A L Willingham

Muhimbili University of Health and Allied Sciences, Dār es Salām, Dar es Salaam, Tanzania

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Publications (79)190.79 Total impact

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    ABSTRACT: Foodborne diseases (FBDs) are a major cause of morbidity and mortality in the human population. Accurate information on the burden of FBDs is needed to inform policy makers and allocate appropriate resources for food safety control and intervention. Consequently, in 2006 the WHO launched an initiative to estimate the global burden of FBDs in terms of Disability Adjusted Life Years (DALYs). This review gives an update of the progress on evaluating the burden of foodborne parasitic diseases that has been generated by this study. Results to date indicate that parasitic diseases that can be transmitted through food make a substantial contribution to the global burden of disease.
    Trends in Parasitology 12/2013; · 5.51 Impact Factor
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    ABSTRACT: Porcine cysticercosis (PC) caused by the larval stage of a zoonotic tapeworm Taenia solium, is known to pose serious economic losses and public health risk among smallholder pig production communities. The present study was conducted to determine prevalence and associated risk factors for PC in smallholder pig production systems in Mbeya region, the major pig rearing region of Tanzania. A cross-sectional survey employing a random sample of 300 pig keepers from 30 villages of Mbozi and Mbeya Rural districts, Mbeya region were used to evaluate pig production systems and practices. Concurrently, 600 male and female pigs of different age categories were randomly selected and examined for PC using lingual examination method and antigen enzyme-linked immunosorbent assay (Ag-ELISA). The overall pig level PC prevalence in Mbozi district was 11.7% (95% CI=8.5-15.8%) and 32% (95% CI: 27-37.5%) based on lingual examination and Ag-ELISA, respectively. In Mbeya Rural district, the prevalences were 6% (95% CI: 3.8-9.3%) and 30.7% (95% CI: 25.8-36.1%) by lingual examination and Ag-ELISA, respectively. In Mbozi district 46% of the households were found infected (one or more infected pigs) and the corresponding figure was 45% for Mbeya Rural district. The agreement between lingual examination and Ag-ELISA was poor (κ<0.40). There were no significant differences in the prevalence of PC in different sex categories of pigs. Significant risk factors associated with PC prevalence were free roaming of pigs (OR=2.1; 95% CI=1.3-3.6; p=0.006), past experience of porcine cysticercosis in the household (OR=2.6; 95% CI=1.5-4.8; p=0.002), increased age of pig (OR=1.9; 95% CI=1.2-3.0), slatted raised floor in pig pen (OR=8.4; 95% CI=1.0-70.0), in-house origin of the pig (OR=1.6; 95% CI=1.1-2.5) and sourcing of water from rivers (OR=3.1; 95% CI=1.6-6.3; p<0.001) and ponds (OR=5.0; 95% CI=1.2-21.7; p=0.031). This study has clearly revealed a high sero-prevalence of PC in the study area, which imposes a major economical and public health burden to the smallholder pig farmers. The study also points to a number of important risk factors in smallholder pig management that may be addressed (e.g. confinement, quality of pens and water sources) in future interventions and educational campaigns for control of T. solium.
    Veterinary Parasitology 09/2013; · 2.38 Impact Factor
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    ABSTRACT: Taenia solium cysticercosis/taeniosis is emerging as a serious public health and economic problem in many developing countries. This study was conducted to determine prevalence and risk factors of human T. solium infections in Mbeya Region, Tanzania. A cross-sectional survey was conducted in 13 villages of Mbozi district in 2009. Sera of 830 people (mean 37.9±11.3 years (SD); 43% females) were tested for circulating cysticerci antigen (Ag-ELISA) and antibody (Ab-ELISA). A subset of persons found seropositive by Ag-ELISA underwent computed tomography (CT) scan of the brain for evidence of neurocysticercosis. Stool samples from 820 of the same participants were tested for taeniosis by copro-antigens (copro-Ag-ELISA) and formol-ether concentration technique. Cases of T. solium taeniosis were confirmed serologically by EITB assay (rES38). A questionnaire was used for identification of risk factors. Active cysticercosis by positive Ag-ELISA was found in 139 (16.7%) persons while anti-cysticercal antibodies were detected in 376 (45.3%) persons by Ab-ELISA. Among 55 persons positive for Ag-ELISA undergoing CT scan, 30 (54.6%) were found to have structures in the brain suggestive of neurocysticercosis. Using faecal analysis, 43 (5.2%) stool samples tested positive for taeniosis by copro-Ag-ELISA while Taenia eggs were detected in 9 (1.1%) stool samples by routine coprology. Antibodies specifically against adult T. solium were detected in 34 copro-Ag-ELISA positive participants by EITB (rES38) indicating T. solium taeniosis prevalence of 4.1%. Increasing age and hand washing by dipping in contrast to using running water, were found associated with Ag-ELISA seropositivity by logistic regression. Gender (higher risk in females) and water source were risk factors associated with Ab-ELISA seropositivity. Reported symptoms of chronic severe headaches and history of epileptic seizures were found associated with positive Ag-ELISA (p≤0.05). The present study indicates T. solium infection in humans is highly endemic in the southern highlands of Tanzania.
