SEROPREVALENCE OF HIV, HBV, HCV, SYPHILIS AMONG DONORS OF BLOOD AT THE NATIONAL CENTER OF BLOOD TRANSFUSION ANTANANARIVO IN 2014

Introduction: Currently, routine screening for HIV, hepatitis B and C and syphilis is done in most blood banks in the world. Methods: We conducted a prospective descriptive study at the National Blood Transfusion Center (CNTS) Antananarivo for a period of 7 months from January to July 2014, which aims to assess the socio-clinical factors accompanying ineligibility of blood products and to determine the seroprevalence of HIV, hepatitis B, C and syphilis of the blood donors who have spent at CNTS HU JRA Antananarivo during this period. All donors who have abnormal results of microbiological examinations were included. The parameters used and studied were age, sex, marital status, blood and results microbiological examinations for HIV, hepatitis B, C, and syphilis. The prevalence of blood donors who presented a serological abnormality is 3.95% with a predominance of donors with hepatitis B (72.93%) followed by syphilis (18.29%) of the hepatitis C (6.95%) and HIV (1.80%) and a predominance of young people. Conclusion: At the CNTS Antananarivo, the HBV is the main definitive reason for exclusion of these donors. This high prevalence is a real public health problem for the country\u27s health authorities. The search for maximum safety in blood transfusion through firstly a better selection of blood donors by implementing a policy of strong loyalty and other early diagnosis of major diseases transmissible by blood and likely to infect the recipient. KEYWORDS: Antananarivo; Blood donor; Microbiology; Seroprevalence

SEROPREVALENCE OF HIV, HBV, HCV, SYPHILIS AMONG DONORS OF BLOOD AT THE NATIONAL CENTER OF BLOOD TRANSFUSION ANTANANARIVO IN 2014

Introduction: Currently, routine screening for HIV, hepatitis B and C and syphilis is done in most blood banks in the world. Methods: We conducted a prospective descriptive study at the National Blood Transfusion Center (CNTS) Antananarivo for a period of 7 months from January to July 2014, which aims to assess the socio-clinical factors accompanying ineligibility of blood products and to determine the seroprevalence of HIV, hepatitis B, C and syphilis of the blood donors who have spent at CNTS HU JRA Antananarivo during this period. All donors who have abnormal results of microbiological examinations were included. The parameters used and studied were age, sex, marital status, blood and results microbiological examinations for HIV, hepatitis B, C, and syphilis. The prevalence of blood donors who presented a serological abnormality is 3.95% with a predominance of donors with hepatitis B (72.93%) followed by syphilis (18.29%) of the hepatitis C (6.95%) and HIV (1.80%) and a predominance of young people. Conclusion: At the CNTS Antananarivo, the HBV is the main definitive reason for exclusion of these donors. This high prevalence is a real public health problem for the country's health authorities. The search for maximum safety in blood transfusion through firstly a better selection of blood donors by implementing a policy of strong loyalty and other early diagnosis of major diseases transmissible by blood and likely to infect the recipient. KEYWORDS: Antananarivo; Blood donor; Microbiology; Seroprevalence

Séroprévalence de la cysticercose et facteurs de risque associés chez un groupe de patients vus au Centre Hospitalier Régional de Référence d’Antsirabe, Madagascar

Introduction: A Madagascar, la cysticercose, maladie causée par la forme larvaire de Taenia solium, demeure un problème de santé publique. En 2003, la séroprévalence de la cysticercose variait entre 7% et 21% avec un taux plus élevé dans les régions centrales de l’île. Toutefois, depuis une dizaine d’année, les données épidémiologiques concernant la cysticercose humaine restent limitées. Notre étude a pour objectif de déterminer, chez les patients issus de la région de Vakinankaratra et qui sont suspects cliniquement, la séroprévalence de la cysticercose par Western blot ainsi que les facteurs de risque associés. Méthodes: Il s’agit d’une étude descriptive transversale menée sur une période de 6 mois au sein du Centre Hospitalier Régional de Référence d’Antsirabe. Tous les patients inclus dans l’étude ont répondu à un questionnaire clinique recueillant leurs caractéristiques sociodémographiques et culturelles ainsi que leurs habitudes alimentaires et leurs symptômes cliniques. Résultats: La séroprévalence de la cysticercose retrouvée dans la population d’étude était de 14,8% (35/237). Ce taux ne diffère pas significativement selon le sexe, l’âge, la consommation de viande de porc ou le mode de préparation de la viande (p > 0,05). Par contre, une différence significative (p < 0,05) a été observée chez les sujets présentant des nodules sous-cutanés ou un résultat de cysticercose antérieur positif. Conclusion: L’index élevé d’exposition à Taenia solium retrouvé dans notre étude justifie le renforcement des mesures de contrôle et de prévention déjà implantés dans le pays

