Co-infection with subclinical HIV and Wuchereria bancrofti, and the role of malaria and hookworms, in adult Tanzanians: infection intensities, CD4/CD8 counts and cytokine responses.

The association between HIV and Wuchereria bancrofti, and the role of malaria and hookworms, were analysed by comparing three groups of individuals with: (1) HIV (HIV+; n=16); (2) W. bancrofti (circulating filarial antigen (CFA)+; n=25); and (3) HIV and W. bancrofti (HIV+/CFA+; n=18). A slightly higher HIV load and lower CD4% was observed in the HIV+/CFA+ group compared with the HIV+ group, and a slightly higher W. bancrofti CFA intensity was observed in the CFA+ group compared with the HIV+/CFA+ group, but none of these differences were statistically significant. Specific and non-specific IL-4, IL-10, IFNgamma and TNF levels were measured. Only specific IL-4 was significantly higher in the CFA+ group compared with the HIV+/CFA+ group. Thus, there was no clear evidence for an interaction between HIV and W. bancrofti infection. A multiple linear regression model showed that the presence of CFA was strongly positively associated with specific TNF response and, similarly, that HIV-positive individuals had higher TNF responses than HIV-negative individuals. Interestingly, the CD4% and CD4/CD8 ratio were higher in HIV-positive individuals with hookworms than in those without hookworm co-infection. Malaria was not associated with any of the other infections, or with CD4/CD8 counts or cytokine responses.

Retracted: Co-infection with sub-clinical HIV and Wuchereria bancrofti, and the role of malaria and hookworms, in adult Tanzanians: infection intensities, CD4/CD8 counts and cytokine responses.

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Cross-sectional relationship between HIV, lymphatic filariasis and other parasitic infections in adults in coastal northeastern Tanzania.

The relationship between HIV, lymphatic filariasis, malaria (Plasmodium falciparum) and intestinal helminths (Ascaris lumbricoides, Trichuris trichiura and hookworm) was assessed in a cross-sectional study conducted in 2002 among 907 adults in Tanga Region, Tanzania. Overall prevalences were 7.9% for HIV, 43.5% for Wuchereria bancrofti-specific circulating filarial antigen (CFA), 12.3% for P. falciparum, 1.2% for A. lumbricoides, 7.1% for T. trichiura and 75.7% for hookworm. Anaemia was assessed separately for males and females and was found to be more prevalent among females (58.8%) than males (34.8%). When sex and age were controlled for, there was a statistically significant positive association between HIV and W. bancrofti (CFA) infection and between malaria and HIV, but not between malaria and W. bancrofti (CFA) infection. Hookworm infection was positively associated with W. bancrofti (CFA) infection but, surprisingly, negatively associated with HIV. Infection with HIV and hookworms, but not malaria, was associated with a significant reduction in haemoglobin concentration. These associations are likely to reflect underlying mechanisms that need to be clarified to better understand the role of co-infections in HIV pathogenesis, and vice versa.

Lymphatic filariasis-specific immune responses in relation to lymphoedema grade and infection status. I. Cellular responses.

The filariasis-specific cellular responsiveness was assessed in 109 adult individuals from a Wuchereria bancrofti-endemic area in north-east Tanzania. There were 9 study groups. Five groups of individuals were negative for microfilariae (mf) and specific circulating filarial antigen (CFA) and had leg lymphoedema of varying severity ranging from early to more advanced grades (pathology groups 1-5). Another group comprised individuals with mixed grades of lymphoedema and positive for mf and/or CFA (mixed pathology group). Three asymptomatic groups consisted of individuals without leg pathology but with different infection status: (i) CFA- and mf-negative individuals, (ii) CFA-positive but mf-negative individuals, and (iii) CFA- and mf-positive individuals. Peripheral blood mononuclear cells were collected and proliferative responsiveness and secretion of interleukin (IL)-4, IL-10 and gamma interferon (IFN gamma) were measured upon stimulation with a Brugia pahangi antigen. No distinct differences in responses were observed between the 5 uninfected pathology groups. Instead, responses were associated with infection status, with generally higher proliferative activity and higher levels of IL-4 and IFN gamma in uninfected as compared to infected individuals. High levels of IL-10 were observed in asymptomatic individuals without infection and in asymptomatic CFA-positive but mf-negative individuals. Asymptomatic individuals with mf had relatively low IL-10 levels. Groups presenting with chronic pathology generally had low levels of IL-10 independently of infection status. The findings thus give no immediate indication that the measured immunological parameters are related to progression of leg pathology. However, alternative interpretations are presented which suggest a possible role of immunological reactions in development of pathology in lymphatic filariasis.

