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D. A. P. Bundy - One of the best experts on this subject based on the ideXlab platform.
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sequence variation in the Trichuris trichiura β tubulin locus implications for the development of benzimidazole resistance
International Journal for Parasitology, 2002Co-Authors: A B Bennett, G C Barker, Tim J Anderson, Edwin Michael, D. A. P. BundyAbstract:Benzimidazole resistance has evolved in a variety of organisms and typically results from mutations in the beta-tubulin locus at specific amino acid sites. Despite widespread treatment of human intestinal nematodes with benzimidazole drugs, there have been no unambiguous reports of resistance. However, since beta-tubulin mutations conferring resistance are generally recessive, frequencies of resistance alleles less than 30% would be difficult to detect on the basis of drug treatment failures. Here we investigate sequence variation in a 1079 bp segment of the beta-tubulin locus in the human whipworm Trichuris trichiura from 72 individual nematodes from seven countries. We did not observe any alleles with amino acid mutations indicative of resistance, and of 40 point mutations there were only four non-synonymous mutations all of which were singletons. Estimated effective population sizes are an order of magnitude lower than those from another nematode species in which benzimidazole resistance has developed (Haemonchus contortus). Both the lower diversity and reduced population sizes suggest that benzimidazole resistance is likely to evolve less rapidly in Trichuris than in trichostrongyle parasites of livestock. We observed moderate levels of population subdivision (Phi(ST)=0.26) comparable with that previously observed in Ascaris lumbricoides, and identical alleles were frequently found in parasites from different continents, suggestive of recent admixture. A particularly interesting feature of the data is the high nucleotide diversities observed in nematodes from the Caribbean. This genetic complexity may be a direct result of extensive admixture and complex history of human populations in this region of the world. These data should encourage (but not make complacent) those involved in large-scale benzimidazole treatment of human intestinal nematodes.
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isolation of a gene family that encodes the porin like proteins from the human parasitic nematode Trichuris trichiura
Gene, 1999Co-Authors: G C Barker, D. A. P. BundyAbstract:The major E/S protein of Trichuris trichiura, the human whipworm, is a highly immunogenic 47-kDa protein that has a pore forming activity that is thought to be essential for the attachment of the worm to host mucosal epithelium. By gene analysis, we have demonstrated that this protein belongs to a multigene family, and we have obtained genomic and cDNA information for two of these genes. The encoded proteins are composed of tandem arrays of alternating 50- and 51-amino-acid domains within which the positioning of the cysteine residues is highly conserved. This structure resembles that of four disulphide core domain proteins, such as secretory leucocyte proteinase-1 (SLP-1), but the Trichuris protein family differs in being composed of multiple domains of this type (nine in TT50, 17 in TT95). An analysis of the relationship between the domains, and a comparison of the fine arrangement of the genes, suggests that TT95 has arisen relatively recently following duplication of the TT50 gene, which itself arose by duplication of a SLP-1-like ancestor.
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Antigenic variability in Trichuris trichiura populations
Parasitology, 1998Co-Authors: R. M. Currie, C. S. Needham, Lesley Drake, Edward S. Cooper, D. A. P. BundyAbstract:The present study examines antigenic variability for the human whipworm Trichuris trichiura. Recognition by IgG of somatic antigens of individual worms collected from 3 intensely infected children from Jamaica, West Indies has been investigated by immunoblotting. When probed with 1 plasma sample, significant differences in recognition of 2 selected antigens among worm populations and between male and female worms was observed. In addition, there was evidence for antigenic variability within worm populations at the individual worm level. Such variation may have considerable implications for the development of immunity to parasitic nematodes.