Epidemiological characteristics of cryptococcal meningoencephalitis associated with Cryptococcus neoformans var. grubii from HIV-infected patients in Madagascar : a cross-sectional study

Cryptococcal meningoencephalitis (CM) remains the most prevalent invasive fungal infection worldwide. The main objective of this study was to describe the prevalence of CM and cryptococcal infection in HIV-infected patients in Madagascar. The secondary objectives were to assess the adjusted prevalence of CM according to clinical presentation and patient characteristics, to determine crude 90-day survival according to cryptococcal antigen (CrAg) status and CM, and to identify the genotypes of Cryptococcus clinical isolates. This cross-sectional study was carried out at two urban hospitals in Antananarivo (central highlands) and Toamasina (east coast) between November 2014 and December 2016. Consecutive HIV-infected adults presenting with CD4 cell counts 64200/\u3bcl were enrolled. Lateral flow immunoassays of CrAg were performed on serum for all patients, and on cerebrospinal fluid for patients with CM symptoms. MALDI-ToF MS, ITS sequencing, and determinations of the molecular and mating types of the isolates were performed. Fluconazole is the only drug for CM treatment available in Madagascar. Patients were treated orally, with high doses (1200 mg/day) for 10-12 weeks and then with 200 mg/day. Minimum inhibitory concentrations were determined for amphotericin B, flucytosine, voriconazole and fluconazole in E-tests. Overall prevalence was 13.2% (95% CI 7.9-20.3) for cryptococcal infection and 10.9% (95% CI 6.1-17.5) for CM, among the 129 HIV-infected patients studied. The 90-day mortality rate was 58.8% (10/17) in CrAg-positive patients and 17.9% (20/112) in CrAg-negative patients (p<0.001). The 13 Cryptococcus strains obtained at baseline were all Cryptococcus neoformans var. grubii, genotypes VNI-\u3b1A (3 isolates), VNII-\u3b1A (4 isolates) or hybrid VNI/VNII-\u3b1AA\u3b1 (6 isolates), suggesting high diversity. Two strains acquired fluconazole resistance after four and five months of exposure, respectively. The prevalence of cryptococcosis is high in Madagascar and this serious condition is life-threatening in HIV-infected patients. These findings will be used to raise the awareness of national authorities to strengthen the national HIV/AIDS control program

Genetic Relationship between Cocirculating Human Enteroviruses Species C

Recombination events between human enteroviruses (HEV) are known to occur frequently and to participate in the evolution of these viruses. In a previous study, we reported the isolation of a panel of viruses belonging to the Human enterovirus species C (HEV-C) that had been cocirculating in a small geographic area of Madagascar in 2002. This panel included type 2 vaccine-derived polioviruses (PV) that had caused several cases of acute flaccid paralysis in humans. Previous partial sequencing of the genome of these HEV-C isolates revealed considerable genetic diversity, mostly due to recombination. In the work presented herein, we carried out a more detailed characterization of the genomes of viruses from this collection. First, we determined the full VP1 sequence of 41 of these isolates of different types. These sequences were compared with those of HEV-C isolates obtained from other countries or in other contexts. The sequences of the Madagascan isolates of a given type formed specific clusters clearly differentiated from those formed by other strains of the same type isolated elsewhere. Second, we sequenced the entire genome of 10 viruses representing most of the lineages present in this panel. All but one of the genomes appeared to be mosaic assemblies of different genomic fragments generated by intra- and intertypic recombination. The location of the breakpoints suggested potential preferred genomic regions for recombination. Our results also suggest that recombination between type HEV-99 and other HEV-C may be quite rare. This first exhaustive genomic analysis of a panel of non-PV HEV-C cocirculating in a small human population highlights the high frequency of inter and intra-typic genetic recombination, constituting a widespread mechanism of genetic plasticity and continually shifting the HEV-C biodiversity

Recombination between Polioviruses and Co-Circulating Coxsackie A Viruses: Role in the Emergence of Pathogenic Vaccine-Derived Polioviruses