Lymphatic filariasis-specific immune responses in relation to lymphoedema grade and infection status. II. Humoral responses.

The filarial-specific humoral responses (IgG1, IgG2, IgG3, IgG4 and IgE) to a Brugia pahangi antigen was assessed in 9 groups of adult individuals from a Wuchereria bancrofti-endemic area in north-east Tanzania. In 5 of the groups, individuals were negative for microfilariae (mf) and circulating filarial antigen (CFA) and had leg lymphoedema of varying severity ranging from early to more advanced grades. A 6th group had mixed grades of lymphoedema and were actively infected with mf and/or CFA. Three groups of asymptomatic individuals with different infection status (mf+CFA+; mf-CFA+; mf-CFA-) were also included. No differences in the antibody levels were observed between the 5 uninfected pathology groups. However, groups with advanced lymphoedema had a significantly higher level of IgG3 as compared to groups with early lymphoedema. A decline in the IgG4/IgE ratios were observed when moving from groups with early to groups with more advanced lymphoedema, which could indicate that increasing levels of IgE relatively to IgG4 are associated with progression of pathology. When all study groups were compared, higher IgG4/IgE ratios were observed in infected groups than in uninfected groups. This could suggest that high levels of IgG4 relative to IgE protect the parasite, whereas the opposite may play a role in parasite killing. When relating IgG4/IgE ratios to levels of gamma interferon (IFN gamma), a clear inverse relationship was observed. Thus, high levels of IFN gamma were found in groups with low IgG4/IgE ratios (uninfected groups) and low levels of IFN gamma were found in groups with high IgG4/IgE ratios (infected groups). The relationship between cellular (IFN gamma) and humoral (IgG4/IgE ratios) responses and their possible role in parasite protection and killing, and in development of early lymphoedema, are discussed.

Lymphatic filariasis in Lower Shire, southern Malawi.

Surveys for lymphatic filariasis were carried out for the first time in Lower Shire (Nsanje and Chikawawa Districts) of southern Malawi, in April-June 2000. There were 3 phases. In phase I, questionnaire surveys in 48 randomly selected villages indicated that chronic manifestations of lymphatic filariasis ('swollen scrotum' and 'swollen legs') were common and widespread in the area. In phase II, volunteers from 10 of the villages reporting frequent manifestations of filariasis in phase I were examined with the ICT whole-blood test for Wuchereria bancrofti-specific circulating filarial antigen (CFA). The observed prevalence of CFA positivity was very high (range, 38.8-79.1% for the villages). In phase III, a more detailed parasitological, CFA and clinical investigation was carried out in 2 of the high CFA prevalence villages identified in phase II (1 in each district). Overall, 18.1% and 22.2% were positive for microfilariae, and 62.3% and 64.6% were positive for CFA in the 2 villages. Among those aged > or = 15 years, 3.7% and 1.3% had leg elephantiasis, and 17.9% and 13.0% (of males only) had hydrocoele. In both phase II and III, CFA prevalences were unexpectedly high, especially in children. This was probably related to a recent increase in transmission of filariasis as a result of extensive flooding in the area prior to the study. The study indicated that lymphatic filariasis is highly endemic in the Lower Shire area of Malawi, and calls for action towards its control.

Ecosystem approaches to human health.

