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Horne B, Badji H, Bhuiyan MTR, Romaina Cachique L, Cornick J, Hotwani A, Juma J, Ochieng JB, Abdou M, Apondi E, Atlas HE, Awuor AO, Baker KS, Ceesay BE, Charles M, Cunliffe NA, Feutz E, Galagan SR, Guindo I, Hossain MJ, Iqbal J, Jallow F, Keita NY, Khanam F, Kotloff KL, Maiden V, Manzanares Villanueva K, Mito O, Mosharraf MP, Nkeze J, Ikumapayi UN, Paredes Olortegui M, Pavlinac PB, Pinedo Vasquez T, Qadri F, Qamar FN, Qureshi S, Rahman N, Sangare A, Sen S, Peñataro Yori P, Yousafzai MT, Ahmed D, Jere KC, Kosek MN, Omore R, Permala-Booth J, Secka O, Tennant SM. Microbiological Methods Used in the Enterics for Global Health Shigella Surveillance Study. Open Forum Infect Dis 2024; 11:S25-S33. [PMID: 38532949 PMCID: PMC10962722 DOI: 10.1093/ofid/ofad576] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
Background Shigella is a major cause of diarrhea in young children worldwide. Multiple vaccines targeting Shigella are in development, and phase 3 clinical trials are imminent to determine efficacy against shigellosis. Methods The Enterics for Global Health (EFGH) Shigella surveillance study is designed to determine the incidence of medically attended shigellosis in 6- to 35-month-old children in 7 resource-limited settings. Here, we describe the microbiological methods used to isolate and identify Shigella. We developed a standardized laboratory protocol for isolation and identification of Shigella by culture. This protocol was implemented across all 7 sites, ensuring consistency and comparability of results. Secondary objectives of the study are to determine the antibiotic resistance profiles of Shigella, compare isolation of Shigella from rectal swabs versus whole stool, and compare isolation of Shigella following transport of rectal swabs in Cary-Blair versus a modified buffered glycerol saline transport medium. Conclusions Data generated from EFGH using culture methods described herein can potentially be used for microbiological endpoints in future phase 3 clinical trials to evaluate vaccines against shigellosis and for other clinical and public health studies focused on these organisms.
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Affiliation(s)
- Bri’Anna Horne
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Henry Badji
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | | | - Jennifer Cornick
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Jane Juma
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | | | - Mahamadou Abdou
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | - Evans Apondi
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Hannah E Atlas
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Alex O Awuor
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Kate S Baker
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Department of Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Bubacarr E Ceesay
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Mary Charles
- Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
| | - Nigel A Cunliffe
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Erika Feutz
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Sean R Galagan
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Ibrehima Guindo
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | - M Jahangir Hossain
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Junaid Iqbal
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Fatima Jallow
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Farhana Khanam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Victor Maiden
- Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
| | | | - Oscar Mito
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Md Parvej Mosharraf
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Joseph Nkeze
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Usman N Ikumapayi
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Patricia B Pavlinac
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Sonia Qureshi
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Nazia Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Aminata Sangare
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | - Sunil Sen
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Pablo Peñataro Yori
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | | | - Dilruba Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Khuzwayo C Jere
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
- Department of Medical Laboratory Sciences, School of Life Sciences and Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Margaret N Kosek
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Richard Omore
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Jasnehta Permala-Booth
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Ousman Secka
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Sharon M Tennant
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
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Babb C, Badji H, Bhuiyan MTR, Cornick J, Qureshi S, Sonye C, Shapiama Lopez WV, Adnan M, Atlas HE, Begum K, Brennhofer SA, Ceesay BE, Ceesay AK, Cunliffe NA, Garcia Bardales PF, Haque S, Horne B, Hossain MJ, Iqbal J, Islam MT, Islam S, Khanam F, Kotloff KL, Malemia T, Manzanares Villanueva K, Million GM, Munthali V, Ochieng JB, Ogwel B, Paredes Olortegui M, Omore R, Pavlinac PB, Platts-Mills JA, Sears KT, Secka O, Tennant SM, Peñataro Yori P, Yousafzai MT, Jere KC, Kosek MN, Munga S, Ikumapayi UN, Qadri F, Qamar FN, Rogawski McQuade ET. Evaluation of Fecal Inflammatory Biomarkers to Identify Bacterial Diarrhea Episodes: Systematic Review and Protocol for the Enterics for Global Health Shigella Surveillance Study. Open Forum Infect Dis 2024; 11:S65-S75. [PMID: 38532957 PMCID: PMC10962755 DOI: 10.1093/ofid/ofad652] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
Background The measurement of fecal inflammatory biomarkers among individuals presenting to care with diarrhea could improve the identification of bacterial diarrheal episodes that would benefit from antibiotic therapy. We reviewed prior literature in this area and describe our proposed methods to evaluate 4 biomarkers in the Enterics for Global Health (EFGH) Shigella surveillance study. Methods We systematically reviewed studies since 1970 from PubMed and Embase that assessed the diagnostic characteristics of inflammatory biomarkers to identify bacterial diarrhea episodes. We extracted sensitivity and specificity and summarized the evidence by biomarker and diarrhea etiology. In EFGH, we propose using commercial enzyme-linked immunosorbent assays to test for myeloperoxidase, calprotectin, lipocalin-2, and hemoglobin in stored whole stool samples collected within 24 hours of enrollment from participants in the Bangladesh, Kenya, Malawi, Pakistan, Peru, and The Gambia sites. We will develop clinical prediction scores that incorporate the inflammatory biomarkers and evaluate their ability to identify Shigella and other bacterial etiologies of diarrhea as determined by quantitative polymerase chain reaction (qPCR). Results Forty-nine studies that assessed fecal leukocytes (n = 39), red blood cells (n = 26), lactoferrin (n = 13), calprotectin (n = 8), and myeloperoxidase (n = 1) were included in the systematic review. Sensitivities were high for identifying Shigella, moderate for identifying any bacteria, and comparable across biomarkers. Specificities varied depending on the outcomes assessed. Prior studies were generally small, identified red and white blood cells by microscopy, and used insensitive gold standard diagnostics, such as conventional bacteriological culture for pathogen detection. Conclusions Our evaluation of inflammatory biomarkers to distinguish diarrhea etiologies as determined by qPCR will provide an important addition to the prior literature, which was likely biased by the limited sensitivity of the gold standard diagnostics used. We will determine whether point-of-care biomarker tests could be a viable strategy to inform treatment decision making and increase appropriate targeting of antibiotic treatment to bacterial diarrhea episodes.
