Genotypic status of the TbAT1/P2 adenosine transporter of Trypanosoma brucei gambiense isolates from northwestern Uganda following melarsoprol withdrawal

Human African trypanosomiasis (HAT) manifests as a chronic infection caused by <i>Trypanosoma brucei gambiense</i>, or as a more acute form due to <i>T. b. rhodesiense</i>. Both manifestations occur in Uganda and melarsoprol use against the former was jeopardised in the 1990s as reports of reduced efficacy increased to the point where it was dismissed as first-line treatment at some treatment centers. Previous work to elucidate possible mechanisms leading to melarsoprol resistance pointed to a P2 type adenosine transporter known to mediate melarsoprol uptake and previously shown to be mutated in significant numbers of patients not responding to the drug. Our present findings indicate that there is a low prevalence of mutants in foci where melarsoprol relapses are infrequent. In addition we observe that at the Omugo focus where the drug was withdrawn as first line over 6 years ago, the mutant alleles have disappeared, suggesting that drug pressure is responsible for fuelling their spread. Thus constant monitoring for mutants could play a key role in cost-effective HAT management by identifying which foci can still use the less logistically demanding melarsoprol as opposed to the alternative drug eflornithine. What is required now is a simple method for identifying such mutants at the point of care, enabling practitioners to make informed prescriptions at first diagnosis

Abundance and Conservation of Cyperus papyrus in the Nakivubo wetland, Uganda

Due to high population growth, there is increasing pressure on wetlands to the extent that wetland natural vegetation is continuously being replaced with food crops to meet the increasing food demands. The natural vegetation of Nakivubo wetland is dominated by Cyperus papyrus. Cyperus papyrus has recently been intensively harvested, there by creating a gap between its conservation and utilization. This study was conducted to compare the abundance of papyrus in the disturbed and non disturbed sites and document the strategies used to conserve Cyperus papyrus in Nakivubo wetland. .The abundance of papyrus was assessed in 1m x 1m plots established along 2 transects in the disturbed and undisturbed parts of the wetland. The strategies used by the wetland users to conserve papyrus were determined by administering a questionnaire regarding wetland utilization to thirty respondents. The results showed that generally individuals of papyrus per hectare were higher in the undisturbed sites than disturbed sites. The non disturbed sites had more culms than the disturbed site though there were more juveniles in the disturbed site than in the non disturbed sites. All the respondents did not domesticate papyrus. Majority of the respondents did not allow the papyrus to regenerate after harvesting. They were not aware of the recommended harvesting intervals for papyrus. It is recommended that responsible authorities sensitize the public about appropriate use of the wetland and inform them about the suitable harvesting intervals for papyrus

Evaluation of Antigens for Development of a Serological Test for Human African Trypanosomiasis

BACKGROUND: Control and elimination of human African trypanosomiasis (HAT) can be accelerated through the use of diagnostic tests that are more accurate and easier to deploy. The goal of this work was to evaluate the immuno-reactivity of antigens and identify candidates to be considered for development of a simple serological test for the detection of Trypanosoma brucei gambiense or T. b. rhodesiense infections, ideally both. METHODOLOGY/PRINCIPAL FINDINGS: The reactivity of 35 antigens was independently evaluated by slot blot and ELISA against sera from both T. b. gambiense and T. b. rhodesiense infected patients and controls. The antigens that were most reactive by both tests to T. b. gambiense sera were the membrane proteins VSG LiTat 1.3, VSG LiTat 1.5 and ISG64. Reactivity to T. b. rhodesiense sera was highest with VSG LiTat 1.3, VSG LiTat 1.5 and SRA, although much lower than with T. b. gambiense samples. The reactivity of all possible combinations of antigens was also calculated. When the slot blot results of 2 antigens were paired, a VSG LiTat 1.3- ISG75 combination performed best on T. b. gambiense sera, while a VSG LiTat 1.3-VSG LiTat 1.5 combination was the most reactive using ELISA. A combination of SRA and either VSG LiTat 1.3 or VSG LiTat 1.5 had the highest reactivity on T. b. rhodesiense sera according to slot blot, while in ELISA, pairing SRA with either GM6 or VSG LiTat 1.3 yielded the best results. CONCLUSIONS: This study identified antigens that were highly reactive to T. b. gambiense sera, which could be considered for developing a serological test for gambiense HAT, either individually or in combination. Antigens with potential for inclusion in a test for T. b. rhodesiense HAT were also identified, but because their reactivity was comparatively lower, a search for additional antigens would be required before developing a test for this form of the disease.Support was provided by Bill & Melinda Gates Foundation (http://www.gatesfoundation.org/), grant 39524 (JMN); National Institutes of Health (https://www.nih.gov/), grant 2R37AI034432 (MAP); National Institute of Allergy and Infectious Diseases (https://www.niaid.nih.gov/), grants AI035739 and AI056866 (JB); Wellcome Trust (https://wellcome.ac.uk/), grant 101842 (MF); The Sandler Foundation to University of California (JMK); Agence nationale de la recherche (http://www.agence-nationale-recherche.fr/), grant ANR-11-LABX-0024 (DRR); Wellcome Trust Centre for Molecular Parasitology (http://www.gla.ac.uk/researchinstitutes/iii/wtcmp/), grant 104111/Z/14/Z (MPB, RMC and JCM). The funders provided support in the form of salaries for authors JMN, SB, AA, GM, MR, MAP, JB, MF, JMK, DRR, MPB, RMC and JCM, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. HW is an employee of MicroCoat Biotechnologie GmbH. This company was contracted by FIND to evaluate the reactivity of the antigens by slot blot and ELISA against sera. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Helminths are positively associated with atopy and wheeze in Ugandan fishing communities: results from a cross-sectional survey.

