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PubMed1994

Cytotaxonomy of the Simulium damnosum complex and description of new cytotypes in the Tukuyu focus, southwest Tanzania.

Larvae of Simulium damnosum complex collected from rivers draining Tukuyu onchocerciasis focus were chromosomally examined. Of the 970 larvae analysed, 910 were identified as Kiwira form, a newly described cytotype found in all S. damnosum larval habitats in the Tukuyu area, while 51 were classified as a new subpopulation, tentatively named as Kasyabone form. The F1 larval progeny obtained from wild caught human biting S. damnosum and reared in the laboratory were chromosomally examined. 509 F1 larvae from 70 females blood fed on human volunteers were identified as Kiwira form. As the main human-biting member of the complex in the Tukuyu area, and because some of the wild caught females had developing filarial larvae indistinguishable from those of Onchocerca volvulus, Kiwira form is thus incriminated as the local vector of onchocerciasis. These observations are discussed with respect to previous literature.

Animals↗
PubMed2001

Characterization and expression of enzymatically active recombinant filarial prolyl 4-hydroxylase.

The cuticle of parasitic nematodes consists primarily of a network of collagen molecules. The enzyme responsible for collagen maturation is prolyl 4-hydroxylase, making this enzyme a central activity in cuticle biosynthesis and a potentially important chemotherapeutic target. Adult and embryonic Brugia malayi are shown to be susceptible to inhibitors of vertebrate prolyl 4-hydroxylase, with exposed parasites exhibiting pathologies consistent with a disruption in cuticle biosynthesis. A full-length cDNA (Ov-phy-1) encoding a catalytically active alpha-subunit of Onchocerca volvulus prolyl 4-hydroxylase was isolated and characterized. The derived amino acid sequence of Ov-phy-1 encoded a peptide that was most similar to the two Caenorhabditis elegans prolyl 4-hydroxylase homologues and to the isoform II enzymes of vertebrates. Expressed sequence tag (EST) analysis and developmental polymerase chain reaction (PCR) studies demonstrated that Ov-phy-1 was expressed in L3 and adult parasites. The gene encoding the Ov-phy-1 open reading frame contained 11 introns, similar in structure to the gene encoding human prolyl 4-hydroxylase isoform I. Genomic Southern blot, EST and genomic PCR studies demonstrated that the O. volvulus genome contained between three and eight genes closely related to Ov-phy-1. Co-expression of Ov-phy-1 with the O. volvulus homologue of protein disulfide isomerase in a baculovirus system resulted in the production of enzymatically active O. volvulus prolyl 4-hydroxylase. In vitro production of enzymatically active O. volvulus prolyl 4-hydroxylase should facilitate identification of specific inhibitors of the parasite enzyme.

Amino Acid Sequence↗
PubMed1996

Met-11 of HLA class II DP alpha 1 first domain associated with onchocerciasis.

Human infection with the pathogenic tissue nematode Onchocerca volvulus may result in a spectrum of clinical manifestations or in a putatively immune condition. A methionine at amino acid position 11 of the HLA class II DP alpha 1 chain correlates with the occurring disease after infection (relative risk 3.3). The alternative alanine at position 11 is, conversely, associated with protection from disease ("relative protection' 3.5). DPA1*0301 is associated with the localized form of disease after O. volvulus infection.

Amino Acid Sequence↗
PubMed2006

Microfilarial distribution of Loa loa in the human host: population dynamics and epidemiological implications.

