Late benefits 10-18 years after drug therapy for infection with Schistosoma haematobium in Kwale District, Coast Province, Kenya.

Late benefits of remote antischistosomal therapy were estimated among long-term residents of an area with high transmission of Schistosoma haematobium (Msambweni, Kenya) by comparing infection and disease prevalence in two local adult cohorts. We compared 132 formerly treated adults (given treatment in childhood or adolescence > or = 10 years previously) compared with 132 age- and sex-matched adults from the same villages who had not received prior treatment. The prevalence of current infection, hematuria, and ultrasound bladder abnormalities were significantly lower among the previously treated group, who were found to be free of severe bladder disease. Nevertheless, heavy infection was equally prevalent (2-3%) in both study groups, and present rates of hydronephrosis were not significantly different. Therapy given in childhood or adolescence appears to improve risk for some but not all manifestations of S. haematobium infection in later adult life. Future prospective studies of continued treatment into adulthood will better define means to obtain optimal, community-based control of S. haematobium-related disease in high-risk locations.

Large-scale, polymerase chain reaction-based surveillance of Schistosoma haematobium DNA in snails from transmission sites in coastal Kenya: a new tool for studying the dynamics of snail infection.

Levels of prepatent Schistosoma haematobium infection were monitored in intermediate host snails (Bulinus nasutus) collected from transmission sites in coastal Kenya, using a polymerase chain reaction (PCR) assay amplifying the Dra I repeated sequence of S. haematobium. The timing and number of prepatent and patent infections were determined for each site and, where the time of first appearance was clear, the minimal prepatent period was estimated to be five weeks. High, persistent, prepatency rates (range = 28-54%), indicated a significant degree of repeated area contamination with parasite ova. In contrast, rates of cercarial shedding proved locally variable, and were either low (range = 0.14-3.4%) or altogether absent, indicating that only a small proportion of infected snails reach the stage of cercarial shedding. Given the apparently strong focal effects of environmental conditions, implications of these new data are discussed regarding the estimation of local force of transmission and the design of control activities.

Randomized comparison of low-dose versus standard-dose praziquantel therapy in treatment of urinary tract morbidity due to Schistosoma haema tobium infection.

At present, anthelmintic therapy with praziquantel at a dose of 40 mg/kg of body weight is the recommended treatment for control of urinary tract morbidity caused by Schistosoma haematobium. Although this standard regimen is effective, drug cost may represent a significant barrier to implementation of large-scale schistosomiasis control programs in developing areas. Previous comparison trials have established that low-dose (20-30 mg/kg) praziquantel regimens can effectively suppress the intensity of S. haematobium infection in endemic settings. However, the efficacy of these low-dose regimens in controlling infection-related morbidity has not been determined in a randomized field trial. The present random allocation study examined the relative efficacy of a 20 mg/kg dose versus a 40 mg/kg dose of praziquantel in control of hematuria and bladder and renal abnormalities associated with S. haematobium infection in an endemic area of Coast Province, Kenya. After a nine-month observation period, the results indicated an advantage to the standard 40 mg/kg praziquantel dose in terms of reduction of infection prevalence and hematuria after therapy (P < 0.01 and P < 0.005, respectively). However, the two treatment groups were equally effective in reducing structural urinary tract morbidity detected on ultrasound examination. We conclude that in certain settings, a 20 mg/kg dose of praziquantel may be sufficient in providing control of morbidity due to urinary schistosomiasis in population-based treatment programs.

Low heritable component of risk for infection intensity and infection-associated disease in urinary schistosomiasis among Wadigo village populations in Coast Province, Kenya.

To estimate their heritable component of risk for Schistosoma haematobium infection intensity and disease, we performed a community-based family study among an endemic population in coastal Kenya. Demography and family linkages were defined by house-to-house interviews, and infection prevalence and disease severity were assessed by standard parasitologic testing and by ultrasound. The total population was 4,408 among 912 households, with 241 identified pedigree-household groups. Although age- and sex-adjusted risk for greater infection intensity was clustered within households (odds ratio = 2.7), analysis of extended pedigree-household groups indicated a relatively low heritability score for this trait (h2 = 0.199), particularly after adjustment for common household exposure effects (adjusted h2 = 0.086). Statistical evidence was slightly stronger (h2 = 0.353) for familial clustering of bladder morbidity, with an adjusted h2 = 0.142 after accounting for household exposure factors. We conclude that among long-established populations of coastal Kenya, heritable variation in host susceptibility is low, and likely plays a minimal role in determining individual risk for infection or disease.

