Onchocerciasis is a blindness-causing disease caused by a nematode called Onchocerca volvulus that is transmitted by Simulium blackflies. The disease is a major epidemiological problem among rural communities living in close proximity to rivers in some population in Sub-Saharan Africa. Recent studies identified Ghana to be a treat of recrudescence of onchocerciasis in neighboring countries. This thesis applies spatial models, predicts, and assesses population at risk of onchocerciasis in Ghana. It also evaluates the disease endemicity in Burundi in order to test the models applied in Ghana. Onchocerciasis prevalence data spanning a period of 2004 (Ghana) and 1985-1992 (Burundi) were integrated together with biophysical variables in a GIS. Next, modeling of the spatial risk of onchocerciasis was based on the principal component analysis (PCA) regression models. The final predictive spatial models represent the risk of the disease. The spatial models showed potential biogeographic zones and epidemiological patterns of onchocerciasis in relation to village settlements that are at risk. Also, the risk of onchocerciasis increased with the proximity to the rivers. The estimated population at risk in Ghana in 2010 was 5,211,808 people (or 21.36% of the total population) and 235,032 people in Burundi (or 2.8% of the total population). Findings from this study can help in the effective design of preventive control measures of the risk of recrudescence of the disease and safeguard the achievements of the OCP and APOC programs.

Le Programme africain de lutte contre l'onchocercose (APOC) et le Programme mondial d'élimination de la filariose lymphatique (GPELF), basés respectivement sur des traitements de masse par ivermectine et par une combinaison d'ivermectine et d'albendazole, sont des succès indéniables. Cependant, en Afrique centrale, région endémique pour la loase, les opérations de lutte sont fortement entravées du fait de la survenue possible d'effets secondaires graves induits par l'ivermectine chez les individus présentant plus de 30.000 microfilaires de Loa loa par mL de sang. Les résultats remarquables de l'APOC ont conduit récemment le programme à afficher un objectif plus ambitieux que celui défini initialement (l'élimination de la maladie comme problème de santé publique) : celui d'une élimination de la transmission. Les objectifs d'élimination d'APOC et du GPELF rendent nécessaires la réalisation d'une cartographie de la filariose lymphatique et de l'onchocercose hypoendémique en Afrique centrale, et imposent de développer des stratégies de lutte alternatives dans les zones coendémiques avec la loase. Nos travaux apportent des éléments nouveaux concernant l'épidémiologie de la filariose lymphatique en Afrique centrale. La distribution très focale de la maladie et les facteurs de risque particuliers que nous avons identifiés devraient être pris en compte pour déterminer l'échelle utilisée pour la réalisation de la cartographie. Par ailleurs, nous avons observé que le test ICT utilisé pour cartographier la filariose lymphatique pouvait se positiver en cas de forte microfilarémie à Loa loa (réaction croisée), ce qui va constituer un défi important pour les programmes de lutte. Nos travaux ont aussi permis de développer des stratégies alternatives permettant de lancer des programmes de lutte dans des zones de coendémie avec L. loa. Ainsi, nous avons participé au développement d'une technique permettant de dépister (et d'exclure des traitements de masse) les individus à risque d'effets secondaires graves post-ivermectine. D'autre part, nous avons montré que des traitements semestriels par albendazole seul pourraient constituer une alternative, applicable en zone de loase, au traitement standard de la filariose lymphatique. Concernant le diagnostic, nous avons montré l'intérêt qu'il y avait à lire les tests de diagnostic de la filariose lymphatique de manière semi-quantitative. Enfin, concernant la loase, nous avons étudié les relations existant, au niveau individuel, entre la microfilarémie à Loa et les antécédents d'œdème de Calabar et de passage sous-conjonctival du ver adulte. / The African Program (APOC) and the (GPELF), relying on the mass drug administration of ivermectine or of a combination of ivermectin and albendazole, respectively, are undeniably successful. Nonetheless, in Central Africa where loiasis is endemic, control operations are hampered by the possible occurence of ivermectine-induced severe adverse events in individuals harbouring more than 30 000 microfilaria of Loa loa per mL whole blood. The outstanding results obtained by APOC have recently led the programme to adopt a more ambitious goal than originally defined (elimination of the disease as a public health concern) : eliminating transmission. The elimination objectives of APOC and of the GPELF arise the need for mapping lymphatic filariasis and hypoendemic onchocerciasis areas in Central Africa, and strenghten the need to develop control strategies for loiasis coendemic areas. Our researches bring new insight into the epidemiology of lymphatic filariasis in Central Africa. The highly focal distribution of the disease, and the risk factors that we identified should be accounted for when defining the scale used for mapping processes. Furthermore, we observed that the immunochromatographic card test (ICT) used for mapping lymphatic filariasis might display false positive result in case of high L. loa microfilarial density (cross reaction), which will constitute a challenge for control programmes. Our work also allowed to develop alternative strategies for launching control programmes in areas of coendemy with L. loa. We participated in the developement of a technique to test (and exclude from mass drug administration) the individuals at risk of post-ivermectin severe adverse events. Besides, we showed that a semiannual mass drug administration of albendazole alone was deemed to be a suitable alternative strategy to standard lymphatic filariasis treatment applicable in loiasis endemic areas. As for the diagnosis, we highlighted the interest of semi-quantitative reading of diagnostic tests for lymphatic filariasis. Eventually, we studied the relation between the microfilaremia of L. loa and the histories of Calabar oedema and of sub-conjonctival migration of the adult worm, at the individual level.

