Effectiveness of Artemether Lumefantrine and Dihydroartemisinin Piperaquine in Clearance of Gametocytes in Uncomplicated Plasmodium falciparum Malaria in Tiwi Kenya

Background: Over 80 countries worldwide have now implemented WHO recommendations to use Artemisinin-Based Combination Therapy as a first-line treatment for Plasmodium falciparum malaria. The sexual stage of P. falciparum is responsible for the transmission of malarial parasites to infectious mosquitoes. Studies on gametocytes are generally based on microscopic detection, which is not sensitive, and there is a need for more sensitive molecular techniques that can detect and quantify gametocytes at densities as low as 0.02 to 0.1 gametocytes per micro-litre. The objective of this study was to determine the clearance rates of gametocytes after AL and DHA&P in uncomplicated P. falciparum and to compare the effectiveness of microscopy and reverse transcriptase-polymerase chain reaction in gametocyte detection.Methods: In a randomised controlled clinical trial of samples collected, gametocyte densities were quantified by microscopy by counting against 500 leukocytes in the thick smear converted to numbers of parasites per micro-litre by assuming a standard count of 800 leukocytes per micro-litre of blood after staining with 10% Giemsa stain and by reverse transcriptase-polymerase chain reaction using primers specific to the pfs25 gene.Results: There was no significant difference between the drug’s gametocyte clearance (p<.082). The drugs cleared gametocytes in infected patients by day 28 as detected by microscopy. There was a significant difference in the detection of gametocytes by RT-PCR and microscopy (p<.001).Conclusion: This study showed that Artemether-Lumefantrine and Dihydroartemisinin piperaquine have gametocytocidal effects on P. falciparum and the study on the clearance of gametocytes using both artemether-lumefantrine and Dihydroartemisinin piperaquine may be carried out using a larger sample size for policy implementation. The reverse transcriptase-polymerase chain reaction is more effective than microscopy in detecting low levels of gametocytes and the pfs25 gene can be used in the detection of gametocytes in the field to monitor the clearance of gametocytes

Characterisation of productivity and diseases affecting dairy goats in smallholder systems of Greater Thika Region, Kenya

The current cross-sectional study aimed at characterising the productivity and diseases affecting dairy goats kept by smallholder farmers in three sub-counties in Thika Region, Kenya. Standard questionnaires were administered to 240 farmers through face-to-face interviews and the outputs were analysed using descriptive and inferential statistics. The farmers mainly kept crosses of Toggenburg (45.9 %), Kenyan Alpine (29.5 %) and Saanen (17.4 %) dairy goats. The average dairy goat flock size was 4.5 (range 1–23) and 77.5 % of the goats were kept for production of milk for domestic consumption. The average milk production per goat per day was 1.26 litres (range 0.5 to 3.5 litres) and was significantly (p 0.05) associated with sub-county of origin, main occupation of the owner, breed, and lactation stages. Goats were mainly fed on napier grass, maize stovers, natural grass and hay; and these feeds did not influence (p 0.05) the milk production levels. The farmers identified helminthosis (84.6 %), pneumonia (32.9 %), coccidiosis (25.8 %) and mastitis (25 %), as the most prevalent goat diseases. In conclusion, the study showed that dairy goat farming in greater Thika Region was characterised by low-input with an objective of provision of milk for home consumption. The observed challenges of low milk productivity and diseases should be addressed by the local extension workers through training on improved husbandry, nutrition and health management of the dairy goats

Mapping of DBLα Sequence Tags of Field Isolates from Two Malaria Endemic Sites in Kenya

Plasmodium falciparum Erythrocyte Membrane Protein 1 (PfEMP1) found on the surface of infected erythrocytes (IEs) mediate antigenic variation during P. falciparum infection enabling the parasite evade host immune responses and prolong infection. These molecules mediate binding of IEs to host endothelial cells and uninfected erythrocytes. Cytoadhesion of IE to host cells leads to sequestration in tissues and PfEMP1 is thought to play an important role in parasite virulence. Here we analysed 1725 sequence tags sampled from the DBLa region of PfEMP1 encoding “var” genes from 27 patients in two different geographical regions in Kenya, Mbita in Western Kenya and Twiga on the Kenyan coast. The objective of this study was to construct a network to assess the extent of shared position specific polymorphic blocks (PSPBs) in sequences isolated from genomic DNA of field isolates from the two malaria endemic sites in Kenya.. Sequences from Mbita study site and those from Tiwi largely clustered into separate giant networks with only a limited number of sequences from the two sites linking to each other. This observation suggests that the parasite populations from the two endemic sites could be genetically varied and that PfEMP1 sequencing could be a useful tool of understanding the genetics of parasite populations. Thus the network approach of studying relationships between DBLα sequences is a useful tool of uncovering the genetic structure of parasite populations circulating in different malaria endemic regions. Keywords: PfEMP1, Networks, Position Specific Polymorphic Groups, DBLα, Malaria, P. falciparu

