dis 2020; 14:e0008187. [PMID: 32453734 PMCID: PMC7274468 DOI: 10.1371/journal.pntd.0008187] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 06/05/2020] [Accepted: 03/02/2020] [Indexed: 11/18/2022] Open
Abstract
Loiasis, caused by the filarial nematode Loa loa, is endemic in Central and West Africa where about 10 million people are infected. There is a scarcity of convenient, commercial diagnostics for L. loa. Microscopy requires trained personnel and has low sensitivity, while the serodiagnosis is currently not standardized. Individual case management is also important in non-endemic countries to treat migrants, expatriates and tourists. We retrospectively compared the performance of a Loa Antibody Rapid Test (RDT) and a commercial ELISA pan-filarial test on 170 patients, 65 with loiasis [8 with eyeworm, 29 with positive microfilaremia, 28 with neither microfilaremia nor history of eyeworm but eosinophilia and history of Calabar swelling (probable loiasis)], 95 with other common parasitic infections and no previous exposure to L. loa (37 with M. perstans, 1 with Brugia sp., 18 with strongyloidiasis, 20 with schistosomiasis, 5 with hookworm, 4 with Ascaris lumbricoides infection, 10 with hyper-reactive malarial splenomegaly), and 10 uninfected controls. The sensitivity of the RDT and of the ELISA were 93.8% (61/65) and 90.8% (59/65), respectively. For the RDT, most of the cross-reactions were observed in patients with M. perstans: 7/37 (18.9%), followed by 1/10 (10%) with hyper-reactive malarial splenomegaly and 1/20 (5%) with schistosomiasis. None of the 27 subjects infected with intestinal nematodes was found positive at this test. The ELISA is meant to be a pan-filarial assay, and reacted extensively with cases of M. perstans (95%), as expected, and also in 11/18 (61.1%) patients with strongyloidiasis and in 3/5 (60%) with hookworm infection. The RDT and the ELISA are both highly sensitive for the diagnosis of loiasis. The main difference lies in the extent of cross-reactivity with other parasites. Considering that the RDT is specifically meant for Loa loa infection, and its high sensitivity, this test could be a useful tool for the diagnosis of occult loiasis. Loa loa is a filarial worm which infects millions of people living in the forested areas of central Africa. The infection is rarely diagnosed outside Africa, but individual case management is also important in non-endemic countries to treat migrants, tourists and expatriates. Aim of this study was to describe the performance of a Rapid Test and an ELISA pan filarial test for the diagnosis of Loa loa infection. Both tests demonstrated good performance for the detection of cases of loiasis. In case of infection with other parasites, the RDT gave less false positive results.
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Affiliation(s)
- Federico Gobbi
- IRCCS Sacro Cuore Don Calabria Hospital, Center for Tropical Diseases, Negrar, Verona, Italy
- * E-mail:
| | - Dora Buonfrate
- IRCCS Sacro Cuore Don Calabria Hospital, Center for Tropical Diseases, Negrar, Verona, Italy
| | - Michel Boussinesq
- Institut de Recherche pour le Développement (IRD), UMI 233-INSERM U1175-Montpellier University, Montpellier, France
| | - Cedric B. Chesnais
- Institut de Recherche pour le Développement (IRD), UMI 233-INSERM U1175-Montpellier University, Montpellier, France
| | - Sebastien D. Pion
- Institut de Recherche pour le Développement (IRD), UMI 233-INSERM U1175-Montpellier University, Montpellier, France
| | - Ronaldo Silva
- IRCCS Sacro Cuore Don Calabria Hospital, Center for Tropical Diseases, Negrar, Verona, Italy
| | - Lucia Moro
- IRCCS Sacro Cuore Don Calabria Hospital, Center for Tropical Diseases, Negrar, Verona, Italy
| | - Paola Rodari
- IRCCS Sacro Cuore Don Calabria Hospital, Center for Tropical Diseases, Negrar, Verona, Italy
| | - Francesca Tamarozzi
- Department of Infectious Diseases, Foodborne and Neglected Parasitic Diseases Unit, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Biamonte
- Drugs & Diagnostics for Tropical Diseases, San Diego, California, United States of America
| | - Zeno Bisoffi
- IRCCS Sacro Cuore Don Calabria Hospital, Center for Tropical Diseases, Negrar, Verona, Italy
- Infectious Infectious Diseases and Tropical Medicine Section, Diagnostic and Public Health Department, University of Verona, Verona, Italy
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Boussinesq M, Enyong P, Chounna-Ndongmo P, Njouendou AJ, Pion SD, Rech A, Roberge C, Gaudriault G, Wanji S. Effects of an injectable long-acting formulation of ivermectin on Onchocerca ochengi in zebu cattle. ACTA ACUST UNITED AC 2020; 27:36. [PMID: 32420864 PMCID: PMC7233116 DOI: 10.1051/parasite/2020036] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 05/05/2020] [Indexed: 11/14/2022]
Abstract
The availability of a safe macrofilaricidal drug would help to accelerate onchocerciasis elimination. A trial was conducted in Cameroon to evaluate the effects of a subcutaneous injectable long-acting formulation of ivermectin (LAFI) on the microfilariae (mf) and adult stages of Onchocerca ochengi. Ten zebu cattle naturally infected with the parasite were injected subcutaneously with either 500 mg (group A, N = 4), or 1000 mg long-acting ivermectin (group B, N = 4) or the vehicle (group C, N = 2). Skin samples were collected from each animal before, and 6, 12, and 24 months after treatment to measure microfilarial densities (MFDs). Nodules excised before, and 6 and 12 months after treatment were examined histologically to assess the adult worms’ viability and reproductive status. Blood samples were collected at pre-determined time-points to obtain pharmacokinetic data. Before treatment, the average O. ochengi MFDs were similar in the three groups. Six months after treatment, all animals in groups A and B were free of skin mf, whereas those in group C still showed high MFDs (mean = 324.5 mf/g). Only one ivermectin-treated animal (belonging to group A) had skin mf 12 months after treatment (0.9 mf/g). At 24 months, another animal in group A showed skin mf (10.0 mf/g). The histologic examination of nodules at 6 and 12 months showed that LAFI was not macrofilaricidal but had a strong effect on embryogenesis. The new LAFI regimen might be an additional tool to accelerate the elimination of human onchocerciasis in specific settings.