No description available.

Ivermectin (IVM) is the only safe drug for mass-treatment of onchocerciasis. IVM-resistance has been reported in gastrointestinal nematode parasites of animals. A reduction in response to IVM in Onchocerca volvulus could have significant consequences for the onchocerciasis control programs. Over the last few years, studies have reported genetic selection or reduced responses to IVM in some O. volvulus populations. The risk of a recrudescence of the disease was recently reported with the emergence of resistant adult parasite population in Ghana. It is important to understand the effects of IVM on O. volvulus populations to be able to identify genetic markers to follow IVM selection in the field. In this study, O. volvulus samples were derived from a clinical trial in Cameroon, in which patients were sampled before, and following three years (1994-1997) of IVM treatments. There were four treatment groups: 150mug/kg (1xp.a. or 4xp.a.) and 800mug/kg (1xp.a. or 4xp.a.). DNA from macrofilariae was genotyped for beta-tubulin and P-glycoprotein-like protein (PLP) gene, as well as two control genes and other loci. Reproductive organs of female worms were analyzed by microscopy. A correlation was established between the reproductive status of the female worms and beta-tubulin genotype with the beta-tubulin heterozygous female worms being less fertile than the homozygous female worms. This disadvantage in fertility seemed to disappear after repeated exposure with IVM. We have found evidence that repeated IVM treatment selects for specific alleles of beta-tubulin and PLP. We observed that IVM selection pressure was higher in the female worms than in the male worms. Additionally, loss of polymorphism and selection pressure were higher following thirteen three-monthly doses of IVM compared to annual doses of IVM. Moreover, we found evidence of excess of homozygosity in O. volvulus population, that may be caused by non-random mating and/or subdivision population, which may have implication for the control program. PLP and beta-tubulin genes appear to be promising DNA markers for field use to follow IVM selection. In this perspective, alternative control measures could be considered locally in regions where gene selection is apparent, reducing the likelihood that IVM resistance would develop further and spread.