Effects of oropharyngeal/buccal insulin on glucose levels in alloxan-induced diabetic rabbits: clinical implications.

The effect of oropharyngeal administration of insulin lente (BP, USP) on alloxan-induced diabetic rabbits was investigated. In mild cases of hyperglycaemia (below 500 mg/dl), a buccal dose of 100 IU was able to produce significant reduction in blood glucose levels over seven hours, as compared with diabetic animals during the same period. As much as 60% reduction in glucose level from the starting level could be achieved. However, at very high levels of hyperglycaemia (above 500 mg/dl), this regimen failed to produce normoglycaemia although it rendered the animal tolerant to high levels of glucose. This mode of administration of insulin did not produce hypoglycaemia in any of the animals: the blood levels in the mildly diabetic animals were reduced to normoglycaemia without progressing into the hypoglycaemic state. The administration of insulin to normoglycaemic rabbits by this route did not produce any reduction in glucose levels. This preliminary report suggests that a noninvasive oropharyngeal route may be an alternative for the clinical management of insulin and non-insulin dependent diabetes mellitus in man.

Cross-reactive studies in visceral leishmaniasis: comparison of antigens of some Leishmania species in Kenya.

Little is known about the common antigens of the various strains of Leishmania in Kenya, and their possible role in immunity to disease. Kenyan isolates of Leishmania donovani, L. Major and L. tropica were cultured, crude antigens prepared and electrophoresced in sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). Immunoblots by pooled sera from cutaneous and visceral leishmaniasis patients revealed common antigens within the 110-116kD, 70kD and the 63kD ranges. Only the 112-116kD antigens from L. major strains were reacted to by both cutaneous and visceral leishmaniasis patient sera. Sera from normal individuals living in an endemic area for leishmaniasis also showed reactivity to the 116kD antigen. We suggest that these common antigens may be of value in future vaccine studies

Trioxolanes: A new generation of compounds with wide-ranging activities.

Direct biological activity of a 1,2,4-trioxolane derivative was assessed in vitro using bacteria and fungi causing common infections. The product was found to be uniformly active against all organisms tested. In addition, it is active against certain tumour cells and protozoa and is also an immunomodulator. These observations are discussed in the light of the product's potential use in the clinical management of conditions in which its use is indicated.

Visceral leishmaniasis : activation of human T-lymphocytes by two specific Leishmania antigens.

T cell responses to a specific Leishmania antigens, 70kD and 116kD were investigated in individuals from an endemic area for leishmaniasis. Peripheral blood mononuclear cells were obtained from 38 individuals (24 test an d14 controls) and T cell responses to phytohaemaglutinin (PHA), Concanavalin A (ConA) and the specific Leishmania antigens were examined. PHA and Con A-induced responses were all positive in both the test and control groups. Eighteen out of 24 individuals with previous history of visceral leishmaniasis and 12 out of 14 normal individuals residing in the endemic areas responded to the 70kD antigen. In contrast, all the eight normal individuals all the eight normal individuals from a non-endemic area for leishmaniasis did not responded, indicating that cellular responses to the 70kD antigen are specific for Leishmanai spp. The 116kD antigen, on the other hand, exhibited poor specificity: about 30% of the individuals with a previous history of leishmaniasis did not respond to this antigen. A significant proportion of the population from an endemic area, but with no history of visceral leishmaniasis, responded to the 70kD antigen. This is an indicator of a prior exposure to Leishmania parasite and is consistent with previous studies which have shown that subclinical infections of visceral leishmaniasis do occur in such areas. Results from the present study suggest that the 70kD antigen is a strong candidate for vaccine development.

Mitochondrial DNA control region sequences from Nairobi (Kenya): inferring phylogenetic parameters for the establishment of a forensic database.