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Affiliation(s)
- Michel Boussinesq
- Recherches Translationnelles sur le VIH et les Maladies Infectieuses (TransVIHMI), UMI233 IRD-U1175 INSERM-Université de Montpellier, BP 64501, 34394 Montpellier Cedex 5, France
| | - Peter Enyong
- Research Foundation for Tropical Diseases and the Environment, PO Box 474, Buea, Cameroon
| | | | - Abdel-Jelil Njouendou
- Research Foundation for Tropical Diseases and the Environment, PO Box 474, Buea, Cameroon
| | - Sébastien David Pion
- Recherches Translationnelles sur le VIH et les Maladies Infectieuses (TransVIHMI), UMI233 IRD-U1175 INSERM-Université de Montpellier, BP 64501, 34394 Montpellier Cedex 5, France
| | - Anthony Rech
- MedinCell S.A., 3 Rue des Frères Lumière, 34830 Jacou, France
| | | | | | - Samuel Wanji
- Research Foundation for Tropical Diseases and the Environment, PO Box 474, Buea, Cameroon
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Campillo JT, Chesnais CB, Pion SDS, Gardon J, Kamgno J, Boussinesq M. Individuals living in an onchocerciasis focus and treated three-monthly with ivermectin develop fewer new onchocercal nodules than individuals treated annually. Parasit Vectors 2020; 13:258. [PMID: 32414398 PMCID: PMC7229600 DOI: 10.1186/s13071-020-04126-x] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/08/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Little information is available on the effect of ivermectin on the third- and fourth-stage larvae of Onchocerca volvulus. To assess a possible prophylactic effect of ivermectin on this parasite, we compared the effects of different ivermectin regimens on the acquisition of onchocercal nodules. METHODS We analyzed data from a controlled randomized clinical trial of ivermectin conducted in the Mbam Valley (Cameroon) between 1994 and 1998 in a cohort of onchocerciasis infected individuals. The number of nodules that appeared between the start and the end of the clinical trial was analyzed, using ANOVA and multivariable Poisson regressions, between four treatment arms: 150 µg/kg annually, 800 µg/kg annually, 150 µg/kg 3-monthly, and 800 µg/kg 3-monthly. RESULTS The mean number of nodules that appeared during the trial was reduced by 17.7% in subjects treated 3-monthly compared to those treated annually (regardless of the dose). Poisson regression model, adjusting on subject's age and weight, initial number of nodules and intensity of O. volvulus infection in his village of residence, confirmed that the incidence of new nodules was reduced in 3-monthly treatment arms compared to annually treatment arms, and that the dosage of ivermectin does not seem to influence this effect. Furthermore, the number of newly acquired nodules was positively associated with the initial number of nodules. Analysis of disappearance of nodules did not show any significant difference between the treatment groups. CONCLUSIONS To our knowledge, these results suggest for the first time in humans, that ivermectin has a partial prophylactic effect on O. volvulus. Three-monthly treatment seems more effective than annual treatment to prevent the appearance of nodules.
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Affiliation(s)
- Jérémy T Campillo
- UMI 233, Institut de Recherche pour le Développement (IRD) and University of Montpellier 1, 911 avenue Agropolis, P.O. Box 64501, 34394, Montpellier Cedex 5, France
| | - Cédric B Chesnais
- UMI 233, Institut de Recherche pour le Développement (IRD) and University of Montpellier 1, 911 avenue Agropolis, P.O. Box 64501, 34394, Montpellier Cedex 5, France
| | - Sébastien D S Pion
- UMI 233, Institut de Recherche pour le Développement (IRD) and University of Montpellier 1, 911 avenue Agropolis, P.O. Box 64501, 34394, Montpellier Cedex 5, France
| | - Jacques Gardon
- Hydrosciences Montpellier, Institut de Recherche pour le Développement (IRD), Montpellier, France
| | - Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Michel Boussinesq
- UMI 233, Institut de Recherche pour le Développement (IRD) and University of Montpellier 1, 911 avenue Agropolis, P.O. Box 64501, 34394, Montpellier Cedex 5, France.
