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Kay A, Vasiliu A, Carratala-Castro L, Mtafya B, Mendez Reyes JE, Maphalala N, Munguambe S, Mulengwa D, Ness T, Saavedra B, Bacha J, Maphalala G, Mejia R, Mtetwa G, Acacio S, Manjate P, Mambuque E, Shiba N, Kota N, Ziyane M, Ntinginya NE, Lange C, Kirchner HL, DiNardo AR, Garcia-Basteiro AL, Mandalakas AM. Performance of a stool-based quantitative PCR assay for the diagnosis of tuberculosis in adolescents and adults: a multinational, prospective diagnostic accuracy study. Lancet Microbe 2024:S2666-5247(23)00391-9. [PMID: 38461830 DOI: 10.1016/s2666-5247(23)00391-9] [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: 06/23/2023] [Revised: 10/23/2023] [Accepted: 11/21/2023] [Indexed: 03/12/2024]
Abstract
BACKGROUND Despite increasing availability of rapid molecular tests for the diagnosis of tuberculosis in high-burden settings, many people with tuberculosis are undiagnosed. Reliance on sputum as the primary specimen for tuberculosis diagnostics contributes to this diagnostic gap. We evaluated the diagnostic accuracy and additive yield of a novel stool quantitative PCR (qPCR) assay for the diagnosis of tuberculosis in three countries in Africa with high tuberculosis burdens. METHODS We undertook a prospective diagnostic accuracy study in Eswatini, Mozambique, and Tanzania from Sept 21, 2020, to Feb 2, 2023, to compare the diagnostic accuracy for tuberculosis of a novel stool qPCR test with the current diagnostic standard for Mycobacterium tuberculosis DNA detection from sputum and stool, Xpert-MTB/RIF Ultra (Xpert Ultra). Sputum, stool, and urine samples were provided by a cohort of participants, aged 10 years or older, diagnosed with tuberculosis. Participants with tuberculosis (cases) were enrolled within 72 h of treatment initiation for tuberculosis diagnosed clinically or following laboratory confirmation. Participants without tuberculosis (controls) consisted of household contacts of the cases who did not develop tuberculosis during a 6-month follow-up. The performance was compared with a robust composite microbiological reference standard (CMRS). FINDINGS The cohort of adolescents and adults (n=408) included 268 participants with confirmed or clinical tuberculosis (cases), 147 (55%) of whom were living with HIV, and 140 participants (controls) without tuberculosis. The sensitivity of the novel stool qPCR was 93·7% (95% CI 87·4-97·4) compared with participants with detectable growth on M tuberculosis culture, and 88·1% (81·3-93·0) compared with sputum Xpert Ultra. The stool qPCR had an equivalent sensitivity as sputum Xpert Ultra (94·8%, 89·1-98·1) compared with culture. Compared with the CMRS, the sensitivity of the stool qPCR was higher than the current standard for tuberculosis diagnostics on stool, Xpert Ultra (80·4%, 73·4-86·2 vs 73·5%, 66·0-80·1; p=0·025 on paired comparison). The qPCR also identified 17-21% additional tuberculosis cases compared to sputum Xpert Ultra or sputum culture. In controls without tuberculosis, the specificity of the stool qPCR was 96·9% (92·2-99·1). INTERPRETATION In this study, a novel qPCR for the diagnosis of tuberculosis from stool specimens had a higher accuracy in adolescents and adults than the current diagnostic PCR gold standard on stool, Xpert-MTB/RIF Ultra, and equivalent sensitivity to Xpert-MTB/RIF Ultra on sputum. FUNDING National Institutes of Health (NIH) Allergy and Infectious Diseases, and NIH Fogarty International Center.
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Affiliation(s)
- Alexander Kay
- Global TB Program, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Baylor College of Medicine Children's Foundation Eswatini, Mbabane, Eswatini.
| | - Anca Vasiliu
- Global TB Program, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Lucia Carratala-Castro
- Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Bariki Mtafya
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center, Mbeya, Tanzania
| | | | - Nontobeko Maphalala
- Baylor College of Medicine Children's Foundation Eswatini, Mbabane, Eswatini
| | - Shilzia Munguambe
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Durbbin Mulengwa
- Baylor College of Medicine Children's Foundation Eswatini, Mbabane, Eswatini
| | - Tara Ness
- Global TB Program, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Belen Saavedra
- Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Jason Bacha
- Baylor College of Medicine Children's Foundation Mbeya, Mbeya, Tanzania
| | | | - Rojelio Mejia
- Pediatric Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Godwin Mtetwa
- Global TB Program, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Sozinho Acacio
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Patricia Manjate
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Edson Mambuque
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Nosisa Shiba
- Baylor College of Medicine Children's Foundation Eswatini, Mbabane, Eswatini
| | - Nokwanda Kota
- Baylor College of Medicine Children's Foundation Eswatini, Mbabane, Eswatini
| | - Mangaliso Ziyane
- Baylor College of Medicine Children's Foundation Eswatini, Mbabane, Eswatini; Eswatini Health Laboratory Service, Mbabane, Eswatini
| | - Nyanda Elias Ntinginya
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center, Mbeya, Tanzania
| | - Christoph Lange
- Global TB Program, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany; Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany
| | - H Lester Kirchner
- Global TB Program, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Department of Population Health Sciences, Geisinger, Danville, PA, USA
| | - Andrew R DiNardo
- Global TB Program, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Alberto L Garcia-Basteiro
- Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
| | - Anna Maria Mandalakas
- Global TB Program, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany; Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany; Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health School of Public Health, Houston, TX, USA
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Aguilar-Rodríguez D, Seco-Hidalgo V, Lopez A, Romero-Sandoval N, Calvopiña M, Guevara A, Baldeón L, Rodríguez A, Mejia R, Nutman TB, Sears WJ, Cooper PJ. Geographic Distribution of Human Infections with Zoonotic Ancylostoma ceylanicum and Anthropophilic Hookworms in Ecuador: A Retrospective Analysis of Archived Stool Samples. Am J Trop Med Hyg 2024; 110:460-469. [PMID: 38266286 PMCID: PMC10919174 DOI: 10.4269/ajtmh.23-0469] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/21/2023] [Indexed: 01/26/2024] Open
Abstract
Zoonotic human infections with Ancylostoma ceylanicum have recently been reported in the Americas. We used archived human stool samples to study the geographic distribution of human infections with A. ceylanicum and anthropophilic hookworms in different geoclimatic regions (coastal, Andean, and Amazon) of Ecuador. We analyzed retrospectively archived human stool samples from five studies previously screened for hookworm infection by microscopy, of which four included hookworm-positive samples only and one involved hookworm-negative samples to increase geographic distribution of sampling. Stools were analyzed using multi-parallel quantitative polymerase chain reaction (qPCR) assays to detect Necator americanus, Ancylostoma duodenale, A. ceylanicum, Ascaris lumbricoides, Trichuris trichiura, and Strongyloides stercoralis. Sequencing was done for the A. ceylanicum cox1 gene. A total of 132 samples were analyzed, of which 69 (52.3%) were from hookworm-positive and 63 (47.7%) from hookworm-negative individuals by microscopy. Overall, 82.6% of microscopy-positive samples and 33.3% of microscopy-negative samples were positive for hookworm by qPCR. Of microscopy-positive samples, 36.2% were A. ceylanicum, 37.7% A. duodenale, and 33.3% N. americanus, whereas equivalent proportions for microscopy-negative samples were 1.6%, 31.7%, and 1.6%, respectively. Ancylostoma duodenale was the most widely dispersed geographically, followed by N. americanus. Ancylostoma ceylanicum was least dispersed but was detected in coastal and Amazon regions. In conclusion, human infections with A. ceylanicum, A. duodenale, and N. americanus were detected in different geoclimatic regions of Ecuador. Additional studies are required to further define the epidemiology of human A. ceylanicum infections, but the potentially widespread presence of this helminth in human populations in Ecuador has implications for hookworm control strategies.
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Affiliation(s)
| | - Victor Seco-Hidalgo
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
- Institute of Infection and Immunity, St. George’s University of London, United Kingdom
| | - Andrea Lopez
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Natalia Romero-Sandoval
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
- Grups de Recerca d’Amèrica i Àfrica Llatines – GRAAL, Barcelona, Spain and Quito, Ecuador
| | - Manuel Calvopiña
- One Health Research Group, Faculty of Medicine, Universidad de las Americas, Quito, Ecuador
| | - Angel Guevara
- Instituto de Biomedicina, Universidad Central, Quito, Ecuador
| | - Lucy Baldeón
- Instituto de Biomedicina, Universidad Central, Quito, Ecuador
| | | | - Rojelio Mejia
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Thomas B. Nutman
- Laboratory of Parasitic Diseases, National Institutes of Health, Bethesda, Maryland
| | - William J. Sears
- Laboratory of Parasitic Diseases, National Institutes of Health, Bethesda, Maryland
| | - Philip J. Cooper
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
- Institute of Infection and Immunity, St. George’s University of London, United Kingdom
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McKim S, Kopystynsky K, Wolf N, Akbar FA, Bottazzi ME, Hotez PJ, Mejia R. Environmental Detection of Parasites in the Marginalized Paiute Reservations Compared to a Nearby Area. Am J Trop Med Hyg 2024; 110:457-459. [PMID: 38350146 PMCID: PMC10919181 DOI: 10.4269/ajtmh.23-0712] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/09/2023] [Indexed: 02/15/2024] Open
Abstract
The amounts of parasite DNA in soil samples from different playgrounds and other public areas can help identify areas of possible microbe transmission and give indications of the possible occurrence of parasite infection in nearby communities. We collected 207 soil samples from parks in Paiute indigenous tribal areas in southwestern Utah and from the higher income city of St. George, Utah, and tested them for 11 parasites that can cause human disease. Molecular tests revealed an elevated odds ratio (OR) of 3.072 (range, 1.114-8.065) for detecting the helminth Trichuris trichiura and an elevated OR of 3.036 (range, 1.101-7.966) for any protozoa (not including Acanthamoeba) in the tribal land playgrounds compared with St. George parks. These findings support previous studies showing that areas in lower socioeconomic communities, especially marginalized communities, tend to have more parasites in the soil, which may lead to higher disease prevalence rates.
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Affiliation(s)
- Shannon McKim
- Rocky Vista University College of Osteopathic Medicine, St. George, Utah
| | | | - Nathaniel Wolf
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Fahim A. Akbar
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Maria Elena Bottazzi
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Peter J. Hotez
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Rojelio Mejia
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
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Mejia R, Verocai GG, Mosley IA, Zhan B, Vongthavaravat L, Busselman RE, Hamer SA. Evaluation of a novel Tc-24 recombinant antigen ELISA for serologic testing for Trypanosoma cruzi in dogs. bioRxiv 2024:2024.02.12.579969. [PMID: 38405948 PMCID: PMC10888942 DOI: 10.1101/2024.02.12.579969] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Chagas disease is a parasitic infection caused by Trypanosoma cruzi. Diagnosis of chronic Chagas disease in dogs relies on limited serological test options. This study used a new Tc-24 recombinant antigen ELISA on an archival set of 70 dog serum samples from multi-dog kennel environments in Texas subjected to three existing Chagas serological tests. Tc-24 ELISA produced a quantitative result and could detect anti-T. cruzi antibodies in dogs with high sensitivity and specificity. Comparing individual tests to Tc-24 ELISA resulted in strong associations and correlations, which suggest that Tc-24 ELISA is a reliable and accurate diagnostic tool for dogs with a single test.
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Affiliation(s)
- Rojelio Mejia
- Department of Pediatrics - Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Guilherme G. Verocai
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Ilana A. Mosley
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Bin Zhan
- Department of Pediatrics - Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Lindsey Vongthavaravat
- Department of Pediatrics - Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Rachel E. Busselman
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Sarah A. Hamer
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
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Brown K, Ceci A, Roby C, Briggs R, Ziolo D, Korba R, Mejia R, Kelly S, Toney D, Friedlander M, Finkielstein C. A comparative analysis exposes an amplification delay distinctive to SARS-CoV-2 Omicron variants of clinical and public health relevance. Emerg Microbes Infect 2023; 12:2154617. [PMID: 36458572 PMCID: PMC9793939 DOI: 10.1080/22221751.2022.2154617] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
ABSTRACTMutations in the SARS-CoV-2 genome may negatively impact a diagnostic test, have no effect, or turn into an opportunity for rapid molecular screening of variants. Using an in-house Emergency Use Authorized RT-qPCR-based COVID-19 diagnostic assay, we combined sequence surveillance of viral variants and computed PCR efficiencies for mismatched templates. We found no significant mismatches for the N, E, and S set of assay primers until the Omicron variant emerged in late November 2021. We found a single mismatch between the Omicron sequence and one of our assay's primers caused a > 4 cycle delay during amplification without impacting overall assay performance.Starting in December 2021, clinical specimens received for COVID-19 diagnostic testing that generated a Cq delay greater than 4 cycles were sequenced and confirmed as Omicron. Clinical samples without a Cq delay were largely confirmed as the Delta variant. The primer-template mismatch was then used as a rapid surrogate marker for Omicron. Primers that correctly identified Omicron were designed and tested, which prepared us for the emergence of future variants with novel mismatches to our diagnostic assay's primers. Our experience demonstrates the importance of monitoring sequences, the need for predicting the impact of mismatches, their value as a surrogate marker, and the relevance of adapting one's molecular diagnostic test for evolving pathogens.