    PLoS Neglected Tropical Diseases 03/2013; 7(3):e2102. · 4.57 Impact Factor
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    PLoS Neglected Tropical Diseases 07/2012; 6(7):e1746. · 4.57 Impact Factor
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    ABSTRACT: A randomized controlled field trial to evaluate the effectiveness of a single oral dose of 30 mg/kg of oxfendazole (OFZ) treatment for control of porcine cysticercosis was conducted in 4 rural villages of Angónia district, north-western Mozambique. Two hundred and sixteen piglets aged 4 months were selected and assigned randomly to OFZ treatment or control groups. Fifty-four piglets were treated at 4 months of age (T1), while another 54 piglets were treated at 9 months of age (T2) and these were matched with 108 control pigs from the same litters and raised under the same conditions. Baseline data were collected on the prevalence of porcine cysticercosis using antigen ELISA (Ag-ELISA), as well as knowledge and practices related to Taenia solium transmission based on questionnaire interviews and observations. All animals were followed and re-tested for porcine cysticercosis by Ag-ELISA at 9 and 12 months of age when the study was terminated. Overall prevalence at baseline was 5.1% with no significant difference between groups. At the end of the study, 66.7% of the controls were found positive, whereas 21.4% of the T1 and 9.1% of the T2 pigs were positive, respectively. Incidence rates of porcine cysticercosis were lower in treated pigs as compared to controls. Necropsy of 30 randomly selected animals revealed that viable cysts were present in none (0/8) of T2 pigs, 12.5% (1/8) of T1 pigs and 42.8% (6/14) of control pigs. There was a significant reduction in the risk of T. solium cysticercosis if pigs were treated with OFZ either at 4 months (OR = 0.14; 95% CI: 0.05-0.36) or at 9 months of age (OR = 0.05; 95% CI: 0.02-0.16). Strategic treatment of pigs in endemic areas should be further explored as a means to control T. solium cysticercosis/taeniosis.
    PLoS Neglected Tropical Diseases 05/2012; 6(5):e1651. · 4.57 Impact Factor
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    ABSTRACT: Diagnostic tools appropriate for undertaking interventions to control helminth infections are key to their success. Many diagnostic tests for helminth infection have unsatisfactory performance characteristics and are not well suited for use in the parasite control programmes that are being increasingly implemented. Although the application of modern laboratory research techniques to improve diagnostics for helminth infection has resulted in some technical advances, uptake has not been uniform. Frequently, pilot or proof of concept studies of promising diagnostic technologies have not been followed by much needed product development, and in many settings diagnosis continues to rely on insensitive and unsatisfactory parasitological or serodiagnostic techniques. In contrast, PCR-based xenomonitoring of arthropod vectors, and use of parasite recombinant proteins as reagents for serodiagnostic tests, have resulted in critical advances in the control of specific helminth parasites. The Disease Reference Group on Helminths Infections (DRG4), established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR) was given the mandate to review helminthiases research and identify research priorities and gaps. In this review, the diagnostic technologies relevant to control of helminth infections, either available or in development, are reviewed. Critical gaps are identified and opportunities to improve needed technologies are discussed.
