65 research outputs found
MDR tuberculosis and non-compliance with therapy
The emergence of multidrug-resistant (MDR) tuberculosis is a worldwide public health problem. We reported a case of pulmonary MDR tuberculosis in a 41-year-old man with diabetes from the West Bank, Palestine. 1
The bacteria belonged to the Beijing family, which is highly virulent and easily disseminated. 2
The patient withdrew from treatment after 2 years while still sputum-positive. Despite persistent efforts of the tuberculosis directly observed treatment programme, he disappeared and cannot be located. The patient might have fled to a neighbouring country, and there is a risk that he will pass on MDR tuberculosis to people with whom he has contact
Prevalence of selected intestinal protozoan infections in marginalized rural communities in Palestine
Background: Intestinal parasitic infections are common in rural areas with poor infrastructure and low
socioeconomic status. The aim of this study was to estimate the prevalence of selected parasitic infections in
marginalized rural areas in the northern part of the Palestinian West Bank Region, using conventional and PCRbased
methods, and also to assess risk predictors of infection.
Methods: A cross-sectional study was conducted on 104 individuals from three rural villages in the Jordan Valley.
Stool samples were collected and examined by a battery of tests that included microscopy of wet fecal samples in
normal saline with iodine, concentration by ethyl acetate sedimentation and also by zinc sulfate floatation, a
conventional PCR and a real-time PCR (qPCR). Risk factors were assessed that included demographic,
socioeconomic, and behavioral characteristics. Data on method performance was analyzed by kappa-statistic,
Cochraneâs Q, and McNemar post hoc test. Mid-P exact test and odds ratio were used to discern association
between outcome and risk predictors.
Results: The overall prevalence of intestinal parasitic infections was 48% (49/102). The predominant parasites were
Giardia lamblia at 37% (37/102) and Hymenolepis nana at 9% (9/102). To concentrate cysts and eggs, sedimentation
can be used as an alternative to floatation with a loss of 1% of positive cases. The methods employing PCRs proved
crucial as it increased the detected infection rate of G. lamblia approximately three-fold from 13% by the
conventional methods to 37% by the qPCR. Multiple infections were present in 13% (13/102) of the study group,
which included double (10%) and triple (3%) infections. Regarding the genus Entamoeba, E. dispar and E. coli were
detected at rates of 2 and 8%, respectively. While none of the individuals were infected with the pathogenic E.
histolytica, E. nana (4%) was detected for the first time in the area. Age was a risk predictor for infection (OR = 2.61,
CI 95% 1.05â6.45, P = 0.038).
Conclusions: The increased prevalence of intestinal parasitic infections in children in marginalized rural areas in
Palestine is worrying. The addition of PCR-based methods is important for the diagnosis of such infections as, with
cautious interpretation, it increases proficiency and overcomes underestimation and misdiagnosis of cases. Control
measures including education on personal hygiene and environmental sanitation, should be introduced to reduce
the prevalence of the intestinal parasites and, thus, the infections they cause in this and other areas.Acknowledgments
We thank L. F. Schnur for reviewing the manuscript.
Authorsâ contributions
AA, conception of the research, study design, data analysis and drafting of
the manuscript. SE and AN, molecular biological testing and analysis. KD and
HA collection of samples and conventional examination. ZA, data analysis
and interpretation. All the authors have read and approved the final
manuscript.
Funding
This research is a self-funded work by the researchers
Prevalence of Trypanosoma evansi in livestock in Palestine
Background: Trypanosoma evansi is the causative agent of surra, a disease that occurs in many animal species. The
disease is responsible for substantial losses in global production and can be fatal if not diagnosed early. This study
aims to determine the prevalence of T. evansi in livestock, equids and dromedary camels in Palestine.
Methods: Blood samples were collected during 2015â2017 from domesticated animals (n = 259 animals; 77%
females and 23% males) including camels (n = 87), horses (n = 46), donkeys (n = 28), mules (n = 2), sheep (n = 49)
and goats (n = 48) from eight districts: Ariha (Jericho), Nablus, Bethlehem, Deir Al Balah, Jenin, Rafah, Tubas, and Khan
Yunis. Parasite prevalence was determined using PCR and blood smear microscopy. PCR-positive samples were further
phylogenetically analyzed using DNA sequences of the 18S ribosomal RNA gene.