PfEMP1 DBLalpha Sequence Tags in Genomic DNA of P. falciparum Field Isolates from Two Malaria Endemic Sites in Kenya

Background Malaria caused by Plasmodium falciparum remains a major cause of childhood morbidity and mortality in sub-Saharan Africa.  PfEMP1 protein, coded for by a family of about sixty variant var genes, is a parasite protein found on infected erythrocyte membrane. PfEMP1 protein mediates cytoadherence of infected erythrocytes on endothelial cells which may lead to severe symptoms of malaria. Although PCR amplification of the whole gene is difficult due to high variability, primers targeting the DBL? domain have been designed and used to study pfemp1 genes. This objective of this study was to establish the distribution of DBL? sequence tags in isolates of Plasmodium falciparum from two malaria endemic sites in Kenya. Methods DNA extracted from field isolates collected from Mbita (Western Kenya) and Tiwi (Coastal region) was used to isolate and amplify DBL? domain sequence tags of pfemp1 by PCR. PCR products were sequenced by 454 next generation sequencing. After assembly, the translated protein sequences (GenBank KP085750-KP087726) were then aligned in Mega 5.2 and classified into cys/PoLV groups based on the number of cysteine residues and the motifs at PoLV1 and PoLV2 within the sequence tag. Six sequence groups were found in sequences from both endemic sites. Group 4 sequences were the most prevalent (57.35% and 57.07% in isolates from Mbita and Tiwi respectively) in the isolates from both sites. Sequence tags from Tiwi had a higher proportion of cys2 (group 1 and 2) than sequences from Mbita although individual group 2 sequence tags were slightly higher in Mbita tags. Similarly the proportion of groups 5 and 6 sequence tags was higher in sequence tags from Tiwi than those from Mbita. Conclusion In conclusion, the frequency of the different cyc/PoLV groups of DBL? sequence tags at both endemic sites follow almost similar pattern with group four sequence tags being the majority among the sequence tags isolated from patient isolates from both study sites. However, in the absence of expression data, the impact of this genomic distribution pattern on malaria pathology remains unknown. Key Words: Malaria, PfEMP1, cys/PoLV, DBL?, var, Sequence tag

Evaluation of a Quantitative Real-Time PCR Assay to Measure HIV-Specific Mucosal CD8+ T Cell Responses in the Cervix

Several candidate HIV vaccines aim to induce virus-specific cellular immunity particularly in the genital tract, typically the initial site of HIV acquisition. However, standardized and sensitive methods for evaluating HIV-specific immune responses at the genital level are lacking. Therefore we evaluated real-time quantitative PCR (qPCR) as a potential platform to measure these responses. β-Actin and GAPDH were identified as the most stable housekeeping reference genes in peripheral blood mononuclear cells (PBMCs) and cervical mononuclear cells (CMCs) respectively and were used for normalizing transcript mRNA expression. HIV-specific cellular T cell immune responses to a pool of optimized CD8+ HIV epitopes (HIV epitope pool) and Staphylococcal enterotoxin B (SEB) superantigen control were assayed in HIV infected PBMC by qPCR, with parallel assessment of cytokine protein production. Peak HIV-specific mRNA expression of IFNγ, IL-2 and TNFα occurred after 3, 5 and 12 hours respectively. PBMCs were titrated to cervical appropriate cell numbers to determine minimum required assay input cell numbers; qPCR retained sensitivity with input of at least 2.5×104 PBMCs. This optimized qPCR assay was then used to assess HIV-specific cellular T cell responses in cytobrush-derived cervical T cells from HIV positive individuals. SEB induced IFNγ mRNA transcription was detected in CMCs and correlated positively with IFNγ protein production. However, qPCR was unable to detect HIV-induced cytokine mRNA production in the cervix of HIV-infected women despite robust detection of gene induction in PBMCs. In conclusion, although qPCR can be used to measure ex vivo cellular immune responses to HIV in blood, HIV-specific responses in the cervix may fall below the threshold of qPCR detection. Nonetheless, this platform may have a potential role in measuring mitogen-induced immune responses in the genital tract