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Navarro M, Camprubí D, Requena-Méndez A, Buonfrate D, Giorli G, Kamgno J, Gardon J, Boussinesq M, Muñoz J, Krolewiecki A. Safety of high-dose ivermectin: a systematic review and meta-analysis. J Antimicrob Chemother 2020; 75:827-834. [PMID: 31960060 DOI: 10.1093/jac/dkz524] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/17/2019] [Accepted: 11/26/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Ivermectin is a key anthelmintic for the control of neglected tropical diseases. The main indications for population-level control with ivermectin through mass drug administration are onchocerciasis and lymphatic filariasis; however, there is interest in using higher, fixed-dose regimens for the control of scabies, soil-transmitted helminths and malaria. Safety data for these higher-dose regimens are needed. METHODS A systematic literature review and meta-analysis on the safety and doses of ivermectin was conducted. Eligible studies reported patient-level data and, for the meta-analysis, clinical trials reporting data on doses ≥200 and ≥400 μg/kg were included. Incidence ratios were used to compare adverse events by severity and organ system affected. RESULTS The systematic search identified six studies for inclusion, revealing no differences in the number of individuals experiencing adverse events. A descriptive analysis of these clinical trials for a variety of indications showed no difference in the severity of the adverse events between standard (up to 400 μg/kg) and higher doses of ivermectin. Organ system involvement only showed an increase in ocular events in the higher-dose group in one trial for the treatment of onchocerciasis, all of them transient and mild to moderate in intensity. CONCLUSIONS Although within this review the safety of high-dose ivermectin appears to be comparable to standard doses, there are not enough data to support a recommendation for its use in higher-than-approved doses. Ocular adverse events, despite being transient, are of concern in onchocerciasis patients. These data can inform programme managers and guide operational research activities as new approaches for the use of ivermectin are evaluated.
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Affiliation(s)
- Miriam Navarro
- Department of Public Health, Science History and Gynecology, Universidad Miguel Hernández de Elche, Alicante, Spain
| | - Daniel Camprubí
- Barcelona Institute for Global Health (ISGlobal) Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Ana Requena-Méndez
- Barcelona Institute for Global Health (ISGlobal) Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Dora Buonfrate
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Giovanni Giorli
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Joseph Kamgno
- Centre de Recherche sur les Filarioses et autres Maladies tropicales, Yaounde, Cameroon
| | - Jacques Gardon
- Institut de Recherche pour le Développement, Montpellier, France
| | | | - Jose Muñoz
- Barcelona Institute for Global Health (ISGlobal) Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Alejandro Krolewiecki
- Barcelona Institute for Global Health (ISGlobal) Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Instituto de Investigaciones de Enfermedades Tropicales Universidad Nacional de Salta/CONICET, Orán, Argentina
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Hedtke SM, Kuesel AC, Crawford KE, Graves PM, Boussinesq M, Lau CL, Boakye DA, Grant WN. Genomic Epidemiology in Filarial Nematodes: Transforming the Basis for Elimination Program Decisions. Front Genet 2020; 10:1282. [PMID: 31998356 PMCID: PMC6964045 DOI: 10.3389/fgene.2019.01282] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 11/21/2019] [Indexed: 11/25/2022] Open
Abstract
Onchocerciasis and lymphatic filariasis are targeted for elimination, primarily using mass drug administration at the country and community levels. Elimination of transmission is the onchocerciasis target and global elimination as a public health problem is the end point for lymphatic filariasis. Where program duration, treatment coverage, and compliance are sufficiently high, elimination is achievable for both parasites within defined geographic areas. However, transmission has re-emerged after apparent elimination in some areas, and in others has continued despite years of mass drug treatment. A critical question is whether this re-emergence and/or persistence of transmission is due to persistence of local parasites-i.e., the result of insufficient duration or drug coverage, poor parasite response to the drugs, or inadequate methods of assessment and/or criteria for determining when to stop treatment-or due to re-introduction of parasites via human or vector movement from another endemic area. We review recent genetics-based research exploring these questions in Onchocerca volvulus, the filarial nematode that causes onchocerciasis, and Wuchereria bancrofti, the major pathogen for lymphatic filariasis. We focus in particular on the combination of genomic epidemiology and genome-wide associations to delineate transmission zones and distinguish between local and introduced parasites as the source of resurgence or continuing transmission, and to identify genetic markers associated with parasite response to chemotherapy. Our ultimate goal is to assist elimination efforts by developing easy-to-use tools that incorporate genetic information about transmission and drug response for more effective mass drug distribution, surveillance strategies, and decisions on when to stop interventions to improve sustainability of elimination.