Large forensic mtDNA databases which adhere to strict guidelines for generation and maintenance, are not available for many populations outside of the United States and western Europe. We have established a high quality mtDNA control region sequence database for urban Nairobi as both a reference database for forensic investigations, and as a tool to examine the genetic variation of Kenyan sequences in the context of known African variation. The Nairobi sequences exhibited high variation and a low random match probability, indicating utility for forensic testing. Haplogroup identification and frequencies were compared with those reported from other published studies on African, or African-origin populations from Mozambique, Sierra Leone, and the United States, and suggest significant differences in the mtDNA compositions of the various populations. The quality of the sequence data in our study was investigated and supported using phylogenetic measures. Our data demonstrate the diversity and distinctiveness of African populations, and underline the importance of establishing additional forensic mtDNA databases of indigenous African populations.

Ethyleneglycol-Bis-((-aminoethyl ether) N,N,N(1),N(1), -Tetraacetic acid (EGTA) inhibits Leishmania donovani in vitro.

Exposure of Leishmania donovani culture promastigotes to ethyleneglycol-bis-((-aminoethyl ether) N,N,N(1),N(1),-tetraacetic acid (EGTA) concentrations of between 0.2 to 1.6 mg/ml significantly inhibited their growth, though the different concentrations did not significantly differ between themselves on their effect on promastigotes in cell free media. EGTA concentrations of between 0.05 and 0.1 mg/ml were non-toxic to mouse peritoneal macrophages in vitro. Treatment of L. donovani-infected macrophages with EGTA at concentrations of 0.05, 0.1 and 0.2 mg/ml contributed significantly to a decline in amastigote parasite-loads in the macrophages. The higher the chelator concentration within the acceptable toxic levels for macrophages, the greater was the rate at which parasites were cleared from the macrophages. It is speculated that EGTA chelates manganese from phosphoenol pyruvate (PEP) carboxykinase, a TCA-rate limiting enzyme in the metabolism of Leishmania parasites. A manganese-complex is also probably used by these parasites as a defense mechanism against oxygen-derived radicals. Chelation of manganese would destabilise PEP carboxykinase, and therefore severely interfere with the parasite metabolism. All these factors would render the Leishmania parasite susceptible to digestion in the lysosomal vacuoles of the macrophage, hence the observed significant reduction in parasite-loads of L. donovani-infected EGTA-treated macrophages in vitro. These results suggest an exciting future potential use of chelators in the experimental chemotherapy of visceral leishmaniasis.

Isolation and characterization of flagellates from rodents and canids in Masinga, Machakos District, Kenya.

A total of 728 animals comprising of 633 rodents and 95 canids were examined for leishmanial parasites. Flagellates were isolated from 67 out of 111 (60.4%) Acomys subspinosus (spiny mouse), 12 out of 143 (8.4% ) Mastomys natalensis (multimammate rat), 2 out of 50 (4.0%) Lemniscomys striatus (striped mouse), 2 out of 6 (33.3%) Herpestes sanguineus (slender mongoose), 1 of 1 Helogale parvula (dwarf mongoose) and 1 out of 84 Canis familiaris (domestic dog). All isolates were characterized by Isoenzyme analysis using nine enzymes, namely, malate dehydrogenase (MDH), phosphoglucomutase (PGM), glucose phosphate isomerase (GPI), isocitrate dehydrogenase (ICD), nucleoside hydrolase (NH), glucose 6-phosphate dehydrogenase (G6PD), malic enzyme (ME), 6-phosphogluconate dehydrogenase (GPGD) and mannose phosphate isomerase (MPI). Enzyme profiles of these isolates were compared with those of five WHO Leishmania reference strains and five well characterized rodent trypanosomes of the subgenus Herpetosoma. The profiles of the isolates were found to be different from those of the Leishmania and Trypanosoma reference strains but the parasites were morphologically similar to rodent trypanosomes. These results suggest that Leishmania parasites were not among the isolates. The enzymes profiles of the three mongoose isolates were identical but differed from profiles of isolates from rodents and dog. This is the first time in Kenya that a high prevalence of nonpathogenic trypanosomes is reported in rodents and canids. From the epidemiological point of view, these trypanosomes must be differentiated from the pathogenic species of trypanosomes and Leishmania that infect man and other animals. The results of this study suggest that rodents do not seem to play a role as reservoirs of Leishmania parasites in Masinga Location, Kenya.

