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PubMed2006

HIV type 1 pol gene diversity and antiretroviral drug resistance mutations in the Democratic Republic of Congo (DRC).

To study recombination and the natural polymorphism in pol of HIV-1 strains in the Democratic Republic of Congo (DRC) we sequenced the protease and RT genes for 70 HIV-1 strains previously characterized in the env V3-V5 region from a sentinel surveillance study in 2002. For 41 of the 70 (58.6%) strains, the same subtype/ CRF designations were observed in pol and env. Twenty-three (32.9%) of 70 pol sequences were complex recombinants involving two to five subtypes as well as fragments that could not be classified into any of the known subtypes. All subtypes were involved in recombination events. Unclassified (U) and env subtype H strains were very likely to be recombinant strains. Overall, many minor mutations were identified in the protease sequences. Although at the time of our study ARV use was not yet widespread in DRC, three strains were identified with one major mutation associated with drug resistance: L90M and M46L in protease and K103N in RT.

Democratic Republic of the Congo↗
PubMedDate not supplied

The clinical pathology of Crimean-Congo hemorrhagic fever.

Observations were made of 15 fatal and 35 nonfatal Crimean-Congo hemorrhagic fever (CCHF) infections diagnosed from February 1981 to March 1987 in Kimberly and Sandringham, Republic of South Africa. Following an incubation period of 2-9 days after exposure to infection, patients had a sudden onset of disease with fever, nausea, severe headache, and myalgia. Petechial rash and hemorrhagic signs such as epistaxis, hematemesis, and melena supervened on days 3-6 of illness. Deaths occurred on days 5-14 of illness. Patients with fatal infections had thrombocytopenia and markedly elevated levels of serum aspartate and alanine aminotransaminases, gamma-glutamyltransferase, lactic dehydrogenase, creatine kinase, bilirubin, creatinine, and urea. Total protein, albumin, fibrinogen, and hemoglobin levels were depressed. Values for prothrombin ratio, activated partial thromboplastin time, thrombin time, and fibrin degradation products were grossly elevated, findings that indicate the occurrence of disseminated intravascular coagulopathy. Many of the clinical pathologic changes were evident at an early stage of the disease and had a highly predictive value for fatal outcome of infection. Changes were present but less marked in nonfatal infections.

Animals↗
PubMedDate not supplied

Antibody response in Crimean-Congo hemorrhagic fever.

IgG and IgM antibodies became demonstrable by indirect immunofluorescence on days 7 to 9 of illness in 35 survivors of Crimean-Congo hemorrhagic fever. Maximum titers of antibody were usually attained in the second to third week of illness. Titers of IgM declined gradually thereafter and were low or negative by the fourth month. In some patients titers of IgG increased markedly between 2 and 4 months after onset of illness and remained readily demonstrable by indirect immunofluorescence 3 years after infection. Endogenous antibody response was demonstrated in only two of 15 patients who died of infection. Techniques for demonstrating antibody were (in order of decreasing sensitivity) enzyme-linked immunosorbent assay, reversed passive hemagglutination-inhibition, indirect immunofluorescence, fluorescent-focus reduction, complement-fixation, and immunodiffusion. Most patients developed relatively low levels of neutralizing antibodies (range, 1:8 to 1:32 by fluorescent-focus reduction tests), but some developed titers of 1:256 to 1:512. Plasma intended for therapeutic use should be selected on the basis of its neutralizing ability.

Antibodies, Viral↗
PubMed1998

Fatness and muscularity as risk indicators of child mortality in rural Congo.

OBJECTIVES: To examine the relationship of anthropometrical indicators of fatness and muscularity with mortality in children in a rural African community. BACKGROUND: A prospective cohort study was carried out in the rural health zone of Bwamanda, Northern Congo using a random cluster sample of 5167 children, aged 0-5 years. MAIN OUTCOME MEASURES: Short- and long-term mortality rates, being deaths within 3 months and deaths in 3-month periods observed 3-30 months after enrolment. Rates of all cause mortality and of mortality from kwashiorkor or marasmus, by level of baseline fatness and muscularity. Indicators of fatness and muscularity were obtained by correcting anthropometric arm fat and arm muscle areas for age, sex, weight and height. RESULTS: The relationship of both the fatness and muscularity scores with short-term mortality was marked by a clear threshold (-0.5 SDS) below which there was a significant rise in mortality from all causes as well as from kwashiorkor and marasmus. These excess mortalities were also found in normal weight children. Fatness and muscularity scores remained significant determining factors of short-term mortality in a multiple logistic regression analysis with sex, age, season and weight-for-age. A ROC curve analysis showed that fat and muscularity scores had better predictive abilities than weight-for-age. Low fat status had a bad prognosis on the long-term in underweight children. CONCLUSIONS: Measures of current nutritional status should not be based on weight indices alone. Objective and/or clinical evaluation of fat and muscle status (also in normal weight children) should be added in order to detect a higher proportion of malnourished children and to more accurately evaluate mortality risk.