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Affiliation(s)
- Shannon M. Hedtke
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, VIC, Australia
| | - Annette C. Kuesel
- Unicef/UNDP/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Katie E. Crawford
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, VIC, Australia
| | - Patricia M. Graves
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
| | - Michel Boussinesq
- Unité Mixte Internationale 233 "TransVIHMI", Institut de Recherche pour le Développement (IRD), INSERM U1175, University of Montpellier, Montpellier, France
| | - Colleen L. Lau
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - Daniel A. Boakye
- Parasitology Department, Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Warwick N. Grant
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, VIC, Australia
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Buell KG, Whittaker C, Chesnais CB, Jewell PD, Pion SDS, Walker M, Basáñez MG, Boussinesq M. Atypical Clinical Manifestations of Loiasis and Their Relevance for Endemic Populations. Open Forum Infect Dis 2019; 6:ofz417. [PMID: 31696139 PMCID: PMC6824532 DOI: 10.1093/ofid/ofz417] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/08/2019] [Indexed: 01/02/2023] Open
Abstract
Background Loiasis is mostly considered a relatively benign infection when compared with other filarial and parasitic diseases, with Calabar swellings and eyeworm being the most common signs. Yet, there are numerous reports in the literature of more serious sequelae. Establishing the relationship between infection and disease is a crucial first step toward estimating the burden of loiasis. Methods We conducted a systematic review of case reports containing 329 individuals and detailing clinical manifestations of loiasis with a focus on nonclassical, atypical presentations. Results Results indicate a high proportion (47%) of atypical presentations in the case reports identified, encompassing a wide range of cardiac, respiratory, gastrointestinal, renal, neurological, ophthalmological, and dermatological pathologies. Individuals with high microfilarial densities and residing in an endemic country were at greater risk of suffering from atypical manifestations. Conclusions Our findings have important implications for understanding the clinical spectrum of conditions associated with Loa loa infection, which extends well beyond the classical eyeworm and Calabar swellings. As case reports may overestimate the true rate of atypical manifestations in endemic populations, large-scale, longitudinal clinico-epidemiological studies will be required to refine our estimates and demonstrate causality between loiasis and the breadth of clinical manifestations reported. Even if the rates of atypical presentations were found to be lower, given that residents of loiasis-endemic areas are both numerous and the group most at risk of severe atypical manifestations, our conclusions support the recognition of loiasis as a significant public health burden across Central Africa.
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Affiliation(s)
- Kevin G Buell
- Department of Infectious Disease Epidemiology, London Centre for Neglected Tropical Disease Research and MRC Centre for Global Infectious Disease Analysis, Faculty of Medicine (St Mary's Campus), Imperial College London, London, UK
| | - Charles Whittaker
- Department of Infectious Disease Epidemiology, London Centre for Neglected Tropical Disease Research and MRC Centre for Global Infectious Disease Analysis, Faculty of Medicine (St Mary's Campus), Imperial College London, London, UK
| | - Cédric B Chesnais
- Institut de Recherche pour le Développement (IRD), UMI 233-INSERM U1175-Montpellier University, Montpellier, France
| | - Paul D Jewell
- Department of Infectious Disease Epidemiology, London Centre for Neglected Tropical Disease Research and MRC Centre for Global Infectious Disease Analysis, Faculty of Medicine (St Mary's Campus), Imperial College London, London, UK
| | - Sébastien D S Pion
- Institut de Recherche pour le Développement (IRD), UMI 233-INSERM U1175-Montpellier University, Montpellier, France
| | - Martin Walker
- Department of Pathobiology and Population Sciences, London Centre for Neglected Tropical Disease Research, Royal Veterinary College, Hatfield, UK
| | - Maria-Gloria Basáñez
- Department of Infectious Disease Epidemiology, London Centre for Neglected Tropical Disease Research and MRC Centre for Global Infectious Disease Analysis, Faculty of Medicine (St Mary's Campus), Imperial College London, London, UK
| | - Michel Boussinesq
- Institut de Recherche pour le Développement (IRD), UMI 233-INSERM U1175-Montpellier University, Montpellier, France
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Pion SD, Nana-Djeunga H, Niamsi-Emalio Y, Chesnais CB, Deléglise H, Mackenzie C, Stolk W, Fletcher DA, Klion AD, Nutman TB, Boussinesq M, Kamgno J. Implications for annual retesting after a test-and-not-treat strategy for onchocerciasis elimination in areas co-endemic with Loa loa infection: an observational cohort study. Lancet Infect Dis 2019; 20:102-109. [PMID: 31676244 PMCID: PMC8150319 DOI: 10.1016/s1473-3099(19)30554-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 07/31/2019] [Accepted: 08/09/2019] [Indexed: 11/22/2022]
Abstract
