[Show abstract][Hide abstract] ABSTRACT: Detection of filarial DNA in mosquitoes by PCR cannot differentiate infective mosquitoes from infected mosquitoes. In order to evaluate transmission risk an assay is needed that can specifically detect infective L3 stage parasites. We now report the development of an assay that specifically detects the infective stage of Wuchereria bancrofti in mosquitoes. The assay detects an L3-activated mRNA transcript by reverse-transcriptase PCR (RT-PCR).
W. bancrofti cuticle-related genes were selected using bioinformatics and screened as potential diagnostic target genes for L3 detection in mosquitoes. Expression profiles were determined using RT-PCR on RNA isolated from mosquitoes collected daily across a two-week period after feeding on infected blood. Conventional multiplex RT-PCR and real-time multiplex RT-PCR assays were developed using an L3-activated cuticlin transcript for L3 detection and a constitutively expressed transcript, tph-1, for 'any-stage' detection.
This assay can be used to simultaneously detect W. bancrofti infective stage larvae and 'any-stage' larvae in pooled vector mosquitoes. This test may be useful as a tool for assessing changes in transmission potential in the context of filariasis elimination programs.
[Show abstract][Hide abstract] ABSTRACT: We studied effects of compliance on the impact of mass drug administration (MDA) with diethylcarbamazine and albendazole for lymphatic filariasis (LF) in an Egyptian village. Baseline microfilaremia (mf) and filarial antigenemia rates were 11.5% and 19.0%, respectively. The MDA compliance rates were excellent (> 85%). However, individual compliance was highly variable; 7.4% of those surveyed after five rounds of MDA denied having ever taken the medications and 52.4% reported that they had taken all five doses. The mf and antigenemia rates were 0.2% and 2.7% in those who reported five doses of MDA and 8.3% and 13.8% in those who reported zero doses. There was no significant difference in residual infection rates among those who had taken two or more doses. These results underscore the importance of compliance for LF elimination programs based on MDA and suggest that two ingested doses of MDA are as effective as five doses for reducing filariasis infection rates.
The American journal of tropical medicine and hygiene 12/2007; 77(6):1069-73. · 2.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We used molecular xenomonitoring (MX, detection of filarial DNA in mosquitoes) to evaluate the impact of mass drug administration (MDA) in sentinel locations in Egypt with high (11.5%) and low (4.1%) baseline microfilaria prevalence rates. Blood-fed Culex pipiens were pooled by household and tested for Wuchereria bancrofti DNA by PCR. There was no significant relationship between the infection status of household residents and parasite DNA status of mosquitoes from the same houses. After 5 MDA rounds, parasite DNA rates in mosquitoes in high- and low-prevalence areas were reduced by 93.8% and 100% to 0.19% (95% CI: 0.076-0.382%) and 0% (95% CI: 0-0.045%), respectively. These changes were consistent with decreases in microfilaria prevalence rates in these sites; they provide insight regarding the minimal mosquito DNA rates necessary for sustained transmission of filariasis in Egypt. We conclude that MX is a powerful tool for monitoring the impact of MDA on filariasis endemicity and transmission.
The American journal of tropical medicine and hygiene 11/2007; 77(4):593-600. · 2.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We developed and evaluated real-time polymerase chain reaction (PCR) assays for detecting Wuchereria bancrofti DNA in human blood and in mosquitoes. An assay based on detection of the W. bancrofti "LDR" repeat DNA sequence was more sensitive than an assay for Wolbachia 16S rDNA. The LDR-based assay was sensitive for detecting microfilarial DNA on dried membrane filters or on filter paper. We also compared real-time PCR with conventional PCR (C-PCR) for detecting W. bancrofti DNA in mosquito samples collected in endemic areas in Egypt and Papua New Guinea. Although the two methods had comparable sensitivity for detecting filarial DNA in reference samples, real-time PCR was more sensitive than C-PCR in practice with field samples. Other advantages of real-time PCR include its high-throughput capacity and decreased risk of cross-contamination between test samples. We believe that real-time PCR has great potential as a tool for monitoring progress in large-scale filariasis elimination programs.