Adipose Tissue↗
PubMed2001

Seroepidemiological survey of hepatitis C virus among commercial sex workers and pregnant women in Kinshasa, Democratic Republic of Congo.

BACKGROUND: Studies conducted mainly in industrialized countries have shown that the transmission of hepatitis C virus (HCV) is mainly parenteral, and have emphasized the role of nosocomial transmission. In Equatorial Africa, the respective contributions of parenteral and non-parenteral routes of transmission are unknown. The potential role of sexual transmission in this area of high HCV endemicity, where sexually transmitted infections (STI) are frequent, is suggested by the fact that HCV infection is rare in infants and young adolescents, but increases thereafter with age. The present study, conducted in Democratic Republic of Congo, was designed to determine the prevalence of HCV infection and associated sexual risk factors in two female populations with different sexual behaviour. METHODS: Cross-sectional studies conducted among commercial sex workers (CSW; n = 1144) and pregnant women (n = 1092) in the late 1980s in Kinshasa showed a high frequency of at-risk sexual behaviour, STI and human immunodeficiency virus (HIV) infection, particularly among CSW. We screened samples collected during these epidemiological studies for antibodies to HCV using a second-generation ELISA with confirmation by a third-generation LIA. We also assessed sociodemographic variables, medical history, STI markers and sexual behaviour, and their potential association with HCV infection. RESULTS: The overall prevalence of anti-HCV was 6.6% (95% CI : 5.2-8.2) among CSW and 4.3% (95% CI : 3.2-5.7) among pregnant women (age-adjusted OR = 1.5, 95% CI : 1.0-2.1, P = 0.05). Multivariate analysis showed that the presence of anti-HCV among CSW was independently associated with a previous history of blood transfusion (P < 0.001), age >30 years (P < 0.001) and the presence of at least one biological marker of STI (P < 0.03). No such links were found among pregnant women (although the history of blood transfusions was not investigated in this group). Anti-HCV was not associated with sociodemographic variables or sexual behaviour in either group, or with individual markers of STI. Despite the high-risk sexual behaviour and the higher prevalence of STI in CSW, the difference in HCV seroprevalence between CSW and pregnant women (6.6% versus 4.3%) was small, particularly when compared with the difference in the seroprevalence of HIV (34.1% versus 2.8%). CONCLUSION: The role of sexual transmission in the spread of HCV seems to be limited. Parenteral transmission (including blood transfusion and injections), possibly related to the treatment of STI, probably plays a major role.

Adolescent↗
PubMed1991

Risk factors for Crimean-Congo hemorrhagic fever in rural northern Senegal.

The extent of infection among 722 residents of an enzootic focus of Crimean-Congo hemorrhagic fever (CCHF) virus in rural northern Senegal and putative modes of transmission were studied by a cross-sectional seroprevalence survey done from February through May 1989. Anti-CCHF virus IgG was found in 13.1% of 283 persons who completed a standard questionnaire and provided blood samples. Seropositivity rates were similar between sexes and increased significantly with age among nomadic persons. Behavior patterns providing exposure to multifactorial risk factors were gender-based. Male risk factors, primarily associated with herding activities, included sleeping outside during seasonal migrations (also a risk factor for nomadic women), bite by a tick (adult male Hyalomma truncatum), tick bite during the cool dry season, and contact with sick animals. Human infection of CCHF occurred more frequently or with less mortality in the region studied than has been found elsewhere in Africa; however, the rate of seroconversion-associated illness is undetermined. Hyalomma ticks appear to be the primary transmission mode.

Adolescent↗
PubMed1990

Replication of Crimean-Congo hemorrhagic fever virus in four species of ixodid ticks (Acari) infected experimentally.