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Affiliation(s)
- Courtney Babb
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Henry Badji
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Md Taufiqur Rahman Bhuiyan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jennifer Cornick
- Institute of Infection, Veterinary and Ecological Sciences, Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
| | - Sonia Qureshi
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Catherine Sonye
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Mehreen Adnan
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Hannah E Atlas
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Kehkashan Begum
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Stephanie A Brennhofer
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Bubacarr E Ceesay
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Abdoulie K Ceesay
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Nigel A Cunliffe
- Institute of Infection, Veterinary and Ecological Sciences, Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| | | | - Shahinur Haque
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Bri’Anna Horne
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - M Jahangir Hossain
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Junaid Iqbal
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Md Taufiqul Islam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sadia Islam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Farhana Khanam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | | | | | | | - Billy Ogwel
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Richard Omore
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Patricia B Pavlinac
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Khandra T Sears
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ousman Secka
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Sharon M Tennant
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Pablo Peñataro Yori
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | | | - Khuzwayo C Jere
- Institute of Infection, Veterinary and Ecological Sciences, Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Department of Medical Laboratory Sciences, Kamuzu University of Health Sciences, School of Life Sciences and Health Professions, Blantyre, Malawi
| | - Margaret N Kosek
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Stephen Munga
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Usman N Ikumapayi
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
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Conteh B, Badji H, Jallow AF, Karim M, Manneh A, Keita B, Sarwar G, Ceesay BE, Jarju S, Jabang AMJ, Baldeh E, Ikumapayi UN, Secka O, Antonio M, Roca A, D’Alessandro U, Kotloff KL, Hossain MJ. The Enterics for Global Health (EFGH) Shigella Surveillance Study in The Gambia. Open Forum Infect Dis 2024; 11:S84-S90. [PMID: 38532959 PMCID: PMC10962724 DOI: 10.1093/ofid/ofae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
Background The Gambia, located in West Africa, is one of 7 country sites conducting the Enterics for Global Health (EFGH) Shigella Surveillance Study to establish incidence and consequence of Shigella-associated medically attended diarrhea among children 6-35 months old. Methods Here we describe the study site and research experience, sociodemographic characteristics of the study catchment area, facilities of recruitment for diarrhea case surveillance, and known care-seeking behavior for diarrheal illness. We also describe The Gambia's healthcare system and financing, current vaccine schedule and Shigella vaccine adaptation, local diarrhea management guidelines and challenges, and antibiotic resistance patterns in the region. Conclusions The EFGH study in The Gambia will contribute to the multisite network of Shigella surveillance study and prepare the site for future vaccine trials. In addition, the data produced will inform policy makers about prevention strategies and upcoming Shigella vaccine studies among children in this setting.
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Affiliation(s)
- Bakary Conteh
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Henry Badji
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Abdoulie F Jallow
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Mehrab Karim
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Alhagie Manneh
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Belali Keita
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Golam Sarwar
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Bubacarr E Ceesay
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Sheikh Jarju
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Abdoulie M J Jabang
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Ebrima Baldeh
- Regional Health Directorate Upper River Region, Ministry of Health and Social Welfare, Basse, The Gambia
| | - Usman N Ikumapayi
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Ousman Secka
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Martin Antonio
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Anna Roca
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Umberto D’Alessandro
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - M Jahangir Hossain
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
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Ikumapayi UN, Hill PC, Hossain I, Olatunji Y, Ndiaye M, Badji H, Manjang A, Salaudeen R, Ceesay L, Adegbola RA, Greenwood BM, Mackenzie GA. Childhood meningitis in rural Gambia: 10 years of population-based surveillance. PLoS One 2022; 17:e0265299. [PMID: 35947593 PMCID: PMC9365145 DOI: 10.1371/journal.pone.0265299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background The introduction in many countries of conjugate vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis has led to significant reductions in acute bacterial meningitis (ABM) in children. However, recent population-based data on ABM in sub-Saharan Africa are limited. Methods Population-based surveillance for meningitis was carried out in a rural area of The Gambia under demographic surveillance from 2008 to 2017, using standardised criteria for referral, diagnosis and investigation. We calculated incidence using population denominators. Results We diagnosed 1,666 patients with suspected meningitis and collected cerebrospinal fluid (n = 1,121) and/or blood (n = 1,070) from 1,427 (88%) of cases. We identified 169 cases of ABM, 209 cases of suspected non-bacterial meningitis (SNBM) and 1,049 cases of clinically suspected meningitis (CSM). The estimated average annual incidence of ABM was high at 145 per 100,000 population in the <2-month age group, 56 per 100,000 in the 2–23-month age group, but lower at 5 per 100,000 in the 5–14-year age group. The most common causes of ABM were Streptococcus pneumoniae (n = 44), Neisseria meningitidis (n = 42), and Gram-negative coliform bacteria (n = 26). Eighteen of 22 cases caused by pneumococcal serotypes included in PCV13 occurred prior to vaccine introduction and four afterwards. The overall case fatality ratio for ABM was 29% (49/169) and was highest in the <2-month age group 37% (10/27). The case fatality ratio was 8.6% (18/209) for suspected non-bacterial meningitis and 12.8% (134/1049) for clinically suspected meningitis cases. Conclusions Gambian children continue to experience substantial morbidity and mortality associated with suspected meningitis, especially acute bacterial meningitis. Such severely ill children in sub-Saharan Africa require improved diagnostics and clinical care.
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Affiliation(s)
- Usman N. Ikumapayi
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- * E-mail:
| | - Philip C. Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Ilias Hossain
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Yekini Olatunji
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Malick Ndiaye
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Henry Badji
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ahmed Manjang
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Rasheed Salaudeen
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Lamin Ceesay
- Ministry of Health, Gambia Government, Banjul, The Gambia
| | - Richard A. Adegbola
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- RAMBICON, Immunisation & Global Health Consulting, Lekki, Lagos, Nigeria
| | | | - Grant A. Mackenzie
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Murdoch Children’s Research Institute, Parkville, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Foster-Nyarko E, Alikhan NF, Ikumapayi UN, Sarwar G, Okoi C, Tientcheu PEM, Defernez M, O'Grady J, Antonio M, Pallen MJ. Genomic diversity of Escherichia coli from healthy children in rural Gambia. PeerJ 2021; 9:e10572. [PMID: 33505796 PMCID: PMC7796664 DOI: 10.7717/peerj.10572] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/23/2020] [Indexed: 01/21/2023] Open
Abstract
Little is known about the genomic diversity of Escherichia coli in healthy children from sub-Saharan Africa, even though this is pertinent to understanding bacterial evolution and ecology and their role in infection. We isolated and whole-genome sequenced up to five colonies of faecal E. coli from 66 asymptomatic children aged three-to-five years in rural Gambia (n = 88 isolates from 21 positive stools). We identified 56 genotypes, with an average of 2.7 genotypes per host. These were spread over 37 seven-allele sequence types and the E. coli phylogroups A, B1, B2, C, D, E, F and Escherichia cryptic clade I. Immigration events accounted for three-quarters of the diversity within our study population, while one-quarter of variants appeared to have arisen from within-host evolution. Several isolates encode putative virulence factors commonly found in Enteropathogenic and Enteroaggregative E. coli, and 53% of the isolates encode resistance to three or more classes of antimicrobials. Thus, resident E. coli in these children may constitute reservoirs of virulence- and resistance-associated genes. Moreover, several study strains were closely related to isolates that caused disease in humans or originated from livestock. Our results suggest that within-host evolution plays a minor role in the generation of diversity compared to independent immigration and the establishment of strains among our study population. Also, this study adds significantly to the number of commensal E. coli genomes, a group that has been traditionally underrepresented in the sequencing of this species.