Screening of metal ion chelators against Leishmania donovani-infected Syrian hamsters.

Leishmania donovani-infected Syrian hamsters were treated intraperitoneally with 0.23 mmoles/kg/day of EDTA, EGTA, HEEDTA and 100 mg/kg/day of Pentostam R. The control group received 0.1 ml of phosphate buffered saline. After 30 days of treatment, the animals were sacrificed. Of the Pentostam-treated animals, 5 out 6 had negative spleen cultures, while all the chelator and PBS-treated ones yielded parasites. While all the Pentostam-treated animals had negative bone marrow cultures, only 1 out of 6 HEEDTA-treated hamsters yielded parasites. Spleen, liver and bone marrow parasite- loads calculated from chelator-treated animals were consistently significantly higher than for Pentostam-treated animals. These results suggest that although metal ion chelators have some antileishmanial potential, their in vivo activity against L. donovani is low compared to Pentostam.

Comparison of Giemsa and acridine orange stains for the diagnosis of Leishmania donovani in biopsies of infected hamsters.

Identical impression smears of spleen, liver and bone marrow biopsy materials from Leishmania donovani-infected hamsters were stained using either acridine orange or Giemsa. Spleen parasite-loads calculated from the two stains for identical biopsy material were significantly different from each other. However, liver and bone marrow parasite- loads calculated from either Giemsa-stained or acridine orange-stained biopsies were not significantly different from each other. This study has shown that acridine orange, which is a quick and simple technique, has great potential in the diagnosis of kala-azar when liver and bone marrow biopsies are used.

Pristane (2,6,10,14-Tetramethyl-pentadecane) inhibits disease progression in Leishmania-infected Balb/c mice.

The course of Leishmania infection in pristane-primed BALB/c mice infected with either Leishmania major or Leishmania donovani was examined. Pristane-primed L. donovani infected mice had spleen parasite-loads that were 13 times less than controls. Likewise pristane-primed L. major infected animals had significantly smaller footpad lesion areas than controls. Pristane-primed mice had an atypical haematology compared to controls. To the best of our knowledge, this is the first report to demonstrate that pristane inhibits progression of disease in Leishmania-infected BALB/c mice.

Establishment of an appropriate inoculum dose of Leishmania donovani promastigotes required to establish a visceral infection in laboratory animal rodent models.

Syrian hamsters and BALB/c mice were inoculated intraperitoneally with various doses of stationary phase Leishmania donovani promastigotes derived from primary, secondary and tertiary cultures. Axenic derived amastigotes from a tertiary culture and mass-culture derived promastigotes from primary, secondary, and tertiary cultures were also used. Animals were sacrificed after 30 days incubation period and parasite-loads quantified from Giemsa stained spleen smears. A primary inoculum dose of 1 x10(8) was found to be the most appropriate in effecting a visceral infection. This parasite dose resulted in a spleen parasite-load of 10-20 amastigotes per field of microscope view at x1,000 magnification. Those involved in candidate vaccine molecules or experimental drugs against kala-azar will find these results useful.

Increased ratio of tumor necrosis factor-alpha to interleukin-10 production is associated with Schistosoma haematobium-induced urinary-tract morbidity.

Bladder and kidney disease, which affect approximately 25%-30% of subjects infected with Schistosoma haematobium, are mediated by T cell-dependent granulomatous responses to schistosome eggs. To determine why only some infected subjects develop disease, we examined the hypothesis that infected Kenyan subjects with ultrasound-detected urinary-tract morbidity (n=49) had dysregulated cytokine production leading to enhanced granulomatous responses, compared with subjects of similar age and intensity of infection without morbidity (n=100). Peripheral blood mononuclear cells from subjects with morbidity produced 8-fold greater levels of egg antigen-driven tumor necrosis factor (TNF)-alpha and had a 99-fold greater mean TNF-alpha:interleukin (IL)-10 ratio, compared with subjects without disease. No differences in cytokine response to non-egg-derived schistosome antigens were observed between groups. Subjects with morbidity had increased TNF-alpha production in response to endotoxin, suggesting an innate hyperresponsiveness. These results indicate that increased TNF-alpha production, relative to that of IL-10, is associated with developing bladder-wall morbidity with S. haematobium infection.