Parasitological detection of Theileria parasites in livestock in various regions of the Northern Emirates of the United Arab Emirates.

Background and Aim: Theileriosis, caused by tick-borne hemoprotozoans of the genus Theileria, severely impacts the economics of the livestock industry in most tropical and subtropical countries. The aim of the present study was to detect Theileria spp. in domesticated animals (camels, cows, sheep, and goats) using direct microscopy and to determine the infection rate in geographically distinct regions in the northern emirates of the UAE. Materials and Methods: Blood samples (n = 536) were collected from clinically symptomatic and asymptomatic domesticated animals and subjected to Giemsa staining and examined microscopically for the identification of Theileria. Results: Smears showed an overall rate of positivity for Theileria spp. in 325/536 (60.6%) animals. Different infection rates were recorded across the various animal groups in the different study areas (Middle region 215/386 [55.7%], East region 100/139 [71.9%]). Of the 11 goat samples collected from the North region, 10 (90%) were positive. Infection rates per animal group based on microscopy were as follows: camels, 3/35 (8.5%); cows, 19/36 (52.7%); goats, 200/303 (66%); and sheep, 103/162 (63.5%). Real-time polymerase chain reaction confirmation of all microscopy-positive samples identified 23/325 (7.1%) results as false-positive. Conclusion: This study clarified that Theileria spp. is present in the Middle (Sharjah, Umm Al Quwain, and Ajman), East, and North regions. This report also confirmed the use of direct microscopy with Giemsa-stained blood films as the method of choice for diagnosing acute infections. Further work is needed to molecularly determine the prevalence and species of Theileria spp. circulating in the different parts of the UAE.

Comparison of Various Diagnostic Techniques for the Detection of Blastocystis Spp. and its Molecular Characterisation in Farm Animals in the United Arab Emirates.

Introduction: Blastocystis spp. is a common anaerobic intestinal parasite infecting humans and a diverse range of animals. The aim of the study was to compare different diagnostic methods for the detection of Blastocystis and survey the occurrence of its subtypes in farm animals, namely sheep, cows and camels, in Al-Ain, United Arab Emirates. Material and Methods: Ninety-seven faecal samples comprised of 69 from sheep, 12 from cows and 16 from camels were submitted to DNA extraction, PCR and sequencing. Blastocystis was screened for microscopically in 65 samples using direct wet-mount, modified acid-fast staining, trichrome staining and in vitro culture techniques. Results: Fifteen (15.5%) samples were positive by PCR, twelve of which were confirmed by sequencing. Using PCR as a comparison standard, the sensitivity and specificity of the direct wet-mount, modified acid-fast staining, trichrome staining and in vitro culture methods were 40.0% and 78.3%, 40.0% and 83.3%, 80.0% and 80.0%, and 80.0% and 76.7% respectively. Only culture and trichrome tests were significantly associated with PCR (odds ratio (OR) = 13.14; 95% confidence interval (CI): 1.35-127.4; P = 0.007 and OR = 16; 95% CI: 1.63-156.5; P = 0.003, respectively) with trichrome detecting more positive cases than in vitro culture. The subtype (ST)10 was the only one found in all 12 sequenced sheep isolates. Conclusion: The study corroborated previous data indicating that sheep are the natural hosts for ST10. No zoonotic subtypes nor mixed-subtype colonisation were found. The report also confirmed the superiority of trichrome staining in detecting Blastocystis spp.

Molecular epidemiology of Microsporidia among HIV-positive and HIV-negative patients in the Limpopo province, South Africa.