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Affiliation(s)
- K.L. Brown
- Virginia Tech Carilion School of Medicine, Virginia Tech, Roanoke, VA, USA,Center for Zoonotic and Arthropod-borne Pathogens, Virginia Tech, Blacksburg, VA, USA
| | - A. Ceci
- Molecular Diagnostics Laboratory, Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, USA
| | - C. Roby
- Molecular Diagnostics Laboratory, Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, USA
| | - R. Briggs
- Molecular Diagnostics Laboratory, Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, USA
| | - D. Ziolo
- ZC Lab Services, Greenacreas, FL, USA
| | - R. Korba
- Molecular Detection and Characterization, Department of General Services, Division of Consolidated Laboratory Services, Richmond, VA, USA
| | - R. Mejia
- Molecular Detection and Characterization, Department of General Services, Division of Consolidated Laboratory Services, Richmond, VA, USA
| | - S.T. Kelly
- Molecular Detection and Characterization, Department of General Services, Division of Consolidated Laboratory Services, Richmond, VA, USA
| | - D. Toney
- Molecular Detection and Characterization, Department of General Services, Division of Consolidated Laboratory Services, Richmond, VA, USA
| | - M.J. Friedlander
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, USA
| | - C.V. Finkielstein
- Molecular Diagnostics Laboratory, Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, USA,Integrated Cellular Responses Laboratory, Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, USA,Department of Biological Sciences, Virginia Tech, Blacksburg, VA, USA,Center for Zoonotic and Arthropod-borne Pathogens, Virginia Tech, Blacksburg, VA, USA, C.V. Finkielstein Molecular Diagnostics Laboratory, Fralin Biomedical Research Institute at VTC, Virginia Tech, 4 Riverside Cr., Roanoke, VA, 24016, USA
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Sandoval-Ramírez T, Seco-Hidalgo V, Calderon-Espinosa E, Garcia-Ramon D, Lopez A, Calvopiña M, Guadalupe I, Chico M, Mejia R, Chis Ster I, Cooper PJ. Epidemiology of giardiasis and assemblages A and B and effects on diarrhea and growth trajectories during the first 8 years of life: Analysis of a birth cohort in a rural district in tropical Ecuador. PLoS Negl Trop Dis 2023; 17:e0011777. [PMID: 37983257 PMCID: PMC10695370 DOI: 10.1371/journal.pntd.0011777] [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: 08/06/2023] [Revised: 12/04/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND There are limited longitudinal data on the acquisition of Giardia lamblia infections in childhood using molecular assays to detect and type assemblages, and measure effects of infections on diarrhea risk and childhood growth. METHODS We analysed stool samples from a surveillance sample within a birth cohort in a rural district in tropical Ecuador. The cohort was followed to 8 years of age for the presence of G. lamblia in stools by quantitative PCR and A and B assemblages by Taqman assay or Sanger sequencing. We explored risk factors associated with infection using generalized estimating equations applied to longitudinal binary outcomes, and longitudinal panel data analysis to estimate effects of infection on diarrhea and growth trajectories. RESULTS 2,812 stool samples collected between 1 month and 8 years of age from 498 children were analyzed and showed high rates of infection: 79.7% were infected at least once with peak prevalence (53.9%) at 5 years. Assemblage B was accounted for 56.8% of genotyped infections. Risk factors for infection included male sex (P = 0.001), daycare attendance (P<0.001), having a household latrine (P = 0.04), childhood (P<0.001) and maternal soil-transmitted helminth (P = 0.029) infections, and exposures to donkeys (age interaction P = 0.034). G. lamblia was associated with increased risk of diarrhea (per episode, RR 1.03, 95% CI 1.01-1.06, P = 0.011) during the first 3 years of life and a transient impairment of weight (age interaction P = 0.017) and height-for-age (age interaction P = 0.025) trajectories between 1 and 4 years of age. There was no increased risk of either assemblage being associated with outcomes. CONCLUSION Our data show a relatively high edemicity of G. lamblia transmission during childhood in coastal Ecuador, and evidence that infection is associated with a transiently increased risk of diarrhea during the first 3 years of life and impairment of weight and height between 1 and 4 years.
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Affiliation(s)
- Tannya Sandoval-Ramírez
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
- Grupo de Investigación en Sanidad Animal y Humana GISAH, Departamento de Ciencias de la Vida y la Agricultura, Universidad de las Fuerzas Armadas ESPE, Quito, Ecuador
| | - Victor Seco-Hidalgo
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
- Institute of Infection and Immunity, St George’s University of London, London, United Kingdom
| | | | - Diana Garcia-Ramon
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Andrea Lopez
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Manuel Calvopiña
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Quito, Ecuador
| | - Irene Guadalupe
- Fundación Ecuatoriana Para la Investigación en Salud, Quito, Ecuador
| | - Martha Chico
- Fundación Ecuatoriana Para la Investigación en Salud, Quito, Ecuador
| | - Rojelio Mejia
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Irina Chis Ster
- Institute of Infection and Immunity, St George’s University of London, London, United Kingdom
| | - Philip J. Cooper
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
- Institute of Infection and Immunity, St George’s University of London, London, United Kingdom
- Fundación Ecuatoriana Para la Investigación en Salud, Quito, Ecuador
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McKim S, Kopystynsky K, Wolf N, Akbar FA, Bottazzi ME, Hotez PJ, Mejia R. Environmental detection of parasites in the marginalized Paiute reservations compared to a nearby area. medRxiv 2023:2023.10.24.23297407. [PMID: 37961205 PMCID: PMC10635189 DOI: 10.1101/2023.10.24.23297407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
The amounts of parasite DNA in soil samples from different playgrounds and other public areas can help identify areas of possible microbe transmission as well as giving indications of possible occurrence of parasite infection in nearby communities. We collected 207 soil samples from parks located on Paiute indigenous tribal areas in southwest Utah and from higher income city of St. George, Utah, and tested them for the presence of 11 parasites that can cause human disease. Molecular tests revealed elevated odds ratio of detecting the helminth Trichuris trichiura 3.072 (1.114 to 8.065) and any protozoa (not including Acanthamoeba ) 3.036 (1.101 to 7.966) in the tribal land playgrounds compared to St. George parks. These findings support previous studies showing that areas in lower socioeconomic communities, especially marginalized communities, tend to have higher presence of parasites in the soil that may lead to higher rates of disease prevalence.
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8
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Castañeda S, Muñoz M, Hotez PJ, Bottazzi ME, Paniz-Mondolfi AE, Jones KM, Mejia R, Poveda C, Ramírez JD. Microbiome Alterations Driven by Trypanosoma cruzi Infection in Two Disjunctive Murine Models. Microbiol Spectr 2023; 11:e0019923. [PMID: 37140369 PMCID: PMC10269900 DOI: 10.1128/spectrum.00199-23] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/08/2023] [Indexed: 05/05/2023] Open
Abstract
Alterations caused by Trypanosoma cruzi in the composition of gut microbiome may play a vital role in the host-parasite interactions that shapes physiology and immune responses against infection. Thus, a better understanding of this parasite-host-microbiome interaction may yield relevant information in the comprehension of the pathophysiology of the disease and the development of new prophylactic and therapeutic alternatives. Therefore, we implemented a murine model with two mice strains (BALB/c and C57BL/6) to evaluate the impact of Trypanosoma cruzi (Tulahuen strain) infection on the gut microbiome utilizing cytokine profiling and shotgun metagenomics. Higher parasite burdens were observed in cardiac and intestinal tissues, including changes in anti-inflammatory (interleukin-4 [IL-4] and IL-10) and proinflammatory (gamma interferon, tumor necrosis factor alpha, and IL-6) cytokines. Bacterial species such as Bacteroides thetaiotaomicron, Faecalibaculum rodentium, and Lactobacillus johnsonii showed a decrease in relative abundance, while Akkermansia muciniphila and Staphylococcus xylosus increased. Likewise, as infection progressed, there was a decrease in gene abundances related to metabolic processes such as lipid synthesis (including short-chain fatty acids) and amino acid synthesis (including branched-chain amino acids). High-quality metagenomic assembled genomes of L. johnsonii and A. muciniphila among other species were reconstructed, confirming, functional changes associated with metabolic pathways that are directly affected by the loss of abundance of specific bacterial taxa. IMPORTANCE Chagas disease (CD) is caused by the protozoan Trypanosoma cruzi, presenting acute and chronic phases where cardiomyopathy, megaesophagus, and/or megacolon stand out. During the course of its life cycle, the parasite has an important gastrointestinal tract transit that leads to severe forms of CD. The intestinal microbiome plays an essential role in the immunological, physiological, and metabolic homeostasis of the host. Therefore, parasite-host-intestinal microbiome interactions may provide information on certain biological and pathophysiological aspects related to CD. The present study proposes a comprehensive evaluation of the potential effects of this interaction based on metagenomic and immunological data from two mice models with different genetic, immunological, and microbiome backgrounds. Our findings suggest that there are alterations in the immune and microbiome profiles that affect several metabolic pathways that can potentially promote the infection's establishment, progression, and persistence. In addition, this information may prove essential in the research of new prophylactic and therapeutic alternatives for CD.
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Affiliation(s)
- Sergio Castañeda
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Marina Muñoz
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Peter J. Hotez
- Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
- Texas Children’s Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, Texas, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
- Department of Biology, Baylor University, Waco, Texas, USA
| | - Maria Elena Bottazzi
- Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
- Texas Children’s Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, Texas, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
- Department of Biology, Baylor University, Waco, Texas, USA
| | - Alberto E. Paniz-Mondolfi
- Molecular Microbiology Laboratory, Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Incubadora Venezolana de la Ciencia, Barquisimeto, Venezuela
| | - Kathryn M. Jones
- Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
- Texas Children’s Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, Texas, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Rojelio Mejia
- Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
- Texas Children’s Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, Texas, USA
| | - Cristina Poveda
- Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
- Texas Children’s Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, Texas, USA
| | - Juan David Ramírez
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
- Molecular Microbiology Laboratory, Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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9
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Ness TE, Meiwes L, Kay A, Mejia R, Lange C, Farhat M, Mandalakas A, DiNardo A. Optimizing DNA Extraction from Pediatric Stool for Diagnosis of Tuberculosis and Use in Next-Generation Sequencing Applications. Microbiol Spectr 2023; 11:e0226922. [PMID: 36475757 PMCID: PMC9927083 DOI: 10.1128/spectrum.02269-22] [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] [Indexed: 12/13/2022] Open
Abstract
The WHO has endorsed the use of stool samples for diagnosis of tuberculosis (TB) in children, and targeted next-generation sequencing (tNGS) of stool has been shown to support diagnosis and provide information about drug susceptibility (DS). Optimizing extraction of DNA from stool for sequencing is critical to ensure high diagnostic sensitivity and accurate DS information. Human stool samples were spiked with various concentrations of Mycobacterium bovis bacillus Calmette-Guérin (BCG), and DNA was extracted from the samples using four different DNA extraction kits. Each sample was subjected to quantitative PCR for identifying Mycobacterium tuberculosis complex bacteria and underwent further analysis to assess the overall DNA yield, fragment length, and purity. This same process was performed with 10 pediatric participants diagnosed with pulmonary TB, and the samples underwent tNGS. The FastDNA spin kit for soil showed the best results on model samples spiked with known quantities of BCG, compared to the other extraction methods evaluated. For clinical samples, the FastDNA and PowerFecal Pro DNA (PowerFecal) kits both showed an increase in the overall DNA quantity, M. tuberculosis-specific DNA quantity, and successful targeted sequencing when testing was performed on stool samples, compared to the two other kits. Three samples extracted via PowerFecal and three samples extracted via FastDNA (from different patients) provided successful sequencing data, with an average depth of coverage of the rpoB region for FastDNA of 298 (range, 107 to 550) and for PowerFecal of 310 (range, 182 to 474), results that were comparable to one another (P = 0.946). The PowerFecal Pro and FastDNA spin kits were superior for extracting DNA from pediatric stool samples for tNGS. IMPORTANCE This is the first study to compare Mycobacterium tuberculosis DNA extraction techniques from pediatric stool samples for use with sequencing technologies. It provides an important starting point for other researchers to isolate quality DNA for this purpose to further the field and to continue to optimize protocols and approaches.
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Affiliation(s)
- Tara E. Ness
- Division of Pediatric Infectious Diseases, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA
- Global TB Program, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA
| | - Lennard Meiwes
- Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany
| | - Alexander Kay
- Global TB Program, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA
- Baylor Center of Excellence, Mbabane, Eswatini
| | - Rojelio Mejia
- Division of Pediatric Infectious Diseases, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA
| | - Christoph Lange
- Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany
| | - Maha Farhat
- Harvard Medical School, Department of Biomedical Informatics, Boston, Massachusetts, USA
- Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anna Mandalakas
- Global TB Program, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA
| | - Andrew DiNardo
- Global TB Program, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA
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10
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Ness T, Meiwes LA, Kay A, Mejia R, Lange C, Mandalakas A, DiNardo A. 326. Optimizing DNA Extraction from Pediatric Stool for Diagnosing Tuberculosis and Use in Next Generation Sequencing. Open Forum Infect Dis 2022. [PMCID: PMC9752410 DOI: 10.1093/ofid/ofac492.404] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Next generation sequencing (NGS) is quickly coming to the forefront of diagnostic tools to provide efficient, highly informative information from patient samples. Recently, it was established that patients with pulmonary Tuberculosis (TB) have Mycobacterium tuberculosis DNA present in their stool samples, which can augment current diagnostic gaps. Optimizing extraction of DNA from stool for analysis via sequencing technologies is a paramount initial step to ensure accuracy of downstream sequencing applications. Methods Attenuated strains of Mycobacterium bovis derived from BCG were used as a model for Mtb. Human stool samples were spiked with varying known concentrations of BCG and extracted with four different DNA extraction kits (Fast DNA Spik Kit for Soil, DNeasy Blood and Tissue Kit, MagAttract HMW DNA Kit, and PowerFecal Pro DNA Kit). Each sample was subjected to quantitative polymerase chain reaction using designed primers and probes specific for identifying Mtb infection from stool. The samples underwent further analysis to assess overall DNA yield (Qubit fluorometer), DNA fragment length (Agilent tape measure), and DNA purity (Nanodrop spectrophotometer). Results Overall, the Fast DNA Spin Kit for Soil extraction kit showed the most optimal results. DNA isolated via this method showed the lowest cycle thresholds of Mtb amplification, indicating the most preserved amount of BCG specific DNA. In addition, this method showed the highest overall DNA yield and highest proportion of long DNA fragment lengths. Fluorometric analysis showed significant contamination in the 230 nm wavelength range, which was amended with an additional AMPure bead cleanup step. Quantiative PCR of Spiked BCG
![]() Quantitative PCR Cycle Threshold Values by Different DNA Extraction Kits Conclusion The MPFast Soil Extraction kit, when compared to three other DNA extraction kits, performed the best on stool samples for isolating BCG DNA. Overall DNA yield, DNA length, and amount of specific BCG DNA were best optimized with this method and provided the best samples for sequencing analysis. This critical step is the first of many to realize the promise of stool-based NGS. DNA Quantity
![]() Quantity of Total DNA by Different DNA Extraction Kits Spectrophotometric Analysis
![]() Analysis of Absorption of Extracted DNA by Different DNA Extraction Kits Spectrophotometric Results Spectrophotometry Results of DNA Samples Extracted by Different DNA Extraction Kits Disclosures Lennard A. Meiwes, n/a, German Center for Infection Research (DZIF): Grant/Research Support.