Severe adverse events (SAEs) following ivermectin treatment may occur in people harbouring high Loa loa microfilarial (mf) densities. In the context of mass ivermectin distribution for onchocerciasis control in Africa, it is crucial to define precisely the geographical distribution of L. loa in relation to that of Onchocerca volvulus and predict the prevalence of heavy infections. To this end, we analysed the distribution of mf loads in 4183 individuals living in 36 villages of central Cameroon. Mf loads were assessed quantitatively by calibrated blood smears, collected prior to ivermectin distribution. We explored the pattern of L. loa mf aggregation by fitting the (zero-truncated) negative binomial distribution and estimating its overdispersion parameter k by maximum likelihood. The value of k varied around 0.3 independently of mf intensity, host age, village and endemicity level. Based on these results, we developed a semi-empirical model to predict the prevalence of heavy L. loa mf loads in a community given its overall mf prevalence. If validated at the continental scale and linked to predictive spatial models of loiasis distribution, this approach would be particularly useful for optimizing the identification of areas at risk of SAEs and providing estimates of populations at risk in localities where L. loa and O. volvulus are co-endemic.

Adolescent↗
PubMed1993

Elevated antifilarial IgG4 antibody levels in microfilaremic and microfilaridermic Gabonese adults and children.

Immunologic analyses of sera from 47 selected individuals living in a mixed filariasis transmission zone in Gabon were carried out. Onchocerca volvulus, Loa loa, Mansonella streptocerca, and M. perstans are transmitted in this region. Based on parasitologic findings and age, the 47 individuals were stratified into four groups: microfilaria negative (Mf-) children (3-15 years old), Mf- adults (> 15 years old), microfilaria positive (Mf+) children and Mf+ adults. For descriptive purposes, the term microfilaria positive refers to individuals with skin and blood microfilariae. Antifilarial antibody titers were determined using an enzyme-linked immunosorbent assay with Dipetalonema viteae antigens. In general, children had higher titers of IgG antibodies than adults. For the IgG1, IgG2, and IgG3 subclass responses, both age and microfilarial status appeared to be important variables since Mf- children consistently had the highest titers whereas Mf- adults had the lowest titers. For the IgG4 antifilarial response, only the microfilarial status was an important variable. All Mf+ individuals had significantly higher levels of IgG4 antibody than Mf- individuals. Pooled sera of Mf- and Mf+ individuals reacted with similar O. volvulus antigens on Western blots. Control sera of individuals who did not reside in the study area, but who had single infections with L. loa or M. perstans, did not react with any O. volvulus antigens.

Adolescent↗
PubMed2004

Association between microfilarial load and excess mortality in onchocerciasis: an epidemiological study.

BACKGROUND: Infection with the parasitic filarial nematode Onchocerca volvulus can lead to severe visual impairment and ultimately blindness. Excess mortality has been noted among people with onchocerciasis, but it is not clear whether this effect is entirely due to blindness, or mediated by some more direct effects of the infection. METHODS: We assessed the relations between infection with O volvulus, visual acuity, and host mortality with data obtained by the Onchocerciasis Control Programme in West Africa from 2315 villages in 11 countries. FINDINGS: 297,756 people were eligible for follow-up, and accumulated 2,579449 person-years of follow-up from 1971 through 2001. 24,517 people died during this period; 1283 (5.2%) of these deaths were due to onchocerciasis. Mortality of the human host was significantly and positively associated with increasing microfilarial burden (p<0.00001), but not with blindness after adjustment for microfilarial load and other variables. Overall, after adjustment for microfilarial load and other variables, female individuals had a risk of death about 7.5% lower than males (p<0.00001). Rates of mortality peaked in the mid 1980s but generally decreased thereafter. INTERPRETATION: We have shown a direct relation between O volvulus microfilarial load and host mortality in a comprehensive dataset and in both sexes.

Adolescent↗
PubMed1998

[Entomologic study on the transmission of onchocerciasis in a forest-savanna transition area of Cameroon].

An entomological study was conducted in the basin area of middle Sanaga (Cameroon) in order to document the pattern of onchocerciasis transmission in a region where a high prevalence of infection had been recorded in villages located 30 km from the main rivers. The main vector of O. volvulus was found to be S. squamosum s.s. No breeding site was found in the small tributaries of the Sanaga and Mbam Rivers, and the dispersal of S. damnosum s.l. in the area thus appeared to be particularly high. The highest blackfly population densities were recorded during the long rainy season, and a second peak of density occurred along the Mbam River during the short rainy season. A seasonal variation in dispersal patterns was found at three of the four transects studied. The transmission of Onchocerca volvulus in the area occurred principally between January and May (i.e. at the end of the long dry season and the beginning of the short rainy season). Vector control operations might well reinforce the effect of ivermectin distributions in this onchocerciasis focus.