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molecular and functional characterization of a recombinant protein of Trichuris trichiura
Proceedings of The Royal Society B: Biological Sciences, 1998Co-Authors: L J Drake, G C Barker, Yuri E Korchev, Max J Lab, Heddwen L Brooks, D. A. P. BundyAbstract:The pore-forming protein of the human whipworm, Trichuris trichiura, has been postulated to facilitate invasion of the host gut and enable the parasite to maintain its syncytial environment. The data presented here describe the first, to our knowledge, molecular characterization of a pore-forming protein in any helminth and provide a unique demonstration of the functional interaction between a parasite antigen and host molecules. Immunological screening of a T. trichiura cDNA library with T. trichiura infection sera identified a clone of 1.4 kB, the cDNA consisting of 1495 base pairs encoding a protein of 50 kDa. The sequence has a highly repetitive nature containing nine four-disulphide-bonded core domains. Structural prediction analyses reveals an amphipathic nature. TT50 induced pore formation in bilayers in a manner identical to that of the native protein. IgG antibody isolated from T. trichiura infection serum was observed to abolish channel activity.
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3 mucosal macrophages and cytokine production in the colon of children with Trichuris trichiura dysentery
Transactions of The Royal Society of Tropical Medicine and Hygiene, 1994Co-Authors: T T Macdonald, D. A. P. Bundy, Jo Spencer, S H Murch, M Y Choy, S Venugopal, Edward CooperAbstract:Mucosal macrophages and accessory cells have been studied by immunohistochemistry in the lamina propria of the colon of children with Trichuris trichiura dysentery syndrome (TDS). No difference was found in the numbers of cells recognized by the monoclonal antibodies CD11c, CD68, or RFD7 between TDS children and local controls. However, large numbers of cells were recognized by an antibody against calprotectin (an anti-bacterial glycoprotein found in tissue infiltrating-monocytes) in TDS colonic mucosa, but few in control colon. Large numbers of cells containing tumour necrosis factor alpha (TNF alpha) were also seen in TDS mucosa; cells isolated from TDS mucosa secreted more TNF alpha than cells from control mucosa; and children with TDS had high levels of circulating TNF alpha. Non-specific macrophage-mediated inflammation and local cytokine production may therefore play a role in the pathogenesis of TDS.
Philip J. Cooper - One of the best experts on this subject based on the ideXlab platform.
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population genomics of ancient and modern Trichuris trichiura
bioRxiv, 2021Co-Authors: S R Doyle, Philip J. Cooper, Peter Nejsum, M J Soe, M Betson, L Peng, X Q Zhu, A Sanchez, G Matamoros, G A F SandovalAbstract:The neglected tropical disease trichuriasis is caused by the whipworm Trichuris trichiura, a soil-transmitted helminth that has infected humans for millennia. Today, T. trichiura infects as many as 500 million people, predominantly in communities with poor sanitary infrastructure enabling sustained faecal-oral transmission. Using whole-genome sequencing of geographically distributed worms collected from human and other primate hosts, together with ancient samples preserved in archaeologically-defined latrines and deposits dated up to one thousand years old, we present the first population genomics study of T. trichiura. We describe the continent-scale genetic structure between whipworms infecting humans and baboons relative to those infecting other primates. Admixture and population demographic analyses support a stepwise distribution of genetic variation that is highest in Uganda, consistent with an African origin and subsequent translocation with human migration. Finally, genome-wide analyses between human samples and between human and non-human primate samples reveal local regions of genetic differentiation between geographically distinct populations. These data provide insight into zoonotic reservoirs of human-infective T. trichiura and will support future efforts toward the implementation of genomic epidemiology of this globally important helminth.