INTRODUCTION: Human microsporidiosis represents an important and rapidly emerging opportunistic disease. The present study investigated the prevalence of microsporidia among HIV positive and HIV negative patients with or without diarrhoea in Vhembe and Mopani Districts in the Limpopo Province. METHODOLOGY: A total of 170 stool samples were collected from these patients and microsporidia species was detected using a Real-Time PCR targeting a conserved region of the small ribosomal subunit rRNA (SSU-rRNA) gene of Enterocytozoon bieneusi, Encephalitozoon intestinalis, Encephalitozoon hellem, and Encephalitozoon cuniculi. RESULTS: Fifty six (32.9%) were positive for microsporidia. The prevalence was higher in HIV negative patients (36.6%) while 24.1% of patients who were HIV positive had microsporidia. Microsporidia was more common among patients aged between 1 and 10 years (52.6%). However among the HIV positive patients, microsporidia prevalence was higher among those that were not taking antiretrovirals (ARVs) compared to those who were on ARVs, (36.6%) and (24.1%), respectively. Microsporidia was also noted to be significantly associated with diarrheal and stomach pains; p = 0.02 and p = 0.048, respectively. Furthermore, microsporidia infections was more prevalent among patients who had animals at home (p = 0.037). CONCLUSIONS: Study has shown a high prevalence of microsporidia among patients attending primary health centers in the Mopani District for the first time. Prevalence of microsporidia was higher among HIV negative and HIV positive patients who were not on ARV treatment. Keeping animals in the household appeared to be a risk of getting infected with microsporidia. Further studies are needed to determine the genetic characteristics of these organisms in the study population.

Prevalence and distribution of Entamoeba species in a rural community in northern South Africa.

Amoebiasis occurs worldwide and affects about 20-50 million people annually. Stool samples were collected from patients attending different rural clinics in Northern South Africa in the present study. Microscopic examination was performed for the initial detection of Entamoeba parasites. A multiplex PCR protocol based on the small subunit rRNA gene of E. moshkovskii, E. dispar, and E. histolytica, was used for the differential detection of the three Entamoeba species (collectively referred to as Entamoeba complex). A total of 170 participants were recruited in the study, with a mean age of 35.9 ±â€¯17.8 years and a median of 37.0 years. The prevalence of Entamoeba species was found to be 34.7% and 33% by PCR and microscopy, respectively. E. histolytica had a prevalence of 4.1%, E. dispar 14.7% and E. moshkovskii 15.9%. Of the three species, only E. histolytica was significantly associated with diarrhoea and was more prevalent among HIV patients even in the absence of diarrhoea while the other two were not, although the difference was not significant (p > 0.05). This is the first study in South Africa to describe the prevalence of E. moshkovskii. E. dispar was significantly associated with abdominal pains (p = 0.003). Further studies are needed to clarify the role of E. moshkovskii and E. dispar in abdominal pain and diarrhoea.

Prevalence and genetic characterization of Giardia lamblia in relation to diarrhea in Limpopo and Gauteng provinces, South Africa.

BACKGROUND: Very few studies have determined the prevalence and assemblage distribution of Giardia lamblia in South Africa. The present study aimed to ascertain the prevalence of G. lamblia infection and the spread of the various assemblages in two communities in South Africa - Giyani, Limpopo province (rural community) and Pretoria Guateng province (urban community). METHODS: Prevalence was determined by immunological and molecular methods analyzing a total of 516 stool samples collected from patients visiting different health centres in Giyani and Pretoria. For immunological assays, samples were screened by ELISA to detect G. lamblia antigen. Furthermore, a semi nested PCR amplifying the triose phosphate isomerase (tpi) gene was used to differentiate between the two most common human assemblages (A and B). FINDINGS: Of the 516 participants, 40 (7.75%) were identified as positive by ELISA. A statistically significant correlation was observed between the stool texture and Giardia infection (ᵡ2 = 10.533; p = .005). G. lamblia was significantly associated with watery stool types in females p = .008. Furthermore, a significant association was also noticed between the origin of samples (ᵡ2 = 9.725; p = .002). No significant correlation between age and gender was noted. Regarding the age groups, most people who were infected were between 3 and 20 years. A statistically significant association was seen (p = .001) with the distribution of the pathogen with the stool type. The prevalence of Giardia infection was higher in watery stool samples (71.4%) in Giyani region (rural) whereas in Pretoria, high prevalence was found in loose stool samples (6.2%). Generally, the distribution was statistically significant in the stool type collected for the study (p = .005). Genotyping revealed more G. lamblia assemblage B (17.8%) than assemblage A (1.7%). Furthermore, 21.0% of the samples exhibited single infection while 4.2% had mixed infections. Assemblage B was more common in Giyani than in urban Pretoria. CONCLUSIONS: The study confirms Giardia as an important cause of diarrhea in the concerned communities with people in rural areas more at risk compared to those in urban areas with higher prevalence among younger patients. Therefore, health education campaigns should target young age groups.