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Affiliation(s)
- Tara Ness
- Baylor College of Medicine/Texas Childrens Hospital, Houston, Texas
| | | | - Alexander Kay
- Baylor Center of Excellence, Mbabane, Hhohho, Swaziland
| | - Rojelio Mejia
- Baylor College of Medicine/Texas Childrens Hospital, Houston, Texas
| | - Christoph Lange
- Research Center Borstel, Clinical Infectious Diseases, Borstel, Hamburg, Germany
| | - Anna Mandalakas
- Baylor College of Medicine/Texas Childrens Hospital, Houston, Texas
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11
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Sibandze DB, Kay A, Dreyer V, Sikhondze W, Dlamini Q, DiNardo A, Mtetwa G, Lukhele B, Vambe D, Lange C, Dlamini MG, Ness T, Mejia R, Kalsdorf B, Heyckendorf J, Kuhns M, Maurer FP, Dlamini S, Maphalala G, Niemann S, Mandalakas A. Correction: Rapid molecular diagnostics of tuberculosis resistance by targeted stool sequencing. Genome Med 2022; 14:107. [PMID: 36127736 PMCID: PMC9487157 DOI: 10.1186/s13073-022-01107-w] [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: 11/10/2022] Open
Affiliation(s)
- Doctor B Sibandze
- National Tuberculosis Reference Laboratory, Eswatini National Health Services Laboratory, Ministry of Health, Mbabane, Eswatini.,Baylor College of Medicine Children's Foundation-Eswatini, Mbabane, Eswatini.,Global Tuberculosis Program, Baylor College of Medicine, Houston, TX, USA.,Department of Global Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Alexander Kay
- Baylor College of Medicine Children's Foundation-Eswatini, Mbabane, Eswatini. .,Global Tuberculosis Program, Baylor College of Medicine, Houston, TX, USA.
| | - Viola Dreyer
- Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany
| | - Welile Sikhondze
- Department of Global Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Eswatini National Tuberculosis Program, Ministry of Health, Mbabane, Eswatini
| | - Qiniso Dlamini
- Baylor College of Medicine Children's Foundation-Eswatini, Mbabane, Eswatini.,Global Tuberculosis Program, Baylor College of Medicine, Houston, TX, USA
| | - Andrew DiNardo
- Global Tuberculosis Program, Baylor College of Medicine, Houston, TX, USA
| | - Godwin Mtetwa
- Baylor College of Medicine Children's Foundation-Eswatini, Mbabane, Eswatini.,Global Tuberculosis Program, Baylor College of Medicine, Houston, TX, USA
| | - Bhekumusa Lukhele
- Baylor College of Medicine Children's Foundation-Eswatini, Mbabane, Eswatini.,Global Tuberculosis Program, Baylor College of Medicine, Houston, TX, USA
| | - Debrah Vambe
- Eswatini National Tuberculosis Program, Ministry of Health, Mbabane, Eswatini
| | - Christoph Lange
- Global Tuberculosis Program, Baylor College of Medicine, Houston, TX, USA.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany.,Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany
| | - Muyalo Glenn Dlamini
- National Tuberculosis Reference Laboratory, Eswatini National Health Services Laboratory, Ministry of Health, Mbabane, Eswatini
| | - Tara Ness
- Global Tuberculosis Program, Baylor College of Medicine, Houston, TX, USA
| | - Rojelio Mejia
- The National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Barbara Kalsdorf
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany.,Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany.,Cluster Precision Medicine in Inflammation, University of Kiel, Kiel, Germany
| | - Jan Heyckendorf
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany.,Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany.,Department of Internal Medicine I, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Martin Kuhns
- National and WHO Supranational Reference Center for Mycobacteria, Research Center Borstel, Borstel, Germany
| | - Florian P Maurer
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany.,National and WHO Supranational Reference Center for Mycobacteria, Research Center Borstel, Borstel, Germany.,Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sindisiwe Dlamini
- National Tuberculosis Reference Laboratory, Eswatini National Health Services Laboratory, Ministry of Health, Mbabane, Eswatini
| | - Gugu Maphalala
- National Tuberculosis Reference Laboratory, Eswatini National Health Services Laboratory, Ministry of Health, Mbabane, Eswatini
| | - Stefan Niemann
- Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany
| | - Anna Mandalakas
- Global Tuberculosis Program, Baylor College of Medicine, Houston, TX, USA. .,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany. .,Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.
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12
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Briggs N, Wei BM, Ahuja C, Baker C, Foppiano Palacios C, Lee E, O’Grady N, Singanamala S, Singh K, Bandaranayake TD, Cohen JM, Damsky W, Davis MW, Mejia R, Nelson CA, Topal JE, Azar MM. Mucocutaneous Leishmaniasis in a Pregnant Immigrant. Open Forum Infect Dis 2022; 9:ofac360. [PMID: 35928503 PMCID: PMC9345408 DOI: 10.1093/ofid/ofac360] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/20/2022] [Indexed: 01/05/2023] Open
Abstract
Cutaneous leishmaniasis is a parasitic infection that causes significant maternal morbidity, and even fetal mortality, during pregnancy, yet there are limited therapeutic options. Here, we report a case of leishmaniasis in a pregnant immigrant with exuberant mucocutaneous lesions with favorable response to liposomal amphotericin B.
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Affiliation(s)
- Neima Briggs
- Correspondence: Neima Briggs, MD, PhD, Yale School of Medicine, PO Box 208022, New Haven, CT 06520-8022, USA ()
| | - Brian M Wei
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Chaarushi Ahuja
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Catherine Baker
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Carlo Foppiano Palacios
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Emily Lee
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Niamh O’Grady
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Santhi Singanamala
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Katelyn Singh
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Thilinie D Bandaranayake
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jeffrey M Cohen
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - William Damsky
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut, USA
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Matthew W Davis
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Rojelio Mejia
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Caroline A Nelson
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Jeffrey E Topal
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Marwan M Azar
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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13
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Iordanov RB, Leining LM, Wu M, Chan G, DiNardo AR, Mejia R. Case Report: Molecular Diagnosis of Cystoisospora belli in a Severely Immunocompromised Patient with HIV and Kaposi Sarcoma. Am J Trop Med Hyg 2022; 106:678-680. [PMID: 34844211 PMCID: PMC8832916 DOI: 10.4269/ajtmh.21-0289] [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: 03/09/2021] [Accepted: 10/06/2021] [Indexed: 02/03/2023] Open
Abstract
Diarrhea in an immunocompromised patient has a broad infectious differential. Diagnosis is difficult despite advances in diagnostic modalities. We report a case of a 45-year-old Nigerian woman who immigrated to the United States 2 years ago. She presented to the hospital with gastrointestinal bleeding, newly diagnosed HIV, and disseminated Kaposi sarcoma. During hospitalization, the patient had an onset of watery diarrhea and high eosinophilia. Subsequent stool analysis using multi-parallel real-time quantitative polymerase chain reaction for 13 parasites was positive for Cystoisospora belli. The patient was treated with trimethoprim-sulfamethoxazole, but had relapsed disease when her antibiotics were stopped prematurely. After restarting trimethoprim-sulfamethoxazole, her diarrhea and eosinophilia improved, and she had undetectable Cystoisospora belli DNA on repeat stool quantitative polymerase chain reaction. This case highlights the importance of a thorough workup for diarrhea, including parasites, especially for immunocompromised patients. Antibiotic prophylaxis is recommended in patients with Cystoisospora belli and HIV/AIDS.
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Affiliation(s)
- Roumen Borilov Iordanov
- Infectious Diseases Section, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Lauren M. Leining
- Laboratory of Human Parasitology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Meng Wu
- Rheumatology & Infectious Diseases, PLLC, Houston, Texas
| | - Galant Chan
- Infectious Diseases Section, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Andrew R. DiNardo
- Infectious Diseases Section, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Rojelio Mejia
- Laboratory of Human Parasitology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas;,Address corresponding to Rojelio Mejia, Baylor College of Medicine, One Baylor Plaza, BCM 113, Houston, TX 77030. E-mail:
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14
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Álvarez-Hernández DA, García-Rodríguez-Arana R, Ortiz-Hernández A, Álvarez-Sánchez M, Wu M, Mejia R, Martínez-Juárez LA, Montoya A, Gallardo-Rincon H, Vázquez-López R, Fernández-Presas AM. A systematic review of historical and current trends in Chagas disease. Ther Adv Infect Dis 2021; 8:20499361211033715. [PMID: 34408874 PMCID: PMC8365018 DOI: 10.1177/20499361211033715] [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: 12/18/2020] [Accepted: 07/01/2021] [Indexed: 01/15/2023] Open
Abstract
Introduction Chagas disease (CD) is caused by Trypanosoma cruzi. When acquired, the disease develops in stages. For diagnosis, laboratory confirmation is required, and an extensive assessment of the patient's health should be performed. Treatment consists of the administration of trypanocidal drugs, which may cause severe adverse effects. The objective of our systematic review was to analyze data contained in the CD published case reports to understand the challenges that patients and clinicians face worldwide. Materials and methods We performed a systematic review following the PRISMA guidance. PubMed database was explored using the terms 'American trypanosomiasis' or 'Chagas disease'. Results were limited to human case reports written in English or Spanish. A total of 258 reports (322 patients) were included in the analysis. Metadata was obtained from each article. Following this, it was analyzed to obtain descriptive measures. Results From the sample, 56.2% were males and 43.8% were females. Most cases were from endemic countries (85.4%). The most common clinical manifestations were fever during the acute stage (70.0%), dyspnea during the chronic stage in its cardiac form (53.7%), and constipation during the chronic stage in its digestive form (73.7%). Most patients were diagnosed in the chronic stage (72.0%). Treatment was administered in 56.2% of cases. The mortality rate for the acute stage cases was 24.4%, while for the chronic stage this was 28.4%. Discussion CD is a parasitic disease endemic to Latin America, with increasing importance due to human and vector migration. In this review, we report reasons for delays in diagnosis and treatment, and trends in medical practices. Community awareness must be increased to improve CD's diagnoses; health professionals should be appropriately trained to detect and treat infected individuals. Furthermore, public health policies are needed to increase the availability of screening and diagnostic tools, trypanocidal drugs, and, eventually, vaccines.
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Affiliation(s)
| | | | - Alejandro Ortiz-Hernández
- Faculty of Health Sciences, Autonomous University of San Luis Potosi, Centro, San Luis Potosi, Mexico
| | - Mariana Álvarez-Sánchez
- Faculty of Health Sciences, Anahuac University Mexico - North Campus, Huixquilucan, Mexico State, Mexico
| | - Meng Wu
- Department of Infectious Diseases, Rheumatology & Infectious Diseases PLLC, Houston, TX, USA
| | - Rojelio Mejia
- Laboratory of Human Parasitology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Alejandra Montoya
- Department of Digital Health, Carlos Slim Foundation, Miguel Hidalgo, Mexico City, Mexico
| | - Héctor Gallardo-Rincon
- Direction of Operational Solutions, Carlos Slim Foundation, Miguel Hidalgo, Mexico City, Mexico
| | - Rosalino Vázquez-López
- Faculty of Health Sciences, Anahuac University Mexico - North Campus, Huixquilucan, Mexico State, Mexico
| | - Ana-María Fernández-Presas
- Faculty of Health Sciences, Anahuac University Mexico - North Campus, Huixquilucan, Mexico State, Mexico
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15
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Grau-Pujol B, Cuamba I, Jairoce C, Cossa A, Da Silva J, Sacoor C, Dobaño C, Nhabomba A, Mejia R, Muñoz J. Molecular Detection of Soil-Transmitted Helminths and Enteric Protozoa Infection in Children and Its Association with Household Water and Sanitation in Manhiça District, Southern Mozambique. Pathogens 2021; 10:pathogens10070838. [PMID: 34357988 PMCID: PMC8308871 DOI: 10.3390/pathogens10070838] [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: 05/21/2021] [Revised: 06/26/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
Intestinal parasite infections can have detrimental health consequences in children. In Mozambique, soil-transmitted helminth (STH) infections are controlled through mass drug administration since 2011, but no specific control program exists for enteric protozoa. This study evaluates STH and protozoan infections in children attending healthcare in Manhiça district, Southern Mozambique, and its association with water and sanitation conditions. We conducted a cross-sectional study in children between 2 and 10 years old in two health centers (n = 405). A stool sample and metadata were collected from each child. Samples were analyzed by multi-parallel real-time quantitative PCR (qPCR). We fitted logistic regression-adjusted models to assess the association between STH or protozoan infection with household water and sanitation use. Nineteen percent were infected with at least one STH and 77.5% with at least one enteric protozoon. qPCR detected 18.8% of participants with intestinal polyparasitism. Protected or unprotected water well use showed a higher risk for at least one protozoan infection in children (OR: 2.59, CI: 1.01-6.65, p-value = 0.010; OR: 5.21, CI: 1.56-17.46, p-value = 0.010, respectively) compared to household piped water. A high proportion of children had enteric protozoan infections. Well consumable water displayed high risk for that.