    PLoS Neglected Tropical Diseases 04/2012; 6(4):e1601. · 4.57 Impact Factor
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    ABSTRACT: There is a high prevalence of Taenia solium taeniosis/cysticercosis in humans and pigs in the Eastern Cape Province (ECP) of South Africa. The objective of this study was to identify risk factors of porcine cysticercosis in select districts of the ECP. Data were collected in 2003 by interviewing 217 pig producers from the area. Blood samples were collected from 261 of their pigs, which were tested using two enzyme-linked immunosorbent assays (ELISA) for the presence of antibodies to cysticercosis. Frequencies of both owner- and pig-level characteristics were determined. For pig-level analysis, all bivariable and multivariable associations were determined using the surveylogistic procedure of the SAS/STAT® software to accommodate for the intraclass correlation that exists for clusters of pigs within one owner and for clusters of owners within a district. All tests for significance were performed at the α = 0.05 level, and adjusted odds ratios (aOR) and 95% confidence intervals (CI) were determined. Among the respondents, 48% of their households lacked a latrine, 98% slaughtered pigs at home, and 99% indicated that meat inspection services were not available. On bivariable analysis, there was a significant association between porcine infection and district (p = 0.003), breed (p = 0.041) and the absence of a latrine (p = 0.006). On multivariable analysis, the absence of a latrine was the only variable significantly associated with porcine infection (aOR = 1.89; 95% CI = 1.07, 3.35) (p = 0.028). The increased odds of porcine infection with households lacking a latrine contributes to our understanding of the transmission of this parasite in the ECP. Determining and addressing the risk factors for T. solium infection can potentially lower the very high prevalence in humans and pigs in this endemic area.
    PLoS ONE 01/2012; 7(5):e37718. · 3.53 Impact Factor
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    ABSTRACT: A pilot survey was conducted in 2 districts in Mozambique to determine the most important health problems facing smallholder pig producers. While African swine fever is the most serious disease that affects pigs at all levels of production in Mozambique, it is likely that productivity is reduced by the presence of mange and gastrointestinal parasites, while in traditional systems the conditions are favourable for the development of porcine cysticercosis caused by the pork tapeworm Taenia solium, which poses a health risk to communities. Results of the pilot survey confirmed that, with the exception of African swine fever, ecto- and endoparasites are probably the most important health risks for producers. Porcine cysticercosis is more prevalent among pigs in traditional, free-ranging systems, while mange becomes a serious factor when pigs are permanently confined.
    Journal of the South African Veterinary Association 09/2011; 82(3):166-9.
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    ABSTRACT: Despite growing awareness of the importance of controlling neglected tropical diseases as a contribution to poverty alleviation and achieving the Millennium Development Goals, there is a need to up-scale programmes to achieve wider public health benefits. This implementation deficit is attributable to several factors but one often overlooked is the specific difficulty in tackling diseases that involve both people and animals - the zoonoses. A Disease Reference Group on Zoonoses and Marginalised Infectious Diseases (DRG6) was convened by the Special Programme for Research and Training in Tropical Diseases (TDR), a programme executed by the World Health Organization and co-sponsored by UNICEF, UNDP, the World Bank and WHO. The key considerations included: (a) the general lack of reliable quantitative data on their public health burden; (b) the need to evaluate livestock production losses and their additional impacts on health and poverty; (c) the relevance of cross-sectoral issues essential to designing and implementing public health interventions for zoonotic diseases; and (d) identifying priority areas for research and interventions to harness resources most effectively. Beyond disease specific research issues, a set of common macro-priorities and interventions were identified which, if implemented through a more integrated approach by countries, would have a significant impact on human health of the most marginalised populations characteristically dependent on livestock.
    Parasites & Vectors 06/2011; 4:106. · 3.25 Impact Factor
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    ABSTRACT: The objective of this paper is to critically review and summarize available scientific and lay literature, and ongoing studies on human and porcine cysticercosis in Mozambique to identify knowledge gaps and direct immediate and long-term research efforts. Data on the spatial distribution and prevalence of the disease in human and swine populations are scarce and fragmented. Human serological studies have shown that 15-21% of apparently healthy adults were positive for cysticercosis antibodies or antigen, while in neuropsychiatric patients seroprevalence was as high as 51%. Slaughterhouse records indicate a countrywide occurrence of porcine cysticercosis, while studies have shown that 10-35% of pigs tested were seropositive for cysticercosis antibodies or antigen. Current research in Mozambique includes studies on the epidemiology, molecular biology, diagnosis and control of the disease. Future research efforts should be directed at better understanding the epidemiology of the disease in Mozambique, particularly risk factors for its occurrence and spread in human and swine populations, documenting the socio-economic impact of the disease, identifying critical control points and evaluating the feasibility and epidemiological impact of control measures and development of local level diagnostic tools for use in humans and swine.
    Animal Health Research Reviews 06/2011; 12(1):123-9.