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Affiliation(s)
- Ebenezer Foster-Nyarko
- Quadram Institute Bioscience, Norwich Research Park, Norfolk, United Kingdom.,Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Usman N Ikumapayi
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Golam Sarwar
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Catherine Okoi
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Marianne Defernez
- Quadram Institute Bioscience, Norwich Research Park, Norfolk, United Kingdom
| | - Justin O'Grady
- Quadram Institute Bioscience, Norwich Research Park, Norfolk, United Kingdom
| | - Martin Antonio
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia.,Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Mark J Pallen
- Quadram Institute Bioscience, Norwich Research Park, Norfolk, United Kingdom.,School of Veterinary Medicine, University of Surrey, Surrey, United Kingdom
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Ikumapayi UN, Sanyang C, Pereira DI. A Case Report of an Intestinal Helminth Infection of Human Hymenolepiasis in Rural Gambia. ACTA ACUST UNITED AC 2019; 6:251. [PMID: 33344886 PMCID: PMC7680930 DOI: 10.23937/2378-3656/1410251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2019] [Indexed: 11/05/2022]
Abstract
Background Hymenolepis nana, also called dwarf tapeworm infection, is an intestinal helminth not previously reported in The Gambia and only very rarely reported in West Africa. Case presentation We report a case of H. nana infection in a 29-month-old child living in a rural community of the north bank of the Upper River Region (URR) in The Gambia. The child presented with mild iron deficiency anaemia and granulocytosis but was otherwise mostly asymptomatic despite the moderate-intensity of infection. Conclusions We support treatment of H. nana infection even in largely asymptomatic children to prevent autoinfection and spread of this intestinal helminth in The Gambia and in other West African countries. Abbreviations GCP: Good Clinical Practice; HAZ: Height-for-age z-score; IHAT-GUT: Acronym for the Iron Hydroxide Adipate Tartrate Supplementation Study; ICH: International Conference on Harmonisation; SD: Standard Deviation; URR: Upper River Region; WAZ: Weight-for-age z-score; WHO: World Health Organization; WHZ: Weight-for-height z-score.
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Affiliation(s)
- Usman N Ikumapayi
- Medical Research Council Unit the Gambia, London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Chilel Sanyang
- Medical Research Council Unit the Gambia, London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Dora Ia Pereira
- Medical Research Council Unit the Gambia, London School of Hygiene & Tropical Medicine, Banjul, The Gambia.,Medical Research Council Unit the Gambia, London School of Hygiene & Tropical Medicine, Banjul, The Gambia
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Ikumapayi UN, Boisen N, Hossain MJ, Betts M, Lamin M, Saha D, Kwambana-Adams B, Dione M, Adegbola RA, Roca A, Nataro JP, Antonio M. Identification of Subsets of Enteroaggregative Escherichia coli Associated with Diarrheal Disease among Under 5 Years of Age Children from Rural Gambia. Am J Trop Med Hyg 2017; 97:997-1004. [PMID: 28820687 PMCID: PMC5637583 DOI: 10.4269/ajtmh.16-0705] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Enteroaggregative Escherichia coli (EAEC) cause acute and persistent diarrhea, mostly in children worldwide. Outbreaks of diarrhea caused by EAEC have been described, including a large outbreak caused by a Shiga toxin expressing strain. This study investigated the association of EAEC virulence factors with diarrhea in children less than 5 years. We characterized 428 EAEC strains isolated from stool samples obtained from moderate-to-severe diarrhea cases (157) and healthy controls (217) children aged 0–59 months recruited over 3 years as part of the Global Enteric Multicenter Study (GEMS) in The Gambia. Four sets of multiplex polymerase chain reaction were applied to detect 21 EAEC-virulence genes from confirmed EAEC strains that target pCVD432 (aatA) and AAIC (aaiC). In addition, Kirby-Bauer disc diffusion antimicrobial susceptibility testing was performed on 88 EAEC strains following Clinical Laboratory Standard Institute guidelines. We observed that the plasmid-encoded enterotoxin [odds ratio (OR): 6.9, 95% confidence interval (CI): 2.06–29.20, P < 0.001], aggregative adherence fimbriae/I fimbriae (aggA) [OR: 2.2, 95% CI: 1.16–4.29, P = 0.008], and hexosyltransferase (capU) [OR: 1.9, 95% CI 1.02–3.51, P = 0.028] were associated with moderate-to-severe diarrhea among children < 12 months old but not in the older age strata (> 12 months). Our data suggest that some EAEC-virulent factors have age-specific associations with moderate-to-severe diarrhea in infants. Furthermore, our study showed that 85% and 72% of EAEC strains tested were resistant to sulphamethoxazole-trimethoprim and ampicillin, respectively. Sulphamethoxazole-trimethoprim and ampicillin are among the first-line antibiotics used for the treatment of diarrhea in The Gambia.