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Affiliation(s)
- Berta Grau-Pujol
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—University of Barcelona, 08036 Barcelona, Spain; (C.D.); (J.M.)
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique; (I.C.); (C.J.); (A.C.); (C.S.); (A.N.)
- Mundo Sano Foundation, Buenos Aires 1535, Argentina
- Correspondence: ; Tel.: +34-9322-75400
| | - Inocencia Cuamba
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique; (I.C.); (C.J.); (A.C.); (C.S.); (A.N.)
| | - Chenjerai Jairoce
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique; (I.C.); (C.J.); (A.C.); (C.S.); (A.N.)
| | - Anelsio Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique; (I.C.); (C.J.); (A.C.); (C.S.); (A.N.)
| | - Juliana Da Silva
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique; (I.C.); (C.J.); (A.C.); (C.S.); (A.N.)
| | - Carlota Dobaño
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—University of Barcelona, 08036 Barcelona, Spain; (C.D.); (J.M.)
| | - Augusto Nhabomba
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique; (I.C.); (C.J.); (A.C.); (C.S.); (A.N.)
| | - Rojelio Mejia
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Jose Muñoz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—University of Barcelona, 08036 Barcelona, Spain; (C.D.); (J.M.)
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16
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Nolan MS, Murray KO, Mejia R, Hotez PJ, Villar Mondragon MJ, Rodriguez S, Palacios JR, Murcia Contreras WE, Lynn MK, Torres ME, Monroy Escobar MC. Elevated Pediatric Chagas Disease Burden Complicated by Concomitant Intestinal Parasites and Malnutrition in El Salvador. Trop Med Infect Dis 2021; 6:tropicalmed6020072. [PMID: 34067079 PMCID: PMC8167768 DOI: 10.3390/tropicalmed6020072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/29/2021] [Revised: 04/26/2021] [Accepted: 05/04/2021] [Indexed: 12/28/2022] Open
Abstract
The eradication of the vector Rhodnius prolixus from Central America was heralded as a victory for controlling transmission of Trypanosoma cruzi, the parasite that causes Chagas disease. While public health officials believed this milestone achievement would effectively eliminate Chagas disease, case reports of acute vector transmission began amassing within a few years. This investigation employed a cross-sectional serosurvey of children either presenting with fever for clinical care or children living in homes with known triatomine presence in the state of Sonsonate, El Salvador. Over the 2018 calendar year, a 2.3% Chagas disease seroprevalence among children with hotspot clustering in Nahuizalco was identified. Positive serology was significantly associated with dogs in the home, older participant age, and a higher number of children in the home by multivariate regression. Concomitant intestinal parasitic infection was noted in a subset of studied children; 60% having at least one intestinal parasite and 15% having two or more concomitant infections. Concomitant parasitic infection was statistically associated with an overall higher parasitic load detected in stool by qPCR. Lastly, a four-fold higher burden of stunting was identified in the cohort compared to the national average, with four-fifths of mothers reporting severe food insecurity. This study highlights that polyparasitism is common, and a systems-based approach is warranted when treating Chagas disease seropositive children.
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Affiliation(s)
- Melissa S. Nolan
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (M.K.L.); (M.E.T.)
- Department of Pediatrics, Section of Tropical Medicine, National School of Tropical Medicine, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX 77030, USA; (K.O.M.); (R.M.); (P.J.H.); (M.J.V.M.)
- Correspondence: ; Tel.: +1-803-777-8932
| | - Kristy O. Murray
- Department of Pediatrics, Section of Tropical Medicine, National School of Tropical Medicine, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX 77030, USA; (K.O.M.); (R.M.); (P.J.H.); (M.J.V.M.)
| | - Rojelio Mejia
- Department of Pediatrics, Section of Tropical Medicine, National School of Tropical Medicine, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX 77030, USA; (K.O.M.); (R.M.); (P.J.H.); (M.J.V.M.)
| | - Peter J. Hotez
- Department of Pediatrics, Section of Tropical Medicine, National School of Tropical Medicine, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX 77030, USA; (K.O.M.); (R.M.); (P.J.H.); (M.J.V.M.)
| | - Maria Jose Villar Mondragon
- Department of Pediatrics, Section of Tropical Medicine, National School of Tropical Medicine, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX 77030, USA; (K.O.M.); (R.M.); (P.J.H.); (M.J.V.M.)
| | - Stanley Rodriguez
- Center of Health Investigation and Discovery (CENSALUD), University of El Salvador, San Salvador, El Salvador; (S.R.); (J.R.P.)
| | - Jose Ricardo Palacios
- Center of Health Investigation and Discovery (CENSALUD), University of El Salvador, San Salvador, El Salvador; (S.R.); (J.R.P.)
| | | | - M. Katie Lynn
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (M.K.L.); (M.E.T.)
| | - Myriam E. Torres
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (M.K.L.); (M.E.T.)
| | - Maria Carlota Monroy Escobar
- Laboratory of Applied Entomology and Parasitology, School of Biology, University of San Carlos, Guatemala City, Guatemala;
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17
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Clark E, Pritchard H, Hemmige V, Restrepo A, Bautista K, Damania A, Ricciardi A, Nutman TB, Mejia R. Strongyloides stercoralis Infection in Solid Organ Transplant Patients Is Associated With Eosinophil Activation and Intestinal Inflammation: A Cross-sectional Study. Clin Infect Dis 2021; 71:e580-e586. [PMID: 32155244 DOI: 10.1093/cid/ciaa233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/04/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Strongyloidiasis can cause devastating morbidity and death in immunosuppressed patients. Identification of reliable biomarkers for strongyloidiasis in immunosuppressed patients is critical for the prevention of severe disease. METHODS In this cross-sectional study of solid organ transplant (SOT) candidates and recipients, we quantified Strongyloides-specific IgG to the recombinant NIE-Strongyloides antigen and/or to a soluble extract of S. stercoralis somatic antigens ("crude antigen") using enzyme-linked immunosorbent assays (ELISAs). We also measured peripheral eosinophilia, 4 different eosinophil granule proteins, and intestinal fatty acid-binding protein (IFABP). RESULTS We evaluated serum biomarkers in 149 individuals; 77 (52%) pre-SOT and 72 (48%) post-SOT. Four percent (6/149) tested positive by NIE ELISA and 9.6% (11/114) by crude antigen ELISA (overall seropositivity of 9.4% [14/149]). Seropositive patients had higher absolute eosinophil counts (AECs) than seronegative patients (P = .004). AEC was positively correlated to the levels of eosinophil granule proteins eosinophil cationic protein (ECP) and eosinophil peroxidase (EPO) (P < .05), while IFABP was positively related to the 2 other eosinophil granule proteins (major basic protein [MBP] and eosinophil-derived neurotoxin [EDN]; Spearman's r = 0.3090 and 0.3778, respectively; P < .05; multivariate analyses slopes = 0.70 and 2.83, respectively). CONCLUSIONS This study suggests that, in SOT patients, strongyloidiasis triggers both eosinophilia and eosinophil activation, the latter being associated with intestinal inflammation. These data provide insight into the pathogenesis of S. stercoralis infection in the immunocompromised population at high risk of severe strongyloidiasis syndromes.
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Affiliation(s)
- Eva Clark
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston Texas, USA.,Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston Texas, USA.,Houston Health Services Research & Development, Innovations in Quality, Effectiveness and Safety (IQuESt), Baylor College of Medicine Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Haley Pritchard
- Department of Medicine, Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Vagish Hemmige
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston Texas, USA.,Department of Medicine, Division of Infectious Diseases, Montefiore Medical Center, Bronx, New York, USA.,Department of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alejandro Restrepo
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston Texas, USA
| | - Karla Bautista
- Laboratory of Clinical Parasitology and Diagnostics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Ashish Damania
- Laboratory of Clinical Parasitology and Diagnostics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Alessandra Ricciardi
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Thomas B Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Rojelio Mejia
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston Texas, USA.,Laboratory of Clinical Parasitology and Diagnostics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
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18
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Balachandran V, Dittmer J, Bayly M, Armarego S, Zhou X, Mejia R, Singh T, James A, Seah P. P46 Renal Effects of Procaine vs. Lignocaine Containing Modified Melbourne Formula Cardioplegia. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.249] [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: 11/26/2022]
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19
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Bryan PE, Romero M, Sánchez M, Torres G, Gómez W, Restrepo M, Restrepo A, Mejia R. Urban versus Rural Prevalence of Intestinal Parasites Using Multi-Parallel qPCR in Colombia. Am J Trop Med Hyg 2020; 104:907-909. [PMID: 33319737 DOI: 10.4269/ajtmh.20-1202] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/24/2020] [Indexed: 11/07/2022] Open
Abstract
Stool samples from 122 children living in an urban slum (n = 72) and rural (n = 50) areas were analyzed using multi-parallel real-time quantitative PCR to determine intestinal prevalence parasites from two communities in Colombia. Findings indicated a prevalence of 86.1% Blastocystis spp., 62.5% Giardia intestinalis, 19.4% Cryptosporidium spp., 19.4% Ascaris lumbricoides, and 5.6% Trichuris trichiura in an urban slum; and 76% Blastocystis spp., 68% G. intestinalis, 20% Entamoeba histolytica, 50% A. lumbricoides, 46% T. trichiura, and 2% Strongyloides stercoralis in rural areas. Polyparasitism was higher in rural (58%) than urban (25%) areas (P = 0.001). Trichuris trichiura burden was higher in the rural area (P = 0.002). Over 40% of helminthic infections in rural areas had a heavy parasite burden by WHO classification. Over half of urban and rural children were infected with G. intestinalis and Blastocystis spp. Our data provide accurate epidemiologic surveillance for public health interventions.
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Affiliation(s)
- Patricia E Bryan
- 1Laboratory of Human Parasitology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Marcela Romero
- 2Instituto Colombiano de Medicina Tropical, Universidad CES, Medellín, Colombia
| | - Miryan Sánchez
- 2Instituto Colombiano de Medicina Tropical, Universidad CES, Medellín, Colombia
| | - Giovanny Torres
- 2Instituto Colombiano de Medicina Tropical, Universidad CES, Medellín, Colombia
| | - Wilber Gómez
- 2Instituto Colombiano de Medicina Tropical, Universidad CES, Medellín, Colombia
| | - Marcos Restrepo
- 2Instituto Colombiano de Medicina Tropical, Universidad CES, Medellín, Colombia
| | - Alejandro Restrepo
- 1Laboratory of Human Parasitology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas.,2Instituto Colombiano de Medicina Tropical, Universidad CES, Medellín, Colombia
| | - Rojelio Mejia
- 1Laboratory of Human Parasitology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
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20
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Abstract
Purpose of Review In this commentary, we summarize and put into perspective the recent information that highlights the associations between coronavirus disease and poverty. We also bring attention to another dimension that will most likely exacerbate the severity and long-term sequelae of COVID-19 in impoverished populations, that is, the comorbidities and the presence of tropical infections. Recent Findings During this first half of 2020, the COVID-19 pandemic has emerged as a poverty-related neglected disease on at least two fronts. First, is its significant impact in low-income neighborhoods in the USA, the epicenter of the pandemic. Second, is its emergence in poor urban areas of South America, and now in Asia and Africa. In both fronts, the pandemic is contributing heavily towards the loss of public health gains that we managed to achieve globally during the last two decades. Specifically, any advances made as part of the United Nations Millennium Development Goals (United Nations, 2020) is eroding, and for the first time, the number of people entering extreme poverty is increasing. Adding to this descent into poverty are new disruptions in ongoing disease control programs, routine vaccination strategies, and a reduction of capacity building efforts globally. Therefore, and as highlighted by many others, we support the notion that a way forward to eliminate this coronavirus pandemic should include linking COVID-19 control to other tropical or poverty-related diseases. Summary COVID-19 is slowing or reversing global health and development gains. To be successful and achieve the global goals including the control of pandemics such as the one seen from the COVID-19, we must rely on strong leadership leading to impactful public policies and global collaborations, including global COVID-19 vaccinations, and potentially linking them to programs for childhood and adult vaccinations and programs for malaria, tuberculosis, HIV/AIDS, and neglected tropical disease treatments. Opportunities also include the creation of unique research opportunities and funding models and increase science engagement for international diplomacy. This can only be done with a better understanding of the relationships between coronavirus disease, poverty, and tropical diseases.
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Affiliation(s)
- Rojelio Mejia
- Department of Pediatrics and Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX USA
| | - Peter Hotez
- Department of Pediatrics and Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX USA.,Texas Children's Hospital Center for Vaccine Development, Houston, TX USA.,Departments of Pediatrics and Molecular Virology & Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX USA.,Department of Biology, Baylor University, Waco, TX USA.,Hagler Institute for Advanced Studies, Texas A&M University, College Station, TX USA.,Scowcroft Institute of International Studies, Bush School of Government and Public Service, Texas A&M University, College Station, TX USA.,James A Baker III Institute of Public Policy, Rice University, Houston, TX USA
| | - Maria Elena Bottazzi
- Department of Pediatrics and Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX USA.,Texas Children's Hospital Center for Vaccine Development, Houston, TX USA.,Departments of Pediatrics and Molecular Virology & Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX USA.,Department of Biology, Baylor University, Waco, TX USA
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21
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Naceanceno KS, Matamoros G, Gabrie JA, Bottazzi ME, Sanchez A, Mejia R. Use of Multi-Parallel Real-Time Quantitative PCR to Determine Blastocystis Prevalence and Association with Other Gastrointestinal Parasite Infection in a Rural Honduran Location. Am J Trop Med Hyg 2020; 102:1373-1375. [PMID: 32189609 DOI: 10.4269/ajtmh.19-0876] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To determine whether the presence of Blastocystis is associated with other gastrointestinal parasite infections, stool samples from 95 Honduran rural children were analyzed using multi-parallel quantitative real-time polymerase chain reaction (PCR) and Kato-Katz. Combined results detected the following prevalence: Blastocystis, 71.6%; Trichuris trichiura, 63.2%; Giardia lamblia, 40.0%; Ascaris lumbricoides, 15.8%; and Necator americanus, 4.2%. Age was found associated with the quantity of both Blastocystis DNA (r s = 0.524, P < 0.001) and T. trichiura DNA in the stool (fg/µL) by quantitative PCR (r s = 0.272, P < 0.001). In addition, there was an association with T. trichiura and Blastocystis infection (odds ratio [OR] = 4.72; 95% CI = 1.83, 12.20; P < 0.001). These findings demonstrate a high prevalence of Blastocystis and other intestinal parasites in a rural location in Honduras.