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    ABSTRACT: Porcine cysticercosis is caused by a zoonotic tapeworm, Taenia solium, which causes serious disease syndromes in human. Effective control of the parasite requires knowledge on the burden and pattern of the infections in order to properly direct limited resources. The objective of this study was to establish the spatial distribution of porcine cysticercosis in Mbulu district, northern Tanzania, to guide control strategies. This study is a secondary analysis of data collected during the baseline and follow-up periods of a randomized community trial aiming at reducing the incidence rate of porcine cysticercosis through an educational program. At baseline, 784 randomly selected pig-keeping households located in 42 villages in 14 wards were included. Lingual examination of indigenous pigs aged 2-12 (median 8) months, one randomly selected from each household, were conducted. Data from the control group of the randomized trial that included 21 of the 42 villages were used for the incidence study. A total of 295 pig-keeping households were provided with sentinel pigs (one each) and reassessed for cysticercosis incidence once or twice for 2-9 (median 4) months using lingual examination and antigen ELISA. Prevalence of porcine cysticercosis was computed in Epi Info 3.5. The prevalence and incidence of porcine cysticercosis were mapped at household level using ArcView 3.2. K functions were computed in R software to assess general clustering of porcine cysticercosis. Spatial scan statistics were computed in SatScan to identify local clusters of the infection. The overall prevalence of porcine cysticercosis was 7.3% (95% CI: 5.6, 9.4; n = 784). The K functions revealed a significant overall clustering of porcine cysticercosis incidence for all distances between 600 m and 5 km from a randomly chosen case household based on Ag-ELISA. Lingual examination revealed clustering from 650 m to 6 km and between 7.5 and 10 km. The prevalence study did not reveal any significant clustering by this method. Spatial scan statistics found one significant cluster of porcine cysticercosis prevalence (P = 0.0036; n = 370). In addition, the analysis found one large cluster of porcine cysticercosis incidence based on Ag-ELISA (P = 0.0010; n = 236) and two relatively small clusters of incidence based on lingual examination (P = 0.0012 and P = 0.0026; n = 241). These clusters had similar spatial location and included six wards, four of which were identified as high risk areas of porcine cysticercosis. This study has identified local clusters of porcine cysticercosis in Mbulu district, northern Tanzania, where limited resources for control of T. solium could be directed. Further studies are needed to establish causes of clustering to institute appropriate interventions.
    PLoS Neglected Tropical Diseases 01/2010; 4(4):e652. · 4.57 Impact Factor
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    A Lee Willingham, Hai-Wei Wu, James Conlan, Fadjar Satrija
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    ABSTRACT: Cysticercosis caused by the zoonotic pork tapeworm Taenia solium is emerging as a constraint for the nutritional and economic well-being of small-holder farming communities in many underdeveloped areas of Southeast Asia. It occurs mainly in impoverished regions with inadequate sanitation, poor pig management practices and lack of meat inspection and control. Neurocysticercosis, the most serious form of the disease, is considered the most common parasitic infection of the human nervous system and the most frequent preventable cause of epilepsy in the developing world. Although theoretically easy to control and declared eradicable, T. solium taeniosis/cysticercosis remains a neglected disease. There is a lack of information and awareness of the burden and transmission of the disease at the regional and global level, partially explained by the unavailability of good quality diagnostic tools in field-applicable formats. These factors are further compounded by a lack of validated simple and sustainable intervention packages as part of integrated helminth control programmes. To date, T. solium taeniosis/cysticercosis has not been eliminated from any region by a specific programme in Southeast Asia, and no national control programmes are yet in place except in parts of the People's Republic of China. The presence, distribution, public health importance and economic relevance of cysticercosis need to be better documented in Southeast Asia in order to bring it to the attention of affected communities, decision-makers and funding bodies. A number of proven cost-effective intervention tools for combating cysticercosis appear to be available but need to be field validated. The Regional Network for Asian Schistosomiasis and Other Helminth Zoonoses (RNAS(+)) serves as an important regional 'driving force' for managing research, capacity building, knowledge and stakeholder engagement essential for controlling cysticercosis in the Southeast Asian region while ensuring that research efforts are integrated with regional needs for surveillance and control.