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de novo assembly and characterization of the Trichuris trichiura adult worm transcriptome using ion torrent sequencing
Acta Tropica, 2016Co-Authors: Leonardo Nascimento Santos, Philip J. Cooper, Eduardo Santos Da Silva, Mauricio Lima Barreto, Andre Soares Santos, Rommel Thiago Juca Ramos, Artur Silva, Sebastiao LoureiroAbstract:Infection with helminthic parasites, including the soil-transmitted helminth Trichuris trichiura (human whipworm), has been shown to modulate host immune responses and, consequently, to have an impact on the development and manifestation of chronic human inflammatory diseases. De novo derivation of helminth proteomes from sequencing of transcriptomes will provide valuable data to aid identification of parasite proteins that could be evaluated as potential immunotherapeutic molecules in near future. Herein, we characterized the transcriptome of the adult stage of the human whipworm T. trichiura, using next-generation sequencing technology and a de novo assembly strategy. Nearly 17.6 million high-quality clean reads were assembled into 6414 contiguous sequences, with an N50 of 1606bp. In total, 5673 protein-encoding sequences were confidentially identified in the T. trichiura adult worm transcriptome; of these, 1013 sequences represent potential newly discovered proteins for the species, most of which presenting orthologs already annotated in the related species T. suis. A number of transcripts representing probable novel non-coding transcripts for the species T. trichiura were also identified. Among the most abundant transcripts, we found sequences that code for proteins involved in lipid transport, such as vitellogenins, and several chitin-binding proteins. Through a cross-species expression analysis of gene orthologs shared by T. trichiura and the closely related parasites T. suis and T. muris it was possible to find twenty-six protein-encoding genes that are consistently highly expressed in the adult stages of the three helminth species. Additionally, twenty transcripts could be identified that code for proteins previously detected by mass spectrometry analysis of protein fractions of the whipworm somatic extract that present immunomodulatory activities. Five of these transcripts were amongst the most highly expressed protein-encoding sequences in the T. trichiura adult worm. Besides, orthologs of proteins demonstrated to have potent immunomodulatory properties in related parasitic helminths were also predicted from the T. trichiura de novo assembled transcriptome.
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a genetic analysis of Trichuris trichiura and Trichuris suis from ecuador
Parasites & Vectors, 2015Co-Authors: Hayley Meekums, Mohamed B F Hawash, Alexandra M Sparks, Yisela Oviedo, Martha E. Chico, Carlos Sandoval, Russell J Stothard, Philip J. CooperAbstract:Background Since the nematodes Trichuris trichiura and T. suis are morphologically indistinguishable, genetic analysis is required to assess epidemiological cross-over between people and pigs. This study aimed to clarify the transmission biology of trichuriasis in Ecuador.
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a genetic analysis of Trichuris trichiura and Trichuris suis from ecuador
Parasites & Vectors, 2015Co-Authors: Hayley Meekums, Mohamed B F Hawash, Alexandra M Sparks, Yisela Oviedo, Martha E. Chico, Carlos Sandoval, Russell J Stothard, Philip J. CooperAbstract:BACKGROUND: Since the nematodes Trichuris trichiura and T. suis are morphologically indistinguishable, genetic analysis is required to assess epidemiological cross-over between people and pigs. This study aimed to clarify the transmission biology of trichuriasis in Ecuador. FINDINGS: Adult Trichuris worms were collected during a parasitological survey of 132 people and 46 pigs in Esmeraldas Province, Ecuador. Morphometric analysis of 49 pig worms and 64 human worms revealed significant variation. In discriminant analysis morphometric characteristics correctly classified male worms according to host species. In PCR-RFLP analysis of the ribosomal Internal Transcribed Spacer (ITS-2) and 18S DNA (59 pig worms and 82 human worms), nearly all Trichuris exhibited expected restriction patterns. However, two pig-derived worms showed a "heterozygous-type" ITS-2 pattern, with one also having a "heterozygous-type" 18S pattern. Phylogenetic analysis of the mitochondrial large ribosomal subunit partitioned worms by host species. Notably, some Ecuadorian T. suis clustered with porcine Trichuris from USA and Denmark and some with Chinese T. suis. CONCLUSION: This is the first study in Latin America to genetically analyse Trichuris parasites. Although T. trichiura does not appear to be zoonotic in Ecuador, there is evidence of genetic exchange between T. trichiura and T. suis warranting more detailed genetic sampling.
