Exploring the role of socioeconomic factors in the development and spread of anti-malarial drug resistance: a qualitative study.

BACKGROUND: Malaria remains a global health issue with the burden unevenly distributed to the disadvantage of the developing countries of the world. Poverty contributes to the malaria burden as it has the ability to affect integral aspects of malaria control. There have been renewed efforts in the global malaria control, resulting in reductions in the global malaria burden over the last decade. However, the development of resistance to artemisinin-based combination therapy threatens the sustainability of the present success in malaria control. Anti-malarial drug use practices/behaviours remain very important drivers of drug resistance. This study adopted a social epidemiological stance in exploring the underlying socioeconomic factors that determine drug use behaviours promoting anti-malarial drug resistance. METHODS: A qualitative approach, involving the use of interviews, was used in this inquiry to explore the existing anti-malarial drug use practices in the Nigerian population; and the different socioeconomic factors influencing the behaviours. RESULTS: The significant malaria treatment behaviours influenced by socioeconomic factors in this study were the practice of 'mixing' drugs for malaria treatment, presumptive treatment, sharing of malaria treatment course, and the use of anti-malaria monotherapies. All the rural dwellers in this study reported they have mixed drugs for malaria treatment. When symptoms were experienced, socio-economic factors, like type of settlement, income level and occupation, tended to determine the treatment behaviour and, therefore, informed and determined the experience of the illness. DISCUSSION: Social and economic contexts can influence behaviours as they contribute in shaping norms and in creating opportunities that promote certain behaviours. As shown in this study, income level and type of settlement, as structural factors, affect the decision on where to seek malaria treatment and whether or not a malaria diagnostic test will be used prior to treatment. One of the dangers of using the mixed anti-malarial drugs is that it offers a safe route for the sale of expired and fake anti-malarial drugs as the mixed drugs are not sold or dispensed in their original packets. CONCLUSIONS AND RECOMMENDATIONS: Population-wide improvements in income, education, environmental and structural conditions of rural dwellers in malaria-endemic settings will encourage behavioural change on how anti-malarial drugs are used.

Commitment to cyst formation in Giardia.

Giardia trophozoites differentiate into infectious cysts (encystment) in response to physiological stimuli; encystment is crucial for Giardia's transmission, survival and pathogenesis. In vitro, Giardia encysts when bile sequesters lipids necessary for this lipid auxotroph, and in vivo they encyst to infect new hosts. In this study, we investigated, for the first time, commitment to encystment in Giardia using both molecular and cellular techniques. We show that after 3-6 h in inducing conditions, encysting trophozoites continue to encyst regardless of whether the inducing stimulus remains. We propose that a trophozoite's inability to revert to a growing or dividing trophozoite represents a commitment to encystment. The onset of commitment correlated with the appearance of encystment specific vesicles (ESVs) and encystment specific protein synthesis. These observations suggest the involvement of regulatory pathways with the ability to 'remember' a transient signal long after its removal; a property that enables encysting trophozoites to complete the encystment process should the unfavourable triggering condition(s) change. The ability to form cysts in response to transient signals or, as we have highlighted in this paper, the ability of a small percentage of the population to form cysts without an inducer is vital for the maintenance of infection within populations.

Complete nucleotide sequence and comparative genomic analysis of microcin B17 plasmid pMccB17.