Background A test-and-not-treat (TaNT) strategy has been developed to prevent people with high concentrations of circulating Loa loa microfilariae (>20 000 microfilariae per mL) developing serious adverse events after ivermectin treatment during mass drug administration to eliminate onchocerciasis. An important question related to cost and programmatic issues is whether annual retesting is required for everyone. We therefore aimed to investigate changes in L loa microfilarial densities during TaNT campaigns run 18 months apart. Methods In this observational cohort study, we assessed the participants of two TaNT campaigns for onchocerciasis. These campaigns, which were run by a research team, together with personnel from the Ministry of Health and community health workers, were done in six health areas (in 89 communities) in Okola health district (Cameroon); the first campaign was run between Aug 10, and Oct 29, 2015, and the second was run between March 7, and May 26, 2017. All individuals aged 5 years and older were invited to be screened for Loa loa microfilaraemia before being offered ivermectin (unless contraindicated). L loa microfilarial density was measured at the point of care using the LoaScope. All those with a L loa microfilarial density of 20 000 microfilariae per mL or less were offered treatment; in the first 2 weeks of the 2015 campaign, a higher exclusion threshold of 26 000 microfilariae per mL or less was used. At both rounds of the intervention, participants were registered with a paper form, in which personal information were collected. In 2017, we also recorded whether each individual reported participation in the 2015 campaign. The primary outcome, assessed in all participants, was whether L loa microfilarial density was above or below the exclusion threshold (ie, the criteria that guided the decision to treat). Findings In the 2015 TaNT campaign, 26 415 people were censused versus 29 587 people in the 2017 TaNT campaign. All individuals aged 5 years and older without other contraindications to treatment (22 842 people in 2015 and 25 421 people in 2017) were invited to be screened for L loa microfilaraemia before being offered ivermectin. In 2015, 16 182 individuals were examined with the LoaScope, versus 18 697 individuals in the same communities in 2017. 344 (2·1%) individuals were excluded from ivermectin treatment because of a high L loa microfilarial density in 2015, versus 283 (1·5%) individuals in 2017 (p<0·0001). Records from 2017 could be matched to those from 2015 for 6983 individuals (43·2% of the 2015 participants). In this cohort, in 2017, 6981 (>99·9%) of 6983 individuals treated with ivermectin in 2015 had L loa microfilariae density below the level associated with neurological serious adverse events. Interpretation Individuals treated with ivermectin do not need to be retested for L loa microfilaraemia before the next treatment, provided that they can be re-identified. This adjusted approach will enable substantial cost savings and facilitate reaching programmatic goals for elimination of onchocerciasis in areas that are co-endemic for loiasis. Funding Bill & Melinda Gates Foundation, Division of Intramural Research (National Institute of Allergy and Infectious Diseases, US National Institutes of Health).
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Affiliation(s)
- Sébastien Ds Pion
- French Research Institute for Development-Unité Mixte Internationale 233 and French National Institute of Health and Medical Research-Unit 1175, University of Montpellier Montpellier, France.
| | - Hugues Nana-Djeunga
- Centre for Research on Filariasis and other Tropical Diseases, Yaounde, Cameroon
| | | | - Cédric B Chesnais
- French Research Institute for Development-Unité Mixte Internationale 233 and French National Institute of Health and Medical Research-Unit 1175, University of Montpellier Montpellier, France
| | - Hugo Deléglise
- French Research Institute for Development-Unité Mixte Internationale 233 and French National Institute of Health and Medical Research-Unit 1175, University of Montpellier Montpellier, France
| | - Charles Mackenzie
- Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing, MI, USA
| | - Wilma Stolk
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Daniel A Fletcher
- Department of Bioengineering and Biophysics Programme, University of California, Berkeley, CA, USA
| | - Amy D Klion
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Thomas B Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Michel Boussinesq
- French Research Institute for Development-Unité Mixte Internationale 233 and French National Institute of Health and Medical Research-Unit 1175, University of Montpellier Montpellier, France
| | - Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases, Yaounde, Cameroon
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Nana-Djeunga HC, Fossuo-Thotchum F, Pion SD, Chesnais CB, Kubofcik J, Mackenzie CD, Klion AD, Boussinesq M, Nutman TB, Kamgno J. Loa loa Microfilariae in Skin Snips: Consequences for Onchocerciasis Monitoring and Evaluation in L. loa-Endemic Areas. Clin Infect Dis 2019; 69:1628-1630. [PMID: 30861060 PMCID: PMC6792118 DOI: 10.1093/cid/ciz172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/26/2019] [Indexed: 01/10/2023] Open
Abstract
The specificity of skin snips for onchocerciasis diagnoses is considered to be almost 100%. Our molecular methods revealed that microfilariae emerging from skin snips collected from highly microfilaremic Loa loa-infected individuals were largely misidentified as Onchocerca volvulus. This has important implications for onchocerciasis diagnostic testing in Loa-endemic areas.