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patent human infections with the whipworm Trichuris trichiura are not associated with alterations in the faecal microbiota
PLOS ONE, 2013Co-Authors: Philip J. Cooper, Martha E. Chico, A Walker, Jorge Reyes, Susannah J Salter, Maritza Vaca, Julian ParkhillAbstract:Background: The soil-transmitted helminth (STH), Trichuris trichiura colonises the human large intestine where it may modify inflammatory responses, an effect possibly mediated through alterations in the intestinal microbiota. We hypothesised that patent T. trichiura infections would be associated with altered faecal microbiota and that anthelmintic treatment would induce a microbiota resembling more closely that observed in uninfected individuals. Materials and Methods: School children in Ecuador were screened for STH infections and allocated to 3 groups: uninfected, T. trichiura only, and mixed infections with T. trichiura and Ascaris lumbricoides. A sample of uninfected children and those with T. trichiura infections only were given anthelmintic treatment. Bacterial community profiles in faecal samples were studied by 454 pyrosequencing of 16 S rRNA genes. Results: Microbiota analyses of faeces were done for 97 children: 30 were uninfected, 17 were infected with T. trichiura, and 50 with T. trichiura and A. lumbricoides. Post-treatment samples were analyzed for 14 children initially infected with T. trichiura alone and for 21 uninfected children. Treatment resulted in 100% cure of STH infections. Comparisons of the microbiota at different taxonomic levels showed no statistically significant differences in composition between uninfected children and those with T. trichiura infections. We observed a decreased proportional abundance of a few bacterial genera from the Clostridia class of Firmicutes and a reduced bacterial diversity among children with mixed infections compared to the other two groups, indicating a possible specific effect of A. lumbricoides infection. Anthelmintic treatment of children with T. trichiura did not alter faecal microbiota composition. Discussion: Our data indicate that patent human infections with T. trichiura may have no effect on faecal microbiota but that A. lumbricoides colonisation might be associated with a disturbed microbiota. Our results also catalogue the microbiota of rural Ecuadorians and indicate differences with individuals from more urban industrialised societies.
Peter Nejsum - One of the best experts on this subject based on the ideXlab platform.
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population genomics of ancient and modern Trichuris trichiura
bioRxiv, 2021Co-Authors: S R Doyle, Philip J. Cooper, Peter Nejsum, M J Soe, M Betson, L Peng, X Q Zhu, A Sanchez, G Matamoros, G A F SandovalAbstract:The neglected tropical disease trichuriasis is caused by the whipworm Trichuris trichiura, a soil-transmitted helminth that has infected humans for millennia. Today, T. trichiura infects as many as 500 million people, predominantly in communities with poor sanitary infrastructure enabling sustained faecal-oral transmission. Using whole-genome sequencing of geographically distributed worms collected from human and other primate hosts, together with ancient samples preserved in archaeologically-defined latrines and deposits dated up to one thousand years old, we present the first population genomics study of T. trichiura. We describe the continent-scale genetic structure between whipworms infecting humans and baboons relative to those infecting other primates. Admixture and population demographic analyses support a stepwise distribution of genetic variation that is highest in Uganda, consistent with an African origin and subsequent translocation with human migration. Finally, genome-wide analyses between human samples and between human and non-human primate samples reveal local regions of genetic differentiation between geographically distinct populations. These data provide insight into zoonotic reservoirs of human-infective T. trichiura and will support future efforts toward the implementation of genomic epidemiology of this globally important helminth.
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mebendazole treatment persistently alters the size profile and morphology of Trichuris trichiura eggs
Acta Tropica, 2020Co-Authors: Peter Nejsum, Kasper Lind Andersen, Sidsel D Andersen, Stig M Thamsborg, Ana Merino TejedorAbstract:The soil transmitted whipworm, Trichuris trichiura affects about half a billion people globally. Diagnosis is based on identification of characteristic lemon-shaped eggs in stool samples. Occasionally large Trichuris eggs have been reported and have been ascribed to variation within T. trichiura or zoonotic infection with T. vulpis from dogs. We observed that the egg size profile changed markedly after anthelmintic treatment, and remained so, in a human individual self-infected with T. trichiura. The large eggs were detected with two standard diagnostic methods, Kato-Katz thick smear and salt-flotation (McMaster) method. It is therefore important to bear in mind that the morphology of parasite eggs may vary, e.g. in response to previous drug treatment. Large Trichuris eggs in human stool samples should not be diagnosed as T. vulpis infection without confirmation by other means.
