Infertility in central Africa

OBJECTIVES: To determine the prevalence and risk factors of primary and secondary infertility in the four Central African countries of Cameroon, Chad, Central African Republic and Gabon. METHODS: Primary infertility was approximated by the percentage of women childless after at least 5 years of marriage. The percentage with no birth at least 5 years subsequent to a previous birth was considered to have secondary infertility. Logistic regression and discrete logistic regression models were estimated to determine the risk factors of primary and secondary infertility, respectively. The relatively few women who were defined as infertile and reported using a traditional or modern method of contraception at survey date were considered fertile to reduce bias from falsely classifying effective contraceptive users as infertile. RESULTS: The prevalence of infertility was highest in Central African Republic and lowest in Chad: primary infertility ranged from 6.9% to 3.1% and secondary infertility for women aged 20-44 years ranged from 26.5% to 18.9%. Women married more than once vs. only once and formerly married women vs. women living with their husbands had higher odds of primary and secondary infertility. Also, younger cohorts had relatively higher risks of primary (born after 1970) and secondary infertility (born after 1960) compared with women born before 1960. In contrast, place of residence, religion, education of wife or husband and socio-economic status were generally not associated with primary or secondary infertility. CONCLUSIONS: Infertility is still prevalent in Central Africa and new interventions aimed at reducing the incidence and social implications of pathologic infertility are needed.     

Shared breastfeeding in central Africa

In this study, shared breastfeeding is described asa novel risk factor for vertical HIV transmission.This cross-sectional survey conducted in the central African country Gabon found that 40% of lactating mothers also breastfed other children than their own, and as many children were additionally breastfed by other women. Shared breastfeeding is increasing the exposure to potentially infectious individuals and has therefore to be considered in breastfeeding recommendations.     

Circulating and unique recombinant forms of HIV type 1 containing subsubtype A2

HIV-1 strains containing subsubtype A2 are relatively rare in the pandemic but have been repeatedly identified in Kenya, where candidate vaccines based in part on subtype A, but not A2 strains, may be evaluated. Among the most recent is CRF16_A2D, a circulating recombinant form (CRF) whose prototypes are complete or partial HIV-1 sequences from Kenya, Korea, and Argentina. Using samples from blood bank discards in Kenya and complete genome sequencing, this report further documents CRF16_A2D and related recombinants and identifies a second CRF, CRF21_A2D. The two A2-containing CRFs, and two recombinants related to CRF16_A2D, share common structural elements but appear to have been independently derived. Concerted selection may have influenced the emergence and spread of certain A2-containing strains in Kenya. The second complete subtype C sequence from Kenya is also reported here. Monitoring of A2-containing recombinants and subtype C strains, both relatively rare in Kenya, may be informative in the course of cohort development and evaluation of candidate vaccines.     

Epidemiology and molecular characterization of influenza viruses in Burkina Faso,sub‐Saharan Africa

Background

The importance of influenza viruses in respiratory infections in sub‐Saharan Africa has been historically overlooked, including in Burkina Faso.

Objectives

This study therefore aimed at evaluating the prevalence and seasonal occurrence of influenza viruses in children under 5 years old, at risk of influenza‐related complications, presenting with influenza‐like illness (ILI) or severe acute respiratory infection (SARI). The study also aimed at identifying the periods with increased influenza transmission for vaccination recommendations in Burkina Faso.

Methods

From January 2014 to December 2015, ILI and SARI (2015 only) patients were recruited in six healthcare centers in Burkina Faso. Influenza A and B molecular detection and subtyping were performed. Clade clustering of a subset of A(H1N1)pdm09 and A(H3N2) strains was deduced by performing phylogenetic analyses on hemagglutinin gene sequences. Weekly surveillance data from FluNet (2011‐2013; 2016) and this study (2014‐2015) were used to identify periods of increased influenza activity.

Results

Influenza A and B viruses were detected in 15.1% (112 of 743) of ILI and 6.6% (12 of 181) of SARI patients. Overall, influenza A viruses were largely predominant (81 of 124, 65.3%), with 69.1% of A(H3N2) and 30.9% of A(H1N1)pdm09 strains. Four waves of increased transmission were identified in 2014‐2015, each dominated by different influenza subtypes and clades. Between 2011 and 2016, periods of increased influenza activity varied in their frequency, duration, and timing.

Conclusion

Influenza A and B viruses were detected in a substantial number of ILI and SARI cases in Burkina Faso. Vaccination in September‐October would likely protect the highest number of patients.     