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Affiliation(s)
| | | | - Sébastien D Pion
- Institut de Recherche pour le Développement (IRD), Unité Mixte Internationale (UMI) 233-Institut National de la Santé et de la Recherche Médicale (INSERM) U1175, Montpellier University, France
| | - Cédric B Chesnais
- Institut de Recherche pour le Développement (IRD), Unité Mixte Internationale (UMI) 233-Institut National de la Santé et de la Recherche Médicale (INSERM) U1175, Montpellier University, France
| | - Joseph Kubofcik
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Charles D Mackenzie
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Atlanta, Georgia
| | - Amy D Klion
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Michel Boussinesq
- Institut de Recherche pour le Développement (IRD), Unité Mixte Internationale (UMI) 233-Institut National de la Santé et de la Recherche Médicale (INSERM) U1175, Montpellier University, France
| | - Thomas B Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Joseph Kamgno
- Centre for Research on Filariasis and Other Tropical Diseases, Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon
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46
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Chesnais CB, Awaca-Uvon NP, Vlaminck J, Tambwe JP, Weil GJ, Pion SD, Boussinesq M. Risk factors for lymphatic filariasis in two villages of the Democratic Republic of the Congo. Parasit Vectors 2019; 12:162. [PMID: 30971305 PMCID: PMC6458702 DOI: 10.1186/s13071-019-3428-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/02/2019] [Indexed: 12/01/2022] Open
Abstract
Background Little is known regarding risk factors for lymphatic filariasis (LF) in Central Africa. To expand on what is known, we studied the epidemiology of LF in two endemic villages in the Democratic Republic of the Congo. Methods Dependent variables were Wuchereria bancrofti antigenaemia detected with filarial test strips (FTS) and microfilaraemia detected by night blood smears. The following factors were investigated: sex, age, the use of bednets, the use of latrines, hunting, fishing and agricultural activities, history of treatment with anthelmintic drugs, overnight stays in the bush, population density, the number of household members, and distance to rivers. Mixed multivariate logistic regression models were used. Results Two hundred and fifty nine out of 820 (31.6%) of subjects aged ≥ 5 years had W. bancrofti antigenaemia and 11.8% (97/820) had microfilaraemia. Multivariable analysis of risk factors for antigenaemia demonstrated increased risk for males (aOR = 1.75, 95% CI: 1.20–2.53, P = 0.003), for older individuals (aOR = 9.12 in those aged > 35 years, 95% CI: 4.47–18.61, P < 0.001), for people not using bednets (aOR = 1.57, 95% CI: 1.06–2.33, P = 0.023), for farmers (aOR = 2.21, 95% CI: 1.25–3.90, P = 0.006), and for those who live close to a river (aOR = 2.78, 95% CI: 1.14–6.74, P = 0.024). Significant risk factors for microfilaraemia included age, male gender, overnight stay in the bush, and residence close to a river (aOR = 1.86, 2.01, 2.73; P = 0.011, 0.010, 0.041; for the three latter variables, respectively). People who reported having taken levamisole (n = 117) during the prior year had a significantly decreased risk of having filarial antigenaemia (aOR = 0.40, 95% CI: 0.21–0.76, P = 0.005). Conclusions Age, sex, not using bednets, and occupation-dependent exposure to mosquitoes were important risk factors for infection with W. bancrofti in this study. The association with levamisole use suggests that the drug may have prevented filarial infections. Other results suggest that transmission often occurs outside of the village. This study provides interesting clues regarding the epidemiology of LF in Central Africa.
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Affiliation(s)
- Cédric B Chesnais
- IRD UMI 233, INSERM U1175, Université de Montpellier, Unité TransVIHMI, 911 Avenue Agropolis, P.O. Box 64501, 34394, Montpellier, France.
| | - Naomi-Pitchouna Awaca-Uvon
- Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive, Ministère de la Santé Publique, 36, Avenue de la Justice, C/Gombe, Kinshasa, Democratic Republic of the Congo
| | - Johnny Vlaminck
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Jean-Paul Tambwe
- Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive, Ministère de la Santé Publique, 36, Avenue de la Justice, C/Gombe, Kinshasa, Democratic Republic of the Congo
| | - Gary J Weil
- Infectious Diseases Division, Department of Internal Medicine, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8051, St. Louis, MO, USA
| | - Sébastien D Pion
- IRD UMI 233, INSERM U1175, Université de Montpellier, Unité TransVIHMI, 911 Avenue Agropolis, P.O. Box 64501, 34394, Montpellier, France
| | - Michel Boussinesq
- IRD UMI 233, INSERM U1175, Université de Montpellier, Unité TransVIHMI, 911 Avenue Agropolis, P.O. Box 64501, 34394, Montpellier, France
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47
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Boullé C, Njamnshi AK, Dema F, Mengnjo MK, Siewe Fodjo JN, Bissek ACZK, Suykerbuyk P, Lenou-Nanga CG, Nana-Djeunga HC, Kamgno J, Chesnais CB, Boussinesq M, Colebunders R. Impact of 19 years of mass drug administration with ivermectin on epilepsy burden in a hyperendemic onchocerciasis area in Cameroon. Parasit Vectors 2019; 12:114. [PMID: 30890155 PMCID: PMC6423875 DOI: 10.1186/s13071-019-3345-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/26/2019] [Indexed: 11/23/2022] Open