Molecular Subtyping of Blastocystis from Diverse Animals in the United Arab Emirates.

The contribution of Blastocystis from non-human hosts to zoonotic transmission is only partly known. The objective of this study was to determine the distribution of Blastocystis genetic subtypes in different animal species in United Arab Emirates. A total of 114 stool samples were tested using PCR of the small subunit (SSU) rRNA gene and sequence analysis. Twenty-three Blastocystis-positive samples were identified. The following detection rates were observed: cattle, 22.7%; sheep, 63.6%; rabbits, 33.3%; rodents, 37.5%; reptiles, 21.2%. Four subtypes were identified in this study; ST4, ST10, ST14, and ST17; ST10 was isolated from sheep and cattle, corroborating previous data indicating that these are natural hosts for this subtype. Cases of mixed subtype colonization were also detected. Conspicuously, we found ST14 in rabbits. The discovery of ST17 in a squirrel indicates a novel host for this subtype. Furthermore, the discovery of ST4 in rodents suggests that these may serve as reservoir for human Blastocystis ST4 colonization. Six tortoises and one iguana were positive for Blastocystis. In conclusion, this is the first report of Blastocystis infection in various animals in the UAE. Apart from ST4, no potentially zoonotic subtypes were detected.

PREVALENCE OF CRYPTOSPORIDIUM SPP. AMONG ASYMPTOMATIC HEALTHY EXPATRIATE WORKERS IN SHARJAH, UNITED ARAB EMIRATES.

BACKGROUND: Epidemiological data on Cryptosporidium infections in the United Arab Emirates (UAE) is scarce. Therefore, the main objective of this study was to determine the prevalence of Cryptosporidium species among a community of expatriates in Sharjah, UAE working in different sectors, including the food industry, house maids and other domestic occupations. MATERIALS AND METHODS: One hundred and thirty four stool samples were collected from asymptomatic individuals presenting to the Sharjah Municipality Public Health Clinic (SMPHC) for screening of intestinal parasites for work permission purposes between 2009 and 2011. Demographic information such as age, sex, and country of origin was collected. Genomic DNA extracted from the stool samples were tested for Cryptosporidium species using real-time PCR (qPCR). RESULTS: Twenty-six individuals (19.4%) were positive for Cryptosporidium sp. by PCR. The infection rate was found to be highest in Afghan nationals (33%; 3/9) compared with the rest of the study population; yet, no significant association existed between nationality and infection rate. Moreover, no association was observed between infection rate and gender (χ2 = 2.439; P = 0.118), nor infection rate and age group (χ2 = 1.219; P = 0.544). CONCLUSION: Infection by Cryptosporidium sp. was common in the study group, and further studies are needed within the native Emirati population before any conclusions can be made about foreigners potentially transmitting the parasite. Furthermore, data provided in this study could help determine its public and veterinary significance particularly in outbreaks in the country.

Intestinal parasitic infections among expatriate workers in various occupations in Sharjah, United Arab Emirates.