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Affiliation(s)
- Kevin S Naceanceno
- Laboratory of Clinical Parasitology and Diagnostics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Gabriela Matamoros
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - José Antonio Gabrie
- Department of Health Sciences, Brock University, St. Catharines, Canada.,Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Maria Elena Bottazzi
- Department of Pediatric Tropical Medicine, Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Ana Sanchez
- Department of Health Sciences, Brock University, St. Catharines, Canada.,Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Rojelio Mejia
- Laboratory of Clinical Parasitology and Diagnostics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas.,Department of Pediatric Tropical Medicine, Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
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22
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Cools P, van Lieshout L, Koelewijn R, Addiss D, Ajjampur SSR, Ayana M, Bradbury RS, Cantera JL, Dana D, Fischer K, Imtiaz R, Kabagenyi J, Lok J, McCarthy J, Mejia R, Mekonnen Z, Njenga SM, Othman N, Shao H, Traub R, Van Esbroeck M, Vercruysse J, Vlaminck J, Williams SA, Verweij JJ, van Hellemond JJ, Levecke B. First international external quality assessment scheme of nucleic acid amplification tests for the detection of Schistosoma and soil-transmitted helminths, including Strongyloides: A pilot study. PLoS Negl Trop Dis 2020; 14:e0008231. [PMID: 32544158 PMCID: PMC7319349 DOI: 10.1371/journal.pntd.0008231] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 08/26/2019] [Revised: 06/26/2020] [Accepted: 03/17/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Nucleic acid amplification tests (NAATs) are increasingly being used as diagnostic tools for soil-transmitted helminths (STHs; Ascaris lumbricoides, Trichuris trichiura, Necator americanus, Ancylostoma duodenale and A. ceylanicum), Strongyloides stercoralis and Schistosoma in human stool. Currently, there is a large diversity of NAATs being applied, but an external quality assessment scheme (EQAS) for these diagnostics is lacking. An EQAS involves a blinded process where test results reported by a laboratory are compared to those reported by reference or expert laboratories, allowing for an objective assessment of the diagnostic performance of a laboratory. In the current study, we piloted an international EQAS for these helminths (i) to investigate the feasibility of designing and delivering an EQAS; (ii) to assess the diagnostic performance of laboratories; and (iii) to gain insights into the different NAAT protocols used. METHODS AND PRINCIPAL FINDINGS A panel of twelve stool samples and eight DNA samples was validated by six expert laboratories for the presence of six helminths (Ascaris, Trichuris, N. americanus, Ancylostoma, Strongyloides and Schistosoma). Subsequently this panel was sent to 15 globally dispersed laboratories. We found a high degree of diversity among the different DNA extraction and NAAT protocols. Although most laboratories performed well, we could clearly identify the laboratories that were poorly performing. CONCLUSIONS/SIGNIFICANCE We showed the technical feasibility of an international EQAS for the NAAT of STHs, Strongyloides and Schistosoma. In addition, we documented that there are clear benefits for participating laboratories, as they can confirm and/or improve the diagnostic performance of their NAATs. Further research should aim to identify factors that explain poor performance of NAATs.
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Affiliation(s)
- Piet Cools
- Laboratory of Parasitology, Ghent University, Merelbeke, Belgium
| | - Lisette van Lieshout
- Leiden University Medical Center, Leiden, The Netherlands
- Dutch Foundation for Quality Assessment in Medical Laboratories, Nijmegen, The Netherlands
| | - Rob Koelewijn
- Dutch Foundation for Quality Assessment in Medical Laboratories, Nijmegen, The Netherlands
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - David Addiss
- The Task Force for Global Health, Decatur, Georgia, United States of America
| | | | | | - Richard S. Bradbury
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Kerstin Fischer
- Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Rubina Imtiaz
- Children Without Worms, Decatur, Georgia, United States of America
| | - Joyce Kabagenyi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - James Lok
- University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - James McCarthy
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Rojelio Mejia
- Baylor College of Medicine, Houston, Texas, United States of America
| | | | | | | | - Hongguang Shao
- University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | | | | | - Jozef Vercruysse
- Laboratory of Parasitology, Ghent University, Merelbeke, Belgium
| | - Johnny Vlaminck
- Laboratory of Parasitology, Ghent University, Merelbeke, Belgium
| | - Steven A. Williams
- Smith College, Northampton, Massachusetts, United States of America
- University of Massachusetts, Amherst, Massachusetts, United States of America
| | | | - Jaap J. van Hellemond
- Dutch Foundation for Quality Assessment in Medical Laboratories, Nijmegen, The Netherlands
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bruno Levecke
- Laboratory of Parasitology, Ghent University, Merelbeke, Belgium
- * E-mail:
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23
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Singer R, Xu TH, Herrera LNS, Villar MJ, Faust KM, Hotez PJ, Aiken ARA, Mejia R. Prevalence of Intestinal Parasites in a Low-Income Texas Community. Am J Trop Med Hyg 2020; 102:1386-1395. [PMID: 32207401 PMCID: PMC7253135 DOI: 10.4269/ajtmh.19-0915] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 12/09/2019] [Accepted: 02/09/2020] [Indexed: 01/14/2023] Open
Abstract
Strongyloidiasis affects an estimated hundreds of millions of people worldwide, with infection possibly persisting for life without appropriate therapy because of the helminth's unique autoinfection cycle. Like other soil-transmitted helminths, because of the environmental conditions required for the life cycle of Strongyloides stercoralis, this parasite is endemic to tropical, subtropical, and temperate countries and areas with inadequate sanitation infrastructure. Given continued poverty and that nearly one in five American homes are lacking proper sanitation systems, many U.S. regions are at risk for intestinal parasites. A central Texas community was chosen as the study site, given previous reports of widespread sanitation failure, degree of poverty, and community willingness to participate. A total of 92 households were surveyed and residents tested for nine intestinal parasites using a multi-parallel quantitative real-time polymerase chain reaction and ELISA serology. From 43 stool samples, 27 (62.8%) tested positive for Blastocystis spp. and one (2.3%) for Giardia lamblia. From 97 serum samples, Strongyloides serology detected 16 (16.5%) positive individuals. These high rates of heterokont and helminthic laboratory findings in a peri-urban central Texas community suggest several key policy implications, including that strongyloidiasis should be added to the Texas notifiable conditions list, that clinical suspicion for this infection should be heightened in the region, and that residents without access to functioning and sustainable sanitation infrastructure should be provided that access as a basic human right and to promote public health.
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Affiliation(s)
- Rachael Singer
- Lyndon B. Johnson School of Public Affairs, The University of Texas at Austin, Austin, Texas
| | - Teena Huan Xu
- Department of Pediatrics: Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Lauren Nicholas S. Herrera
- Department of Pediatrics: Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Maria Jose Villar
- Department of Pediatrics: Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Kasey M. Faust
- Department of Civil, Architectural and Environmental Engineering, The University of Texas at Austin, Austin, Texas
| | - Peter J. Hotez
- Department of Pediatrics: Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Abigail R. A. Aiken
- Lyndon B. Johnson School of Public Affairs, The University of Texas at Austin, Austin, Texas
| | - Rojelio Mejia
- Department of Pediatrics: Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
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24
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Mejia R, Damania A, Jeun R, Bryan PE, Vargas P, Juarez M, Cajal PS, Nasser J, Krolewiecki A, Lefoulon E, Long C, Drake E, Cimino RO, Slatko B. Impact of intestinal parasites on microbiota and cobalamin gene sequences: a pilot study. Parasit Vectors 2020; 13:200. [PMID: 32306993 PMCID: PMC7168842 DOI: 10.1186/s13071-020-04073-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 12/10/2019] [Accepted: 04/10/2020] [Indexed: 01/10/2023] Open
Abstract
Background Approximately 30% of children worldwide are infected with gastrointestinal parasites. Depending on the species, parasites can disrupt intestinal bacterial microbiota affecting essential vitamin biosynthesis. Methods Stool samples were collected from 37 asymptomatic children from a previous cross-sectional Argentinian study. A multi-parallel real-time quantitative PCR was implemented for Ascaris lumbricoides, Ancylostoma duodenale, Necator americanus, Strongyloides stercoralis, Trichuris trichiura, Cryptosporidium spp., Entamoeba histolytica and Giardia duodenalis. In addition, whole-genome sequencing analysis was conducted for bacterial microbiota on all samples and analyzed using Livermore Metagenomic Analysis Toolkit and DIAMOND software. Separate analyses were carried out for uninfected, Giardia-only, Giardia + helminth co-infections, and helminth-only groups. Results For Giardia-only infected children compared to uninfected children, DNA sequencing data showed a decrease in microbiota biodiversity that correlated with increasing Giardia burden and was statistically significant using Shannonʼs alpha diversity (Giardia-only > 1 fg/µl 2.346; non-infected group 3.253, P = 0.0317). An increase in diversity was observed for helminth-only infections with a decrease in diversity for Giardia + helminth co-infections (P = 0.00178). In Giardia-only infections, microbiome taxonomy changed from Firmicutes towards increasing proportions of Prevotella, with the degree of change related to the intensity of infection compared to uninfected (P = 0.0317). The abundance of Prevotella bacteria was decreased in the helminths-only group but increased for Giardia + helminth co-infections (P = 0.0262). Metagenomic analysis determined cobalamin synthesis was decreased in the Giardia > 1 fg/µl group compared to both the Giardia < 1 fg/µl and the uninfected group (P = 0.0369). Giardia + helminth group also had a decrease in cobalamin CbiM genes from helminth-only infections (P = 0.000754). Conclusion The study results may provide evidence for an effect of parasitic infections enabling the permissive growth of anaerobic bacteria such as Prevotella, suggesting an altered capacity of vitamin B12 (cobalamin) biosynthesis and potential impact on growth and development in children .
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Affiliation(s)
- Rojelio Mejia
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA. .,Universidad Nacional de Salta, Salta, Argentina.
| | - Ashish Damania
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Rebecca Jeun
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Patricia E Bryan
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | | | | | | | | | | | | | - Evan Drake
- New England Biolabs, Inc, Ipswich, MA, USA
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25
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Mejia R, Seco-Hidalgo V, Garcia-Ramon D, Calderón E, Lopez A, Cooper PJ. Detection of enteric parasite DNA in household and bed dust samples: potential for infection transmission. Parasit Vectors 2020; 13:141. [PMID: 32188497 PMCID: PMC7079405 DOI: 10.1186/s13071-020-04012-6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 03/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Enteric parasites are transmitted in households but few studies have sampled inside households for parasites and none have used sensitive molecular methods. METHODS We collected bed and living room dust samples from households of children participating in a clinical trial of anthelmintic treatment in rural coastal Ecuador. Dust was examined for presence of DNA specific for 11 enteric parasites (Ascaris lumbricoides, Trichuris trichiura, Ancylostoma duodenale, Necator americanus, Strongyloides stercoralis, Toxocara canis and T. cati, Giardia lamblia, Blastocystis hominis, Cryptosporidium spp., and Entamoeba histolytica) by quantitative PCR (qPCR). RESULTS Of the 38 households sampled, 37 had positive dust for at least one parasite and up to 8 parasites were detected in single samples. Positivity was greatest for B. hominis (79% of household samples) indicating a high level of environmental fecal contamination. Dust positivity rates for individual pathogens were: S. stercoralis (52%), A. lumbricoides (39%), G. lamblia (39%), Toxocara spp. (42%), hookworm (18%) and T. trichiura (8%). DNA for Cryptosporidium spp. and E. histolytica was not detected. Bed dust was more frequently positive than floor samples for all parasites detected. Positivity for A. lumbricoides DNA in bed (adjusted OR: 10.0, 95% CI: 2.0-50.1) but not floor dust (adjusted OR: 3.6, 95% CI: 0.3-37.9) was significantly associated with active infections in children. CONCLUSIONS To our knowledge, this is the first use of qPCR on environmental samples to detect a wide range of enteric pathogen DNA. Our results indicate widespread contamination of households with parasite DNA and raise the possibility that beds, under conditions of overcrowding in a humid tropical setting, may be a source of transmission.
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Affiliation(s)
- Rojelio Mejia
- National School of Tropical Medicine, Baylor College of Medicine, Texas, USA.,School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
| | | | - Diana Garcia-Ramon
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Evelyn Calderón
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Andrea Lopez
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Philip J Cooper
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador. .,Institute of Infection and Immunity, St George's University of London, London, UK.