We present a comprehensive sequence and bioinformatic analysis of the prototypical microcin plasmid, pMccb17, which includes a definitive sequence for the microcin operon, mcb. Microcin B17 (MccB17) is a ribosomally synthesized and posttranslationally modified peptide produced by Escherichia coli. It inhibits bacterial DNA gyrase similarly to quinolone antibiotics. The mcb operon, which consists of seven genes encoding biosynthetic and immunity/export functions, was originally located on the low copy number IncFII plasmid pMccB17 in the Escherichia coli strain LP17. It was later transferred to E. coli K-12 through conjugation. In this study, the plasmid was extracted from the E. coli K-12 strain RYC1000 [pMccB17] and sequenced twice using an Illumina short-read method. The first sequencing was conducted with the host bacterial chromosome, and the plasmid DNA was then purified and sequenced separately. After assembly into a single contig, polymerase chain reaction primers were designed to close the single remaining gap via Sanger sequencing. The resulting complete circular DNA sequence is 69,190 bp long and includes 81 predicted genes. These genes were initially identified by Prokka and subsequently manually reannotated using BLAST. The plasmid was assigned to the F2:A-:B- replicon type with a MOBF12 group conjugation system. A comparison with other IncFII plasmids revealed a large proportion of shared genes, particularly in the conjugative plasmid backbone. However, unlike many contemporary IncFII plasmids, pMccB17 lacks transposable elements and antibiotic resistance genes. In addition to the mcb operon, this plasmid carries 25 genes of unknown function.

Liposomal Drug Delivery against Helicobacter pylori Using Furazolidone and N-Acetyl Cysteine in Augmented Therapy.

Helicobacter pylori (H. pylori) infection is a significant global health concern, affecting approximately 50% of the world's population and leading to gastric ulcers, gastritis, and gastric cancer. The increase in antibiotic resistance has compromised the efficacy of existing therapeutic regimens, necessitating novel approaches for effective eradication. This study aimed to develop a targeted liposomal drug delivery system incorporating furazolidone and N-acetylcysteine (NAC) to enhance mucopenetration and improve Helicobacter pylori eradication. Liposomes were formulated with furazolidone, NAC, and Pluronic F-127 using a modified reverse-phase evaporation technique. The formulations were categorized based on charge as neutral, negative, and positive and tested for mucopenetration using a modified silicon tube method with coumarin-6 as a fluorescent marker. The encapsulation efficiency and particle size were analyzed using HPLC and an Izon q-nano particle size analyzer. The results indicated that charged liposomes showed a higher encapsulation efficiency than neutral liposomes with Pluronic F-127. Notably, combining furazolidone with 1% NAC achieved complete eradication of H. pylori in 2.5 h, compared to six hours without NAC. The findings of this study suggest that incorporating NAC and Pluronic F-127 into liposomal formulations significantly enhances mucopenetration and antimicrobial efficacy.

Programmed cell death in Giardia.

Programmed cell death (PCD) has been observed in many unicellular eukaryotes; however, in very few cases have the pathways been described. Recently the early divergent amitochondrial eukaryote Giardia has been included in this group. In this paper we investigate the processes of PCD in Giardia. We performed a bioinformatics survey of Giardia genomes to identify genes associated with PCD alongside traditional methods for studying apoptosis and autophagy. Analysis of Giardia genomes failed to highlight any genes involved in apoptotic-like PCD; however, we were able to induce apoptotic-like morphological changes in response to oxidative stress (H2O2) and drugs (metronidazole). In addition we did not detect caspase activity in induced cells. Interestingly, we did observe changes resembling autophagy when cells were starved (staining with MDC) and genome analysis revealed some key genes associated with autophagy such as TOR, ATG1 and ATG 16. In organisms such as Trichomonas vaginalis, Entamoeba histolytica and Blastocystis similar observations have been made but no genes have been identified. We propose that Giardia possess a pathway of autophagy and a form of apoptosis very different from the classical known mechanism; this may represent an early form of programmed cell death.

Oxygen levels are key to understanding "Anaerobic" protozoan pathogens with micro-aerophilic lifestyles.

Publications abound on the physiology, biochemistry and molecular biology of "anaerobic" protozoal parasites as usually grown under "anaerobic" culture conditions. The media routinely used are poised at low redox potentials using techniques that remove O2 to "undetectable" levels in sealed containers. However there is growing understanding that these culture conditions do not faithfully resemble the O2 environments these organisms inhabit. Here we review for protists lacking oxidative energy metabolism, the oxygen cascade from atmospheric to intracellular concentrations and relevant methods of measurements of O2, some well-studied parasitic or symbiotic protozoan lifestyles, their homeodynamic metabolic and redox balances, organism-drug-oxygen interactions, and the present and future prospects for improved drugs and treatment regimes.