The American journal of tropical medicine and hygiene 06/2006; 74(5):826-32. · 2.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Egypt was one of the first countries to implement a national programme to eliminate lymphatic filariasis based on WHO's strategy of repeated rounds of mass drug administration (MDA) with diethylcarbamazine and albendazole (target population, 2.5 million in 181 localities). We assessed the effect of five yearly rounds of MDA on filariasis in four sentinel villages in Egypt.
We studied two areas with different infection rates before MDA: the Qalubyia study area had a low infection rate because of previous treatment with diethylcarbamazine; this was typical of most filariasis-endemic villages in Egypt before MDA. The Giza study area had a high baseline infection rate. We undertook repeated surveys in villages for treatment compliance and tests for microfilaraemia and circulating filarial antigenaemia, antibodies to filarial antigen Bm14 in schoolchildren, and infections in indoor-resting mosquitoes (assessed by PCR).
MDA compliance rates were excellent (>80%). In Giza after MDA, prevalence rates of microfilaraemia and circulating filarial antigenaemia fell from 11.5% to 1.2%, and from 19.0% to 4.8%, respectively (p<0.0001). Corresponding rates in Qalubyia fell from 3.1% to 0% and 13.6% to 3.1%, respectively (p<0.0001). Rates of antifilarial antibody and circulating filarial antigenaemia in schoolchildren (aged about 7-8 years), fell from 18.3% to 0.2% (p<0.0001) and from 10.0% to 0.4% (p<0.0001) in Giza, respectively, and from 1.7% to 0% and 1.7% to 0% (both p=0.13) in Qalubyia, respectively. Mosquito infection rates fell from 3.07% (95% CI 2.38-3.88) to 0.19% (0.08-0.38) in Giza and from 4.37% (3.07-5.99) to 0% (0-0.05) in Qalubyia.
MDA greatly affects variables related to infection (microfilaraemia and circulating filarial antigenaemia prevalence rates) and transmission (antifilarial antibodies in young children and mosquito infection rates). Our results suggest that after five rounds of MDA filariasis is likely to have been eliminated in most endemic localities in Egypt.
The Lancet 03/2006; 367(9515):992-9. · 39.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We studied effects of combined diethylcarbamazine (DEC) and albendazole (ALB) treatment on Wuchereria bancrofti microfilaria (MF) uptake and development of infective larvae (L3) in Culex pipiens. Consenting Egyptian adults with microfilaremia (MF > 300/mL) were treated with one or seven daily doses of DEC/ALB. Laboratory-reared mosquitoes were fed on subjects before and after treatment. MF uptake and infectivity (assessed by mosquito dissection) were reduced by 89.6% and 82.9%, respectively, 12 months after single-dose treatment and by 96.2% and 99.7%, respectively, after multi-dose treatment. The L3:mosquito ratio decreased by 88% to 0.082 after single-dose treatment and by 99.8% to 0.001 after multi-dose treatment. If high coverage rates can be achieved for several annual cycles, mass drug administration (MDA) with DEC/ALB has the potential to decrease transmission to unsustainable levels and eliminate filariasis in populations. Multi-dose MDA (especially in the first year) might interrupt transmission with fewer cycles than single-dose treatment.
The American journal of tropical medicine and hygiene 08/2005; 73(1):108-14. · 2.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Global Program for Elimination of Lymphatic Filariasis calls for mass drug administration for endemic populations outside of sub-Saharan Africa with a single dose of diethylcarbamazine (DEC) and albendazole (Alb) annually for 4-6 years. Single-dose DEC/Alb dramatically reduces blood microfilaria (MF) counts, but most treated subjects fail to completely clear MF after a single dose. A more effective regimen might reduce the number of years required for elimination programs. We performed a randomized clinical trial in Egyptian adults with asymptomatic microfilaremia to compare treatment with seven daily doses of oral DEC (6 mg/kg) and Alb (400 mg) with a single dose of the same combination. We also studied the effect of re-treatment with single-dose DEC/Alb 12 months after the first treatment course. Multi-dose DEC/Alb was significantly more effective than single-dose therapy for reducing and clearing microfilaremia (mean reduction in MF/ml relative to pretreatment counts at 12 months, 99.6% versus 85.7%, with complete clearance in 75% versus 23.1%). The two regimens had similar activity against adult filarial worms, as indicated by serial ultrasound assessments. Neither regimen resulted in complete clearance of filarial antigenemia. There was no difference in adverse events, which were mild to moderate. Blood microfilaria and parasite antigen clearance rates increased following re-treatment. Multi-dose DEC/Alb may be a useful option for filariasis elimination programs, especially in the first year (when enthusiasm for mass drug administration and coverage rates are high), to quickly reduce community MF loads and transmission rates.