Onchocerciasis, commonly known as "River blindness" is a disease affecting over 37 million people, worldwide. It is caused by the parasitic nematode Onchocerca volvulus and transmitted by the blackfly vector of the genus Simulium. The drug ivermectin (IVM) is the principal means of controlling the disease. As a result of recent reports on sub-optimal response to ivermectin and genetic selection in O. volvulus, we carried out a 21 month epidemiological study to investigate the response of O. volvulus to repeated rounds of IVM treatments in 2501 subjects from 19 Ghanaian communities that have received between 6 and 18 annual treatments and one IVM naive community. Skin microfilaria (mt) assessments were done before IVM treatment and at days 30, 90, 180 and 364 post-IVM treatment. At day 90 after the second IVM treatment, nodulectomies were carried out on 140 patients and embryogrammes constructed on female worms. We found IVM is still an effective microfilaricide, with efficacy of 98-100%. However, its effect on adult worm fertility has been reduced. Day 90 and 180 post-treatment showed significantly higher (p<0.05) skin mf repopulation of 7.1% to 53.9%, and >100% of pretreatment counts at day 364 post-treatment in four communities compared with the other six communities, which had <80% of pretreatment mf counts on day 364. From these results we classified the 10 communities into good IVM response (four communities), intermediate IVM response (two communities), poor IVM response (three communities), and the previously IVM naive community. Nodule and worm viability and worm densities were significantly higher (p<0.05) in the poor response communities compared with the good response communities, with the intermediate falling between the two. Embryogramme analysis showed significantly higher reproductive activity and output in worms from poor response communities with up to 41% of females having live stretched mf in utero compared with good response communities which had no intra-uterine stretched mf. These results show evidence of lack of sustained response of adult O. volvulus to IVM in the poor response communities, manifested as a rapid return to fertility after IVM treatment. We conclude that IVM resistance is emerging in onchocerciasis and is manifested as a loss of effect of IVM on suppression of parasite reproduction. / Beta tubulin isotype 1 gene has been shown to be linked to IVM treatment and selection in O. volvulus and veterinary nematodes. Genetic analysis of the full length genomic DNA sequence of beta-tubulin from worms obtained in the three IVM response categories and IVM naive community showed single nucleotide polymorphisms (SNPs) at 24 sites on the entire 3696 bp. The frequencies of eight SNPs were significantly different (p< 0.05) between the poor response communities and the good response/naive communities. Four SNPs, 183 T/G, 1188 T/C, 1309 CIT and 1545 A/G resulting in a genotype configuration GG/CC/TT/GG (183/1188/1309/1545) was significantly higher in the poor IVM response communities than the other communities. The phenotypic and genotypic analyses are consistent with a conclusion that IVM resistance has been selected. These four SNPs could be used to develop a genetic marker for early detection of IVM resistance. This study has shown for the first time that IVM resistance is emerging in Onchocerca volvulus and that there are genetic changes associated with IVM resistance which could be used for epidemiological monitoring for emerging resistance.

Onchocerca volvulus is a parasitic filarial nematode responsible for human onchocerciasis, a disease commonly known as "River Blindness". Although there are no well documented cases of ivermectin resistance in O. volvulus, reports of suboptimal responses to ivermectin have appeared. The purpose of this thesis was to examine genetic polymorphisms in O. volvulus and to determine whether there was genetic evidence of ivermectin selection on O. volvulus genes. Analysis of 17 genes from O. volvulus was undertaken in two populations of worms, either from ivermectin-naive patients or from patients who had been repeatedly treated with ivermectin annually. In 14 of the genes no differences in genetic polymorphism were found (although polymorphisms were identified). However, chi square analysis (chi2=0.05) indicated significant differences in allele frequencies for a P-glycoprotein, a beta-tubulin and a putative dyf=8 gene. Analysis of the O. volvulusbeta-tubulin alleles identified three amino acid substitutions in the H3 region with ivermectin selection. Microtubules play a key structural role in the formation of neurons, and in ivermectin-resistant Haemonchus contortus, amphidial neurons show distorted microtubule bundles. Polymerization and depolymerization assays of the recombinant O. volvulus beta-tubulin alleles showed interesting differences between the polymerized tubulin using the two different alleles. It is speculated that similar differences could cause the disorganization of the microtubules identified in the amphidial neurons in ivermectin resistant H. contortus. In addition to the coding mutations, a 24 bp deletion in the adjacent intron to the H3 was detected. A PCR diagnostic assay was developed to genotype individual macro- and microfilariae. Further analyses were conducted to investigate the possibility of a direct relationship between ivermectin and beta-tubulin. Data obtained from equilibrium dialysis experiments indicated that BODIPY FL ivermectin bound to purified O. volvulus alpha- and beta-tubulins. More interesting, non-fluorescent ivermectin and taxol competed with the BODIPY FL ivermectin. The work presented in this thesis provides evidence of genetic selection by ivermectin on O. volvulus and suggests a putative binding site for ivermectin on tubulin. These data provide novel information on ivermectin selection in O. volvulus and on the possible involvement of tubulin in ivermectin resistance.