Ten outbreaks of poliomyelitis caused by pathogenic circulating vaccine-derived polioviruses (cVDPVs) have recently been reported in different regions of the world. Two of these outbreaks occurred in Madagascar. Most cVDPVs were recombinants of mutated poliovaccine strains and other unidentified enteroviruses of species C. We previously reported that a type 2 cVDPV isolated during an outbreak in Madagascar was co-circulating with coxsackieviruses A17 (CA17) and that sequences in the 3′ half of the cVDPV and CA17 genomes were related. The goal of this study was to investigate whether these CA17 isolates can act as recombination partners of poliovirus and subsequently to evaluate the major effects of recombination events on the phenotype of the recombinants. We first cloned the infectious cDNA of a Madagascar CA17 isolate. We then generated recombinant constructs combining the genetic material of this CA17 isolate with that of the type 2 vaccine strain and that of the type 2 cVDPV. Our results showed that poliovirus/CA17 recombinants are viable. The recombinant in which the 3′ half of the vaccine strain genome had been replaced by that of the CA17 genome yielded larger plaques and was less temperature sensitive than its parental strains. The virus in which the 3′ portion of the cVDPV genome was replaced by the 3′ half of the CA17 genome was almost as neurovirulent as the cVDPV in transgenic mice expressing the poliovirus cellular receptor gene. The co-circulation in children and genetic recombination of viruses, differing in their pathogenicity for humans and in certain other biological properties such as receptor usage, can lead to the generation of pathogenic recombinants, thus constituting an interesting model of viral evolution and emergence

The diagnosis of fungal neglected tropical diseases (fungal NTDs) and the role of investigation and laboratory tests: An expert consensus report

The diagnosis of fungal Neglected Tropical Diseases (NTD) is primarily based on initial visual recognition of a suspected case followed by confirmatory laboratory testing, which is often limited to specialized facilities. Although molecular and serodiagnostic tools have advanced, a substantial gap remains between the desirable and the practical in endemic settings. To explore this issue further, we conducted a survey of subject matter experts on the optimal diagnostic methods sufficient to initiate treatment in well-equipped versus basic healthcare settings, as well as optimal sampling methods, for three fungal NTDs: mycetoma, chromoblastomycosis, and sporotrichosis. A survey of 23 centres found consensus on the key role of semi-invasive sampling methods such as biopsy diagnosis as compared with swabs or impression smears, and on the importance of histopathology, direct microscopy, and culture for mycetoma and chromoblastomycosis confirmation in well-equipped laboratories. In basic healthcare settings, direct microscopy combined with clinical signs were reported to be the most useful diagnostic indicators to prompt referral for treatment. The survey identified that the diagnosis of sporotrichosis is the most problematic with poor sensitivity across the most widely available laboratory tests except fungal culture, highlighting the need to improve mycological diagnostic capacity and to develop innovative diagnostic solutions. Fungal microscopy and culture are now recognized as WHO essential diagnostic tests and better training in their application will help improve the situation. For mycetoma and sporotrichosis, in particular, advances in identifying specific marker antigens or genomic sequences may pave the way for new laboratory-based or point-of-care tests, although this is a formidable task given the large number of different organisms that can cause fungal NTDs. © 2019 by the authors

A cluster randomized controlled trial for assessing POC-CCA test based praziquantel treatment for schistosomiasis control in pregnant women and their young children: study protocol of the freeBILy clinical trial in Madagascar.

BACKGROUND: Mass drug administration (MDA) of praziquantel is one of the main control measures against human schistosomiasis. Although there are claims for including pregnant women, infants and children under the age of 5 years in high-endemic regions in MDA campaigns, they are usually not treated without a diagnosis. Diagnostic tools identifying infections at the primary health care centre (PHCC) level could therefore help to integrate these vulnerable groups into control programmes. freeBILy (fast and reliable easy-to-use-diagnostics for eliminating bilharzia in young children and mothers) is an international consortium focused on implementing and evaluating new schistosomiasis diagnostic strategies. In Madagascar, the study aims to determine the effectiveness of a test-based schistosomiasis treatment (TBST) strategy for pregnant women and their infants and children up until the age of 2 years. METHODS: A two-armed, cluster-randomized, controlled phase III trial including 5200 women and their offspring assesses the impact of TBST on child growth and maternal haemoglobin in areas of medium to high endemicity of Schistosoma mansoni. The participants are being tested with the point of care-circulating cathodic antigen (POC-CCA) test, a commercially available urine-based non-invasive rapid diagnostic test for schistosomiasis. In the intervention arm, a POC-CCA-TBST strategy is offered to women during pregnancy and 9 months after delivery, for their infants at 9 months of age. In the control arm, study visit procedures are the same, but without the POC-CCA-TBST procedure. All participants are being offered the POC-CCA-TBST 24 months after delivery. This trial is being integrated into the routine maternal and child primary health care programmes at 40 different PHCC in Madagascar's highlands. The purpose of the trial is to assess the effectiveness of the POC-CCA-TBST for controlling schistosomiasis in young children and mothers. DISCUSSION: This trial assesses a strategy to integrate pregnant women and their children under the age of 2 years into schistosomiasis control programmes using rapid diagnostic tests. It includes local capacity building for clinical trials and large-scale intervention research. TRIAL REGISTRATION: Pan-African Clinical Trial Register PACTR201905784271304. Retrospectively registered on 15 May 2019