BACKGROUND: Parasitic helminths are potent immunomodulators and chronic infections may protect against allergy-related disease and atopy. We conducted a cross-sectional survey to test the hypothesis that in heavily helminth-exposed fishing villages on Lake Victoria, Uganda, helminth infections would be inversely associated with allergy-related conditions. METHODS: A household survey was conducted as baseline to an anthelminthic intervention trial. Outcomes were reported wheeze in last year, atopy assessed both by skin prick test (SPT) and by the measurement of allergen-specific IgE to dust mites and cockroach in plasma. Helminth infections were ascertained by stool, urine and haemoparasitology. Associations were examined using multivariable regression. RESULTS: Two thousand three hundred and sixteen individuals were surveyed. Prevalence of reported wheeze was 2% in under-fives and 5% in participants ≥5 years; 19% had a positive SPT; median Dermatophagoides-specific IgE and cockroach-specific IgE were 1440 and 220 ng/ml, respectively. S. mansoni, N. americanus, S. stercoralis, T. trichiura, M. perstans and A. lumbricoides prevalence was estimated as 51%, 22%, 12%, 10%, 2% and 1%, respectively. S. mansoni was positively associated with Dermatophagoides-specific IgE [adjusted geometric mean ratio (aGMR) (95% confidence interval) 1.64 (1.23, 2.18)]; T. trichiura with SPT [adjusted odds ratio (aOR) 2.08 (1.38, 3.15)]; M. perstans with cockroach-specific IgE [aGMR 2.37 (1.39, 4.06)], A. lumbricoides with wheeze in participants ≥5 years [aOR 6.36 (1.10, 36.63)] and with Dermatophagoides-specific IgE [aGMR 2.34 (1.11, 4.95)]. No inverse associations were observed. CONCLUSIONS: Contrary to our hypothesis, we found little evidence of an inverse relationship between helminths and allergy-related outcomes, but strong evidence that individuals with certain helminths were more prone to atopy in this setting

Aquaporin 2 mutations in Trypanosoma brucei gambiense field isolates correlate with decreased susceptibility to pentamidine and melarsoprol

The predominant mechanism of drug resistance in African trypanosomes is decreased drug uptake due to loss-of-function mutations in the genes for the transporters that mediate drug import. The role of transporters as determinants of drug susceptibility is well documented from laboratory-selected Trypanosoma brucei mutants. But clinical isolates, especially of T. b. gambiense, are less amenable to experimental investigation since they do not readily grow in culture without prior adaptation. Here we analyze a selected panel of 16 T. brucei ssp. field isolates that (i) have been adapted to axenic in vitro cultivation and (ii) mostly stem from treatment-refractory cases. For each isolate, we quantify the sensitivity to melarsoprol, pentamidine, and diminazene, and sequence the genomic loci of the transporter genes TbAT1 and TbAQP2. The former encodes the well-characterized aminopurine permease P2 which transports several trypanocides including melarsoprol, pentamidine, and diminazene. We find that diminazene-resistant field isolates of T. b. brucei and T. b. rhodesiense carry the same set of point mutations in TbAT1 that was previously described from lab mutants. Aquaglyceroporin 2 has only recently been identified as a second transporter involved in melarsoprol/pentamidine cross-resistance. Here we describe two different kinds of TbAQP2 mutations found in T. b. gambiense field isolates: simple loss of TbAQP2, or loss of wild-type TbAQP2 allele combined with the formation of a novel type of TbAQP2/3 chimera. The identified mutant T. b. gambiense are 40- to 50-fold less sensitive to pentamidine and 3- to 5-times less sensitive to melarsoprol than the reference isolates. We thus demonstrate for the first time that rearrangements of the TbAQP2/TbAQP3 locus accompanied by TbAQP2 gene loss also occur in the field, and that the T. b. gambiense carrying such mutations correlate with a significantly reduced susceptibility to pentamidine and melarsoprol

Capacity for science in sub-Saharan Africa.

