The Role of Schistosoma Mansoni Eggs in Protection against Plasmodium Berghei Infected Mice

The co-occurrence of malaria and schistosomiasis is common in tropical regions of the world. Malaria remains a global burden with no vaccine discovered yet. These necessitated the need to look at the immune responses that could be triggered in a coinfection setting. Malaria induces a strong Th1 response while schistosomiasis skews the response to a Th2. This study examined the role of Schistosoma mansoni eggs on malaria disease progression in BALB/c mice infected with Plasmodium berghei. The objectives were to determine the immune correlates to protection. Two groups of mice were used: the experimental and control groups. Experimental were injected with a triple dose of S. mansoni eggs at ten day interval before being challenged with P. berghei while controls were infected with P. berghei only. Five mice from both groups at each time point were euthanized and spleen and serum collected. Mice were euthanized at day 3, 6, 9 and 12 post-challenge with P. berghei. Parasitaemia was monitored daily using Giemsa stained blood smears. Results showed that experimental mice exhibited lower levels of P. berghei parasitaemia (15.52%) as compared to the controls (23.06%). IgG levels were high in the experimental mice compared to controls following stimulation by soluble egg antigen (SEA). Differences in IgG levels between the two study groups were not significant (p>0.05). Levels of IFN- ? and IL-4 were high in the experimental mice than the control group though the difference was not significant (p=0.213). S. mansoni eggs did not induce significant differences in cytokine and IgG levels; nevertheless they contributed to delaying death in the experimental mice by two days by enhancing levels of IgG and IL-4. These findings provide grounds for further studies in non-human primates to better understand the immunomodulatory role of schistosome eggs on malaria progression. Keywords: Schistosoma mansoni, Plasmodium berghe, iSoluble egg Antige

Prevention of Hyperglycemia

Hyperglycemia is the elevation of blood glucose concentrations above the normal range. Prolonged uncontrolled hyperglycemia is associated with serious life-threatening complications. Hyperglycemia arises from an imbalance between glucose production and glucose uptake and utilization by peripheral tissues. Disorders that compromise pancreatic function or affect the glucose counter-regulatory hormones cause hyperglycemia. Acute or serious illness or injury may also bring about hyperglycemia, as can many classes of drugs. Metformin lowers blood glucose levels by inhibiting the production of glucose by the liver whilst enhancing uptake of circulating glucose and its utilization in peripheral tissues such as muscle and adipose tissue. Metformin suppresses hepatic gluconeogenesis by inhibiting mitochondrial respiration and causing a reduction of cellular ATP levels. Metformin may also modulate the gut-brain-liver axis, resulting in suppression of hepatic glucose production. Metformin also opposes the hyperglycemic action of glucagon and may ameliorate pancreatic cell dysfunction associated with hyperglycemia. Metformin is therefore recommended for use in the prevention of hyperglycemia, including drug-induced hyperglycemia, in at risk patients. The benefits of metformin in the prevention of hyperglycemia are unmatched despite its contraindications

Plasmodium knowlesi Ligand-receptor Process in Baboon (Papio anubis) Placenta

Pregnancy associated malaria poses many risks to both women and their infants. It is characterized by the accumulation of infected erythrocytes in the intervillous spaces of the placenta leading to adverse reactions. Studies using the P. knowlesi-Olive baboon model of pregnancy malaria have demonstrated this phenomenon though the mechanisms and molecules involved are not known. This study sought to identify the ligands and receptor molecules that permit accumulation of infected erythrocytes in the placenta of P. knowlesi infected Olive baboons and to further test placental isolates for adhesion to purified receptors. Sequences of known Plasmodium erythrocyte binding antigens and human placental receptors were BLASTed against the genome of P. knowlesi and P. anubis respectively. Hits generated were analysed and characterized to determine the prospective ligands and receptors in P. knowlesi and P. anubis respectively. Also, four adult female baboons (P. anubis) were infected with P. knowlesi parasites and their placentas sampled. Infected erythrocytes isolated from these placentas were tested for binding against purified receptors. We identified Predicted CSPG 4 partial and Predicted HAPLN 1 as the putative receptor molecules in the Olive baboon. Further, the P. knowlesi erythrocyte binding proteins (EBP-alpha, EBP-beta and EBP-gamma) matched closely to the placental P. falciparum ligand Var2csa. However, static binding assays with P. knowlesi infected erythrocytes did not show any binding to purified receptors. This study has identified and proposed receptors and ligands involved in the adherence process in P. knowlesi infected Olive baboons during pregnancy. Keywords: Plasmodium knowlesi, Olive baboon, receptor, ligand, malaria, pregnanc

Relation between falciparum malaria and bacteraemia in Kenyan children: a population-based, case-control study and a longitudinal study.