Seronegative infection and AIDS caused by an A2 subsubtype HIV-1

The study of true seronegative HIV-1 infections may have important implications for the diagnosis and prevention of HIV-1 infection. The case of an AIDS patient with persistently negative HIV serology is described. Genetic and phylogenetic analysis indicated that she was infected with A2 subsubtype HIV-1 transmitted by her seropositive and asymptomatic sexual partner. The clinical and serological discordant results suggest the presence of an immunological deficiency that prevents the formation of HIV-1-specific antibodies.     

Diabetic renal disease in central Africa

Six hundred African diabetic patients were examined using a protocol based on the WHO Multinational study in which no country from Africa was represented. The salicylsulphonic acid test for proteinuria was used to assess the presence of diabetic renal disease. Overall 23.8% of patients had proteinuria (95% confidence interval 20.4 to 27.2) and 3.8% chronic renal failure (95% confidence interval 2.3 to 5.3). Patients with proteinuria were older and had had diabetes longer than those without (p less than 0.001). Systolic blood pressure rose with increasing proteinuria in both sexes but only men with severe nephropathy showed an increase in diastolic pressure. Minimal diabetic nephropathy was more common than severe nephropathy which carried a particularly poor prognosis in African diabetic patients due to lack of resources.     

Oesophageal cancer and alcoholic spirits in central Africa

A geographical pathology survey of a large area in central Africa is described and a contrast is recognized between neighbouring areas with apparently many and apparently few cases of oesophageal cancer. This distribution is compared first with other known areas of high and low incidence in sub-Saharan Africa and then with the drinking of indigenous types of distilled spirits. A significant order of spatial correlation is shown between the geographical pattern of the disease and the drinking of sugar-based alcoholic spirit in central Africa. Samples of spirits from eastern Zambia, central Kenya, and the Transkei, although prepared in apparently dissimilar utensils, were all shown to be contaminated in varying degree with zinc. Nitrosamine-like compounds in native spirits were also reported in all these areas.The need for a geographical survey of indigenous drinking habits in Africa is illustrated. Since legislation against distilling is ineffective, a simple means of excluding carcinogenic compounds from illicit spirits should be ascertained and widely promulgated at village level.     

A survey of the prevalence of leprosy in 5 countries in central Africa

The authors report the results of national surveys conducted in 5 Central Africa states: Cameroon, Congo, Gabon, Equatorial Guinea and RCA. The method used was cluster sampling among random populations. Only adults (greater than 15 years of age) took part in the study. The prevalence rates were between 6 and 14 per thousand. They are markedly higher than the official data.     

Identification and characterization of leukotriene C4 receptors in isolated rat renal glomeruli

The immediate reduction of renal blood flow and glomerular filtration rate in response to intravenous infusion of leukotriene C4 in the rat prompted an analysis of isolated rat renal glomeruli for the presence of specific receptors for leukotriene C4. Specific binding of [3H]leukotriene C4 to glomeruli increased in a time-dependent manner, reached equilibrium after 60 minutes of incubation at 4 degrees C, and was 80% reversible upon addition of excess unlabeled leukotriene C4 at equilibrium. Specific binding of [3H]leukotriene C4 to glomeruli increased in a dose-dependent manner, approaching saturation at concentrations of 40-60 nM. Inhibition of binding of [3H]leukotriene C4 with increasing concentrations of unlabeled leukotriene C4 was dose dependent. The equilibrium dissociation constant for [3H]leukotriene C4 binding to glomeruli, calculated from saturation and competitive binding-inhibition studies, was 25 +/- 7 nM and 35 +/- 16 nM (mean +/- SEM), respectively, and glomerular leukotriene C4 receptor density was 8.5 +/- 1.5 and 9.0 +/- 3.0 pmol/mg protein, respectively. The other natural vasoactive sulfidopeptide leukotrienes, leukotriene D4 and leukotriene E4, the chemotactic agent, leukotriene B4, and the sulfidopeptide leukotriene antagonist, FPL 55712, competed for the receptor at concentrations 2-3 orders of magnitude higher than the homoligand, leukotriene C4. The binding and specificity characteristics of the glomerular leukotriene C4 receptor are similar to those previously reported for the DDT1 nonvascular smooth muscle cell line derived from hamster vas deferens, for guinea pig ileum smooth muscle, and for a subcellular fraction of rat lung homogenate, and represent the first characterization of such a receptor in a vascular tissue.     