Results: The overall infection prevalence was 18% (46/259). The positivity rates according to PCR and microscopy
examination were 17% (45/259) and 2.7% (7/259), respectively. The infection rates were as follows: camels, 26/61
(30%); horses, 8/46 (17%); donkeys, 3/28 (11%); mules, 1/2 (50%); sheep, 2/42 (4%); and goats, 6/42 (13%). Phylogenetic
analyses of the 18S rRNA gene showed that 24 positive T. evansi samples from Palestine formed a monophyletic
cluster with seven T. evansi sequences from Africa, Asia and South America, and three T. brucei sequences from Africa
retrieved from GenBank. The spatial analysis showed three statistically significant foci of T. evansi infection in Jenin,
Tubas (P = 0.02) and Ariha (Jericho) (P = 0.04). No statistically significant foci were detected in the Gaza Strip.
Conclusions: To the best of our knowledge, this is the first confirmation of high levels of infection with T. evansi as
a causative agent of surra in Palestine. Our study emphasizes the need for a stringent surveillance system and risk
assessment studies as prerequisites for control measures. Further investigations focusing on vectors and evaluation of
risk factors are needed.Acknowledgments
Not applicable.
Authorsâ contributions
AN, SE, AA-J and ZA conceived and designed the experiments. AN, SE, HA-J,
NA-L and AA-J performed the experiments. SE, AN and AA-J analyzed the data.
AN, AA-J and SE wrote the first draft of the manuscript. AN, SE, NA-L, HA, AA-J
and ZA competed the final revision of the manuscript to be published. All
authors read and approved the final manuscript.
Funding
This research received no financial support
Amphotericin B-loaded nanoparticles for local treatment of cutaneous leishmaniasis
Cutaneous leishmaniasis (CL) is an infectious, parasitic disease caused by the protozoan Leishmania. Amphotericin B (AMB) is
a macrolide polyene antibiotic presenting potent antifungal and antileishmanial activity, but due to poor water solubility at
physiological pH, side effects, and toxicity, its therapeutic efficiency is limited. In the present study, poly(lactic-co-glycolic acid)
(PLGA) nanoparticles (NPs) loaded with AMB were generated to reduce drug toxicity and facilitate localized delivery over a
prolonged time. AMB NPs were characterized for particle size, zeta potential, polydispersity index, and degree of aggregation.
In vitro assessments demonstrated its sustained activity against Leishmania major promastigotes and parasite-infected macrophages.
A single intralesional administration to infected BALB/c mice revealed that AMB NPs were more effective than AMB
deoxycholate in terms of reducing lesion area. Taken together, these findings suggest thatAMB NPs improve AMB delivery and
can be used for local treatment of CL.This research was funded by the GIP program of the
Deutsche Forschungsgemeinschaft (DFG) German Research Foundation.
EZ wish to acknowledge the financial support of the RBNI-The Russell
Berrie Nanotechnology Institute at the Technion. CLJ holds the Michael
and Penny Feiwel Chair of Dermatology
Genetic characterization of Mycobacterium tuberculosis in the West Bank, Palestinian Territories
BACKGROUND: The World Health Organization (WHO) declared human tuberculosis (TB) a global health emergency and launched the âGlobal Plan to Stop Tuberculosisâ which aims to save a million lives by 2015. Global control of TB is increasingly dependent on rapid and accurate genetic typing of species of the Mycobacterium tuberculosis (MTB) complex including M. tuberculosis. The aim of this study was to identify and genetically characterize the MTB isolates circulating in the West Bank, Palestinian Territories. Genotyping of the MTB isolates from patients with pulmonary TB was carried out using two molecular genetic techniques, spoligotyping and mycobacterial interspersed repetitive units-variable number of tandem repeat (MIRU-VNTR) supported by analysis of the MTB specific deletion 1 (TbD1). FINDINGS: A total of 17 MTB patterns were obtained from the 31 clinical isolates analyzed by spoligotyping; corresponding to 2 orphans and 15 shared-types (SITs). Fourteen SITs matched a preexisting shared-type in the SITVIT2 database, whereas a single shared-type SIT3348 was newly created. The most common spoligotyping profile was SIT53 (T1 variant), identified in 35.5â% of the TB cases studied. Genetic characterization of 22 clinical isolates via the 15 loci MIRU-VNTR typing distinguished 19 patterns. The 15-loci MIT144 and MIT145 were newly created within this study. Both methods determined the present of M. bovis strains among the isolates. CONCLUSIONS: Significant diversity among the MTB isolates circulating in the West Bank was identified with SIT53-T1 genotype being the most frequent strain. Our results are used as reference database of the strains circulating in our region and may facilitate the implementation of an efficient TB control program
First-Time Detection of Mycobacterium bovis in Livestock Tissues and Milk in the West Bank, Palestinian Territories
Background: Bovine tuberculosis, bTB, is classified by the WHO as one of the seven neglected zoonontic diseases that cause
animal health problems and has high potential to infect humans. In the West Bank, bTB was not studied among animals and
the prevalence of human tuberculosis caused by M. bovis is unknown. Therefore, the aim of this study was to estimate the
prevalence of bTB among cattle and goats and identify the molecular characteristics of bTB in our area.