The American journal of tropical medicine and hygiene 03/2004; 70(2):191-6. · 2.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Bancroftian filariasis is targeted for elimination in the Nile Delta of Egypt. Improved simple methods are needed for monitoring Wuchereria bancrofti infection in the mosquito vector and thereby the success of elimination programmes. We evaluated the performance of the SspI-PCR assay combined with a DNA Detection Test StripTM method and used the PoolScreen algorithm method for estimating mosquito infection rates. A total of 769 indoor-resting Culex pipiens were captured in 79 randomly selected houses from a filaria-endemic village in the Nile Delta of Egypt (24.4% antigenaemia and 8.6% microfilaraemia). Collected mosquitoes were pooled by house, and assayed by the SspI-PCR. Amplified parasite DNA was detected by both electrophoresis of agarose gel stained with ethidium bromide (EtBr) and by test strips. PCR based on EtBr and test strip methods identified 43 (54.4%) and 45 (56.9%) houses, respectively, as being filaria positive. The minimum mosquito infection rate, assuming one infected female/pool was 6.85% by the PCR test strips. Mosquito infection rate calculated by the PoolScreen2 algorithm software amounted to 8.1% [95% confidence interval 5.85, 10.47]. Because it is faster and safer, the PCR test strip is a practical tool, especially when combined with the PoolScreen algorithm method, for xenomonitoring the success of elimination programmes.
Tropical Medicine & International Health 02/2004; 9(1):158-63. · 2.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Stimulating or augmenting the innate immune response of insect vectors has been shown to impede or disrupt the development and transmission of eukaryotic pathogens; however, the majority of such studies have utilized model systems and not natural parasite-vector systems. The Culex pipiens complex of mosquitoes functions as a primary urban vector of Wuchereria bancrofti, a causative agent of lymphatic filariasis. To test the effects of immune activation on this vector-parasite interaction, Culex pipiens pipiens from the filariasis-endemic Nile Delta were subjected to bacteria inoculation and subsequently fed a blood meal containing W. bancrofti. No difference was seen between parasite development in these mosquitoes as compared to non-inoculated controls. A set of expressed sequence tags from blood-fed midgut and bacteria-inoculated Cx. p. pipiens reveals transcripts for the immune peptides cecropin, gambicin and defensin--all of which have been reported to have antiparasitic effects. Sequences and transcriptional profiles for these peptides are reported. The discrepancy between these results and those reported for the model parasite, Brugia malayi, in the mosquito Aedes aegypti are discussed.
Molecular and Biochemical Parasitology 09/2003; 130(1):43-50. · 2.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The elimination strategy for lymphatic filariasis aims at reducing blood microfilaraemia to levels at which vector transmission cannot be sustained. We aimed to determine whether patients with pre-treatment low or ultra-low microfilaria (MF) counts could be a reservoir of infection after mass drug administration (MDA) with a combined regimen. Laboratory-reared mosquitoes were fed on 30 volunteers after 2 rounds of MDA. Microfilaria uptake, infectivity rates and number of Wuchereria bancrofti L3 per mosquito were assessed. One year after MDA-1, 6 subjects transmitted MF, but up to 9 months after MDA-2 transmission failed. Six months after MDA-2 > 90% had clear MF smears and either failed to transmit MF or transmitted MF that did not develop to L3. We conclude that the transmission cycle is seriously weakened after MDA-2.
Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ 08/2003; 9(4):863-72.