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Sequence depth, genetic variation and phylogeny of Ascaris lumbricoides and Trichuris trichiura mitochondrial genomes.
2018Co-Authors: Martin Jensen Søe, Peter Nejsum, Frederik Valeur Seersholm, Brian Lund Fredensborg, Ruben Habraken, Kirstine Haase, Mette Marie Hald, Rikke Simonsen, Flemming Højlund, Louise BlankeAbstract:Top left: Depth of coverage and number of potential SNPs when mapping unique hits (Fig 2) to the closest related mitochondrial genomes of Ascaris lumbricoides (KY045805) and Trichuris trichiura (KT449826). Top right: Frequency of identified haplotypes. Average depth coverage of minimally 5–10x was required to estimate the number of potential SNPs and the frequency of haplotypes. Bottom: Phylogenies of consensus mitochondrial genomes and all published mitochondrial genomes. The T. muris consensus sequence was generated by remapping unique hits to NC_028621. The scale bar indicates number of base substitutions per site.
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faecal egg counts and expulsion dynamics of the whipworm Trichuris trichiura following self infection
Journal of Helminthology, 2016Co-Authors: Eline Palm Hansen, Stig Milan Thamsborg, A M Tejedor, T Alstrup V Hansen, Jens Frederik Dahlerup, Peter NejsumAbstract:More than 400 million humans are estimated to be infected with the intestinal helminth parasite, Trichuris trichiura. The infection is chronic in nature and highintensity infection can lead to colitis, anaemia, Trichuris Dysentery Syndrome and reduced cognitive performance. Single doses of 400 mg albendazole or 500 mg mebendazole (MBZ) are used in mass drug administration programmes, but this has been shown to be insufficient. In this study, worm expulsion dynamics are described after MBZ treatment, given as a multi-dose and singledose treatment in two separate T. trichiura self-infection studies. Worm expulsion dynamics post-treatment showed a similar pattern regardless of the dose regime, with the first worms observed on day 2 and the last worms expelled on days 9 and 13 post-treatment. Establishment of a chronic infection was observed following the inefficient single-dose treatment. The prepatent period was 13 ‐ 16 weeks in both studies and worms were found to have a lifespan of at least 1 year and 10 months. These self-infection studies provide key information on the chronicity of T. trichiura infections, expulsion dynamics after anthelmintic treatment and the prepatent period, as well as the fecundity of female worms, which was around 18,000 eggs/female per day.
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albendazole and mebendazole have low efficacy against Trichuris trichiura in school age children in kabale district uganda
Transactions of The Royal Society of Tropical Medicine and Hygiene, 2009Co-Authors: Annette Olsen, Peter Nejsum, Harriet Namwanje, Allan Roepstorff, Stig Milan ThamsborgAbstract:Summary Three groups of Trichuris trichiura-infected school-age children were treated with one dose 400 mg albendazole, 100 mg mebendazole twice daily for 3 d, or 100 mg mebendazole twice daily for 5 d. The albendazole study investigated cure and egg reduction rates and found that only 5 of 66 infected children were egg-negative 7 d post-treatment, giving a cure rate of 8% and a geometric mean egg reduction rate of 89%. However, at day 14 post-treatment, all children were again egg-positive with significantly higher egg counts than at day 7 (P
David Wimmersberger - One of the best experts on this subject based on the ideXlab platform.