福建省非典型肠致病性大肠杆菌（aEPEC）的发现及某些分子特征的研究

目的2010年10月从一名死婴粪便标本中分离到非典型肠致病性大肠杆菌（aEPEC）,为福建省首次鉴定该病原菌。本研究的目的是了解该病原菌的特征,为进一步开展aEPEC的研究工作提供基础数据。方法包括常规的系统生化鉴定、血清学鉴定、药敏试验、PCR检测毒力基因分布、eaeA基因的测序分析。结果该菌株生化表现符合大肠埃希氏菌特征;现有的典型的EPEC血清型不能凝集;药敏实验结果提示对大部分的药物均敏感;毒力基因检测为eaeA+、bfp-、stx1-、stx2-、ehxA-、paa-;eaeA序列在NCBI上比对的结果均提示为大肠埃希氏菌（EHEC/EPEC）紧密素（intimin）的eaeA基因。结论根据常规实验、分子诊断及测序结果证实该病原菌为福建省首次鉴定的非典型肠致病性大肠杆菌（aEPEC）,同时我们需要进一步检测其它的毒力相关基因,探讨这些基因和该菌株致病力的关系。     

Identification and characterization of IgG4‐associated autoimmune hepatitis

Background: Autoimmune hepatitis (AIH) and autoimmune pancreatitis (AIP) share clinical and pathological features such as high serum levels of immunoglobulin (Ig) G and autoantibodies, and lymphoplasmacytic infiltration, suggesting the presence of common immunological abnormalities. However, little is known about the possible involvement of IgG4, a hallmark of AIP, in AIH. Aims: In this study, we examined whether the IgG4 response contributes to the histopathological and clinical findings in AIH. Methods: Liver sections from 26 patients with AIH, 10 patients with primary biliary cirrhosis (PBC), three patients with primary sclerosing cholangitis (PSC) and 20 chronic hepatitis patients with hepatitis C virus (HCV) infection were immunostained for IgG4. We investigated the relationship among the histopathology, the responses to steroid therapy and the IgG4 staining. Results: Nine of the 26 liver specimens from patients with AIH showed positive staining for IgG4 whereas none of the 10 samples from patients with PBC, the three samples from patients with PSC or the 20 samples from patients with HCV hepatitis were positive. Patients with IgG4‐positive AIH also showed increased serum levels of IgG. The numbers of T cells, B cells and plasma cells were significantly increased in the livers of patients with IgG4‐positive AIH as compared with those patients with IgG4‐negative AIH. Patients with IgG4‐positive AIH also showed a marked response to prednisolone therapy. Conclusions: AIH may be classified into either an IgG4‐associated type or an IgG4 non‐associated type with the former showing a marked response to prednisolone treatment.     

Identification and molecular characterization of three GnRH ligands and five GnRH receptors in the spotted green pufferfish

Gonadotropin-releasing hormone (GnRH) is thought to have diverse physiological functions. Understanding regulatory mechanisms of GnRH functions requires detailed knowledge of gene expressions of both GnRH ligands and receptors in a single species. This report concerns identification and molecular characterization of GnRH ligands and receptors in the spotted green pufferfish Tetraodon nigroviridis. It was identified that the pufferfish possessed three types of GnRH ligands and five types of GnRH receptors. All types of ligands and receptors showed different expression patterns, and were widely expressed both inside and outside the brain. Gonads expressed all the ligand and receptor subtypes. Two of five receptor subtypes could not be detected in the pituitary gland of reproductively active individuals, suggesting the existence of novel GnRH systems independent of hypothalamic-pituitary-gonadal axis. Alternative splicing was also observed for some receptor subtypes. The present results indicate that diversified gene expressions combined with molecular diversity contribute to the functional diversity of GnRH.     

Helicobacter pyrlori in Malawi, central Africa.

A total of 160 adult Malawians with epigastric pain for longer than 2 weeks was investigated by endoscopy and serologically for evidence of infection with Helicobacter pylori. The organism was demonstrated histologically and/or by culture in 141 (88%) patients. With histological means and/or culture as the 'gold standard', the histological technique was 100% sensitive while culture was only 81% sensitive. All isolates tested were sensitive to amoxycillin and tetracycline; 74% were resistant to metronidazole. Endoscopic findings were normal in 104 (65%) patients (86.5% H. pylori positive). Evidence of duodenal ulcer was found in 41 (25%) patients (95% H. pylori positive). Histologically, gastritis was common, severe gastritis being associated with increased colonisation by H. pylori. Two kinds of urease test were found to be 100% specific for the presence of H. pylori. The sensitivity of the serological test (Helico-G test) was 98% but its specificity was only 27%. These results provide important background information for planned therapeutic studies in patients with upper gastro-intestinal disease in Malawi.     