[Show abstract][Hide abstract] ABSTRACT: This study examined relationships between blood microfilaria (MF) counts and parasite uptake and maturation in Culex pipiens fed on Egyptian volunteers with bancroftian filariasis. Uptake of MF and production of infective larvae (L3) were more closely correlated with MF counts in finger prick blood than in venous blood. Only a minority of ingested MF developed into L3. Few MF were ingested, and very few L3 were produced by mosquitoes that fed on infected subjects who were amicrofilaremic by 50 microL thick blood smear; the contribution of such carriers to filariasis transmission in Egypt is probably negligible. These results suggest that filariasis elimination programs should aim to achieve MF smear rates of zero. Single-dose diethylcarbamazine therapy reduced MF counts by 87.9% 6-7 months after treatment; similar reductions were observed for MF uptake, MF/mosquito, infectivity, and L3/mosquito. Thus, single-dose diethylcarbamazine had a major impact on MF ingestion and L3 production by mosquitoes.
The American journal of tropical medicine and hygiene 04/2003; 68(3):286-93. · 2.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study was designed to evaluate the effect of a single dose of diethylcarbamazine (DEC, 6 mg/kg) on Wuchereria bancrofti infections in a low-endemicity setting in Egypt (microfilaremia, or MF, 3.7%, median MF 34/mL). Subjects with MF or filarial antigenemia were treated and restudied 1 year later. Treatment with DEC dramatically reduced blood MF counts, with clearance in 69% of subjects. Treatment also reduced filarial antigen levels, but low clearance rates suggest that some adult worms survived treatment in most patients. Mass treatment was administered in one village; 27 months later, MF prevalence had decreased 84% (from 4.9% to 0.8%). These results show that single-dose DEC treatment can have a major effect on MF prevalence rates and levels in low-endemicity settings. Although the World Health Organization advocates repeated multidrug regimens for filariasis elimination, mass treatment with DEC alone may be sufficient to interrupt transmission in areas with low infection intensities and prevalence rates.
The American journal of tropical medicine and hygiene 09/2002; 67(2):196-200. · 2.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Focally endemic bancroftian filariasis is targeted for elimination in the Nile delta of Egypt. Improved methods are needed for identifying endemic villages to be included in the control programme and for monitoring its success. We have evaluated the performance of a polymerase chain reaction (PCR) assay in estimating Wuchereria bancrofti infection in pools of Culex pipiens (1-25 females) from 2 adjacent villages with high (El Qolzom, 10.8%) and low (Kafr Shorafa, 2.1%) prevalence rates of human filariasis. This assay detects a repeated sequence in W. bancrofti deoxyribonucleic acid (DNA). Mosquitoes resting within houses were captured by aspiration and pooled by house. Houses were classified as positive or negative for human filarial infection based on night blood examinations of residents. The assay detected parasite DNA in mosquitoes from 60% of 25 infected houses and 24% of 25 uninfected houses. PCR processing of mosquitoes caught within houses of unknown filariasis infection status (44 in El Qolzom, 37 in Kafr Shorafa) identified 31.8% and 8.1% of houses, respectively, as containing infected mosquitoes. These results support the validity of the PCR assay for evaluating filarial prevalence in different villages. C. pipiens collected outdoors in dry ice-baited traps and tested by PCR (266 in Qolzom, 82 in Kafr Shorafa) did not contain parasite DNA. Pools of female mosquitoes (296 in Qolzom, 240 in Kafr Shorafa) captured in oviposition traps were also negative. We concluded that the PCR based assay is a powerful epidemiological tool that can be used for evaluating W. bancrofti infection in villages in the Nile delta and for monitoring the application of control programmes in filariasis endemic areas.