Intestinal parasitic infections are prevalent throughout many countries. This study aimed to determine the prevalence of intestinal parasite carriers among 21,347 expatriate workers, including food handlers and housemaids attending the public health center laboratory in Sharjah, UAE. Stool sample collection was performed throughout the period between January and December 2013. All samples were examined microscopically. Demographic data were also obtained and analyzed. Intestinal parasites were found in 3.3% (708/21,347) of the studied samples (single and multiple infections). Among positive samples, six hundred and eighty-three samples (96.5%) were positive for a single parasite: Giardia lamblia (257; 36.3%) and Entamoeba histolytica/Entamoeba dispar (220; 31.1%), respectively, whereas mono-infections with helminths accounted for 206 (29.1%) of the samples. Infection rates with single worms were: Ascaris lumbricoides (84; 11.9%), Hookworm (34; 4.8%), Trichuris trichiura (33; 4.7%), Taenia spp. (27; 3.81%), Strongyloides stercoralis (13; 1.8%), Hymenolepis nana (13; 1.8%), and Enterobius vermicularis (2; 0.28%), respectively. Infections were significantly associated with gender (x2 = 14.18; p = 0.002) with males as the most commonly infected with both groups of intestinal parasites (protozoa and helminths). A strong statistical association was noted correlating the parasite occurrence with certain nationalities (x2= 49.5, p <0.001). Furthermore, the study has also found a strong statistical correlation between parasite occurrence and occupation (x2= 15.60; p = 0.029). Multiple infections were not common (3.5% of the positive samples), although one individual (0.14%) had four helminth species, concurrently. These findings emphasized that food handlers with different pathogenic parasitic organisms may pose a significant health risk to the public.

Prevalence and subtype distribution of Blastocystis in healthy individuals in Sharjah, United Arab Emirates.

Blastocystis is estimated to be one of the most common parasites of the intestinal tract of humans, comprising multiple subtypes (ST). Meanwhile, the distribution of Blastocystis ST in many communities and countries remains unknown. In the present work, we aimed to identify the prevalence of Blastocystis and the ST distribution in human stool samples collected from healthy expatriates from different geographical regions and residing in Sharjah, United Arabian Emirates (UAE). A total of 133 samples were screened and subtyped using partial small subunit ribosomal RNA gene sequencing. Fifty-nine (44.4%) samples were identified as positive. Among these, 39 were successfully sequenced and subtyped. The ST distribution was as follows: ST3, 58.9% (23/39); ST1, 28.2% (11/39); and ST2, 7.6% (3/39). No correlation between geographic origin and infection (χ(2)=11.006; P=0.528) nor gender and infection (χ(2)=1.264; P=0.261) was observed. The data were compared with those available for other Middle Eastern and North African neighboring countries. This study is the first to provide data concerning the prevalence of Blastocystis and the frequency of various STs in the UAE, confirming the absence of ST4 and the commonness of ST1, ST2, and ST3 in this geographical region.

Genetic variability of the serine-rich Entamoeba histolytica protein gene in clinical isolates from the United Arab Emirates.

The genetic diversity of 20 Entamoeba histolytica isolates from asymptomatic individuals from the UAE was investigated by analyzing polymorphism in the serine-rich E. histolytica gene (SREHP) by nested polymerase chain reaction (PCR) amplification followed by restriction fragment length polymorphism (RFLP) on DNA extracted directly from stool samples. The SREHP gene was successfully amplified in 15 out of 20 E. histolytica-positive samples. Four out of the remaining five isolates did not amplify for the SREHP gene. Despite successful amplification of the SREHP gene in the fifth isolate, AluI digestion of the amplified PCR product revealed no bands. As a result, all five samples were excluded from the study. Twelve different profiles were obtained from the 15 successfully amplified isolates. Thus, demonstrating extensive genetic variability and reinforcing the argument that E. histolytica has an extremely polymorphic genetic structure. Despite the sample size limitation, a finding in the study was the occurrence of one profile common to one Indian isolate while another profile common to one Pakistani isolate; indicating the possibility of clonal infection. Furthermore, we found one isolate from a Bangladeshi expatriate identical to 2 asymptomatic Bangladeshi isolates reported in an earlier study. No clear association between the different genotypes and the study population demographics was noted. The results also indicated the possibility of strains clustering by region.