    Advances in Parasitology 01/2010; 72:235-66. · 3.78 Impact Factor
  • A. Lee Willingham, Hai-Wei Wu, James Conlan, Fadjar Satrija
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    ABSTRACT: Cysticercosis caused by the zoonotic pork tapeworm Taenia solium is emerging as a constraint for the nutritional and economic well-being of small-holder farming communities in many underdeveloped areas of Southeast Asia. It occurs mainly in impoverished regions with inadequate sanitation, poor pig management practices and lack of meat inspection and control. Neurocysticercosis, the most serious form of the disease, is considered the most common parasitic infection of the human nervous system and the most frequent preventable cause of epilepsy in the developing world. Although theoretically easy to control and declared eradicable, T. solium taeniosis/cysticercosis remains a neglected disease. There is a lack of information and awareness of the burden and transmission of the disease at the regional and global level, partially explained by the unavailability of good quality diagnostic tools in field-applicable formats. These factors are further compounded by a lack of validated simple and sustainable intervention packages as part of integrated helminth control programmes. To date, T. solium taeniosis/cysticercosis has not been eliminated from any region by a specific programme in Southeast Asia, and no national control programmes are yet in place except in parts of the People's Republic of China. The presence, distribution, public health importance and economic relevance of cysticercosis need to be better documented in Southeast Asia in order to bring it to the attention of affected communities, decision-makers and funding bodies. A number of proven cost-effective intervention tools for combating cysticercosis appear to be available but need to be field validated. The Regional Network for Asian Schistosomiasis and Other Helminth Zoonoses (RNAS+) serves as an important regional ‘driving force’ for managing research, capacity building, knowledge and stakeholder engagement essential for controlling cysticercosis in the Southeast Asian region while ensuring that research efforts are integrated with regional needs for surveillance and control.
    Advances in Parasitology - ADVAN PARASITOL. 01/2010; 72:235-266.
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    ABSTRACT: Taenia solium is an important zoonosis in many developing countries. Cysticercosis poses a serious public health risk and incurs sizeable economic losses to pig production. Because data on the epidemiology of porcine cysticercosis in Mozambique are scarce, the present study was conducted to determine the prevalence and risk factors for porcine cysticercosis. A cross-sectional survey was carried out in 11 villages in Angónia district, Tete province in northwestern Mozambique. Between September and November, 2007, a total of 661 pigs were tested serologically and examined by tongue inspection. Serum samples were tested for the presence of circulating parasite antigen using a monoclonal antibody-based sandwich enzyme-linked immunosorbent assay (Ag-ELISA). In addition, a questionnaire survey to collect information on pig production, occurrence and transmission of porcine cysticercosis, risk factors and awareness of porcine cysticercosis was conducted in the selected households from which pigs were sampled. Two hundred thirty-one samples (34.9%) were found positive by the Ag-ELISA, while by tongue inspection on the same animals cysticerci were detected in 84 pigs (12.7%). Increasing age (OR = 1.63; 95% CI = 1.13-2.37) and free-range pig husbandry system (OR = 3.81; 95% CI = 2.08-7.06) were important risk factors for porcine cysticercosis in the district. The present findings indicate that porcine cysticercosis is endemic in the region, and that increasing pig age and pig husbandry practices contribute significantly to porcine cysticercosis transmission. Further epidemiological studies on the prevalence and transmission of porcine cysticercosis in rural communities in Mozambique are needed to enable collection of more baseline data and implementation of effective control strategies within the country.
    PLoS Neglected Tropical Diseases 01/2010; 4(2):e594. · 4.57 Impact Factor
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    Pfukenyi D.M, Willingham A.L, Mukaratirwa S, Monrad J
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    ABSTRACT: Between January 1999 and December 2000 faecal samples from 16 264 cattle at 12 dipping sites in the highveld and nine in the lowveld communal grazing areas of Zimbabwe were examined for gastrointestinal (GI) nematode and cestodes eggs, and coccidia oocysts. Strongyle larvae were identified following culture of pooled faecal samples collected at monthly intervals. The effects of region, age, sex and season on the prevalence of GI nematodes, cestodes and coccidia were determined. Faecal egg and oocyst counts showed an overall prevalence of GI nematodes of 43 %, coccidia 19.8 % and cestodes 4.8 %. A significantly higher prevalence of infection with GI nematodes, cestodes and coccidia was recorded in calves (P < 0.01) than in adults. Pregnant and lactating cows had significantly higher prevalences than bulls, oxen and non-lactating (dry cows) (P < 0.01). The general trend of eggs per gram (epg) of faeces and oocysts per gram (opg) of faeces was associated with the rainfall pattern in the two regions, with high epg and opg being recorded during the wet months. The most prevalent genera of GI nematodes were Cooperia, Haemonchus and Trichostrongylus in that order. Strongyloides papillosus was found exclusively in calves. Haemonchus was significantly more prevalent during the wet season than the dry season (P < 0.01). In contrast, Trichostrongylus was present in significantly (P < 0.01) higher numbers during the dry months than the wet months, while Cooperia and Oesophagostomum revealed no significant differences between the wet and dry season. These findings are discussed with reference to their relevance for strategic control of GI parasites in cattle in communal grazing areas of Zimbabwe.