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Herrick JA, Nordstrom M, Maloney P, Rodriguez M, Naceanceno K, Gallo G, Mejia R, Hershow R. Parasitic infections represent a significant health threat among recent immigrants in Chicago. Parasitol Res 2020; 119:1139-1148. [PMID: 32008064 PMCID: PMC7075846 DOI: 10.1007/s00436-020-06608-4] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/14/2020] [Indexed: 12/19/2022]
Abstract
Parasitic infections are likely under-recognized among immigrant populations in the USA. We conducted a cross-sectional study to evaluate if such infections have health impacts among recent immigrants in Chicago and to identify predictive factors for parasitic infections. A total of 133 recent immigrants were enrolled, filling out a standardized medical questionnaire and providing blood and stool samples. Appriximately 12% of subjects (15/125) who provided a blood or stool sample for testing were found to have evidence of current or prior infection with a pathogenic parasite, of which Toxocara spp. (8 subjects, 6.4%) and Strongyloides stercoralis (5 subjects, 4%) were most commonly identified. Parasitic infection was more likely among subjects who had immigrated within the previous 2 years and those with a self-reported history of worms in the stool. The most useful surrogate markers identified for parasitic infections were an elevated immunoglobulin E level (seen in 46.7% (7/15) of subjects with parasitic infections and 20% (22/110) of uninfected individuals, p = 0.04) and the presence of Blastocystis hominis cysts on Ova & Parasite exam (detected in 38.5% (5/13) of subjects with parasitic infections who provided a stool sample and 5.1% (5/98) of uninfected subjects, p = 0.002). Our study found that parasitic infections may be common in recent US immigrants, which highlights an important health disparity among a vulnerable population that merits further study. Additionally, clinical risk factors, symptoms, and laboratory findings traditionally thought to be associated with parasites were commonly found but not predictive of infection in this study population.
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Affiliation(s)
- Jesica A. Herrick
- grid.185648.60000 0001 2175 0319Department of Medicine, Division of Infectious Diseases, Immunology, and International Medicine, University of Illinois at Chicago, 808 South Wood, M/C 735, Chicago, IL 60612 USA
| | - Monica Nordstrom
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago School of Public Health, Chicago, IL USA
| | - Patrick Maloney
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago School of Public Health, Chicago, IL USA
| | - Miguel Rodriguez
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago School of Public Health, Chicago, IL USA
| | - Kevin Naceanceno
- grid.39382.330000 0001 2160 926XDepartment of Medicine, Section of Infectious Diseases, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX USA
| | - Gloria Gallo
- grid.39382.330000 0001 2160 926XDepartment of Medicine, Section of Infectious Diseases, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX USA
- grid.411249.b0000 0001 0514 7202Science and Technology Institute, Federal University of São Paulo, São José dos Campos, São Paulo, Brazil
| | - Rojelio Mejia
- grid.39382.330000 0001 2160 926XDepartment of Medicine, Section of Infectious Diseases, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX USA
| | - Ron Hershow
- grid.185648.60000 0001 2175 0319Department of Medicine, Division of Infectious Diseases, Immunology, and International Medicine, University of Illinois at Chicago, 808 South Wood, M/C 735, Chicago, IL 60612 USA
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago School of Public Health, Chicago, IL USA
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Sugito S, McGee M, Al-Omary M, Senanayake T, Hartnett D, Oakley P, Sverdlov A, Boyle A, Mejia R, Iyengar A. 703 Outcomes After Cardiac Surgery in a Contemporary Aboriginal and Torres Strait Islander Cohort in New South Wales, Australia. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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Reimer-McAtee M, Somasunderam A, Huan Xu T, Arduino R, Serpa J, Mejia R, Utay NS. 376. Effect of Parasitic Infections on Gut Epithelial Barrier and Immune Activation among Foreign-Born HIV-infected Patients. Open Forum Infect Dis 2019. [PMCID: PMC6809743 DOI: 10.1093/ofid/ofz360.449] [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] [Indexed: 11/21/2022] Open
Abstract
Background Strongyloides stercoralis often causes an asymptomatic infection despite continuous autoinfection for the lifetime of the host. Both HIV and recurrent enteric parasitic infections cause gut damage and increased microbial translocation, but little is known about the effects of co-infection. We aimed to evaluate changes in immune activation, mucosal damage, and microbial translocation in people with HIV-1 (PWH) and parasite co-infection. Methods In this pilot prospective cohort study, we enrolled foreign-born PWH on suppressive antiretroviral therapy (ART) in an ambulatory clinic in Houston, Texas. We evaluated serum Strongyloides IgG using ELISA with an S. stercoralis-specific recombinant protein. Intestinal fatty acid-binding protein (I-FABP), soluble CD14 (sCD14), sCD163, IL-6, and sTNFRII were analyzed as markers of enterocyte turnover, inflammation, and immune activation. Non-parametric tests were used for analysis. Results 52 participants born in 14 countries were enrolled February–March 2019. Median CD4 count was 464/uL [95% CI 315–598]. Fourteen (27%) were positive for Strongyloides IgG. Strongyloides IgG levels correlated positively with sCD14 levels [r=0.36; P = 0.008]. Strongyloides+ participants had significantly higher sCD14 levels compared with Strongyloides− participants [1.67 vs. 1.48 μg/mL, P = 0.031]. Among the Strongyloides+ participants, Strongyloides IgG levels correlated with sCD163 levels [r=0.65, P = 0.026]. There were no difference in the other biomarkers. Logistical regression analysis showed that predictors of Strongyloides+ include absolute eosinophil count (AEC) (OR 1.45 for every 100 increase of AEC [95% CI: 1.02, 2.15; P = 0.047]). CD4 count, number of years living in the United States, country of origin, and years from HIV diagnosis were not associated with test positivity. Conclusion Strongyloides co-infection is common among foreign-born PWH and may contribute to chronic monocyte/macrophage activation, a predictor of morbidity and mortality in PWH. Future directions include stool PCR confirmation of these infections, continued enrollment, and follow-up assays 6 months after treatment of Strongyloides to determine the impact on inflammation and risk of co-morbidities. ![]()
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Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | | | | | - Jose Serpa
- Baylor College of Medicine, Houston, Texas
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Chung R, Mancuso A, Sparks A, Duran H, Mejia R. Pregnancy predictors in the fresh cycle using dual trigger. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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30
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Place T, Mejia R, Sparks A, Duran H, Summers K, Ten Eyck P, Van Voorhis B. Effect of endometrial thickness on live birth rate in both fresh and frozen blastocyst transfers. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.602] [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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31
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Mejia R, Summers K, Kresowik J, Van Voorhis B. A randomized controlled trial of combination of letrozole and clomiphene citrate versus letrozole alone for ovulation induction in women with polycystic ovary syndrome. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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32
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Mejia R, Summers K, Cox T, Nguyen E, Sparks A, Van Voorhis B. Effect of body weight on early hormone levels in singleton pregnancies resulting in delivery following in vitro fertilization. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.738] [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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33
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DiNardo AR, Nishiguchi T, Mace EM, Rajapakshe K, Mtetwa G, Kay A, Maphalala G, Secor WE, Mejia R, Orange JS, Coarfa C, Bhalla KN, Graviss EA, Mandalakas AM, Makedonas G. Schistosomiasis Induces Persistent DNA Methylation and Tuberculosis-Specific Immune Changes. J Immunol 2018; 201:124-133. [PMID: 29752313 DOI: 10.4049/jimmunol.1800101] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/09/2018] [Indexed: 12/29/2022]
Abstract
Epigenetic mechanisms, such as DNA methylation, determine immune cell phenotype. To understand the epigenetic alterations induced by helminth coinfections, we evaluated the longitudinal effect of ascariasis and schistosomiasis infection on CD4+ T cell DNA methylation and the downstream tuberculosis (TB)-specific and bacillus Calmette-Guérin-induced immune phenotype. All experiments were performed on human primary immune cells from a longitudinal cohort of recently TB-exposed children. Compared with age-matched uninfected controls, children with active Schistosoma haematobium and Ascaris lumbricoides infection had 751 differentially DNA-methylated genes, with 72% hypermethylated. Gene ontology pathway analysis identified inhibition of IFN-γ signaling, cellular proliferation, and the Th1 pathway. Targeted real-time quantitative PCR after methyl-specific endonuclease digestion confirmed DNA hypermethylation of the transcription factors BATF3, ID2, STAT5A, IRF5, PPARg, RUNX2, IRF4, and NFATC1 and cytokines or cytokine receptors IFNGR1, TNFS11, RELT (TNF receptor), IL12RB2, and IL12B (p < 0.001; Sidak-Bonferroni). Functional blockage of the IFN-γ signaling pathway was confirmed, with helminth-infected individuals having decreased upregulation of IFN-γ-inducible genes (Mann-Whitney p < 0.05). Hypomethylation of the IL-4 pathway and DNA hypermethylation of the Th1 pathway was confirmed by Ag-specific multidimensional flow cytometry demonstrating decreased TB-specific IFN-γ and TNF and increased IL-4 production by CD4+ T cells (Wilcoxon signed-rank p < 0.05). In S. haematobium-infected individuals, these DNA methylation and immune phenotypic changes persisted at least 6 mo after successful deworming. This work demonstrates that helminth infection induces DNA methylation and immune perturbations that inhibit TB-specific immune control and that the duration of these changes are helminth specific.
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Affiliation(s)
- Andrew R DiNardo
- The Global Tuberculosis Program, Immigrant and Global Health, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030;
| | - Tomoki Nishiguchi
- The Global Tuberculosis Program, Immigrant and Global Health, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030
| | - Emily M Mace
- Department of Pathology, Baylor College of Medicine, Houston, TX 77030.,Texas Children's Hospital Center for Human Immunobiology, Department of Pediatrics, Texas Children's Hospital Center for Human Immunobiology, Baylor College of Medicine, Houston, TX 77030
| | - Kimal Rajapakshe
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030
| | - Godwin Mtetwa
- Baylor-Swaziland Children's Foundation, Mbabane H100, Swaziland
| | - Alexander Kay
- Baylor-Swaziland Children's Foundation, Mbabane H100, Swaziland
| | | | - W Evan Secor
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA 30333
| | - Rojelio Mejia
- Department of Pediatrics, National School of Tropical Medicine, Texas Children's Hospital Center for Human Immunobiology, Houston, TX 77030
| | - Jordan S Orange
- Department of Pathology, Baylor College of Medicine, Houston, TX 77030.,Texas Children's Hospital Center for Human Immunobiology, Department of Pediatrics, Texas Children's Hospital Center for Human Immunobiology, Baylor College of Medicine, Houston, TX 77030
| | - Cristian Coarfa
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030
| | - Kapil N Bhalla
- Department of Leukemia, MD Anderson Cancer Center, Houston, TX 77030; and
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital Research Institute, Houston, TX 77030
| | - Anna M Mandalakas
- The Global Tuberculosis Program, Immigrant and Global Health, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030
| | - George Makedonas
- Department of Pathology, Baylor College of Medicine, Houston, TX 77030.,Texas Children's Hospital Center for Human Immunobiology, Department of Pediatrics, Texas Children's Hospital Center for Human Immunobiology, Baylor College of Medicine, Houston, TX 77030
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Diemert D, Campbell D, Brelsford J, Leasure C, Li G, Peng J, Zumer M, Younes N, Bottazzi ME, Mejia R, Pritchard DI, Hawdon JM, Bethony JM. Controlled Human Hookworm Infection: Accelerating Human Hookworm Vaccine Development. Open Forum Infect Dis 2018; 5:ofy083. [PMID: 29780848 PMCID: PMC5952933 DOI: 10.1093/ofid/ofy083] [Citation(s) in RCA: 30] [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: 01/10/2018] [Accepted: 04/16/2018] [Indexed: 11/14/2022] Open
Abstract
Background Controlled human hookworm infection (CHHI) is a central component of a proposed hookworm vaccination-challenge model (HVCM) to test the efficacy of candidate vaccines. Critical to CHHI is the manufacture of Necator americanus infective larvae (NaL3) according to current Good Manufacturing Practice (cGMP) and the determination of an inoculum of NaL3 that is safe and reliably induces patent infection. Methods cGMP-grade NaL3 were produced for a phase 1 trial in 20 healthy, hookworm-naïve adults in the United States, who received either 25 or 50 NaL3. Participants were monitored for 12–18 weeks postinfection for safety, tolerability, and patency of N. americanus infection. Results Both NaL3 doses were well tolerated. Early manifestations of infection included pruritus, pain, and papulovesicular rash at the application site. Gastrointestinal symptoms and eosinophilia appeared after week 4 postinfection. The 50 NaL3 inoculum induced patent N. americanus infection in 90% of this dose group. Conclusions The inoculum of 50 NaL3 was well tolerated and consistently induced patent N. americanus infection suitable for future HVCM trials. Clinical Trials Registration NCT01940757.