Performance of methylcellulose and Avicel overlays in plaque and focus assays of Chikungunya virus

Background: Chikungunya virus is a re-emerging pathogen that is responsible for Chikungunya fever periodic outbreaks along the Kenyan coast and in other African countries.  Epidemiological data from the World Health Organization show that in 2014-2015, there was a major outbreak of Chikungunya fever in the Americas and Pacific Islands.  Surveillance and correct diagnosis are therefore key in controlling the spread and management of the disease. Plaque and focus assays are key techniques in viral characterization or quantification, and both assays typically require overlay with gelling polymers to limit the spread of viruses in cell culture.  There are anecdotal reports that Avicel may be superior to methylcellulose in assay of Influenza virus. However, it is unclear whether this would apply to other viruses. Objective: The objective of this study was to determine the performance of methylcellulose and Avicel overlays in plaque and focus assays of Chikungunya virus. Methods: Confluent Vero cells were seeded in 6- or 96-well plates for plaque and focus assays respectively. Cells were inoculated with serially diluted Chikungunya virus, and incubated to allow adherence of the virus to the cells. The inoculum was removed; replaced with Avicel or methylcellulose overlay at various concentrations and stained with crystal violet or immunostained.  Statistical significance was computed using the Holm-Sidak test. Results: The size of plaques formed by Chikungunya virus was dependent on the concentration of both Avicel and methylcellulose gels used as overlays, with Avicel overlays giving consistently larger plaques than methylcellulose.  Chikungunya virus formed plaques nearly 2.5 times larger in diameter (2 vs 0.8 mm) with 1.2 % Avicel than with 1.25 % methylcellulose after 60 hr growth.  Plaques formed with Avicel were better defined and easier to count after 48 hr growth period compared to a 60 hr period. However, methycellulose overlays provided smaller, more distinct and better defined foci in focus assays. Conclusion: Both methylcellulose and Avicel are good overlay media for viral assays. Avicel is marginally better for plaque assays while methylcellulose provides more distinct and easier to count foci in focus assays. Key words: Chikungunya virus, plaque assay, focus assay, methylcellulose, Avice

Development of Dromedary Antibody-based Enzyme Linked Immunosorbent Assay for Detecting Chikungunya virus Infections

Background: Chikungunya virus (CHIKV) is an arthropod-borne Togavirus belonging to the genus Alphavirus that is responsible for sporadic worldwide outbreaks of Chikungunya fever, an acute febrile illness often associated with severe polyarthralgia. In Kenya, Chikungunya virus is of great epidemiological concern, with the last major outbreak occurring in 2016 in North Eastern Kenya. Reliable detection of CHIKV infections is key to controlling this re-emerging pathogen, for which no cure currently exists.  Current diagnostic methods for CHIKV employ a combination of tests, particularly immunologic, serologic or virologic techniques.  However, the independent scientific reviews on the validity and sensitivity of currently available commercial assays have been conflicting. Objective: This study aimed to develop and validate a dromedary antibody-based enzyme linked immunosorbent assay for detecting Chikungunya virus infections. Methods: To produce sufficient antigen for camel immunization, Chikungunya virus (strain Lamu 33) was propagated in confluent C6-36 E2 cells using Cytodex microcarrier system. Purified and inactivated CHIKV immunogen was used to inoculate two camels reared at the University of Nairobi farm in Kibwezi, Kenya. Camel serum samples collected over the entire immunization period were assayed for the presence of anti-Chikungunya IgG by indirect ELISA. Purification of camel Heavy Chain IgG antibodies was performed by lectin affinity chromatography on protein A and protein G-Sepharose columns; then conjugated with horse radish peroxidase (HRP). The HRP-conjugated camel Heavy Chain IgG2 and IgG3 were optimized for ELISA, with optical density measured using a microplate reader set at 492nm.   A total of 188 human sera samples were assayed using the developed dromedary-based enzyme linked immunosorbent assay to determine Chikungunya virus infections. Results: The sensitivity of the dromedary HCAb IgG2 assay was 91.3% (95% CI: 0.831 - 0.994); while that for HCAb IgG3 assay was 95.7% (95% CI: 0.898 - 1.01).  The specificity of HCAb IgG2 assay was 92.3% (95% CI: 0.879 - 0.967); while the specificity of HCAb IgG3 method was 90% (95% CI: 0.851 - 0.949). For HCAb IgG2 and IgG3 based assays, the positive predictive values were 79.2% and 75.8 % respectively; while the negative predictive values were 97% and 98.4% for HCAb IgG2 and IgG3 based assays respectively. Conclusion: The camel antibody based assay was found to be reliable assay with very good sensitivity and specificity, and can be deployed for detection of Chikungunya virus infections. Key words: Chikungunya, ELISA, camel antibodies, diagnosi