Transactions of the Royal Society of Tropical Medicine and Hygiene 01/2001; 95(1):29-32. · 1.82 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In the Nile Delta of Egypt, levels of W. bancrofti infection in humans vary among nearby villages. Ecological and entomological factors that might explain variability between adjacent villages, El Qolzom (QOL) and Kafr Shorafa (KSH) with respective 10.8% and 2.1% microfilaria (MF) prevalence were examined. The epidemiological study covered 127 and 79 houses scattered in QOL and KSH, respectively, and described 25 items relating to housing characters, socio-economic state and human activities. It revealed that QOL is more rural than KSH, and therefore would be more favorable to the vector mosquito population and hence, filarial parasite transmission in QOL. Weekly records (N = 81 and 62 for QOL and KSH, respectively) of ambient temperature, relative humidity and wind speed taken at sunset, over 3 months during summer, revealed no significant variation between villages. Those measured at sunrise revealed significant, although inconsistent, differences at a particular month, but no difference over the whole period. Whether climatological conditions could have influenced mosquito bionomics in the study villages is questionable. Abundance of female Cx. pipiens collected weekly by standard sampling methods using 247 and 240 dry ice-baited CDC trap-nights in QOL and KSH, respectively, oral aspiration from within 346 and 304 respective house-nights, and 65 and 40 respective ovitrap-nights, did not vary significantly over the whole study period. Daily survival and survival to infectivity rates of wild-caught mosquitoes were based on parity and were generally more elevated in QOL than KSH. Monthly records of abundance and survival seemed to favor filaria transmission by mosquitoes in QOL. Autogeny amounted to 6.5 and 20% for QOL and KSH, respectively. Experimental infection of Cx. pipiens from the study villages with W. bancrofti revealed that QOL females were 3.3 times more efficient vectors than KSH ones, mainly because QOL mosquitoes survived longer. The ultimate outcome of observed entomological factors might explain its preponderance in QOL.
Journal of the Egyptian Society of Parasitology 09/2000; 30(2):469-85.
[Show abstract][Hide abstract] ABSTRACT: In 1993, Rift Valley fever (RVF) virus reappeared in Egypt. We determined the prevalence and feeding patterns of mosquitoes in 5 villages where the virus was active. Of 10 species recovered, Aedes caspius (Pallas), Culex pipiens L., Cx. antennatus (Becker), and Cx. perexiguus Theobald constituted 99% of > 35,000 mosquitoes captured in dry ice-baited CDC light traps. Ae. caspius was most prevalent, except at Nag' El Hagar where it was replaced by Cx. perexiguus. Cx. pipiens ranked 2nd, except at Nag' El Ghuneimiya, where it was replaced by Cx. antennatus. Most blood meals analyzed by an enzyme-linked immunosorbent assay reacted to > or = 1 antiserum. Cx. pipiens was mainly anthropophagic, and therefore may have been the main vector of RVF virus among humans. Ae. caspius feeds were chiefly from humans, bovines, and equines. Cx. antennatus and Cx. perexiguus fed generally on bovines. Mixed blood meals from humans and RVF virus susceptible animals were identified in the predominant mosquitoes. Prevalence and host selection, as well as predicted probability for a blood meal being interrupted, indicated that Ae. caspius may have served as a bridge vector between humans and bovines in 4 of the villages. Cx. perexiguus may have played this role at Nag' El Hagar. Because potential vectors are abundant, susceptible domestic animals are associated closely with humans, and surveillance of imported livestock is not systematic, we conclude that RVF virus sporadically will recur in Egypt.
Journal of Medical Entomology 12/1999; 36(6):709-14. · 1.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Age-specific levels of Wuchereria bancrofti infection determined by microfilaremia in filarious 10 to 60 years old males from endemic village revealed that microfilaria intensity was higher in younger age, presumably because of increased vector biting rate of younger individuals. Out of 1334 Cx. pipiens captured while attempting to bite 51 child-adult bait pairs, 54.0% selected a host in the 10-15 age group. Biting preference towards children was more evaluated (79.2%) later than earlier in the night. Frequency distribution of age-specific biting collections indicated that 62.7% recorded exceeding numbers of bites on children, 21.6% adult biting, and 15.7% equal biting of one of the baits in the pair. Furthermore, 21.6% of the children were exposed to nightly bites ranging from 21 to 64 and only 7.8% of the adults experienced from 21 to 85 bites. Mosquito biting intensity averaged 14.2 and 11.6 bites/night for children and adults respectively. Children experienced 22.4% more bites per night than adults. Thus, children are more exposed to filaria infection and seem to represent an important source of infection. It is concluded that attempts at widespread control of filariasis in the densely populated Nile Delta, where youngsters may account for an immense proportion of the local population, should concentrate on immatures.
Journal of the Egyptian Society of Parasitology 09/1997; 27(2):355-64.