Animals↗
PubMed1995

The chemotherapy of onchocerciasis XX: ivermectin in combination with albendazole.

Ivermectin is a potent microfilaricide that also blocks microfilarial release while albendazole is toxic to all intrauterine stages. We investigated whether their combination would permanently sterilize the adult worms. In the first open phase, all 69 patients received 150 micrograms/kg of ivermectin. In the second double-blind phase one week later, 35 patients were randomized to receive 800 mg of albendazole with a fatty breakfast for three consecutive days while 34 patients received matching placebo tablets. Detailed clinical and laboratory examinations were done before treatment and were repeated at intervals over one year. Nodules were excised at three and six months. There was a rapid reduction in skin microfilariae, maximal at four weeks (99.9%). Counts increased subsequently and were between 11 and 18% of initial values at one year. Nodule histology showed no macrofilaricidal activity of the combination. A high proportion of the stretched intrauterine microfilariae were degenerate in both groups. Anterior chamber microfilarial counts were unchanged until day 18 and then fell successively. Low levels persisted in several patients at one year. Dead corneal microfilariae and corneal punctate opacities increased initially, fell with time and then disappeared in most patients. Systemic and ocular reactions were mild to moderate and biochemical abnormalities were minor. A pronounced posttreatment eosinophilia subsided by day 30. There was no significant difference between the two groups in clinical and laboratory tolerance or in alterations in skin and ocular parasites and no important differences in the effect on the adult worms. The combination of ivermectin with albendazole given one week apart is well tolerated but produces no additional effect against Onchocerca volvulus when compared to ivermectin given alone.

Adolescent↗
PubMedDate not supplied

Density-dependent parasite establishment suggests infection-associated immunosuppression as an important mechanism for parasite density regulation in onchocerciasis.

The modulation of human immune response by filarial parasites has yielded contradictory experimental findings and attracted much controversy. We address the unresolved question of acquisition, establishment and accumulation of Onchocerca volvulus by using a modelling approach that relates computer simulations to cross-sectional data concerning parasite burdens in 913 West African onchocerciasis patients. It is shown that the acquisition of O. volvulus is not constant with host age; instead, the analysis of age profiles of parasite burdens strongly indicate the operation of immunosuppressive processes within the human host, associated with the presence of adult parasites or microfilariae. It is suggested that these processes suppress immunity against incoming infective larvae (L3), which themselves act as an immune modulating component once they have successfully overcome the barrier of concomitant immunity. Suppression of parasite-specific immunity leads to parasite establishment rates which increase along with the parasite burden, but which hardly depend on hyperendemic annual transmission potentials. Children, still immunocompetent due to low parasite burdens, acquire 0.1-0.5 adult female parasites per year, whereas older people, immunosuppressed due to high burdens, acquire 2-4 adult female parasites per year. Differences in parasite establishment between the forest and the savannah strains of O. volvulus are quantified and dynamic aspects of density-dependent parasite establishment discussed.

Adolescent↗
PubMed2001

Combined benefits of annual mass treatment with ivermectin and cattle zooprophylaxis on the severity of human onchocerciasis in northern Cameroon.

We studied the effect of 10 annual distributions of ivermectin for control of human onchocerciasis on the reduction of Onchocerca volvulus transmission by Simulium vector flies. Prevalence and infection load in the human population decreased, whilst the annual biting rates (ABR) of the vector remained unchanged. The annual transmission potential of infective larvae of O. volvulus fell to 40% of the pre-intervention level, but was still sufficient to maintain endemicity. However, recent immigration of herds of nomadic cattle into the study area has diverted the flies from man to cattle, creating an additional zooprophylactic effect. The predominant transmission of the bovine filaria O. ochengi to man also provides some concomitant cross-protective immunity against further infestations with O. volvulus. The effects of ivermectin on O. volvulus, combined with the zooprophylactic effects of the increased cattle population, have produced a complex beneficial influence on the transmission of human onchocerciasis.