Abstract
Background Surveys conducted in 1991–1992 in the Mbam Valley (Cameroon) revealed that onchocerciasis was highly endemic, with community microfilarial loads (CMFL) > 100 microfilariae/snip in some villages. Also in 1991–1992, a survey of suspected cases of epilepsy (SCE) found 746 SCE using a questionnaire administered to individuals identified by key informants, with prevalences reaching 13.6% in some communities. From 1998, annual community-directed treatment with ivermectin (CDTI) was implemented to control onchocerciasis. In 2017, a door-to-door household survey was conducted in three of the villages visited in 1991–1992, using a standardized 5-item epilepsy screening questionnaire. Results In 2017, a total of 2286 individuals living in 324 households were screened (582 in Bayomen, 553 in Ngongol and 1151 in Nyamongo) and 112 SCE were identified (4.9%). Neurologists examined 92 of these SCE and confirmed the diagnosis of epilepsy for 81 of them (3.5%). Between the surveys in 1991–1992 and 2017, the prevalence of SCE decreased from 13.6% to 2.5% in Bayomen (P = 0.001), from 8.7% to 6.6% in Ngongol (P = 0.205) and from 6.4% to 5.4% in Nyamongo (P = 0.282). The median age of SCE shifted from 20 (IQR: 12–23) to 29 years (IQR: 18–33; P = 0.018) in Bayomen, from 16 (IQR: 12–21) to 26 years (IQR: 21–39; P < 0.001) in Ngongol and from 16 (IQR: 13–19) to 24 years (IQR: 19–32; P < 0.001) in Nyamongo. The proportions of SCE aged < 10, 10–19, 20–29 and ≥ 30 years shifted from 9.5, 58.3, 25.0 and 7.1% in 1991–1992 to 2.7, 20.5, 39.3 and 37.5% in 2017, respectively. Conclusions SCE prevalence decreased overall between 1991–1992 and 2017. The age shift observed is probably due to a decrease in the number of new cases of epilepsy resulting from the dramatic reduction of Onchocerca volvulus transmission after 19 years of CDTI. Electronic supplementary material The online version of this article (10.1186/s13071-019-3345-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Charlotte Boullé
- TransVIHMI, University of Montpellier, Inserm, IRD, Montpellier, France.,Infectious and Tropical Diseases Department, University Hospital, Nîmes, France
| | - Alfred K Njamnshi
- Neurology Department, Central Hospital of Yaoundé, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | | | - Michel K Mengnjo
- Neurology Department, Central Hospital of Yaoundé, Yaoundé, Cameroon
| | - Joseph Nelson Siewe Fodjo
- Subdivisonal hospital of Mbangassina, Mbangassina, Cameroon.,Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Anne-Cécile Zoung-Kanyi Bissek
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Ministry of Public Health, Yaoundé, Cameroon.,Dermatology Department, Chantal Biya Mother-Child Center, Yaoundé, Cameroon
| | | | - Cédric G Lenou-Nanga
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
| | | | - Joseph Kamgno
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
| | - Cédric B Chesnais
- TransVIHMI, University of Montpellier, Inserm, IRD, Montpellier, France
| | - Michel Boussinesq
- TransVIHMI, University of Montpellier, Inserm, IRD, Montpellier, France
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48
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Pion SD, Tchatchueng-Mbougua JB, Chesnais CB, Kamgno J, Gardon J, Chippaux JP, Ranque S, Ernould JC, Garcia A, Boussinesq M. Effect of a Single Standard Dose (150-200 μg/kg) of Ivermectin on Loa loa Microfilaremia: Systematic Review and Meta-analysis. Open Forum Infect Dis 2019; 6:ofz019. [PMID: 30968052 PMCID: PMC6449757 DOI: 10.1093/ofid/ofz019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/11/2019] [Indexed: 12/17/2022] Open
Abstract
Background In central Africa, millions of individuals infected with Loa loa have received the anthelminthic drug ivermectin (IVM) as part of mass drug administration (MDA) campaigns targeting onchocerciasis control or elimination. Nonetheless, the parasitological surveys that are occasionally conducted to evaluate the impact of IVM treatments on Onchocerca volvulus do not include an assessment of the extra benefits of those MDA campaigns on L. loa. Methods We conducted a systematic review of trials on the effect of a single standard (150–200 μg/kg) dose of IVM on L. loa microfilarial density (MFD). The dynamics of MFD over 365 days of treatment were described using multilevel regression and latent class modeling. Results IVM brings about a rapid, dramatic, and sustained decrease, with reduction rates of 60%, 75%, 85%, and 90% on day 1 (D1), D2, D7, and D365, respectively. At D365, no participants (0/238) with an initial MFD of <20 000 microfilariae (mf)/mL were at risk of postivermectin severe adverse events, and only 1/57 individuals with an initial MFD of ≥20 000 mf/mL presented with an MFD above this value. The main predictor of post-treatment MFD was the pretreatment value, but this post-treatment value varied little between D8 and D365 regardless of the pretreatment level. Conclusions A single dose of IVM is very effective at substantially reducing L. loa MFD for at least a year, irrespective of the initial level of parasitemia. Individuals treated with IVM are probably not any more at risk of severe adverse events when retreated 1 year later.