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pharmacokinetics of ascending doses of ivermectin in Trichuris trichiura infected children aged 2 12 years
Journal of Antimicrobial Chemotherapy, 2019Co-Authors: David Wimmersberger, Jessica D Schulz, Jean T Coulibaly, Jennifer Keiser, Christian SchindlerAbstract:Background Yearly, millions of children are treated globally with ivermectin mainly for neglected tropical diseases. Anatomical, physiological and biochemical differences between children and adults may result in changes in pharmacokinetics. However, paediatric pharmacokinetic data of ivermectin are lacking. Methods In the framework of a randomized controlled dose-finding trial in rural Cote d'Ivoire, Trichuris trichiura-infected pre-school-aged children (PSAC, 2-5 years) and school-aged children (SAC, 6-12 years) were assigned to 100 or 200 μg/kg and 200, 400 or 600 μg/kg ivermectin, respectively (ISRCTN registry no. ISRCTN15871729). Capillary blood was collected on dried blood spot cards until 72 h post-treatment. Ivermectin was quantified by LC-MS/MS, and pharmacokinetic parameters were evaluated by non-compartmental analysis. Results C max and AUC increased in PSAC and SAC with ascending doses and were similar in both age groups when the current standard dose (200 μg/kg) was administered (∼23 ng/mL and ∼350 ng×h/mL, respectively). PSAC with lower BMI were associated with significantly higher AUCs. AUC and Cmax were ∼2-fold lower in children compared with parameters previously studied in adults, whereas body weight-adjusted CL/F (∼0.35 L/h/kg) was significantly higher in children. Tmax (∼6 h), t1/2 (∼18 h), mean residence time (MRTINF) (∼28 h) and V/F (∼8 L/kg) were similar in all paediatric treatment arms. Conclusions A positive association of AUC or Cmax with dose was observed in both age groups. Undernutrition might influence the AUC of ivermectin in PSAC. Ivermectin shows a lower exposure profile in children compared with adults, highlighting the need to establish dosing recommendations for different age groups.
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efficacy and safety of ivermectin against Trichuris trichiura in preschool aged and school aged children a randomized controlled dose finding trial
Clinical Infectious Diseases, 2018Co-Authors: David Wimmersberger, Maxim Puchkow, Jessica D Schulz, Jean T Coulibaly, Yves K NgbessoAbstract:Although trichuriasis affects millions of children worldwide, recommended drugs lack efficacy and new treatment options are urgently needed. Ivermectin has promising potential to complement the anthelminthic armamentarium.; A randomized placebo-controlled trial was conducted in rural Cote d'Ivoire to provide evidence on the efficacy and safety of ascending oral ivermectin dosages in preschool-aged children (PSAC) and school-aged children (SAC) infected with Trichuris trichiura. The primary outcome was the cure rate (CR) for T. trichiura infection, and the secondary outcomes were safety, egg-reduction rates (ERRs) against T. trichiura infection, and CRs and ERRs against other soil-transmitted helminth species.; A total of 126 PSAC and 166 SAC were included in an available case analysis. In PSAC, efficacy against T. trichiura did not differ between 200 µg/kg ivermectin and placebo treatment arm, as expressed in CRs (20.9% [95% confidence interval {CI}, 11.9%-52.8%] vs 19.5% [10.4%-49.9%]) and geometric mean ERRs (78.6% [60.1%-89.5%] vs 68.2% [40.5%-84.8%]). In SAC, the highest administered ivermectin dose of 600 µg/kg had a low CRs (12.2% [95% CI, 4.8%-32.3%]) and moderate ERRs (66.3% [43.8%-80.2%]). Only mild adverse events and no organ toxicity, based on serum biomarkers, was observed.; Ivermectin can be administered safely to PSAC with trichuriasis. Given the low efficacy of ivermectin monotherapy against T. trichiura infection, further research should investigate the optimal drug combinations and dosages with ivermectin against soil-transmitted helminthiasis.; ISRCTN15871729 (www.isrctn.com).