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Affiliation(s)
- Usman N Ikumapayi
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia.,Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Nadia Boisen
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - Mohammad J Hossain
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Modupeh Betts
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Modou Lamin
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Debasish Saha
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Brenda Kwambana-Adams
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Michel Dione
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Richard A Adegbola
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Anna Roca
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - James P Nataro
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia.,Centre for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland
| | - Martin Antonio
- Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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8
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Kwambana-Adams B, Darboe S, Nabwera H, Foster-Nyarko E, Ikumapayi UN, Secka O, Betts M, Bradbury R, Wegmüller R, Lawal B, Saha D, Hossain MJ, Prentice AM, Kampmann B, Anderson S, Dalessandro U, Antonio M. Salmonella Infections in The Gambia, 2005-2015. Clin Infect Dis 2016; 61 Suppl 4:S354-62. [PMID: 26449952 DOI: 10.1093/cid/civ781] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There are large data gaps in the epidemiology of diseases caused by Salmonella enterica in West Africa. Regional surveillance of Salmonella infections is necessary, especially with the emergence and spread of multidrug-resistant clones. METHODS Data on Salmonella isolated from various clinical specimens from patients from across The Gambia were collected and analyzed retrospectively from 2005 to April 2015. Antibiotic sensitivity testing of Salmonella isolates was performed by disk diffusion method. Serotyping and serogrouping of Salmonella isolates was performed using standard microbiology techniques. RESULTS Two hundred three Salmonella isolates were isolated from 190 patients: 52% (106/203) from blood and 39% (79/203) from stool specimens. Salmonella was also isolated from urine, aspirates, cerebrospinal fluid, wounds, and abscesses. The prevalence of Salmonella in blood cultures was 0.8% (106/13,905). Of the serotyped salmonellae, 14% (21/152) were Salmonella enterica serovar Typhi, whereas 86% (131/152) were serovars other than Typhi (nontyphoidal Salmonella). Of the 102 typed NTS isolates, 40% (41) were Salmonella enterica serovar Typhimurium, 10% (10) were Salmonella enterica serovar Enteritidis, and 3% (3) were Salmonella enterica serovar Arizonae. Overall, 70% (142/203) of the salmonellae were pansusceptible. Multidrug resistance was found in 4% (9/203) of the isolates, 3 of which were Salmonella Enteritidis. CONCLUSIONS Salmonellae are associated with a wide spectrum of invasive and noninvasive infections across all ages in The Gambia. There is evidence of multidrug resistance in salmonellae that warrants vigilant monitoring and surveillance.
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Affiliation(s)
| | | | - Helen Nabwera
- Medical Research Council Unit, Fajara International Nutrition Group, Medical Research Council Unit, Banjul, The Gambia
| | | | | | | | | | - Richard Bradbury
- School of Medical and Applied Sciences, Central Queensland University, North Rockhampton, Australia
| | - Rita Wegmüller
- Medical Research Council Unit, Fajara International Nutrition Group, Medical Research Council Unit, Banjul, The Gambia
| | | | | | | | - Andrew M Prentice
- Medical Research Council Unit, Fajara International Nutrition Group, Medical Research Council Unit, Banjul, The Gambia
| | | | | | - Umberto Dalessandro
- Medical Research Council Unit, Fajara Institute of Tropical Medicine, Antwerp, Belgium Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine
| | - Martin Antonio
- Medical Research Council Unit, Fajara Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Ashu EE, Jarju S, Dione M, Mackenzie G, Ikumapayi UN, Manjang A, Azuine R, Antonio M. Population structure, epidemiology and antibiotic resistance patterns of Streptococcus pneumoniae serotype 5: prior to PCV-13 vaccine introduction in Eastern Gambia. BMC Infect Dis 2016; 16:33. [PMID: 26822883 PMCID: PMC4731921 DOI: 10.1186/s12879-016-1370-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 01/22/2016] [Indexed: 11/25/2022] Open
Abstract
Background Streptococcus pneumoniae serotype 5 is among the most common serotypes causing invasive pneumococcal disease (IPD) in The Gambia. We anticipate that introduction of the 13-valent pneumococcal conjugate vaccine (PCV-13) into routine vaccination in The Gambia will reduce serotype 5 IPD. However, the emergence of new clones that have altered their genetic repertoire through capsular switching or genetic recombination after vaccination with PCV-13 poses a threat to this public health effort. In order to monitor for potential genetic changes post-PCV-13 vaccination, we established the baseline population structure, epidemiology, and antibiotic resistance patterns of serotype 5 before the introduction of PCV-13. Methods Fifty-five invasive S. pneumoniae serotype 5 isolates were recovered from January 2009 to August 2011 in a population-based study in the Upper River Region of The Gambia. Serotyping was done by latex agglutination and confirmed by serotype-specific Polymerase Chain Reaction (PCR). Genotyping was undertaken using Multilocus Sequence Typing (MLST). Antimicrobial sensitivity was done using disc diffusion. Contingency table analyses were conducted using Pearson’s Chi2 and Fisher’s exact test. Clustering was performed using Bionumerics version 6.5. Results MLST resolved S. pneumoniae serotype 5 isolates into 3 sequence types (ST), namely ST 289(6/55), ST 3339(19/55) and ST 3404(30/55). ST 289 was identified as the major clonal complex. ST 3339, the prevalent genotype in 2009 [84.6 % (11/13)], was replaced by ST 3404 [70.4 % (19/27)] in 2010 as the dominant ST. Interestingly, ST 3404 showed lower resistance to tetracycline and oxacillin (P < 0.001), an empirical surrogate to penicillin in The Gambia. Conclusions There has been an emergence of ST 3404 in The Gambia prior to the introduction of PCV-13. Our findings provide important background data for future assessment of the impact of PCV-13 into routine immunization in developing countries, such as The Gambia.
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Affiliation(s)
- Eta E Ashu
- Department of Biology, McMaster University, 1280 Main St. W, Hamilton, ON, L8S 4 K1, Canada. .,Medical Research Council Unit, P. O. Box 273, Fajara, The Gambia.
| | - Sheikh Jarju
- Medical Research Council Unit, P. O. Box 273, Fajara, The Gambia
| | - Michel Dione
- Medical Research Council Unit, P. O. Box 273, Fajara, The Gambia
| | - Grant Mackenzie
- Medical Research Council Unit, P. O. Box 273, Fajara, The Gambia
| | | | - Ahmed Manjang
- Medical Research Council Unit, P. O. Box 273, Fajara, The Gambia.,King Fahad Medical City, Central, 11525, Saudi Arabia
| | - Romuladus Azuine
- Center for Global Health and Health Policy, Global Health and Education Projects, P. O. BOX 234, Riverdale, MD, 20738, USA
| | - Martin Antonio
- Medical Research Council Unit, P. O. Box 273, Fajara, The Gambia
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Lindsay B, Oundo J, Hossain MA, Antonio M, Tamboura B, Walker AW, Paulson JN, Parkhill J, Omore R, Faruque ASG, Das SK, Ikumapayi UN, Adeyemi M, Sanogo D, Saha D, Sow S, Farag TH, Nasrin D, Li S, Panchalingam S, Levine MM, Kotloff K, Magder LS, Hungerford L, Sommerfelt H, Pop M, Nataro JP, Stine OC. Microbiota that affect risk for shigellosis in children in low-income countries. Emerg Infect Dis 2015; 21:242-50. [PMID: 25625766 PMCID: PMC4313639 DOI: 10.3201/eid2101.140795] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Pathogens in the gastrointestinal tract exist within a vast population of microbes. We examined associations between pathogens and composition of gut microbiota as they relate to Shigella spp./enteroinvasive Escherichia coli infection. We analyzed 3,035 stool specimens (1,735 nondiarrheal and 1,300 moderate-to-severe diarrheal) from the Global Enteric Multicenter Study for 9 enteropathogens. Diarrheal specimens had a higher number of enteropathogens (diarrheal mean 1.4, nondiarrheal mean 0.95; p<0.0001). Rotavirus showed a negative association with Shigella spp. in cases of diarrhea (odds ratio 0.31, 95% CI 0.17-0.55) and had a large combined effect on moderate-to-severe diarrhea (odds ratio 29, 95% CI 3.8-220). In 4 Lactobacillus taxa identified by 16S rRNA gene sequencing, the association between pathogen and disease was decreased, which is consistent with the possibility that Lactobacillus spp. are protective against Shigella spp.-induced diarrhea. Bacterial diversity of gut microbiota was associated with diarrhea status, not high levels of the Shigella spp. ipaH gene.