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Affiliation(s)
- Sébastien D Pion
- IRD UMI 233-INSERM U1175- University of Montpellier, Montpellier, France
| | | | - Cédric B Chesnais
- IRD UMI 233-INSERM U1175- University of Montpellier, Montpellier, France
| | - Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Jacques Gardon
- IRD UMR 050, HydroSciences Montpellier, CNRS, University of Montpellier, Montpellier, France
| | | | - Stéphane Ranque
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | | | - André Garcia
- IRD MERIT, Université Paris 5, Sorbonne Paris Cité, Paris, France
| | - Michel Boussinesq
- IRD UMI 233-INSERM U1175- University of Montpellier, Montpellier, France
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49
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Chesnais CB, Boussinesq M. Onchocerciasis-associated epilepsy - Authors' reply. Lancet Infect Dis 2018; 19:22. [PMID: 30587288 DOI: 10.1016/s1473-3099(18)30743-6] [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] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Cédric B Chesnais
- Institut de Recherche pour le Développement, 34394 Montpellier, France.
| | - Michel Boussinesq
- Institut de Recherche pour le Développement, 34394 Montpellier, France
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50
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Siewe Fodjo JN, Tatah G, Tabah EN, Ngarka L, Nfor LN, Chokote SE, Mengnjo MK, Dema F, Sitouok AT, Nkoro G, Ntone FE, Bissek ACZK, Chesnais CB, Boussinesq M, Colebunders R, Njamnshi AK. Epidemiology of onchocerciasis-associated epilepsy in the Mbam and Sanaga river valleys of Cameroon: impact of more than 13 years of ivermectin. Infect Dis Poverty 2018; 7:114. [PMID: 30501640 DOI: 10.1186/s40249-018-0497-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [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: 07/19/2018] [Accepted: 10/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A high epilepsy prevalence has been reported in several onchocerciasis-endemic villages along the Mbam and Sanaga river valleys in Cameroon, including Bilomo and Kelleng. We sought to determine the prevalence of epilepsy in these two villages following more than 13 years of community-directed treatment with ivermectin (CDTI). METHODS Door-to-door surveys were performed on the entire resident population in the villages in August 2017 and January 2018. Epilepsy was diagnosed using a 2-step approach: administration of a standardized 5-item questionnaire followed by confirmation by a neurologist. Previously published diagnostic criteria for onchocerciasis-associated epilepsy (OAE) were used. Ov16 serology was done for children aged 7-10 years to assess onchocerciasis transmission. Findings were compared with previous data from these two villages. RESULTS A total of 1525 individuals (1321 in Bilomo and 204 in Kelleng) in 233 households were surveyed in both villages. The crude prevalence of epilepsy was 4.6% in Bilomo (2017) and 7.8% in Kelleng (2018), including 12 (15.6% of cases) persons with epilepsy (PWE) with nodding seizures. The age and sex-standardized prevalence in Kelleng decreased from 13.5% in 2004 to 9.3% in 2018 (P < 0.001). The median age of PWE shifted from 17 (IQR: 12-22) years to 24 (IQR: 20-30) years in Bilomo (P < 0.001); and slightly from 24 (IQR: 14-34) years to 28 (IQR: 21.25-36.75) years in Kelleng (P = 0.112). Furthermore, 47.6% of all tested children between 7 and 10 years had Ov16 antibodies. CONCLUSIONS There is a decrease in epilepsy prevalence after 13 years and more of CDTI in both villages. The age-shift observed in PWE suggests that ivermectin may prevent OAE in younger residents. Ov16 seropositivity in children indicates ongoing onchocerciasis transmission possibly due to suboptimal control measures. Our findings support the existence of OAE in Cameroon and highlight the need to strengthen onchocerciasis elimination programs.
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Affiliation(s)
| | - Godwin Tatah
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Neurology Department, CH Saint-Nazaire, Saint-Nazaire, France.,Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon
| | - Earnest Njih Tabah
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Ministry of Public Health, Yaoundé, Cameroon
| | - Leonard Ngarka
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon
| | - Leonard Njamnshi Nfor
- Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon.,Neurology Department, CHU Brugman, Brussels, Belgium
| | - Samuel Eric Chokote
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon
| | - Michel K Mengnjo
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon
| | - Fidèle Dema
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Yoko District Hospital, Yaoundé, Cameroon
| | - Aurélien Tele Sitouok
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon
| | - Grace Nkoro
- Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon
| | - Félicien E Ntone
- Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon
| | - Anne-Cécile Zoung-Kanyi Bissek
- Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon.,Ministry of Public Health, Yaoundé, Cameroon
| | - Cédric B Chesnais
- UMI 233, Institut de Recherche pour le Développement (IRD), Montpellier, France.,Université Montpellier, Montpellier, France.,INSERM Unité 1175, Montpellier, France
| | - Michel Boussinesq
- UMI 233, Institut de Recherche pour le Développement (IRD), Montpellier, France.,Université Montpellier, Montpellier, France.,INSERM Unité 1175, Montpellier, France
| | | | - Alfred K Njamnshi
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.,Neuroscience Laboratory, FMBS, The University of Yaoundé I, Yaoundé, Cameroon.,Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
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