Animals↗
PubMed1994

Onchocerciasis in New York City. The Moa-Manhattan connection.

When faced with a patient with travel-associated dermatitis, clinicians often diagnose and treat for a suspected hypersensitivity reaction or infestation with an ectoparasite. We studied a small cluster of travelers from New York, NY, to the Moa River in Sierra Leone who developed dermatitis caused by Onchocerca volvulus. Our patients had relatively long stays in an endemic area and numerous bites by blackflies. Such patients represent a subset of travelers in whom dermatitis should prompt evaluation for onchocerciasis.

Adult↗
PubMedDate not supplied

A new focus of onchocerciasis in Mwanza District, Malawi.

Anecdotal information suggested that a new focus of onchocerciasis had recently developed in Mwanza in Malawi, a district not contiguous with Thyolo, the only district in Malawi with recognized autochthonous transmission. We carried out a survey of the northern half of Mwanza district, randomly selecting 62 villages for assessment. Two iliac crest skin snips were taken from 2215 residents over the age of 15 years; one-quarter had Onchocerca volvulus microfilariae. Prevalence increased with age and was higher overall among men than women. The age-adjusted prevalence among migrants from Thyolo was 31%. Among residents who had never been outside Mwanza, the gender-specific prevalences and microfilarial loads were similar. The intensity of infection was low. Autochthonous transmission of O. volvulus has thus been demonstrated in Mwanza and illustrates the possibility of the spread of the disease to new foci in Malawi and the surrounding countries, due to significant population shifts.

Adolescent↗
PubMed2005

Chemokines in onchocerciasis patients after a single dose of ivermectin.

Ivermectin treatment will effectively diminish microfilariae (Mf) of Onchocerca volvulus in the skin of patients, but therapy is associated with adverse host inflammatory responses. To investigate the association of proinflammatory chemokines with the intensity of infection and clinical adverse reactions, chemokine serum levels were measured in patients following ivermectin treatment (100 microg/kg, 150 microg/kg or 200 microg/kg) or placebo. The density of O. volvulus Mf per mg skin decreased by 85%, 97%, 97% and 90% at day 3, at month 3, month 6 and at 1 year post-ivermectin. The cutaneous T cell-attracting chemokine (CTACK/CCL27) was found highly elevated in onchocerciasis patients compared to infection-free European controls (P = 0.0004) and it did not change following ivermectin or placebo to 1 year post-therapy. The chemokine RANTES/CCL5 (regulated on activated and normally T cell-expressed) was similarly high in onchocerciasis patients and infection-free European controls; the RANTES/CCL5 levels did not change following treatment until 6 months post-therapy but were slightly elevated at 1 year post-therapy (P < 0.02). In contrast, the Th2-type chemoattractants, thymus and activation regulated chemokine (TARC/CCL17) and macrophage-derived chemokine (MDC/CCL22), were activated at 3 days post-ivermectin (P < 0.0001) to return to pretreatment or lower levels thereafter. The Th1-type chemoattractants, macrophage inflammatory protein (MIP)-1alpha/CCL3 and MIP-1beta/CCL4 were low before ivermectin treatment, but following clearance of microfilariae of O. volvulus their levels increased from 6 months post-therapy onwards (for both at 12 months post-therapy, P < 0.0001). The adverse reaction scores (RS) in treated patients increased significantly on day 3 (P < 0.02) while it remained unchanged in those who received placebo (P = 0.22); RS interacted with the microfilarial density (P = 0.01), but not with the dose of ivermectin or with the serum levels of MIP-1alpha/CCL3, MIP-1beta/CCL4, TARC/CCL17, MDC/CCL22 and CTACK/CCL27. Our observations suggest that following ivermectin, macrophages as well as memory Th2-type lymphocytes and B cells, attracted and activated by MDC/CCL22, TARC/CCL17 and CTACK/CCL27, may contribute to dermal immune responses and O. volvulus Mf killing and clearance. The transient changes of TARC/CCL17 and MDC/CCL22 were not associated with clinical adverse responses, and the later rise of MIP-1alpha/CCL3 and MIP-1beta/CCL4 showed a reactivation of Type 1 immune responses associated with persistent low levels of O. volvulus microfilariae and an expiring O. volvulus infection.