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Pop M, Walker AW, Paulson J, Lindsay B, Antonio M, Hossain MA, Oundo J, Tamboura B, Mai V, Astrovskaya I, Corrada Bravo H, Rance R, Stares M, Levine MM, Panchalingam S, Kotloff K, Ikumapayi UN, Ebruke C, Adeyemi M, Ahmed D, Ahmed F, Alam MT, Amin R, Siddiqui S, Ochieng JB, Ouma E, Juma J, Mailu E, Omore R, Morris JG, Breiman RF, Saha D, Parkhill J, Nataro JP, Stine OC. Diarrhea in young children from low-income countries leads to large-scale alterations in intestinal microbiota composition. Genome Biol 2014; 15:R76. [PMID: 24995464 PMCID: PMC4072981 DOI: 10.1186/gb-2014-15-6-r76] [Citation(s) in RCA: 162] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 06/27/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Diarrheal diseases continue to contribute significantly to morbidity and mortality in infants and young children in developing countries. There is an urgent need to better understand the contributions of novel, potentially uncultured, diarrheal pathogens to severe diarrheal disease, as well as distortions in normal gut microbiota composition that might facilitate severe disease. RESULTS We use high throughput 16S rRNA gene sequencing to compare fecal microbiota composition in children under five years of age who have been diagnosed with moderate to severe diarrhea (MSD) with the microbiota from diarrhea-free controls. Our study includes 992 children from four low-income countries in West and East Africa, and Southeast Asia. Known pathogens, as well as bacteria currently not considered as important diarrhea-causing pathogens, are positively associated with MSD, and these include Escherichia/Shigella, and Granulicatella species, and Streptococcus mitis/pneumoniae groups. In both cases and controls, there tend to be distinct negative correlations between facultative anaerobic lineages and obligate anaerobic lineages. Overall genus-level microbiota composition exhibit a shift in controls from low to high levels of Prevotella and in MSD cases from high to low levels of Escherichia/Shigella in younger versus older children; however, there was significant variation among many genera by both site and age. CONCLUSIONS Our findings expand the current understanding of microbiota-associated diarrhea pathogenicity in young children from developing countries. Our findings are necessarily based on correlative analyses and must be further validated through epidemiological and molecular techniques.
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Hossain MJ, Roca A, Mackenzie GA, Jasseh M, Hossain MI, Muhammad S, Ahmed M, Chidiebere OD, Malick N, Bilquees SM, Ikumapayi UN, Jeng B, Njie B, Cham M, Kampmann B, Corrah T, Howie S, D'Alessandro U. Serogroup W135 meningococcal disease, The Gambia, 2012. Emerg Infect Dis 2014; 19:1507-10. [PMID: 23965435 PMCID: PMC3810914 DOI: 10.3201/eid1909.130077] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In 2012, an outbreak of Neisseria meningitidis serogroup W135 occurred in The Gambia. The attack rate was highest among young children. The associated risk factors were male sex, contact with meningitis patients, and difficult breathing. Enhanced surveillance facilitates early epidemic detection, and multiserogroup conjugate vaccine could reduce meningococcal epidemics in The Gambia.
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Lim ES, Reyes A, Antonio M, Saha D, Ikumapayi UN, Adeyemi M, Stine OC, Skelton R, Brennan DC, Mkakosya RS, Manary MJ, Gordon JI, Wang D. Corrigendum to “Discovery of STL polyomavirus, a polyomavirus of ancestral recombinant origin that encodes a unique T antigen by alternative splicing” [Virology 436 (2) (2013) 295–303]. Virology 2013. [DOI: 10.1016/j.virol.2013.01.016] [Citation(s) in RCA: 3] [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: 11/15/2022]
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Lim ES, Reyes A, Antonio M, Saha D, Ikumapayi UN, Adeyemi M, Stine OC, Skelton R, Brennan DC, Mkakosya RS, Manary MJ, Gordon JI, Wang D. Discovery of STL polyomavirus, a polyomavirus of ancestral recombinant origin that encodes a unique T antigen by alternative splicing. Virology 2013; 436:295-303. [PMID: 23276405 PMCID: PMC3693558 DOI: 10.1016/j.virol.2012.12.005] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [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: 08/15/2012] [Revised: 10/08/2012] [Accepted: 12/05/2012] [Indexed: 12/12/2022]
Abstract
The family Polyomaviridae is comprised of circular double-stranded DNA viruses, several of which are associated with diseases, including cancer, in immunocompromised patients. Here we describe a novel polyomavirus recovered from the fecal microbiota of a child in Malawi, provisionally named STL polyomavirus (STLPyV). We detected STLPyV in clinical stool specimens from USA and The Gambia at up to 1% frequency. Complete genome comparisons of two STLPyV strains demonstrated 5.2% nucleotide divergence. Alternative splicing of the STLPyV early region yielded a unique form of T antigen, which we named 229T, in addition to the expected large and small T antigens. STLPyV has a mosaic genome and shares an ancestral recombinant origin with MWPyV. The discovery of STLPyV highlights a novel alternative splicing strategy and advances our understanding of the complex evolutionary history of polyomaviruses.