Potential of cationic porphyrins for photodynamic treatment of cutaneous Leishmaniasis.

Four tetracationic porphyrins have been investigated for their ability to photo-inactivate Leishmania major promastigotes. Parallel photocytotoxicity assays against keratinocytes and macrophages show significant differences in activity between the microorganism and mammalian cells. Results suggest that it may be possible to photodynamically inactivate macrophages infected with Leishmania and the promastigote form of the microorganism, while minimising damage to surrounding tissue.

Formulation and advantages of furazolidone in liposomal drug delivery systems.

Furazolidone has proven to have antiprotozoal and antibacterial activity. A number of literature supported its use against Helicobacter pylori. This potential application opens new prospects of its use in clinical settings in triple therapy. In order to avoid side effects associated with this drug, liposomal mucoadhesive drug delivery that can work locally in stomach is considered as an appropriate approach. This study is a focus on formulations and in vitro characterization of liposomes containing furazolidone. Therefore, the effects of variable amounts of drug and cholesterol on encapsulation efficacy and in vitro drug release were evaluated for different liposomal formulations. Mucoadhesive behavior of chitosan coated liposomal at two different pHs was also evaluated and increase in pH from 1.3 to 4.5 increased mucoadhesion from 42% to 60% respectively. Increasing the amount of drug from 4mg to 5mg increased encapsulation activity however, increasing the drug any further decreased encapsulation activity. In contrast, by increasing the amount of cholesterol decrease in encapsulation activity was observed. The optimized formulation with 5mg of drug and 53mg of cholesterol in formulation gave 57% drug release at pH 1.3 but release was increased up to 71% by increasing pH to 4.5 for same amount of drug. However, by using 10.6mg of cholesterol and 5mg of drug the overall release was increased at both pH conditions, at pH 1.3 release was 69% as compared to 77% at pH 4.5. This trend of drug release profile and mucoadhesion that favors pH 4.5 is documented as useful in targeting H. pylori as normal pH of stomach is expected to be higher by the influence of this microbe. Hence, the results of this research can be taken further into a future in vivo study.

Chemical and Antimicrobial Profiling of Propolis from Different Regions within Libya.

Extracts from twelve samples of propolis collected from different regions of Libya were tested for their activity against Trypanosoma brucei, Leishmania donovani, Plasmodium falciparum, Crithidia fasciculata and Mycobacterium marinum and the cytotoxicity of the extracts was tested against mammalian cells. All the extracts were active to some degree against all of the protozoa and the mycobacterium, exhibiting a range of EC50 values between 1.65 and 53.6 µg/ml. The toxicity against mammalian cell lines was only moderate; the most active extract against the protozoan species, P2, displayed an IC50 value of 53.2 µg/ml. The extracts were profiled by using liquid chromatography coupled to high resolution mass spectrometry. The data sets were extracted using m/z Mine and the accurate masses of the features extracted were searched against the Dictionary of Natural Products (DNP). A principal component analysis (PCA) model was constructed which, in combination with hierarchical cluster analysis (HCA), divided the samples into five groups. The outlying groups had different sets of dominant compounds in the extracts, which could be characterised by their elemental composition. Orthogonal partial least squares (OPLS) analysis was used to link the activity of each extract against the different micro-organisms to particular components in the extracts.

Metabolomics and protozoan parasites.

In this review, we examine the state-of-the-art technologies (gas and liquid chromatography, mass spectroscopy and nuclear magnetic resonance, etc.) in the well-established area of metabolomics especially as they relate to protozoan parasites.

Campylobacter in waterfowl and aquatic environments: incidence and methods of detection.