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efficacy and safety of ivermectin against Trichuris trichiura in preschool aged and school aged children a randomized controlled dose finding trial
Clinical Infectious Diseases, 2018Co-Authors: David Wimmersberger, Maxim Puchkow, Jessica D Schulz, Jean T Coulibaly, Jörg Huwyler, Yves K NgbessoAbstract:Although trichuriasis affects millions of children worldwide, recommended drugs lack efficacy and new treatment options are urgently needed. Ivermectin has promising potential to complement the anthelminthic armamentarium.; A randomized placebo-controlled trial was conducted in rural Cote d'Ivoire to provide evidence on the efficacy and safety of ascending oral ivermectin dosages in preschool-aged children (PSAC) and school-aged children (SAC) infected with Trichuris trichiura. The primary outcome was the cure rate (CR) for T. trichiura infection, and the secondary outcomes were safety, egg-reduction rates (ERRs) against T. trichiura infection, and CRs and ERRs against other soil-transmitted helminth species.; A total of 126 PSAC and 166 SAC were included in an available case analysis. In PSAC, efficacy against T. trichiura did not differ between 200 µg/kg ivermectin and placebo treatment arm, as expressed in CRs (20.9% [95% confidence interval {CI}, 11.9%-52.8%] vs 19.5% [10.4%-49.9%]) and geometric mean ERRs (78.6% [60.1%-89.5%] vs 68.2% [40.5%-84.8%]). In SAC, the highest administered ivermectin dose of 600 µg/kg had a low CRs (12.2% [95% CI, 4.8%-32.3%]) and moderate ERRs (66.3% [43.8%-80.2%]). Only mild adverse events and no organ toxicity, based on serum biomarkers, was observed.; Ivermectin can be administered safely to PSAC with trichuriasis. Given the low efficacy of ivermectin monotherapy against T. trichiura infection, further research should investigate the optimal drug combinations and dosages with ivermectin against soil-transmitted helminthiasis.; ISRCTN15871729 (www.isrctn.com).
Jennifer Keiser - One of the best experts on this subject based on the ideXlab platform.
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pharmacokinetics of ascending doses of ivermectin in Trichuris trichiura infected children aged 2 12 years
Journal of Antimicrobial Chemotherapy, 2019Co-Authors: David Wimmersberger, Jessica D Schulz, Jean T Coulibaly, Jennifer Keiser, Christian SchindlerAbstract:Background Yearly, millions of children are treated globally with ivermectin mainly for neglected tropical diseases. Anatomical, physiological and biochemical differences between children and adults may result in changes in pharmacokinetics. However, paediatric pharmacokinetic data of ivermectin are lacking. Methods In the framework of a randomized controlled dose-finding trial in rural Cote d'Ivoire, Trichuris trichiura-infected pre-school-aged children (PSAC, 2-5 years) and school-aged children (SAC, 6-12 years) were assigned to 100 or 200 μg/kg and 200, 400 or 600 μg/kg ivermectin, respectively (ISRCTN registry no. ISRCTN15871729). Capillary blood was collected on dried blood spot cards until 72 h post-treatment. Ivermectin was quantified by LC-MS/MS, and pharmacokinetic parameters were evaluated by non-compartmental analysis. Results C max and AUC increased in PSAC and SAC with ascending doses and were similar in both age groups when the current standard dose (200 μg/kg) was administered (∼23 ng/mL and ∼350 ng×h/mL, respectively). PSAC with lower BMI were associated with significantly higher AUCs. AUC and Cmax were ∼2-fold lower in children compared with parameters previously studied in adults, whereas body weight-adjusted CL/F (∼0.35 L/h/kg) was significantly higher in children. Tmax (∼6 h), t1/2 (∼18 h), mean residence time (MRTINF) (∼28 h) and V/F (∼8 L/kg) were similar in all paediatric treatment arms. Conclusions A positive association of AUC or Cmax with dose was observed in both age groups. Undernutrition might influence the AUC of ivermectin in PSAC. Ivermectin shows a lower exposure profile in children compared with adults, highlighting the need to establish dosing recommendations for different age groups.