Presence of CD8+ T Cells in the Ectocervical Mucosa Correlates with Genital Viral Shedding in HIV-Infected Women despite a Low Prevalence of HIV RNA–Expressing Cells in the Tissue

The female genital tract is a portal of entry for sexual HIV transmission and a possible viral reservoir. In this study, the ectocervical CD8+ T cell distribution was explored in situ and was related to expression of CD3 and HLA-DR and presence of HIV RNA. For this purpose, ectocervical tissue samples and genital secretions were collected from HIV-seropositive (HIV+) Kenyan female sex workers (FSWs) (n = 20), HIV-seronegative (HIV−) FSWs (n = 17), and HIV− lower-risk women (n = 21). Cell markers were assessed by in situ staining and by quantitative PCR. HIV RNA expression in tissue was analyzed by in situ hybridization, and viral shedding was assessed by quantitative PCR. The HIV+FSW group had a higher amount of total cells and CD8+, CD3+, and HLA-DR+ cells compared with the HIV−FSW group and HIV− lower-risk women. The majority of CD8+ cells were CD3+ T cells, and the numbers of CD8+ cells correlated significantly with plasma and cervical viral load. HIV RNA expression in situ was found in 4 of the 20 HIV+FSW women but did not correlate with cervical or plasma viral load. Thus, the HIV+ women displayed high numbers of CD8+, CD3+, and HLA-DR+ cells, as well as a limited number of HIV RNA+ cells, in their ectocervical mucosa; hence, this localization cannot be neglected as a potential viral reservoir. The elevated levels of CD8+ T cells may play a role in the immunopathogenesis of HIV in the female genital tract

Presence of CD8+ T Cells in the Ectocervical Mucosa Correlates with Genital Viral Shedding in HIV-Infected Women despite a Low Prevalence of HIV RNA–Expressing Cells in the Tissue

The female genital tract is a portal of entry for sexual HIV transmission and a possible viral reservoir. In this study, the ectocervical CD8+ T cell distribution was explored in situ and was related to expression of CD3 and HLA-DR and presence of HIV RNA. For this purpose, ectocervical tissue samples and genital secretions were collected from HIV-seropositive (HIV+) Kenyan female sex workers (FSWs) (n = 20), HIV-seronegative (HIV−) FSWs (n = 17), and HIV− lower-risk women (n = 21). Cell markers were assessed by in situ staining and by quantitative PCR. HIV RNA expression in tissue was analyzed by in situ hybridization, and viral shedding was assessed by quantitative PCR. The HIV+FSW group had a higher amount of total cells and CD8+, CD3+, and HLA-DR+ cells compared with the HIV−FSW group and HIV− lower-risk women. The majority of CD8+ cells were CD3+ T cells, and the numbers of CD8+ cells correlated significantly with plasma and cervical viral load. HIV RNA expression in situ was found in 4 of the 20 HIV+FSW women but did not correlate with cervical or plasma viral load. Thus, the HIV+ women displayed high numbers of CD8+, CD3+, and HLA-DR+ cells, as well as a limited number of HIV RNA+ cells, in their ectocervical mucosa; hence, this localization cannot be neglected as a potential viral reservoir. The elevated levels of CD8+ T cells may play a role in the immunopathogenesis of HIV in the female genital tract