Campylobacters are emerging as one of the most significant causes of human infections worldwide, and the role that waterfowl and the aquatic environment have in the spread of disease is beginning to be elucidated. On a world scale campylobacters are possibly the major cause of gastrointestinal infections. Campylobacters are common commensals in the intestinal tract of many species of wild birds, including waterfowl. They are also widely distributed in aquatic environments where their origins may include waterfowl as well as sewage effluents and agricultural runoff. Campylobacters have marked seasonal trends. In temperate aquatic environments they peak during winter, whereas spring-summer is the peak period for human infection. Campylobacter species may survive, and remain potentially pathogenic, for long periods in aquatic environments. The utility of bacterial fecal indicators in predicting the presence of campylobacters in natural waters is questionable. Viable but nonculturable Campylobacter cells may occur, but whether they have any role in the generation of outbreaks of campylobacteriosis is unclear. The routine detection of Campylobacter spp. in avian feces and environmental waters largely relies on conventional culture methods, while the recognition of a particular species or strain is based on serotyping and increasingly on molecular methods. Thus, PCR combined with selective enrichment enhances the detection of campylobacters in water and feces, while DNA sequencing facilitates recognition of particular species and strains.

Molecular tools for speciation and epidemiological studies of Acanthamoeba.

Current diagnostic methods for Acanthamoeba identification rely heavily on light microscopic techniques that do not provide sufficient information about the identification of Acanthamoeba at the species level, thus delaying accurate identification of the infective agent. Here we report the use of polymerase chain reaction (PCR)-based restriction enzyme analyses to detect and speciate Acanthamoeba from both clinical and environmental sources by comparing their restriction endonuclease patterns. Significant diversity was observed between and within morphologically defined Acanthamoeba species. The usefulness of PCR-based assays and other available diagnostic methods is discussed.

Molecular and physiological differentiation between pathogenic and nonpathogenic Acanthamoeba.

In this study, 14 isolates of Acanthamoeba from both clinical and environmental sources belonging to seven different species were assayed for tolerance of high osmotic pressure, temperature tolerance, extracellular proteases, and cytopathic effects (CPE) on immortalized rabbit corneal epithelial cells. On the basis of the results, amoeba isolates were divided into pathogenic and nonpathogenic groups. Ribosomal DNA sequencing was performed on these isolates. Phylogenetic relationships revealed that all the pathogenic strains tested clustered together as one group, while nonpathogenic strains clustered into other groups. Sequence comparisons with previously published sequences determined that among the six new pathogenic isolates used in this study, five belong to T4 genotype and one to T11. This is the first report of a T11 genotype being found in Acanthamoeba keratitis.

Menadione kills trophozoites and cysts of Giardia intestinalis.

Production of reactive oxygen species by redox cycling in the presence of low levels of oxygen has been studied as a possible approach to anti-protozoal chemotherapeutic strategy. Incubation of the diplomonad flagellate Giardia intestinalis with 2-methy-1,4-naphthoquinone (menadione), under anaerobic conditions, gave UV absorption changes characteristic of reduction to menadiol; partial reversal was observed on admitting O(2). Under microaerobic conditions, similar to those on the surface of the jejunal mucosa, trophozoites consumed O(2) rapidly in the presence of menadione; reaction products included singlet O(2) (monitored by single photon counting of O(2)-dependent low-level chemiluminescence) and H(2)O(2) (measured by the formation of Complex I of microperoxidase). Trophozoites became swollen and incapable of regulatory volume control; these irreversible responses led to loss of motility, cessation of flagellar activity and cell death. Comparison of the sensitivities of trophozoites to metronidazole and menadione gave LC(50) values ( microg x ml(-1)) of 1.2 and 0.7, respectively; corresponding values for cysts (measured by in vitro excystation capacities) were >50 and 1.3. Menadione (LD(50) in mice, 0.5 g kg(-1)) is therefore a potentially more useful and general anti-giardial agent than metronidazole, as it is active against cysts as well as trophozoites.