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oxantel pamoate albendazole for Trichuris trichiura infection
The New England Journal of Medicine, 2014Co-Authors: Benjamin Speich, Jan Hattendorf, Jörg Huwyler, Marco Albonico, Jurg Utzinger, Rainer Alles, Jennifer KeiserAbstract:BACKGROUND Infections with soil-transmitted helminths (Ascaris lumbricoides, hookworm, and Trichuris trichiura) are widespread and often occur concomitantly. These parasiticworm infections are typically treated with albendazole or mebendazole, but both drugs show low efficacy against T. trichiura. Albendazole is the drug of choice against hookworm. METHODS In this double-blind trial conducted on Pemba Island, Tanzania, we randomly assigned children, 6 to 14 years of age, to receive one of four treatments: oxantel pamoate at a dose of 20 mg per kilogram of body weight, plus 400 mg of albendazole, administered on consecutive days; oxantel pamoate at a single dose of 20 mg per kilogram; albendazole at a single dose of 400 mg; or mebendazole at a single dose of 500 mg. We assessed the efficacy and safety profile of oxantel pamoate– albendazole when used in the treatment of T. trichiura infection (primary outcome) and concomitant soil-transmitted helminth infection (secondary outcome). Efficacy was determined by means of assessment of the cure rate and egg-reduction rate. Adverse events were assessed four times after treatment. RESULTS Complete data were available for 458 children, of whom 450 were infected with T. trichiura, 443 with hookworm, and 293 with A. lumbricoides. The cure rate of T. trichiura infection was significantly higher with oxantel pamoate–albendazole than with mebendazole (31.2% vs. 11.8%, P = 0.001), as was the egg-reduction rate (96.0% [95% confidence interval {CI}, 93.5 to 97.6] vs. 75.0% [95% CI, 64.2 to 82.0]). The cure rate with albendazole (2.6%) and the egg-reduction rate with albendazole (45.0%; 95% CI, 32.0 to 56.4) were significantly lower than the rates with mebendazole (P = 0.02 for the comparison of cure rates). Oxantel pamoate had low efficacy against hookworm and A. lumbricoides. Adverse events (mainly mild) were reported by 30.9% of all children. CONCLUSIONS Treatment with oxantel pamoate–albendazole resulted in higher cure and eggreduction rates for T. trichiura infection than the rates with standard therapy. (Funded by the Medicor Foundation and the Swiss National Science Foundation; Current Controlled Trials number, ISRCTN54577342.)
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efficacy and safety of nitazoxanide albendazole and nitazoxanide albendazole against Trichuris trichiura infection a randomized controlled trial
PLOS Neglected Tropical Diseases, 2012Co-Authors: Benjamin Speich, Jan Hattendorf, Marco Albonico, Jurg Utzinger, Rainer Alles, Jennifer KeiserAbstract:BACKGROUND: The currently used anthelmintic drugs, in single oral application, have low efficacy against Trichuris trichiura infection, and hence novel anthelmintic drugs are needed. Nitazoxanide has been suggested as potential drug candidate. METHODOLOGY: The efficacy and safety of a single oral dose of nitazoxanide (1,000 mg), or albendazole (400 mg), and a nitazoxanide-albendazole combination (1,000 mg-400 mg), with each drug administered separately on two consecutive days, were assessed in a double-blind, randomized, placebo-controlled trial in two schools on Pemba, Tanzania. Cure and egg reduction rates were calculated by per-protocol analysis and by available case analysis. Adverse events were assessed and graded before treatment and four times after treatment. PRINCIPAL FINDINGS: Complete data for the per-protocol analysis were available from 533 T. trichiura-positive children. Cure rates against T. trichiura were low regardless of the treatment (nitazoxanide-albendazole, 16.0%; albendazole, 14.5%; and nitazoxanide, 6.6%). Egg reduction rates were 54.9% for the nitazoxanide-albendazole combination, 45.6% for single albendazole, and 13.4% for single nitazoxanide. Similar cure and egg reduction rates were calculated using the available case analysis. Children receiving nitazoxanide had significantly more adverse events compared to placebo recipients. Most of the adverse events were mild and had resolved within 24 hours posttreatment. CONCLUSIONS/SIGNIFICANCE: Nitazoxanide shows no effect on T. trichiura infection. The low efficacy of albendazole against T. trichiura in the current setting characterized by high anthelmintic drug pressure is confirmed. There is a pressing need to develop new anthelmintics against trichuriasis. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN08336605