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Affiliation(s)
- David Diemert
- Department of Microbiology, Immunology and Tropical Medicine, Washington DC.,Department of Medicine, Washington DC
| | - Doreen Campbell
- Department of Microbiology, Immunology and Tropical Medicine, Washington DC
| | - Jill Brelsford
- Department of Microbiology, Immunology and Tropical Medicine, Washington DC
| | - Caitlyn Leasure
- Department of Microbiology, Immunology and Tropical Medicine, Washington DC
| | - Guangzhao Li
- Department of Microbiology, Immunology and Tropical Medicine, Washington DC
| | - Jin Peng
- Department of Microbiology, Immunology and Tropical Medicine, Washington DC
| | | | - Naji Younes
- Milken Institute School of Public Health, The George Washington University, Washington DC
| | - Maria Elena Bottazzi
- Department of Pediatrics, Section of Pediatric Tropical Medicine, Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Rojelio Mejia
- Department of Pediatrics, Section of Pediatric Tropical Medicine, Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - David I Pritchard
- Department of Pharmacy, University of Nottingham, Nottingham, United Kingdom
| | - John M Hawdon
- Department of Microbiology, Immunology and Tropical Medicine, Washington DC
| | - Jeffrey M Bethony
- Department of Microbiology, Immunology and Tropical Medicine, Washington DC
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35
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DiNardo AR, Kay AW, Maphalala G, Harris NM, Fung C, Mtetwa G, Ustero P, Dlamini S, Ha N, Graviss EA, Mejia R, Mandalakas AM. Diagnostic and Treatment Monitoring Potential of A Stool-Based Quantitative Polymerase Chain Reaction Assay for Pulmonary Tuberculosis. Am J Trop Med Hyg 2018; 99:310-316. [PMID: 29692304 DOI: 10.4269/ajtmh.18-0004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A quantifiable, stool-based, Mycobacterium tuberculosis (Mtb) test has potential complementary value to respiratory specimens. Limit of detection (LOD) was determined by spiking control stool. Clinical test performance was evaluated in a cohort with pulmonary tuberculosis (TB) (N = 166) and asymptomatic household TB child contacts (N = 105). Stool-quantitative polymerase chain reaction (qPCR) results were compared with sputum acid-fast bacilli (AFB) microscopy, GeneXpert MTB/RIF (Xpert MTB/RIF), and cultures. In Mtb stool-spiking studies, the LOD was 96 colony-forming units/50 mg of stool (95% confidence interval [CI]: 84.8-105.6). Among specimens collected within 72 hours of antituberculosis treatment (ATT) initiation, stool qPCR detected 22 of 23 (95%) of culture-positive cases. Among clinically diagnosed cases that were Xpert MTB/RIF and culture negative, stool qPCR detected an additional 8% (3/37). Among asymptomatic, recently TB-exposed participants, stool PCR detected Mtb in two of 105 (1.9%) patients. Two months after ATT, the Mtb quantitative burden in femtogram per microliters decreased (Wilcoxon signed-rank P < 0.001) and persistent positive stool PCR was associated with treatment failure or drug resistance (relative risk 2.8, CI: 1.2-6.5; P = 0.012). Stool-based qPCR is a promising complementary technique to sputum-based diagnosis. It detects and quantifies low levels of stool Mtb DNA, thereby supporting adjunct diagnosis and treatment monitoring in pulmonary TB.
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Affiliation(s)
- Andrew R DiNardo
- Internal Medicine-Infectious Diseases, Baylor College of Medicine, Houston, Texas.,The Global TB Program, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Alexander W Kay
- The Baylor-Swaziland Children's Foundation, Mbabane, Swaziland.,The Global TB Program, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | | | - Nadine M Harris
- Internal Medicine-Infectious Diseases, Baylor College of Medicine, Houston, Texas.,The Global TB Program, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Celia Fung
- The Baylor-Swaziland Children's Foundation, Mbabane, Swaziland.,The Global TB Program, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Godwin Mtetwa
- The Baylor-Swaziland Children's Foundation, Mbabane, Swaziland.,The Global TB Program, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Pilar Ustero
- The Global TB Program, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | | | - Ngan Ha
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas
| | - Rojelio Mejia
- The National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Anna M Mandalakas
- The Global TB Program, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.,The Baylor-Swaziland Children's Foundation, Mbabane, Swaziland
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McKenna ML, McAtee S, Bryan PE, Jeun R, Ward T, Kraus J, Bottazzi ME, Hotez PJ, Flowers CC, Mejia R. Human Intestinal Parasite Burden and Poor Sanitation in Rural Alabama. Am J Trop Med Hyg 2017; 97:1623-1628. [PMID: 29016326 PMCID: PMC5817782 DOI: 10.4269/ajtmh.17-0396] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Hookworm infection affects 430 million people worldwide, causing iron deficiency, impaired cognitive development, and stunting in children. Because of the environmental conditions needed for the hookworm life-cycle, this parasite is endemic to resource-limited countries. Necator americanus was endemic in the southern United States before improvement of sewage disposal systems and eradication programs. With continued poverty, poor sanitation, and an environment suitable for the hookworm life-cycle in some regions of the southern United States, a current prevalence study using modern molecular diagnostics is warranted. Lowndes County, Alabama, was chosen as the study site given previous high hookworm burdens, degree of poverty, and use of open-sewage systems. Participants were interviewed, and stool, serum, and soil samples were tested for nine intestinal parasites using a multiparallel quantitative real-time PCR (qPCR) and enzyme-linked immunosorbent assays. We found that, among 24 households, 42.4% reported exposure to raw sewage within their home, and from 55 stool samples, 19 (34.5%) tested positive for N. americanus, four (7.3%) for Strongyloides stercoralis, and one (1.8%) for Entamoeba histolytica. Stool tested positive for N. americanus contained low levels of parasite DNA (geometric mean 0.0302 fg/μL). Soil studies detected one (2.9%) Cryptosporidium species, and Toxocara serology assay detected one (5.2%) positive in this population. Individuals living in this high-risk environment within the United States continue to have stool samples positive for N. americanus. Gastrointestinal parasites known to be endemic to developing countries are identifiable in American poverty regions, and areas with lower disease burden are more likely to be identified by using qPCR.
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Affiliation(s)
- Megan L McKenna
- Departments of Pediatrics and Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Shannon McAtee
- Departments of Pediatrics and Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Patricia E Bryan
- Departments of Pediatrics and Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Rebecca Jeun
- Departments of Pediatrics and Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Tabitha Ward
- Departments of Pediatrics and Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Jacob Kraus
- Departments of Pediatrics and Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Maria E Bottazzi
- Departments of Pediatrics and Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Peter J Hotez
- Departments of Pediatrics and Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Rojelio Mejia
- Departments of Pediatrics and Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
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37
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Klenov V, Boulet S, Mejia R, Kissin D, Munch E, Mancuso A, Van Voorhis B. Live birth and multiple birth rates in donor oocyte cycles using elective single embryo transfer vs double embryo transfer in United States in-vitro-fertilization clinics. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.299] [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: 11/26/2022]
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Weatherhead J, Cortés AA, Sandoval C, Vaca M, Chico M, Loor S, Cooper PJ, Mejia R. Comparison of Cytokine Responses in Ecuadorian Children Infected with Giardia, Ascaris, or Both Parasites. Am J Trop Med Hyg 2017; 96:1394-1399. [PMID: 28719267 DOI: 10.4269/ajtmh.16-0580] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
AbstractMore than 2 billion people are infected with parasites globally, and the majority have coinfections. Intestinal protozoa and helminths induce polarizing CD4+ T-helper cell 1 (Th1) mediated cytokine responses within the host. Such immune polarization may inhibit the ability of the host to mount an adequate immune response for pathogen clearance to concurrent pathogens. The current study evaluated the plasma cytokine profile in Ascaris and Giardia coinfected children compared with Giardia- and Ascaris-only infected children. Fecal samples and blood samples were collected from asymptomatic 3-year-old children living in the district of Quininde, Ecuador. Stool samples that tested positive for Giardia lamblia-only, Ascaris lumbricoides-only, or G. lamblia and A. lumbricoides coinfections were confirmed by quantitative real-time polymerase chain reaction. Plasma samples from the study subjects were used to quantitate cytokines. A total of 39 patients were evaluated. Children with coinfection had a significant decrease in Th1 cytokine production, interleukin 2 (IL-2) (P < 0.05), IL-12 (P < 0.05), and tumor necrosis factor alpha (P < 0.05) compared with Giardia-only infected children. Coinfected children had an increase in IL-10/interferon gamma (IFN-γ) ratio compared with uninfected (P < 0.05) and Ascaris alone (P < 0.05). The increased IL-10/IFN-γ ratio in the setting of decreased Th1 cytokine response indicates Th2 polarization in the coinfected group. Reduced Th1 cytokines in children coinfected with Ascaris and Giardia may impair the host's ability to eradicate Giardia infection leading to chronic giardiasis.
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Affiliation(s)
- Jill Weatherhead
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Carlos Sandoval
- Fundación Ecuatoriana para la Investigación en Salud, Quito, Ecuador
| | - Maritza Vaca
- Fundación Ecuatoriana para la Investigación en Salud, Quito, Ecuador
| | - Martha Chico
- Fundación Ecuatoriana para la Investigación en Salud, Quito, Ecuador
| | - Sophia Loor
- Fundación Ecuatoriana para la Investigación en Salud, Quito, Ecuador
| | - Philip J Cooper
- Institute of Infection and Immunity, St. George's University of London, London, United Kingdom.,Facultad de Ciencias Medicas, de la Salud y la Vida, Universidad Internacional del Ecuador, Quito, Ecuador.,Fundación Ecuatoriana para la Investigación en Salud, Quito, Ecuador
| | - Rojelio Mejia
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
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Abstract
Helminth infections, including soil-transmitted helminths and schistosomiasis, remain one of the most common infections in the world with over 1 billion people infected. These infections cause significant morbidity, particularly in young children, that may last a lifetime, including growth and cognitive stunting. There is an urgent need for the control and elimination of helminth infections from areas of poverty to reduce morbidity in children. Mass drug administration programs were adopted by the World Health Assembly in 2001 and have evolved to provide coverage with multiple anthelmintic medications in a single rapid impact package and more extensive coverage within a community.
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Affiliation(s)
- Jill E Weatherhead
- Department of Pediatrics, Section of Tropical Medicine, Baylor College of Medicine, Feigin Research Building, 1102 Bates Avenue, Suite 550, Houston, TX 77030, USA; National School of Tropical Medicine, Baylor College of Medicine, One Baylor Plaza, MS: BCM-113, Houston, TX 77030, USA.
| | - Peter J Hotez
- Department of Pediatrics, Section of Tropical Medicine, Baylor College of Medicine, Feigin Research Building, 1102 Bates Avenue, Suite 550, Houston, TX 77030, USA; National School of Tropical Medicine, Baylor College of Medicine, One Baylor Plaza, MS: BCM-113, Houston, TX 77030, USA; Department of Molecular Virology and Microbiology, Baylor College of Medicine, One Baylor Plaza, MS: BCM-385, Houston, TX 77030, USA; Sabin Vaccine Institute and Texas Children's Hospital (TCH), Center for Vaccine Development, Feigin Research Building, 1102 Bates Avenue, Suite 550, Houston, TX 77030, USA
| | - Rojelio Mejia
- Department of Pediatrics, Section of Tropical Medicine, Baylor College of Medicine, Feigin Research Building, 1102 Bates Avenue, Suite 550, Houston, TX 77030, USA; National School of Tropical Medicine, Baylor College of Medicine, One Baylor Plaza, MS: BCM-113, Houston, TX 77030, USA.
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Papaiakovou M, Pilotte N, Grant JR, Traub RJ, Llewellyn S, McCarthy JS, Krolewiecki AJ, Cimino R, Mejia R, Williams SA. A novel, species-specific, real-time PCR assay for the detection of the emerging zoonotic parasite Ancylostoma ceylanicum in human stool. PLoS Negl Trop Dis 2017; 11:e0005734. [PMID: 28692668 PMCID: PMC5519186 DOI: 10.1371/journal.pntd.0005734] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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: 04/05/2017] [Revised: 07/20/2017] [Accepted: 06/21/2017] [Indexed: 11/18/2022] Open
Abstract
Background Molecular-based surveys have indicated that Ancylostoma ceylanicum, a zoonotic hookworm, is likely the second most prevalent hookworm species infecting humans in Asia. Most current PCR-based diagnostic options for the detection of Ancylostoma species target the Internal Transcribed Spacer (ITS) regions of the ribosomal gene cluster. These regions possess a considerable degree of conservation among the species of this genus and this conservation can lead to the misidentification of infecting species or require additional labor for accurate species-level determination. We have developed a novel, real-time PCR-based assay for the sensitive and species-specific detection of A. ceylanicum that targets a non-coding, highly repetitive genomic DNA element. Comparative testing of this PCR assay with an assay that targets ITS sequences was conducted on field-collected samples from Argentina and Timor-Leste to provide further evidence of the sensitivity and species-specificity of this assay. Methods/Principal findings A previously described platform for the design of primers/probe targeting non-coding highly repetitive regions was used for the development of this novel assay. The assay’s limits of detection (sensitivity) and cross-reactivity with other soil-transmitted helminth species (specificity) were assessed with real-time PCR experiments. The assay was successfully used to identify infections caused by A. ceylanicum that were previously only identified to the genus level as Ancylostoma spp. when analyzed using other published primer-probe pairings. Further proof of sensitive, species-specific detection was provided using a published, semi-nested restriction fragment length polymorphism-PCR assay that differentiates between Ancylostoma species. Conclusions/Significance Due to the close proximity of people and domestic/wild animals in many regions of the world, the potential for zoonotic infections is substantial. Sensitive tools enabling the screening for different soil-transmitted helminth infections are essential to the success of mass deworming efforts and facilitate the appropriate interpretation of data. This study describes a novel, species-specific, real-time PCR-based assay for the detection of A. ceylanicum that will help to address the need for such tools in integrated STH deworming programs. Trial registration ANZCTR.org.au ACTRN12614000680662 Historically, Ancylostoma ceylanicum has been viewed as an uncommon cause of human hookworm infection, with minimal public health importance. However, recent reports have indicated that this zoonotic hookworm causes a much greater incidence of infection within certain human populations than was previously believed. Current methods for the species-level detection of A. ceylanicum rely on techniques that involve conventional PCR accompanied by restriction enzyme digestions. These PCR-based assays are not only laborious but they lack sensitivity as they target suboptimal regions on the DNA. As efforts aimed at the eradication of hookworm disease have grown substantially over the last decade, the need for sensitive and specific tools to monitor and evaluate programmatic successes has correspondingly escalated. Since a growing body of evidence suggests that patient responses to drug treatment can vary based upon the species of hookworm that is causing infection, accurate species-level diagnostics are advantageous. Accordingly, the novel real-time PCR-based assay described here provides a sensitive, species-specific diagnostic tool that will facilitate the accurate mapping of disease endemicity and will aid in the evaluation of progress of programmatic deworming efforts.