    The Onderstepoort journal of veterinary research 01/2010; · 0.55 Impact Factor
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    ABSTRACT: Over the last decades, studies in sub-Saharan Africa have indicated that epilepsy is a highly prevalent neurological disorder. Causes may be varied with infections of the central nervous system playing an important role. Neurocysticercosis (NCC) has recently been recognised as an emerging public health problem and a growing concern throughout sub-Saharan Africa and has been estimated to be responsible for 30-50% of acquired epilepsy. NCC is closely linked with porcine cysticercosis and human taeniosis, the former reaching a prevalence of almost 50% in some pig populations. In this review, we first summarize prevalence data on epilepsy and highlight some special aspects of the disorder within sub-Saharan Africa. We then focus on the prevalence of NCC, clinical signs and symptoms and diagnostic criteria for NCC with special reference to sub-Saharan Africa. This is followed by a section on the latest developments regarding serodiagnosis of cysticercosis and a section on care management of people infected with NCC. NCC clearly represents a major risk factor of epilepsy, thus detecting and treating NCC may help cure epilepsy in millions of people in sub-Saharan Africa.
    Wiener klinische Wochenschrift 10/2009; 121 Suppl 3:3-12. · 0.81 Impact Factor
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    ABSTRACT: This study was designed to investigate the longevity of maternally-acquired specific antibody (Ab) isotypes in piglets born to sows with Taenia solium cysticercosis. Four isotypes of anti-cysticercal immunoglobulins (IgG(total), IgG1, IgG2 and IgA), were assessed in sows naturally infected with T. solium (n=5) and their piglets (5/sow). Specific IgG2 and IgA responses were not detected in piglets at any sampling point. However, IgG(total) and IgG1 responses were detectable in sera from piglets from day 0 but not at 2months of age. Antibody profiles differed significantly over time between littermates and between piglets from different sows. These findings raise important questions as to the optimal timing of mass vaccination of piglets as a method of controlling cysticercosis in humans. The observed variations in the level of maternally-acquired Abs amongst piglets will pose a major challenge to the implementation of vaccination programmes against T. solium cysticercosis.
    The Veterinary Journal 05/2009; 184(3):318-21. · 2.42 Impact Factor
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    ABSTRACT: The recent recognition of neurocysticercosis as a major cause of epilepsy in Uganda and changes in pig demography have lead to a need to better understand the basic epidemiology of Taenia solium infections in pigs and humans. Human exposure is a function of the size of the animal reservoir of this zoonosis. This is the first field survey for porcine cysticercosis to investigate the prevalence of antigen-positive pigs across an entire rural district of south-east Uganda. In our field surveys, 8.6% of 480 pigs screened were seropositive for the parasite by B158/B60 Ag-ELISA. In addition, of the 528 homesteads surveyed 138 (26%) did not have pit latrines indicating a high probability of pigs having access to human faeces and thus T. solium eggs. This study thus indicates the need for better data on this neglected zoonotic disease in Uganda, with a particular emphasis on the risk factors for infection in both pigs and humans. In this regard, further surveys of pigs, seroprevalence surveys in humans and an understanding of cysticercosis-related epilepsy are required, together with risk-factor studies for human and porcine infections.
    Journal of Parasitology Research 01/2009; 2009.