Host-parasite interactio

Implementation of genomics research in Africa: challenges and recommendations

Background: There is exponential growth in the interest and implementation of genomics research in Africa. This growth has been facilitated by the Human Hereditary and Health in Africa (H3Africa) initiative, which aims to promote a contemporary research approach to the study of genomics and environmental determinants of common diseases in African populations. Objective: The purpose of this article is to describe important challenges affecting genomics research implementation in Africa. Methods: The observations, challenges and recommendations presented in this article were obtained through discussions by African scientists at teleconferences and face-to-face meetings, seminars at consortium conferences and in-depth individual discussions. Results: Challenges affecting genomics research implementation in Africa, which are related to limited resources include ill-equipped facilities, poor accessibility to research centers, lack of expertise and an enabling environment for research activities in local hospitals. Challenges related to the research study include delayed funding, extensive procedures and interventions requiring multiple visits, delays setting up research teams and insufficient staff training, language barriers and an underappreciation of cultural norms. While many African countries are struggling to initiate genomics projects, others have set up genomics research facilities that meet international standards. Conclusions: The lessons learned in implementing successful genomics projects in Africa are recommended as strategies to overcome these challenges. These recommendations may guide the development and application of new research programs in low-resource settings

High prevalence of Schistosoma mansoni infection and stunting among school age children in communities along the Albert-Nile, Northern Uganda: A cross sectional study

BackgroundKnowing the prevalence of schistosomiasis is key to informing programmes to control and eliminate the disease as a public health problem. It is also important to understand the impact of infection on child growth and development in order to allocate appropriate resources and effort to the control of the disease.MethodsWe conducted a survey to estimate the prevalence of schistosomiasis among school aged children in villages along the Albert-Nile shore line in the district of Pakwach, North Western Uganda. A total of 914 children aged between 10-15 years were screened for Schistosoma mansoni using the POC-CCA and Kato Katz (KK) techniques. The infection intensities were assessed by POC-CCA and KK as well as CAA tests. The KK intensities were also correlated with POC-CCA and with CAA intensity. Anthropometric measurements were also taken and multivariate analysis was carried out to investigate their association with infection status.ResultsThe prevalence of schistosomiasis using the POC-CCA diagnostic test was estimated at 85% (95% CI: 83-87), being highest amongst children living closer to the Albert-Nile shoreline. Visual scoring of the POC-CCA results was more sensitive than the Kato Katz test and was positively correlated with the quantified infection intensities by the CAA test. The majority of the children were underweight (BMI< 18.5), and most notably, boys had significantly lower height for age (stunting) than girls in the same age range (p < 0.0001), but this was not directly associated with S. mansoni infection.ConclusionHigh prevalence of S. mansoni infection in the region calls for more frequent mass drug administration with praziquantel. We observed high levels of stunting which was not associated with schistosomiasis. There is a need for improved nutrition among the children in the area.Author summarySchistosomiasis is a neglected but frequent disease that is caused by schistosomes, with over 290 million people worldwide at risk of infection. The major mode of transmission is through contact with fresh water sources infested with infected snails (the intermediate host). In this study, using the point of care test (POC-CCA), we screened 914 school aged children (10-15 years) living in the rural communities along the Lake Albert- River Nile shores of Pakwach district in Northern Uganda. We observed a very high prevalence of S. mansoni infections (over 80%) although the prevalence dropped to 40% in communities that were further from the lake shores. This high prevalence was also coupled with Kato Katz light schistosome infection intensities as categorised by WHO guidelines. We further compared the POC-CCA and Kato Katz tests to the more sensitive CAA assay and this revealed that even though both tests gave good probability of positive prediction, the POC-CCA had higher sensitivity in screening for S. mansoni infections than Kato Katz assay. The study also revealed high levels of stunting within the children, more so amongst boys. Frequent screening and mass treatment of these communities with praziquantel will reduce on the infection rates. But in addition, improved hygiene and sanitation will be required for a sustainable reduction in the prevalence and morbidity of schistosomiasis in the Albert-Nile communities along with dietary intervention for optimal child health