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MESH Headings
- Adolescent
- Adult
- Alternative Splicing
- Antigens, Viral, Tumor/genetics
- Child
- Child, Preschool
- Cluster Analysis
- DNA, Viral/chemistry
- DNA, Viral/genetics
- Evolution, Molecular
- Feces/virology
- Female
- Gambia
- Gene Expression Regulation, Viral
- Genome, Viral
- Humans
- Infant
- Malawi
- Male
- Molecular Sequence Data
- Phylogeny
- Polyomavirus/classification
- Polyomavirus/genetics
- Polyomavirus/isolation & purification
- Polyomavirus Infections/epidemiology
- Polyomavirus Infections/virology
- Prevalence
- Recombination, Genetic
- Sequence Analysis, DNA
- Sequence Homology, Nucleic Acid
- United States
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Affiliation(s)
- Efrem S. Lim
- Departments of Molecular Microbiology and Pathology & Immunology, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, Missouri, USA
| | - Alejandro Reyes
- Center for Genome Sciences and Systems Biology, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, Missouri, USA
| | - Martin Antonio
- Medical Research Council Unit, PO Box 273, Banjul, The Gambia
| | - Debasish Saha
- Medical Research Council Unit, PO Box 273, Banjul, The Gambia
| | | | | | - O. Colin Stine
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 660 W Redwood St., Baltimore, Maryland, USA
| | - Rebecca Skelton
- Department of Internal Medicine, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, Missouri, USA
| | - Daniel C. Brennan
- Department of Internal Medicine, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, Missouri, USA
| | - Rajhab S. Mkakosya
- Department of Pathology, University of Malawi College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Mark J. Manary
- Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, Missouri, USA
- Department of Community Health, University of Malawi College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Jeffrey I. Gordon
- Center for Genome Sciences and Systems Biology, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, Missouri, USA
| | - David Wang
- Departments of Molecular Microbiology and Pathology & Immunology, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, Missouri, USA
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Mackenzie GA, Plumb ID, Sambou S, Saha D, Uchendu U, Akinsola B, Ikumapayi UN, Baldeh I, Usuf E, Touray K, Jasseh M, Howie SRC, Wattiaux A, Lee E, Knoll MD, Levine OS, Greenwood BM, Adegbola RA, Hill PC. Monitoring the introduction of pneumococcal conjugate vaccines into West Africa: design and implementation of a population-based surveillance system. PLoS Med 2012; 9:e1001161. [PMID: 22272192 PMCID: PMC3260317 DOI: 10.1371/journal.pmed.1001161] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Routine use of pneumococcal conjugate vaccines (PCVs) in developing countries is expected to lead to a significant reduction in childhood deaths. However, PCVs have been associated with replacement disease with non-vaccine serotypes. We established a population-based surveillance system to document the direct and indirect impact of PCVs on the incidence of invasive pneumococcal disease (IPD) and radiological pneumonia in those aged 2 months and older in The Gambia, and to monitor changes in serotype-specific IPD. Here we describe how this surveillance system was set up and is being operated as a partnership between the Medical Research Council Unit and the Gambian Government. This surveillance system is expected to provide crucial information for immunisation policy and serves as a potential model for those introducing routine PCV vaccination in diverse settings.
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16
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Dione MM, Ikumapayi UN, Saha D, Mohammed NI, Geerts S, Ieven M, Adegbola RA, Antonio M. Clonal differences between Non-Typhoidal Salmonella (NTS) recovered from children and animals living in close contact in the Gambia. PLoS Negl Trop Dis 2011; 5:e1148. [PMID: 21655353 PMCID: PMC3104961 DOI: 10.1371/journal.pntd.0001148] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [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: 10/07/2010] [Accepted: 03/15/2011] [Indexed: 11/23/2022] Open
Abstract
Background Non-Typhoidal Salmonella (NTS) is an important cause of invasive bacterial disease and associated with mortality in Africa. However, little is known about the environmental reservoirs and predominant modes of transmission. Our study aimed to study the role of domestic animals in the transmission of NTS to humans in rural area of The Gambia. Methodology Human NTS isolates were obtained through an active population-based case-control surveillance study designated to determine the aetiology and epidemiology of enteric infections covering 27,567 Gambian children less than five years of age in the surveillance area. Fourteen children infected with NTS were traced back to their family compounds and anal swabs collected from 210 domestic animals present in their households. Identified NTSs were serotyped and genotyped by multi-locus sequencing typing. Principal Findings NTS was identified from 21/210 animal sources in the households of the 14 infected children. Chickens carried NTS more frequently than sheep and goats; 66.6%, 28.6% and 4.8% respectively. The most common NTS serovars were S. Colindale in humans (21.42%) and S. Poona in animals (14.28%). MLST on the 35 NTS revealed four new alleles and 24 sequence types (ST) of which 18 (75%) STs were novel. There was no overlap in serovars or genotypes of NTS recovered from humans or animal sources in the same household. Conclusion Our results do not support the hypothesis that humans and animals in close contact in the same household carry genotypically similar Salmonella serovars. These findings form an important baseline for future studies of transmission of NTS in humans and animals in Africa. Salmonellosis is a neglected tropical disease causing serious dysentery and septicaemia particularly in young infants, elderly and immunocompromised individuals such as HIV patients and associated with substantial mortality in developing countries. Salmonellosis also constitutes a major public health problem as it is considered the most widespread bacterial zoonosis of food origin throughout the world. Many epidemiological data exist from developed countries concerning transmission of Non-Typhoidal Salmonella (NTS) but few are available from developing countries. In addition few studies in sub-Saharan Africa have considered the interface between humans and their environment in relation to animals present in the household and food hygiene. This study describes the prevalence of NTS among fourteen Gambian children and 210 domestic animals living in close proximity (household) to the children in a rural setting in The Gambia. We found that the domestic animals living in the same household as patients carried different NTS serovar and genotypes; indicating that zoonotic transmission does not occur in our setting. This study provides baseline data for future studies of transmission of NTS in rural Africa.
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Affiliation(s)
- Michel M. Dione
- International Trypanotolerance Centre, Banjul, The Gambia
- Institute of Tropical Medicine, Antwerp, Belgium
- University of Antwerp, Antwerp, Belgium
| | | | - Debasish Saha
- Medical Research Council (UK) Laboratories, Banjul, The Gambia
| | | | | | | | | | - Martin Antonio
- Medical Research Council (UK) Laboratories, Banjul, The Gambia
- * E-mail:
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17
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Morris GAJ, Ikumapayi UN, Antonio M, Howie SRC, Adegbola RA. A novel Campylobacter jejuni sequence type from a culture-negative patient in the Gambia. PLoS One 2008; 3:e1773. [PMID: 18335047 PMCID: PMC2258414 DOI: 10.1371/journal.pone.0001773] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 12/14/2007] [Accepted: 02/09/2008] [Indexed: 11/19/2022] Open
Abstract
The introduction of molecular diagnostic methods is crucial for improved understanding of the aetiology and epidemiology of bacterial infections in communities in resource poor settings. A blood sample from a 7 month old patient diagnosed with malaria in 2001 in a Gambian outpatient clinic was reported as culture negative after it was subjected to traditional bacterial culture protocols. We re-addressed the analysis of the blood sample from this case more recently (after 6.5 years in archival storage) in pilot work establishing 16S rRNA PCR in our molecular laboratory. Initial 16S rRNA PCR results confirmed the presence of bacterial DNA in the sample. 16S rRNA sequence analysis identified the organism as Campylobacter spp. In light of the molecular evidence we successfully grew the organism using appropriate culture conditions and subsequently biochemically confirmed that the isolate was Campylobacter jejuni. PCR and DNA sequencing of a set of seven C. jejuni housekeeping genes and in silico Multilocus Sequence Typing (MLST) analysis revealed that the isolate exhibits a novel sequence type (ST) of C. jejuni (ST 2928) and belongs to ST-443 clonal complex. This study demonstrates the potential for molecular tools to enhance the diagnosis of bacterial infections, which remain a major killer globally, not least in children in the developing world. Improvements in diagnostics are needed, and will be important not only for sick individuals but also for populations, where better measures of disease burden will contribute significantly to the improvement of public health policy.