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    ABSTRACT: Few studies have estimated prevalence of neurocysticercosis (NCC) among persons with epilepsy in sub-Saharan Africa. While the limitations of serological testing in identification of NCC are well known, the characteristics of persons who are misdiagnosed based on serology have not been explored. The first objective of this pilot study was to estimate the prevalence of NCC in epilepsy outpatients from an area of South Africa endemic for cysticercosis. The second objective was to estimate the accuracy of serological testing in detecting NCC in these outpatients and characterize sources of disagreement between serology and neuroimaging. All out-patients aged 5 or older attending the epilepsy clinic of St. Elizabeth's Hospital in Lusikisiki, Eastern Cape Province, between July 2004 and April 2005 were invited to participate. Epidemiological data were collected by local study staff using a standardized questionnaire. Blood samples were tested by ELISA for antibody and antigen for Taenia solium. Four randomly chosen, consenting participants were transported each week to Mthatha for brain CT scan. The proportion of persons with epilepsy attending St. Elizabeth clinic with CT-confirmed NCC was 37% (95% CI: 27%-48%). Using CT as the gold standard, the sensitivity and specificity of antibody testing for identifying NCC were 54.5% (36.4%-71.9%) and 69.2% (52.4%-83.0%), respectively. Sensitivity improved to 78.6% (49.2%-95.3%) for those with active lesions. Sensitivity and specificity of antigen testing were considerably poorer. Compared to false negatives, true positives more often had active lesions. False positives were more likely to keep pigs and to have seizure onset within the past year than were true negatives. The prevalence of NCC in South African outpatients with epilepsy is similar to that observed in other countries where cysticercosis is prevalent. Errors in classification of NCC using serology alone may reflect the natural history of NCC.
    PLoS Neglected Tropical Diseases 01/2009; 3(12):e562. · 4.57 Impact Factor
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    ABSTRACT: Immunohistochemistry was used to examine the immuno-pathological changes and the extent of neuronal damage caused by either viable or dead Taenia solium cysticerci during porcine neurocysticercosis. Thirty pig brains with cerebral cysticercosis and 5 brains from T. solium free pigs were used in this study. Results revealed extensive astrogliosis, neuronal and mostly axonal damage in both early (grade I) and late (grades III and V) lesions as evidenced by an increased expression of glial fibrillary acidic protein (GFAP) and neurofilament protein (NFP). In many late lesions, astrocyte end-feet formed glial scars that surrounded the dead parasite. Rapid angiogenesis resulted in blood vessels lacking astrocyte end-feet suggesting loss of blood-brain barrier (BBB) hence allowing an influx of peripheral blood immune cells such as eosinophils, macrophages, CD3+ T cells, B lymphocytes and plasma cells into lesions. This study showed that porcine NCC was associated with severe nervous tissue damage, the host response of which is a collaborative effort between the local and peripheral immune responses comparable to that observed in human NCC. Results further implied that porcine NCC could be a useful model for understanding the course of NCC in human as well as provide useful information for therapeutic and/or immune strategies.
    Veterinary Parasitology 12/2008; 160(3-4):242-50. · 2.38 Impact Factor

Publication Stats

1k Citations
190.79 Total Impact Points

Institutions

  • 2013
    • Muhimbili University of Health and Allied Sciences
      Dār es Salām, Dar es Salaam, Tanzania
  • 2008–2013
    • IT University of Copenhagen
      København, Capital Region, Denmark
    • Ross University, School of Medicine
      Ross, Ohio, United States
  • 2007–2013
    • University of Copenhagen
      • • Department of Veterinary Disease Biology
      • • Faculty of Life Sciences
      København, Capital Region, Denmark
  • 2010–2012
    • Eduardo Mondlane University
      Lourenço Marques, Maputo City, Mozambique
  • 2011
    • Agricultural Research Institute of Mozambique
      Lourenço Marques, Maputo City, Mozambique
  • 2001–2010
    • Sokoine University of Agriculture (SUA)
      • • Department of Veterinary Medicine and Public Health
      • • Department of Veterinary Microbiology and Parasitology
      Morogoro, Morogoro Region, Tanzania
  • 2009
    • Makerere University
      Kampala, Central Region, Uganda
  • 2003–2007
    • University of Zambia
      • School of Veterinary Medicine
      Lusaka, Lusaka Province, Zambia
    • University of Pretoria
      • Department of Neurology
      Pretoria, Gauteng, South Africa
  • 2006
    • Universidad Nacional Autónoma de México
      • School of Medicine
      Mexico City, The Federal District, Mexico
    • University of Zimbabwe
      • Department Of Clinical Veterinary Studies
      Salisbury, Harare Province, Zimbabwe
    • University of Oklahoma Health Sciences Center
      • Department of Biostatistics and Epidemiology
      Oklahoma City, OK, United States
  • 1996–2000
    • Swedish University of Agricultural Sciences
      • Department of Biomedical Sciences and Veterinary Public Health
      Uppsala, Uppsala, Sweden