Adolescent↗
PubMed2005

Onchocerciasis-related epilepsy? Prospects at a time of uncertainty.

Epilepsy and onchocerciasis (river blindness) constitute serious public health problems in several tropical countries. There are four main mechanisms that might explain a relationship between these two diseases: (i) the presence of Onchocerca volvulus in the central nervous system; (ii) the pathogenicity of various O. volvulus strains; (iii) immunological mechanisms involving cross-reactive immunization or cytokine production during infection; and (iv) the triggering role of insomnia due to itching.

Animals↗
PubMed1993

Epidemiological studies of onchocerciasis in southern Benin.

We studied the prevalence of human onchocerciasis in four geographically different regions of the southern part of Benin in West Africa. In a total of thirteen villages 1596 individuals were examined for clinical and parasitological signs of onchocerciasis. Prevalence of microfilariae of Onchocerca volvulus in skin snips was 29% in region I (lower Oueme river), 64% in region II (Mono river), 56% in region III (upper Oueme river) and 70% in region IV (Okpara river). Based on endemicity criteria of the WHO regions II and IV were found to be hyperendemic, region III mesoendemic and region I hypoendemic for onchocerciasis. The community microfilarial load ranged from 4 mf/mg skin in the hypoendemic region to 10.5 mf/mg skin in the hyperendemic regions. The prevalence of nodules was 21% in region I, 30% in region II, 17% in region III and 41% in region IV. The overall prevalence of chronic onchocercal dermatitis was 12%. Of 689 individuals infected with O. volvulus 388 were treated with a single dose of ivermectin.

Adolescent↗
PubMed1998

Identification of a novel family of non-lysosomal aspartic proteases in nematodes.

A protein encoded by cDNAs from the human parasite Onchocerca volvulus and its homologs from Caenorhabditis elegans and Ancyclostoma caninum define a family of aspartic proteases that are most closely related to cathepsins D, but differ from them in lacking the N-glycosylation site known to be required for lysosomal targeting. The nematode proteins have a potential N-glycosylation site at the same position as mammalian cathepsins E and in common with these have atypically long N-terminal extensions. The literature implies that cathepsins E may be secreted, and adult female O. volvulus are known to secrete a specific inhibitor of aspartic proteases; we therefore predict that the protease is secreted as an enzyme-inhibitor complex.

Amino Acid Sequence↗
PubMed1998

Chemotherapy for onchocerciasis: results of in vitro experiments with promising new compounds.

An improved short-term in vitro culture system was used for the routine screening of hundreds of promising new compounds with the target organism, the filarial nematode Onchocerca volvulus. The most active leads were identified among the pyrimidinylguanidines, amidine derivatives, the imidazolinylhydrazones, thiosemicarbazone derivatives and thiadiazole derivatives. Single compounds of these leads demonstrated strong macrofilaricidal efficacy in minimum effective dose trials down to 0.1 microM and in experiments evaluating the minimum time of exposure after less than 6 h exposure. In the group of the pyrimidinylguanidines we found a significant correlation of structure and activity: change of a single side-group in the molecules had dramatic influence on compound activity. Most of the new compounds that were active on the macrofilariae did not show significant activity on microfilariae (mf) in in vitro trials. Only one compound with significant activity against female O. volvulus worms killed mf at very low concentrations. Some of the promising leads will be processed in further trials on a preclinical level with predictive cattle models.

Animals↗