The promotion of human health must be embedded in the wider pursuit of ecosystem health. Interventions will be impaired if ecosystem-linked determinants of health are not taken into account. In the extreme case, if ecosystems lose their capacity for renewal, society will lose life support services. Essential features of ecosystem health are the capacity to maintain integrity and to achieve reasonable and sustainable human goals. An ecosystem approach to research and management must be transdisciplinary and assure participation of stakeholders. These requisites provide a means for science to better deal with the complexity of ecosystems, and for policy-makers and managers to establish and achieve reasonable societal goals. The ecosystem approach can determine links between human health and activities or events which disturb ecosystem state and function. Examples are: landscape disturbance in agriculture, mining, forestry, urbanization, and natural disasters. An understanding of these links can provide guidance for management interventions and policy options that promote human health. An ecosystem approach to management must be adaptive because of irreducible uncertainty in ecosystem function.

Age-dependent occurrence of the intestinal ciliate Balantidium coli in pigs at a Danish research farm.

A cross sectional study of the prevalence and intensity of Balantidium coli in pigs was carried out on a Danish research farm. The prevalence of B. coli infection increased from 57% in suckling piglets to 100% in most pig groups > or = 4 weeks old. The mean number of cysts per gram faeces (CPG) of pigs aged 12 weeks and younger were < or = 206, whereas pigs aged 28 weeks and > 52 weeks had significantly higher counts of > or = 865 CPG. Although some lactating sows had very high CPG's, no significant differences in CPG could be detected between the intensities of pregnant sows, lactating sows and empty and dry sows. No human cases of B. coli infection have been published in Denmark though it is zoonotic.

Lymphoproliferation in captive wild ruminants affected with malignant catarrhal fever: 25 cases (1977-1985).

The severity of lymphoproliferative disease associated with malignant catarrhal fever was extremely variable among 25 animals at the San Diego Wild Animal Park. Severe lymphoproliferative disease was seen in 3 of 10 Formosan Sika deer (Cervus nippon taiouanus), 3 of 6 Indian Axis deer (Cervus a axis), 3 of 6 Barasingha deer (Cervus d duvauceli), and 1 of 3 Nilgai (Boselaphus tragocamelus). Two Sika deer and 2 Barasingha deer had lesions morphologically indistinguishable from lymphosarcoma. Our findings were consistent with the hypothesis that alcelaphine herpesvirus-1 has oncogenic potential.

Fatal respiratory disease in Nilgiri tahr: possibly malignant catarrhal fever.

Nilgiri tahr (Hemitragus hylocrius) are native to India and are a rare zoo exhibit. This report describes an acute respiratory disease in tahr that caused the death of 15 of 16 animals in an extensive exhibit of about 35 acres where they were housed together with a variety of other exotic species of ruminants. The deaths occurred in two separate outbreaks and were associated with losses from malignant catarrhal fever in other ruminants in the exhibit. The most prominent clinical sign was severe dyspnea, and death occurred within five days. The principal lesions were an acute nonsuppurative inflammation of the respiratory tract and pulmonary vessels, lymphadenopathy and lymphoid cell infiltration in the organs of some animals. It was conjectured that the tahr died of a unique pneumonic form of malignant catarrhal fever. Attempts at viral isolation were negative.

Dexamethasone-induced recrudescence of malignant catarrhal fever and associated lymphosarcoma and granulomatous disease in a Formosan sika deer (Cervus nippon taiouanus).

Malignant catarrhal fever (MCF) was diagnosed in a 2-week-old Formosan sika deer. The fawn had been previously exposed to a clinically normal neonatal wildebeest calf from which alcelaphine herpesvirus-1 was isolated. Alcelaphine herpesvirus-1 was isolated from buffy coat leukocytes and nasal and ocular secretions of the fawn during the acute illness. The fawn clinically recovered after 3 weeks. Virus was not recovered from blood at this time. Dexamethasone, given 4 months after clinical recovery, resulted in reisolation of MCF virus from blood and recrudescence of clinical MCF. The deer was euthanatized. At necropsy, pathognomonic lesions of MCF, granulomatous disease, and malignant lymphoma were observed. Antibodies to bovine leukosis viral antigens were not detected in the serum. The epidemiologic and pathogenetic importance of the findings are discussed.