Methodology/principal findings: A total of 208 tissue samples, representing 104 animals, and 150 raw milk samples,
obtained from cows and goats were examined for the presence of mycobacteria. The tissue samples were collected during
routine meat inspection from the Jericho abattoir. DNA was extracted from all samples, milk and tissue biopsies (n = 358),
and screened for presence of TB DNA by amplifying a 123-bp segment of the insertion sequence IS6110. Eight out of 254
animals (3.1%) were found to be TB positive based on the IS6110-PCR. Identification of M. bovis among the positive TB
samples was carried out via real time PCR followed by high resolution melt curve analysis, targeting the A/G transition along
the oxyR gene. Spoligotyping analysis revealed a new genotype of M. bovis that was revealed from one tissue sample.
Significance: Detection of M. bovis in tissue and milk of livestock suggests that apparently healthy cattle and goats are a
potential source of infection of bTB and may pose a risk to public health. Hence, appropriate measures including meat
inspection at abattoirs in the region are required together with promotion of a health campaign emphasizing the
importance of drinking pasteurized milk. In addition, further studies are essential at the farm level to determine the exact
prevalence of bTB in goats and cattle herds in the West Bank and Israel.Financial support was provided by the Dutch government; project M27-072NVHU 2009 02 âVector-Borne Pathogens in Israel and the Palestinian Authority.â The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
Case Report: Autochthonous Case of Human Visceral Leishmaniasis in the West Bank, Palestine
Human visceral leishmaniasis (HVL) is a parasitic disease infecting children in the Mediterranean region.
Here,weportray a case of a 2-year-old child with an epidemiological description of the situation surrounding the case. The
patient was suffering from recurrent fever, weakness and abdominal discomfort associated with loss of appetite. Routine
blood investigations showed pancytopenia, whereas examination revealed hepatomegaly. A diagnosis of HVL was made
by demonstrating amastigotes in a Giemsa-stained smear from a bone marrow aspirate followed by genotyping by PCR
and sequencing. In conclusion, early detection of VL infection followed by appropriate treatment protocols is essential to
saving the patient
Simultaneous detection of Mycobacterium bovis and M. tuberculosis in an apparentlyimmunocompetent patient
Mycobacterium tuberculosis remains the main cause
of human tuberculosis (TB), with an unknown proportion
of cases caused by M. bovis. Here we describe
a case of pulmonary TB caused by mixed infection as
studied from sequential sputum sampling and isolation
of M. tuberculosis and M. bovis using a reverse
dot blot (RDB) assay
New Clinicoepidemiologic Profile of Cutaneous Leishmaniasis, Morocco
During the past 20 years, cutaneous leishmaniasis has emerged as a major public health threat in Morocco. We describe distribution of Leishmania major and L. tropica in Morocco and a new focus of cutaneous leishmaniasis due to L. infantum. We recommend using molecular techniques to diagnose suspected leishmaniasis cases
Epidemiological and clinical features of cutaneous leishmaniases in Jenin District,Palestine, including characterisation of the causative agents in clinical samples
During 2002â2009, 466 cases of cutaneous leishmaniasis (CL) were reported from Jenin
District, Palestine, affecting both genders. The average annual incidence was 23 cases per
100 000 inhabitants, increasing with age in children. Most cases presented a single lesion,
generally on the face. Diagnosis and species identification was done by applying internal
transcribed spacer 1 (ITS1) RFLP analysis to 47 isolates, of which 44 (93.6%) were Leishmania
tropica and 3 (6.4%) were L. major. RFLP analysis was also performed on 256 skin tissue scrapings
spotted onto filter papers, showing that 138 (53.9%) were positive, of which 50.7% were
infected with L. tropica, 17.4% with L. major and 2.9% with L. donovani s.l., and 29.0% could
not be identified. This is the first report from Palestine on human CL caused by L. infantum.
Nine of the strains of L. tropica were subjected to multilocus enzyme electrophoresis, six
of which belonged to the zymodeme MON-137 and three to a new zymodeme (MON-307).
This separation was corroborated by excreted factor serotyping. This observation modifies
the classical epidemiological view of CL in Palestine. Jenin District is an active focus of CL
caused by L. tropica, where Phlebotomus sergenti, the putative vector, is abundant. These
data suggest that CL is a zoonotic infection, but an animal reservoir has not been found.This research was supported by the
Deutsche Forschungsgemeinschaft (DFG) as part of a
GermanâIsraeliâPalestinian co-operation project on the
Emergence of Cutaneous Leishmaniasis in the Middle East:
an investigation of Leishmania tropica in the Palestinian
Authority and Israel
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