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Affiliation(s)
- Marina Papaiakovou
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America
- * E-mail:
| | - Nils Pilotte
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America
- Molecular and Cellular Biology Program, University of Massachusetts, Amherst, Massachusetts, United States of America
| | - Jessica R. Grant
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America
| | - Rebecca J. Traub
- Faculty of Veterinary and Agricultural Science, University of Melbourne, Parkville, Australia
| | - Stacey Llewellyn
- Clinical Medical Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - James S. McCarthy
- Clinical Medical Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Alejandro J. Krolewiecki
- Instituto de Investigaciones en Enfermedades Tropicales, Universidad Nacional de Salta/CONICET, Orán, Argentina
- Instituto de Patología Experimental (IPE-CONICET), Facultad de Ciencias de la Salud, Universidad Nacional de Salta, Salta, Argentina
| | - Rubén Cimino
- Instituto de Investigaciones en Enfermedades Tropicales, Universidad Nacional de Salta/CONICET, Orán, Argentina
| | - Rojelio Mejia
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Steven A. Williams
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America
- Molecular and Cellular Biology Program, University of Massachusetts, Amherst, Massachusetts, United States of America
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Morawski BM, Yunus M, Kerukadho E, Turyasingura G, Barbra L, Ojok AM, DiNardo AR, Sowinski S, Boulware DR, Mejia R. Hookworm infection is associated with decreased CD4+ T cell counts in HIV-infected adult Ugandans. PLoS Negl Trop Dis 2017; 11:e0005634. [PMID: 28542260 PMCID: PMC5462474 DOI: 10.1371/journal.pntd.0005634] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 08/19/2016] [Revised: 06/07/2017] [Accepted: 05/10/2017] [Indexed: 01/02/2023] Open
Abstract
Most studies evaluating epidemiologic relationships between helminths and HIV have been conducted in the pre-ART era, and evidence of the impact of helminth infections on HIV disease progression remains conflicting. Less is known about helminth infection and clinical outcomes in HIV-infected adults receiving antiretroviral therapy (ART). We sampled HIV-infected adults for eight gastrointestinal parasites and correlated parasitic infection with demographic predictors, and clinical and immunologic outcomes. Contrasting with previous studies, we measured parasitic infection with a quantitative, highly sensitive and specific polymerase chain reaction (PCR) method. This cohort study enrolled HIV-infected Ugandans from August-September 2013 in Mbale, Uganda and collected stool and blood samples at enrollment. Real-time PCR quantified stool: Ascaris lumbricoides, Ancylostoma duodenale, Necator americanus, Strongyloides stercoralis, Trichuris trichiura, Cryptosporidium spp., Entamoeba histolytica, and Giardia intestinalis infection. Generalized linear models assessed relationships between parasitic infection and clinical or demographic data. 35% of participants (71/202) tested positive for ≥1 helminth, mainly N. americanus (55/199, 28%), and 4.5% (9/202) were infected with ≥2 stool parasites. Participants with hookworm infection had lower average CD4+ cell counts (-94 cells/mcL, 95%CI: -141, -48 cells/mcL; p<0.001) after adjustment for sex, CD4+ nadir at clinic entry, and time on ART. The high prevalence of parasitic infection and correlation with decreased CD4+ concentrations highlight the need to re-examine the effects of invasive helminth co-infection in rural, HIV-infected populations in the era of widely available ART. Elucidating the relationship between hookworm infection and immune recovery could provide opportunities for health optimization, e.g. integrated deworming, in these vulnerable populations.
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Affiliation(s)
- Bozena M. Morawski
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America
- * E-mail:
| | - Miya Yunus
- The AIDS Support Organization, Kampala, Uganda
| | | | | | | | | | - Andrew R. DiNardo
- Division of Global and Immigrant Health, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States of America
| | - Stefanie Sowinski
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
- The Gladstone Institute of Virology and Immunology, University of California, San Francisco, San Francisco, CA, United States of America
| | - David R. Boulware
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America
| | - Rojelio Mejia
- Section of Tropical Medicine, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States of America
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Cuamba I, Grau-Pujol B, Nhabomba A, Gutiérrez J, Lázaro C, Mejia R. PREVALENCE OF GASTROINTESTINAL PARASITES IN SOUTHERN MOZAMBIQUE USING A NOVEL MULTIPARALLEL QUANTITATIVE REAL-TIME PCR. BMJ Glob Health 2017. [DOI: 10.1136/bmjgh-2016-000260.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Liu J, Kaul B, Shioleno A, Mehta N, Mejia R. Brucellosis Prostatitis: A Neglected Diagnosis for a Tropical Disease. Curr Trop Med Rep 2016. [DOI: 10.1007/s40475-016-0089-8] [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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Wei J, Damania A, Gao X, Liu Z, Mejia R, Mitreva M, Strych U, Bottazzi ME, Hotez PJ, Zhan B. The hookworm Ancylostoma ceylanicum intestinal transcriptome provides a platform for selecting drug and vaccine candidates. Parasit Vectors 2016; 9:518. [PMID: 27677574 PMCID: PMC5039805 DOI: 10.1186/s13071-016-1795-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 05/17/2016] [Accepted: 09/12/2016] [Indexed: 12/02/2022] Open
Abstract
Background The intestine of hookworms contains enzymes and proteins involved in the blood-feeding process of the parasite and is therefore a promising source of possible vaccine antigens. One such antigen, the hemoglobin-digesting intestinal aspartic protease known as Na-APR-1 from the human hookworm Necator americanus, is currently a lead candidate antigen in clinical trials, as is Na-GST-1 a heme-detoxifying glutathione S-transferase. Methods In order to discover additional hookworm vaccine antigens, messenger RNA was obtained from the intestine of male hookworms, Ancylostoma ceylanicum, maintained in hamsters. RNA-seq was performed using Illumina high-throughput sequencing technology. The genes expressed in the hookworm intestine were compared with those expressed in the whole worm and those genes overexpressed in the parasite intestine transcriptome were further analyzed. Results Among the lead transcripts identified were genes encoding for proteolytic enzymes including an A. ceylanicum APR-1, but the most common proteases were cysteine-, serine-, and metallo-proteases. Also in abundance were specific transporters of key breakdown metabolites, including amino acids, glucose, lipids, ions and water; detoxifying and heme-binding glutathione S-transferases; a family of cysteine-rich/antigen 5/pathogenesis-related 1 proteins (CAP) previously found in high abundance in parasitic nematodes; C-type lectins; and heat shock proteins. These candidates will be ranked for downstream antigen target selection based on key criteria including abundance, uniqueness in the parasite versus the vertebrate host, as well as solubility and yield of expression. Conclusion The intestinal transcriptome of A. ceylanicum provides useful information for the identification of proteins involved in the blood-feeding process, representing a first step towards a reverse vaccinology approach to a human hookworm vaccine. Electronic supplementary material The online version of this article (doi:10.1186/s13071-016-1795-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Junfei Wei
- Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Ashish Damania
- Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Xin Gao
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, 63108, USA
| | - Zhuyun Liu
- Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Rojelio Mejia
- Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Makedonka Mitreva
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, 63108, USA.,Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63108, USA
| | - Ulrich Strych
- Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Maria Elena Bottazzi
- Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, 77030, USA.,Department of Biology, Baylor University, Waco, TX, 76706, USA
| | - Peter J Hotez
- Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, 77030, USA.,Department of Biology, Baylor University, Waco, TX, 76706, USA
| | - Bin Zhan
- Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, 77030, USA.
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Mejia R. Erratum to: Current Treatment Options for Giardiasis and Cryptosporidiosis. Curr Trop Med Rep 2016. [DOI: 10.1007/s40475-016-0085-z] [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: 12/01/2022]
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Rajagopal S, Oliver N, Palau L, Plamenac J, Mejia R. Invited Commentary on Treatment of Nocardia wallacei in an HIV Patient With Renal Failure. Curr Trop Med Rep 2016. [DOI: 10.1007/s40475-016-0073-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Crannell Z, Castellanos-Gonzalez A, Nair G, Mejia R, White AC, Richards-Kortum R. Multiplexed Recombinase Polymerase Amplification Assay To Detect Intestinal Protozoa. Anal Chem 2016; 88:1610-6. [PMID: 26669715 DOI: 10.1021/acs.analchem.5b03267] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This work describes a proof-of-concept multiplex recombinase polymerase amplification (RPA) assay with lateral flow readout that is capable of simultaneously detecting and differentiating DNA from any of the diarrhea-causing protozoa Giardia, Cryptosporidium, and Entamoeba. Together, these parasites contribute significantly to the global burden of diarrheal illness. Differential diagnosis of these parasites is traditionally accomplished via stool microscopy. However, microscopy is insensitive and can miss up to half of all cases. DNA-based diagnostics such as polymerase chain reaction (PCR) are far more sensitive; however, they rely on expensive thermal cycling equipment, limiting their availability to centralized reference laboratories. Isothermal DNA amplification platforms, such as the RPA platform used in this study, alleviate the need for thermal cycling equipment and have the potential to broaden access to more sensitive diagnostics. Until now, multiplex RPA assays have not been developed that are capable of simultaneously detecting and differentiating infections caused by different pathogens. We developed a multiplex RPA assay to detect the presence of DNA from Giardia, Cryptosporidium, and Entamoeba. The multiplex assay was characterized using synthetic DNA, where the limits-of-detection were calculated to be 403, 425, and 368 gene copies per reaction of the synthetic Giardia, Cryptosporidium, and Entamoeba targets, respectively (roughly 1.5 orders of magnitude higher than for the same targets in a singleplex RPA assay). The multiplex assay was also characterized using DNA extracted from live parasites spiked into stool samples where the limits-of-detection were calculated to be 444, 6, and 9 parasites per reaction for Giardia, Cryptosporidium, and Entamoeba parasites, respectively. This proof-of-concept assay may be reconfigured to detect a wide variety of targets by re-designing the primer and probe sequences.
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Affiliation(s)
- Zachary Crannell
- 1980 West Getaway Trail, Flagstaff, Arizona 86005, United States.,Department of Internal Medicine, University of Texas Medical Branch , 301 University Boulevard, Galveston, Texas 77555.0435, United States.,Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch , 1709 Dryden Road, No. 1700, Houston, Texas 77030, United States.,Department of Pediatrics, Section of Tropical Medicine; Department of Medicine, Section of Infectious Diseases; and National School of Tropical Medicine, Baylor College of Medicine 1709 Dryden Road, No. 1700, Houston, Texas 77030, United States.,Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch , Mary Moody Northen, Room 4.230, 301 University Boulevard, Galveston, Texas 77555-0435, United States
| | - Alejandro Castellanos-Gonzalez
- 1980 West Getaway Trail, Flagstaff, Arizona 86005, United States.,Department of Internal Medicine, University of Texas Medical Branch , 301 University Boulevard, Galveston, Texas 77555.0435, United States.,Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch , 1709 Dryden Road, No. 1700, Houston, Texas 77030, United States.,Department of Pediatrics, Section of Tropical Medicine; Department of Medicine, Section of Infectious Diseases; and National School of Tropical Medicine, Baylor College of Medicine 1709 Dryden Road, No. 1700, Houston, Texas 77030, United States.,Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch , Mary Moody Northen, Room 4.230, 301 University Boulevard, Galveston, Texas 77555-0435, United States
| | - Gayatri Nair
- 1980 West Getaway Trail, Flagstaff, Arizona 86005, United States.,Department of Internal Medicine, University of Texas Medical Branch , 301 University Boulevard, Galveston, Texas 77555.0435, United States.,Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch , 1709 Dryden Road, No. 1700, Houston, Texas 77030, United States.,Department of Pediatrics, Section of Tropical Medicine; Department of Medicine, Section of Infectious Diseases; and National School of Tropical Medicine, Baylor College of Medicine 1709 Dryden Road, No. 1700, Houston, Texas 77030, United States.,Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch , Mary Moody Northen, Room 4.230, 301 University Boulevard, Galveston, Texas 77555-0435, United States
| | - Rojelio Mejia
- 1980 West Getaway Trail, Flagstaff, Arizona 86005, United States.,Department of Internal Medicine, University of Texas Medical Branch , 301 University Boulevard, Galveston, Texas 77555.0435, United States.,Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch , 1709 Dryden Road, No. 1700, Houston, Texas 77030, United States.,Department of Pediatrics, Section of Tropical Medicine; Department of Medicine, Section of Infectious Diseases; and National School of Tropical Medicine, Baylor College of Medicine 1709 Dryden Road, No. 1700, Houston, Texas 77030, United States.,Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch , Mary Moody Northen, Room 4.230, 301 University Boulevard, Galveston, Texas 77555-0435, United States
| | - A Clinton White
- 1980 West Getaway Trail, Flagstaff, Arizona 86005, United States.,Department of Internal Medicine, University of Texas Medical Branch , 301 University Boulevard, Galveston, Texas 77555.0435, United States.,Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch , 1709 Dryden Road, No. 1700, Houston, Texas 77030, United States.,Department of Pediatrics, Section of Tropical Medicine; Department of Medicine, Section of Infectious Diseases; and National School of Tropical Medicine, Baylor College of Medicine 1709 Dryden Road, No. 1700, Houston, Texas 77030, United States.,Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch , Mary Moody Northen, Room 4.230, 301 University Boulevard, Galveston, Texas 77555-0435, United States
| | - Rebecca Richards-Kortum
- Department of Bioengineering, Rice University , Houston, Texas 77030, United States.,1980 West Getaway Trail, Flagstaff, Arizona 86005, United States.,Department of Internal Medicine, University of Texas Medical Branch , 301 University Boulevard, Galveston, Texas 77555.0435, United States.,Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch , 1709 Dryden Road, No. 1700, Houston, Texas 77030, United States.,Department of Pediatrics, Section of Tropical Medicine; Department of Medicine, Section of Infectious Diseases; and National School of Tropical Medicine, Baylor College of Medicine 1709 Dryden Road, No. 1700, Houston, Texas 77030, United States.,Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch , Mary Moody Northen, Room 4.230, 301 University Boulevard, Galveston, Texas 77555-0435, United States
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Mejia R, Bruschi F, Bottazzi ME. Global Health and Tropical Medicine in the Twenty-First Century: A Renewed Interest in the Understanding and the Control of Helminth Infections. Curr Trop Med Rep 2015. [DOI: 10.1007/s40475-015-0060-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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