Phenotypic and molecular characterization of Staphylococcus aureus isolates expressing low- and high-level mupirocin resistance in Nigeria and South Africa

Background  

Mupirocin is a topical antimicrobial agent which is used for the treatment of skin and postoperative wound infections, and the prevention of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA). However, the prevalence of mupirocin resistance in S. aureus, particularly in MRSA, has increased with the extensive and widespread use of this agent in hospital settings. This study characterized low- and high-level mupirocin-resistant S. aureus isolates obtained from Nigeria and South Africa.     

Identification and characterization of high molecular weight forms of basic fibroblast growth factor in human pituitary adenomas.

Basic fibroblast growth factor (bFGF) extracted from 23 human pituitary adenomas and 2 nontumorous anterior pituitary glands was examined by Western blot analysis to elucidate their molecular forms. Four bands that specifically interacted with anti-bFGF antibody were identified at the regions of 16K, 18K, 22K, and 24K mol wt. These immunodetectable bFGFs were bound to a heparin-Sepharose affinity column and eluted with 1-2 M NaCl. These partially purified tumor extracts could stimulate dose-dependently the growth of FGF-responsive cells. Some tumors contained bFGF with a mol wt of 24 K as a dominant form. In contrast, a major form of bFGF at the region of 18K was identified in the nontumorous anterior pituitary glands. We also addressed the possible presence of FGF receptor mRNA using Northern blot analysis. Many, but not all, human pituitary adenomas were found to contain detectable levels of FGF receptor mRNA with a size of 3.5 kilobases. The present results suggest that the role of bFGF in growth and hormone secretion in human pituitary adenomas should be examined using high mol wt forms of bFGF.     

Identification and characterization of melanocortin-4 receptor gene mutations in morbidly obese finnish children and adults

Two Finnish cohorts, comprising 56 children with severe early-onset obesity (relative weight for height greater than or equal to +70% before age 10) and 252 morbidly obese adults (body mass index, > or = 40 kg/m(2)), were screened for melanocortin-4 receptor (MC4R) mutations. We identified a pathogenic mutation (S127L) in one child, causing severe early-onset obesity. We describe the phenotype of this particular mutation for the first time. We also identified a novel (I226T) polymorphism in the coding and two new variations (-439delGC and 1059C>T) outside the coding region of the MC4R gene. Three previously described polymorphisms (V103I, T112M, and I125L) were identified. In vitro functional studies of variants T112M, S127L, and I226T supported a pathogenic role of the S127L mutation, because signaling properties of the receptor in response to the MC4R agonists alpha-MSH, beta-MSH, and gamma(1)-MSH were impaired. The S127L mutation did not affect receptor inhibition by the antagonist agouti-related protein. Localization of the three variant receptors was similar to that of wild type. In conclusion, a pathogenic MC4R mutation was found among subjects with severe early-onset obesity but not among morbidly obese adults. Impaired function of the S127L receptor was due to reduced activation, not a defect of protein transport to the cell membrane.     

Identification of novel antigens within the Schistosoma japonicum tetraspanin family based on molecular characterization

Tetraspanins (TSPs) are proteins found on the surface of the parasite Schistosoma mansoni that have been regarded as potential protective antigens. However, divergent evolution may occur among the species of S. mansoni and Schistosoma japonicum under different environmental pressure. Thus, it was essential to characterize the S. japonicum TSP family members before selecting potential candidate TSP antigens. In this study, we used bioinformatics and experimental validation to investigate 29 TSP members from S. japonicum, including all known genes, Sj23, TE736, Sj25, and Sj-TSP-2. Five TSP members were found to be variable, and two others (Sj-tsp genes) were alternatively spliced. The phylogenetic analysis showed that schistosome TSPs were highly divergent from those of other phyla. Quantitative RT-PCR revealed that the Sj-tsp genes were differentially transcribed in the developmental stages of cercariae, schistosomula, adult worms, and eggs. Six Sj-tsp genes were significantly up-regulated during the transformation from cercariae to schistosomula. Four Sj-tsp genes, including Sj-tsp-1, Sj-tsp-8, Sj-tsp-14, and Sj-tsp-26 were confirmed as potential protective antigens based on the molecular characterization. RNAi was preformed against the conserved Sj-tsp genes which were highly expressed in schistosomula to explore gene functions. These data will promote the identification of candidate antigens within the TSP family for developing novel vaccines against S. japonicum infections.