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Affiliation(s)
- Gerard A J Morris
- Bacterial Diseases Programme, Medical Research Council Laboratories, Fajara, The Gambia.
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Burton MJ, Adegbola RA, Kinteh F, Ikumapayi UN, Foster A, Mabey DCW, Bailey RL. Bacterial infection and trachoma in the gambia: a case control study. Invest Ophthalmol Vis Sci 2007; 48:4440-4. [PMID: 17898263 DOI: 10.1167/iovs.07-0315] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Trachoma is the leading infectious cause of blindness worldwide. Conjunctival scarring is initiated by recurrent Chlamydia trachomatis infection. However, disease progression to trichiasis occurs even in regions where chlamydial prevalence is currently low, which suggests that other factors, for example other bacterial infection, may also drive inflammation and scarring, particularly in the late stages of trachoma. This study was undertaken to investigate whether trachomatous trichiasis or conjunctival scarring are associated with increased prevalence of bacterial infection. METHODS Within a case-control study design, individuals with trichiasis or conjunctival scarring (without trichiasis) were compared with normal matched control subjects. Subjects were examined for signs of trachoma. Conjunctival swab samples were collected for bacteriologic culture and C. trachomatis PCR. RESULTS Recruited for the study were 121 trichiasis case-control pairs and 117 conjunctival scarring case-control pairs. Eyes with trichiasis were more frequently infected with bacteria (37%) than were normal control eyes (7%) (OR: 8.2; P < 0.001; 95% CI: 3.24-20.8). Bacterial infection was more common with increased trichiasis severity. In the conjunctival scarring case-control group, scarred eyes had slightly more bacterial infection (11%) than did normal control eyes (6%), although this was not significantly different (OR: 2.2; P = 0.144; 95% CI: 0.79-6.33). CONCLUSIONS Trichiasis is associated with increased risk of bacterial infection, and there may be a similar trend in eyes with conjunctival scarring. Bacterial infection of the conjunctiva is associated with inflammation, which may result in progressive scarring. Prospective studies are needed to determine the contribution of bacterial infection to disease progression. Bacterial infection probably also contributes to the development of corneal opacification.
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Affiliation(s)
- Matthew J Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Ikumapayi UN, Antonio M, Sonne-Hansen J, Biney E, Enwere G, Okoko B, Oluwalana C, Vaughan A, Zaman SMA, Greenwood BM, Cutts FT, Adegbola RA. Molecular epidemiology of community-acquired invasive non-typhoidal Salmonella among children aged 2–29 months in rural Gambia and discovery of a new serovar, Salmonella enterica Dingiri. J Med Microbiol 2007; 56:1479-1484. [PMID: 17965348 DOI: 10.1099/jmm.0.47416-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Sixty-two invasive non-typhoidal Salmonella (NTS) isolates from children aged 2–29 months in rural Gambia were examined for serovar prevalence and antimicrobial susceptibility, and characterized using multilocus sequence typing (MLST) of seven genes, aroC, dnaN, hemD, hisD, purE, sucA and thrA. Salmonella enterica serovar Enteritidis was the most common serovar (80.6 %), followed by S. enterica serovar Typhimurium (8.0 %). Thirty-three per cent of the isolates were resistant to all eight antimicrobials tested, including ampicillin (74.2 %), cotrimoxazole (64.5 %) and tetracycline (63 %). A total of 40.3 % of the NTS cases had an initial clinical diagnosis of malaria, whilst 27.3 % had a diagnosis of clinical pneumonia and 18 % had a diagnosis of septicaemia. MLST of NTS resulted in ten different sequence types (STs), of which five were novel, representing five different NTS serovars. In general, STs were restricted to the same serovar. One type (ST11) encompassed 80.6 % of the NTSs. A new NTS serovar named S. enterica serovar Dingiri was discovered. S. Dingiri was isolated from a 6-month-old male with an initial clinical diagnosis of malaria but a final clinical diagnosis of anaemia and septicaemia. S. Dingiri, which possesses an antigenic formula of 17:z:1,6, was sensitive to ampicillin, cefotaxime, chloramphenicol, ciprofloxacin, cotrimoxazole and tetracycline but resistant to gentamicin, and was ST338.
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Affiliation(s)
| | - Martin Antonio
- Medical Research Council Laboratories, Banjul, The Gambia, West Africa
| | | | - Ekow Biney
- Medical Research Council Laboratories, Banjul, The Gambia, West Africa
| | - Godwin Enwere
- Medical Research Council Laboratories, Banjul, The Gambia, West Africa
| | - Brown Okoko
- Medical Research Council Laboratories, Banjul, The Gambia, West Africa
| | - Claire Oluwalana
- Medical Research Council Laboratories, Banjul, The Gambia, West Africa
| | - Adeola Vaughan
- Medical Research Council Laboratories, Banjul, The Gambia, West Africa
| | - Syed M. A. Zaman
- Medical Research Council Laboratories, Banjul, The Gambia, West Africa
| | - Brian M. Greenwood
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Felicity T. Cutts
- Medical Research Council Laboratories, Banjul, The Gambia, West Africa
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Adegbola RA, Hill PC, Secka O, Ikumapayi UN, Lahai G, Greenwood BM, Corrah T. Serotype and antimicrobial susceptibility patterns of isolates of Streptococcus pneumoniae causing invasive disease in The Gambia 1996-2003. Trop Med Int Health 2006; 11:1128-35. [PMID: 16827713 DOI: 10.1111/j.1365-3156.2006.01652.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To describe the characteristics of pneumococcal isolates obtained from patients with invasive pneumococcal disease in The Gambia. METHODS Pneumococcal isolates were obtained from children aged < or =6 years with invasive pneumococcal disease during a Haemophilus influenzae vaccine effectiveness study (1997-2002) and from patients with invasive pneumococcal disease admitted to the MRC hospital, Fajara, for routine care (1996-2003). Isolates were identified, serotyped and tested for antibiotic susceptibility. RESULTS Five hundred and thirty one pneumococcal isolates were obtained from 518 patients; 55 (10.6%) patients died; 415 isolates (79%) were from blood culture, 84 (16%) from CSF, and 42 (8%) from lung aspirates. Forty serogroups and serotypes were identified; six accounted for 64% and 16 for 86% of all episodes; 33.7% were of serotypes 1 and 5. 23.5% were of a 7-valent vaccine serotype, 57.1% were of a 9-valent vaccine serotype; 56% were of a 7-valent serogroup and 78% were of a 9-valent serogroup. There was a significant increase in the proportion of isolates of non-vaccine serogroup with increasing age (P < 0.0001). Antibiotic resistance had not significantly increased over time; but intermediate non-susceptibility to penicillin had risen and resistance to chloramphenicol had fallen in isolates of vaccine serotype compared with those of non-vaccine serotype. CONCLUSIONS The majority of invasive pneumococcal disease in The Gambia is caused by pneumococci of relatively few serogroups. A conjugate vaccine would be expected to reduce the pneumococcal disease burden substantially and to have a beneficial effect on pneumococcal antibiotic resistance to penicillins.