p. 1-112 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-04-24T21:04:41Z No. of bitstreams: 1 11111111111.pdf: 829006 bytes, checksum: d72adf5912d3d4a5a6ab9659a04a516d (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-04T17:26:41Z (GMT) No. of bitstreams: 1 11111111111.pdf: 829006 bytes, checksum: d72adf5912d3d4a5a6ab9659a04a516d (MD5) / Made available in DSpace on 2013-05-04T17:26:41Z (GMT). No. of bitstreams: 1 11111111111.pdf: 829006 bytes, checksum: d72adf5912d3d4a5a6ab9659a04a516d (MD5) Previous issue date: 2008 / Introducción: El control de las infecciones causadas por geohelmintos está basado en la administración periódica de drogas antihelmínticas a los grupos de alto riesgo, particularmente a niños en edad escolar que viven en áreas endémicas. Existen datos limitados sobre la efectividad de tratamientos antihelmínticos periódicos a largo plazo en la prevalencia de infecciones por geohelmintos particularmente desde programas operacionales. Objetivo: El presente estudio investigó el impacto de 17 años de tratamiento en masa con un antihelmíntico de amplio espectro, la ivermectina, usada para el control de la oncocercosis, en la parevalencia e intensidad de infección por geohelmintos en niños escolares. Métodos: Un estudio transversal fue conducido en comunidades que han recibido tratamientos anuales o bianuales y comunidades adyacentes que no han recibido dicho tratamiento en dos cantones de la Provincia de Esmeraldas en Ecuador. Una única muestra de heces fue colectada de cada niño y fue examinada usando las técnicas de Kato Katz y por concentración con formol-éter. Datos sobre los factores de riesgo para las infecciones por geohelmintos fueron colectadas por medio de cuestionarios aplicados a los padres. Resultados: Un total de 3563 niños en edad escolar (6-16 años) de 31 comunidades tratadas y 27 comunidades no tratadas fueron investigados. El tratamiento con ivermectina tuvo un efecto significante en la prevalencia (ORadj= 0,06; IC 95%: 0,03-0,14) y en la intensidad de la infección (RPadj=0,28; IC 95%: 0,11-0,70) por Trichuris trichiura pero no se observó dicho efecto en la infección por Ascaris lumbricoides o uncinarias. Conclusión: Tratamientos con ivermectina anuales y bianuales por un periodo de alrededor de 17 años tuvieron un efecto significante en la infección por T. trichiura pero no sobre otras infecciones por geohelmintos. La adición de una segunda droga antihelmíntica, tal como el albendazol, sería necesaria para obtener un efecto a largo plazo en la infección por A. lumbricoides en áreas altamente endémicas. / Salvador

Onchocerca volvulus is a filarial parasite transmitted to humans by female Simulium spp. black flies. Infection with this parasite can cause blindness and severe skin disease among humans in Africa and the Americas. Enzyme-linked Immunosorbent Assay serological testing of OV-16 antigen is a diagnostic tool for determining effective elimination of the parasite. Programs typically rely on OV–16 ELISA to evaluate the progress towards interruption and/or elimination of disease by mass drug distribution of ivermectin and vector larvicidal control efforts. As elimination grows closer, monoclonal antibody positive controls for OV-16 ELISA become important to develop for Onchocerca testing due to the limited availability of pooled sera positive controls. Recent evaluation of laboratory designed OV-16 ELISA coating antigen by the Unnasch Lab (University of South Florida) showed that polymorphisms occurred which may alter the ability of the humanized monoclonal antibody to recognize the cognate antigen. With this development, it was important to evaluate these polymorphisms and isolate them for further testing against the standardized monoclonal antibody and positive sera to determine the effects antigenic polymorphisms could have on diagnostic testing. Upon evaluation, the polymorphisms did influence signaling when testing the monoclonal antibody. However, little effect on the recognition of the antigen was seen when different isoforms were evaluated against sera from O. volvulus infected individuals. Data suggest that the epitope recognized by the synthetically produced monoclonal antibody is not immuno-dominant in infected individuals.

No description available.

No description available.