Detection and molecular characterisation of Giardia lamblia genotypes in Sharjah, United Arab Emirates.

BACKGROUND: No data are available on Giardia lamblia genotypes in the United Arab Emirates (UAE). This study aimed to identify G. lamblia from DNA extracted from human stool samples to gain information on its prevalence and to perform molecular analysis on isolates collected from expatriates from different localities residing in Sharjah, UAE. METHODS: In total, 111 healthy expatriates residing in Sharjah were screened for G. lamblia using nested PCR amplification of the small subunit ribosomal RNA (ssu-rRNA) gene. Positive samples were genotyped using a nested PCR amplifying the triosephosphate isomerase (tpi) gene to differentiate between the two human assemblages (A and B). A subset of the PCR products (n=23) were sequenced and their phylogenetic relationships were determined. RESULTS: Of the 111 participants, 67 (60.4%) were identified as positive for the ssu-rRNA gene. When genotyped for the tpi gene, 18.9% (21/111) were of assemblage A, 17.1% (19/111) belonged to assemblage B and 5.4% (6/111) showed patterns compatible with mixed infections. A strong correlation between the presence of diarrhoea and assemblage B was observed (χ(2)=10.553; p=0.001). Moreover, an association was also observed between mixed infections (A+B) and diarrhoea (χ(2)=8.899; p=0.003). No correlation between age, gender and geographic origin of the infected individual was noted. Phylogenetic analysis showed three clusters for the tpi gene. No relationship between the clusters and the origin of samples was noted. CONCLUSION: This study is the first to determine the infection rate and genotypic composition of Giardia in Sharjah, UAE.

Differential detection of Entamoeba histolytica, Entamoeba dispar and Entamoeba moshkovskii in fecal samples by nested PCR in the United Arab Emirates (UAE).

Amoebiasis is one of the most important infectious diseases afflicting mainly tropical and subtropical countries. This study was carried out in the Sharjah Emirate, UAE in order to accurately detect and differentiate Entamoeba histolytica, Entamoeba dispar and E. moshkovskii in fecal samples collected from the Sharjah municipality public health clinic by ELISA and nested polymerase chain reaction (PCR). One hundred and twenty specimens were examined and the PCR was positive for E. histolytica, E. dispar and E. moshkovskii (collectively referred to as Entamoeba complex) in 19.2% (23 out of 120). Of those, 10% (12/120) were mono - infection with E. histolytica; 2.5% (3/120) with E. dispar; and 2.5% (3/120) E. moshkovskii. The nested PCR also detected mixed infections by both E. histolytica and E. dispar in 3.3% (4/120) and E. dispar and E. moshkovskii in 0.8% (1/120). The TechLab ELISA kit failed to detect E. histolytica in any of the E. histolytica PCR positive samples. Overall, the percentage of E. histolytica including those found in mixed infections was 13.3% (16/120). Compared to nested PCR, microscopy was found to have an overall sensitivity of 52.2% and a specificity of 75.2% for detection of Entamoeba complex. The present study indicates that E. histolytica is present in the UAE with an average incidence rate of 13.3%. However, larger studies need to be conducted in order to confirm these findings. We propose the use of PCR in both the routine diagnosis of amoebiasis and epidemiological survey in the UAE.

The state of antibody therapy.

Therapeutic antibodies are widely used in the treatment of various diseases and disease conditions, including cardiovascular diseases, autoimmune disorders, malignancies, and infections. With at least 23 therapeutic agents currently in clinical use and a successful business generating large revenues, major technological advances are now in place to improve the specificity and efficacy of those antibodies already in the market and also generate new, safe and effective macromolecules for the treatment of other ailments. This review provides a summary of the current state of antibody therapy, highlights and discusses recent developments in the field of antibody-based therapeutics production, combination therapy and shows the status of some of the agents that are in clinical trial.