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Affiliation(s)
- Richard A Adegbola
- Bacterial Diseases Programme, Medical Research Council Laboratories, PO Box 273, Banjul, The Gambia.
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Burton MJ, Bowman RJC, Faal H, Aryee EAN, Ikumapayi UN, Alexander NDE, Adegbola RA, Mabey DCW, Foster A, Johnson GJ, Bailey RL. The long-term natural history of trachomatous trichiasis in the Gambia. Invest Ophthalmol Vis Sci 2006; 47:847-52. [PMID: 16505016 DOI: 10.1167/iovs.05-0714] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Trachoma is the leading infectious cause of blindness. However, there are few data on the natural history of trachomatous trichiasis to guide program planning or that investigate its pathogenesis. METHODS A cohort of Gambians with trichiasis in one or both eyes who had declined surgery was observed. Clinical examinations were performed at baseline and 4 years later. Conjunctival swab samples were collected for Chlamydia trachomatis PCR and bacteriology. RESULTS One hundred fifty-four people were examined at baseline and 4 years later (241 nonsurgical eyes). At baseline 124 (52%) eyes had major trichiasis (5+ lashes), 75 (31%) minor trichiasis (1-4 lashes), and 42 (17%) no trichiasis. By 4 years, trichiasis had developed in 12 (29%) of 42 previously unaffected eyes. Minor trichiasis progressed to major in 28 (37%) of 75 eyes. New corneal opacification more commonly developed in eyes that had major (10%) compared to minor (5%) trichiasis at baseline. Bacterial infection was common (23%), becoming more frequent with increasing trichiasis. C. trachomatis infection was rare (1%). Conjunctival inflammation was common (29%) and was associated with progressive trichiasis and corneal opacification. CONCLUSIONS Trichiasis progressed in the long-term in this environment, despite a low prevalence of C. trachomatis. Blinding corneal opacification develops infrequently, unless major trichiasis is present. Epilation and early surgery need to be formally compared for the management of minor trichiasis. The pathologic correlates and promoters of conjunctival inflammation need to be investigated.
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Affiliation(s)
- Matthew J Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Burton MJ, Kinteh F, Jallow O, Sillah A, Bah M, Faye M, Aryee EAN, Ikumapayi UN, Alexander NDE, Adegbola RA, Faal H, Mabey DCW, Foster A, Johnson GJ, Bailey RL. A randomised controlled trial of azithromycin following surgery for trachomatous trichiasis in the Gambia. Br J Ophthalmol 2005; 89:1282-8. [PMID: 16170117 PMCID: PMC1772881 DOI: 10.1136/bjo.2004.062489] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIM Trachomatous trichiasis frequently returns following surgery. Several factors may promote recurrence: preoperative disease severity, surgeon ability, surgical procedure, healing responses, and infection. This study investigates whether enhanced control of infection, both of Chlamydia trachomatis and other bacteria, with azithromycin can improve surgical outcome in a trachoma control programme. METHODS Individuals with trachomatous trichiasis were examined and operated. After surgery patients were randomised to the azithromycin or control group. The azithromycin group and children in their household were given a dose of azithromycin. Antibiotic treatment was repeated at 6 months. All patients were reassessed at 6 months and 12 months. Samples were collected for C trachomatis polymerase chain reaction and general microbiology at each examination. RESULTS 451 patients were enrolled. 426 (94%) were reassessed at 1 year, of whom 176 (41.3%) had one or more lashes touching the eye and 84 (19.7%) had five or more lashes. There was no difference in trichiasis recurrence between the azithromycin and control group. Recurrent trichiasis was significantly associated with more severe preoperative trichiasis, bacterial infection, and severe conjunctival inflammation at 12 months. Significant variability in outcome was found between surgeons. Visual acuity and symptoms significantly improved following surgery. CONCLUSION In this setting, with a low prevalence of active trachoma, azithromycin did not improve the outcome of trichiasis surgery conducted by a trachoma control programme. Audit of trichiasis surgery should be routine.
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Affiliation(s)
- M J Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Burton MJ, Bowman RJC, Faal H, Aryee EAN, Ikumapayi UN, Alexander NDE, Adegbola RA, West SK, Mabey DCW, Foster A, Johnson GJ, Bailey RL. Long term outcome of trichiasis surgery in the Gambia. Br J Ophthalmol 2005; 89:575-9. [PMID: 15834088 PMCID: PMC1772648 DOI: 10.1136/bjo.2004.055996] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Trichiasis surgery is believed to reduce the risk of losing vision from trachoma. There are limited data on the long term outcome of surgery and its effect on vision and corneal opacification. Similarly, the determinants of failure are not well understood. METHODS A cohort of people in the Gambia who had undergone surgery for trachomatous trichiasis 3-4 years earlier was re-assessed. They were examined clinically and the conjunctiva was sampled for Chlamydia trachomatis polymerase chain reaction (PCR) and general bacterial culture. RESULTS In total, 141/162 people were re-examined. Recurrent trichiasis was found in 89/214 (41.6%) operated eyes and 52 (24.3%) eyes had five or more lashes touching the globe. Corneal opacification improved in 36 of 78 previously affected eyes. There was a general deterioration in visual acuity between surgery and follow up, which was greater if new corneal opacification developed or trichiasis returned. Recurrent trichiasis was associated with severe conjunctival inflammation and bacterial infection. C trachomatis was detected in only one individual. CONCLUSIONS Recurrent trichiasis following surgery is a common potentially sight threatening problem. Some improvement in the cornea can occur following surgery and the rate of visual loss tended to be less in those without recurrent trichiasis. The role of conjunctival inflammation and bacterial infection needs to be investigated further. Follow up of patients is advised to identify individuals needing additional surgical treatment.
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Affiliation(s)
- M J Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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