BACKGROUND: Many investigators have suggested that malaria infection predisposes individuals to bacteraemia. We tested this hypothesis with mendelian randomisation studies of children with the malaria-protective phenotype of sickle-cell trait (HbAS). METHODS: This study was done in a defined area around Kilifi District Hospital, Kilifi, Kenya. We did a matched case-control study to identify risk factors for invasive bacterial disease, in which cases were children aged 3 months to 13 years who were admitted to hospital with bacteraemia between Sept 16, 1999, and July 31, 2002. We aimed to match two controls, by age, sex, location, and time of recruitment, for every case. We then did a longitudinal case-control study to assess the relation between HbAS and invasive bacterial disease as malaria incidence decreased. Cases were children aged 0-13 years who were admitted to hospital with bacteraemia between Jan 1, 1999, and Dec 31, 2007. Controls were born in the study area between Jan 1, 2006, and June 23, 2009. Finally, we modelled the annual incidence of bacteraemia against the community prevalence of malaria during 9 years with Poisson regression. RESULTS: In the matched case-control study, we recruited 292 cases-we recruited two controls for 236, and one for the remaining 56. Sickle-cell disease, HIV, leucocyte haemozoin pigment, and undernutrition were positively associated with bacteraemia and HbAS was strongly negatively associated with bacteraemia (odds ratio 0·36; 95% CI 0·20-0·65). In the longitudinal case-control study, we assessed data from 1454 cases and 10,749 controls. During the study period, the incidence of admission to hospital with malaria per 1000 child-years decreased from 28·5 to 3·45, with a reduction in protection afforded by HbAS against bacteraemia occurring in parallel (p=0·0008). The incidence of hospital admissions for bacteraemia per 1000 child-years also decreased from 2·59 to 1·45. The bacteraemia incidence rate ratio associated with malaria parasitaemia was 6·69 (95% CI 1·31-34·3) and, at a community parasite prevalence of 29% in 1999, 62% (8·2-91) of bacteraemia cases were attributable to malaria. INTERPRETATION: Malaria infection strongly predisposes individuals to bacteraemia and can account for more than half of all cases of bacteraemia in malaria-endemic areas. Interventions to control malaria will have a major additional benefit by reducing the burden of invasive bacterial disease. FUNDING: Wellcome Trust

Sero-surveillance for IgG to SARS-CoV-2 at antenatal care clinics in three Kenyan referral hospitals: Repeated cross-sectional surveys 2020-21.

INTRODUCTION: The high proportion of SARS-CoV-2 infections that have remained undetected presents a challenge to tracking the progress of the pandemic and estimating the extent of population immunity. METHODS: We used residual blood samples from women attending antenatal care services at three hospitals in Kenya between August 2020 and October 2021and a validated IgG ELISA for SARS-Cov-2 spike protein and adjusted the results for assay sensitivity and specificity. We fitted a two-component mixture model as an alternative to the threshold analysis to estimate of the proportion of individuals with past SARS-CoV-2 infection. RESULTS: We estimated seroprevalence in 2,981 women; 706 in Nairobi, 567 in Busia and 1,708 in Kilifi. By October 2021, 13% of participants were vaccinated (at least one dose) in Nairobi, 2% in Busia. Adjusted seroprevalence rose in all sites; from 50% (95%CI 42-58) in August 2020, to 85% (95%CI 78-92) in October 2021 in Nairobi; from 31% (95%CI 25-37) in May 2021 to 71% (95%CI 64-77) in October 2021 in Busia; and from 1% (95% CI 0-3) in September 2020 to 63% (95% CI 56-69) in October 2021 in Kilifi. Mixture modelling, suggests adjusted cross-sectional prevalence estimates are underestimates; seroprevalence in October 2021 could be 74% in Busia and 72% in Kilifi. CONCLUSIONS: There has been substantial, unobserved transmission of SARS-CoV-2 in Nairobi, Busia and Kilifi Counties. Due to the length of time since the beginning of the pandemic, repeated cross-sectional surveys are now difficult to interpret without the use of models to account for antibody waning

Seroprevalence of Antibodies to Severe Acute Respiratory Syndrome Coronavirus 2 Among Healthcare Workers in Kenya.

BACKGROUND: Few studies have assessed the seroprevalence of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among healthcare workers (HCWs) in Africa. We report findings from a survey among HCWs in 3 counties in Kenya. METHODS: We recruited 684 HCWs from Kilifi (rural), Busia (rural), and Nairobi (urban) counties. The serosurvey was conducted between 30 July and 4 December 2020. We tested for immunoglobulin G antibodies to SARS-CoV-2 spike protein, using enzyme-linked immunosorbent assay. Assay sensitivity and specificity were 92.7 (95% CI, 87.9-96.1) and 99.0% (95% CI, 98.1-99.5), respectively. We adjusted prevalence estimates, using bayesian modeling to account for assay performance. RESULTS: The crude overall seroprevalence was 19.7% (135 of 684). After adjustment for assay performance, seroprevalence was 20.8% (95% credible interval, 17.5%-24.4%). Seroprevalence varied significantly (P < .001) by site: 43.8% (95% credible interval, 35.8%-52.2%) in Nairobi, 12.6% (8.8%-17.1%) in Busia and 11.5% (7.2%-17.6%) in Kilifi. In a multivariable model controlling for age, sex, and site, professional cadre was not associated with differences in seroprevalence. CONCLUSION: These initial data demonstrate a high seroprevalence of antibodies to SARS-CoV-2 among HCWs in Kenya. There was significant variation in seroprevalence by region, but not by cadre

Specific Receptor Usage in Plasmodium falciparum Cytoadherence Is Associated with Disease Outcome

Our understanding of the basis of severe disease in malaria is incomplete. It is clear that pathology is in part related to the pro-inflammatory nature of the host response but a number of other factors are also thought to be involved, including the interaction between infected erythrocytes and endothelium. This is a complex system involving several host receptors and a major parasite-derived variant antigen (PfEMP1) expressed on the surface of the infected erythrocyte membrane. Previous studies have suggested a role for ICAM-1 in the pathology of cerebral malaria, although these have been inconclusive. In this study we have examined the cytoadherence patterns of 101 patient isolates from varying clinical syndromes to CD36 and ICAM-1, and have used variant ICAM-1 proteins to further characterise this adhesive phenotype. Our results show that increased binding to CD36 is associated with uncomplicated malaria while ICAM-1 adhesion is raised in parasites from cerebral malaria cases