The vector potentials of Hyalomma dromedarii Koch, H. impeltatum Schulze & Schlottke, H. truncatum Koch, and Rhipicephalus appendiculatus Neumann for Crimean-Congo hemorrhagic fever (CCHF) virus (IbAr 10200) were evaluated by intracoelomic inoculation. All three Hyalomma species became infected; infection rates ranged between 80 and 100% at 7-14 d after inoculation, and viral titers increased in unfed specimens almost 100 times above inoculation levels within the first week following infection. Only 40% of the R. appendiculatus became infected, and viral titers of unfed specimens increased less than 10 times above inoculation levels. The virus persisted to 153 d in unfed H. impeltatum. Viral titers were significantly higher in female than in male H. dromedarii, H. impeltatum, H. truncatum, and R. appendiculatus after blood feeding. Blood feeding had little effect on the viral titers of male Hyalomma species. However, the percentage of female and male ticks from which virus was recovered was significantly higher from fed ticks compared with unfed ticks. No virological evidence of transovarial transmission was found in greater than 78,000 first-generation progeny (larvae, nymphs, and adults) of inoculated female H. dromedarii, H. impeltatum, H. truncatum, and R. appendiculatus. All species transmitted CCHF virus to guinea pigs when allowed to feed at both 6 and 21 d after inoculation.

Animals↗
PubMed1992

Replication and tissue tropisms of Crimean-Congo hemorrhagic fever virus in experimentally infected adult Hyalomma truncatum (Acari: Ixodidae).

Adult Hyalomma truncatum Koch ticks were inoculated intracoelomically with Crimean-Congo hemorrhagic fever (CCHF) virus to examine tissue tropisms of this virus in ticks. Virus was recovered from all 185 ticks examined between 2 and 42 d after inoculation with CCHF virus. Titers or virus recovered from unfed male and female ticks were essentially the same (means, 10(2.4) and 10(2.5) plaque-forming units [PFU] per tick, respectively). Infection rates and titers recovered per gland for both salivary glands and reproductive tissues (ovaries and testes) were positively associated with blood feeding; average titers were 10-fold greater in organs from fed compared with those from unfed individuals. In contrast, neither the tick's sex nor feeding status (unfed or engorged) affected the titer of virus recovered from hemolymph (mean, 10(1.6) PFU/microliters). Although virus was recovered from Malpighian tubules, midgut, muscle, and nervous tissues from nearly all of the ticks tested, viral titers were consistently low. The increase in viral titer associated with blood feeding by ticks appeared to be due primarily to proliferation of tissue (e.g., salivary gland and reproductive tissues), rather than to increased replication in tissue already present.

Animals↗
PubMed1993

Experimental vector incompetence of a soft tick, Ornithodoros sonrai (Acari: Argasidae), for Crimean-Congo hemorrhagic fever virus.

Adults and nymphs of a soft tick, Ornithodoros sonrai Sautet & Witkowski, were allowed to feed on suckling mice that had been experimentally infected with Crimean-Congo hemorrhagic fever (CCHF) virus (IbAr 10200 strain). The mean viral titer of mouse blood at the time of tick feeding was 10(3.2) plaque-forming units (PFU) per ml. Samples of ticks were assayed on 12 occasions between days 0 and 31 after the viremic blood meal. Mean CCHF viral titers were 10(2.1) PFU per tick immediately after the viremic meal but declined to 10(1.2) PFU per tick after 2 d, and no virus was detected beyond 8 d. The percentage of ticks with detectable virus was 92% (22/24) immediately after the viremic meal, but then declined to 20% (2/10) after 4 d and to 0% (0/44) after 11 or more days. Ticks were allowed to feed on sets of three naive suckling mice on days 0, 2, 5, 8, 11, 14, 21, and 28 after the viremic blood meal, but CCHF viral transmission did not occur. Similarly, no transovarial transmission of virus from CCHF virus-exposed O. sonrai to their progeny was observed. These results strongly indicate that O. sonrai is not a vector of CCHF virus.

Animals↗
PubMed1996

Transmission of Crimean-Congo hemorrhagic fever virus by Hyalomma impeltatum (Acari:Ixodidae) after experimental infection.

We examined the potential for Hyalomma impeltatum Schulze & Schlottke ticks to transmit Crimean-Congo hemorrhagic fever (CCHF) virus. After feeding on 1-d-old mice that had been inoculated with CCHF virus, larval H. impeltatum became infected with and subsequently transmitted CCHF virus transstadially to nymphs. These nymphs transmitted virus horizontally to guinea pigs and transstadially to adults. A minimum of 13% of the adult H. impeltatum, exposed to virus as larvae, transmitted virus by bite to guinea pigs. An enzyme-linked immunosorbent assay detected CCHF viral antigen in 63% of the adult ticks derived from those exposed to this virus as larvae. This tick species should be considered as a potential vector of CCHF virus.

Animals↗
PubMed2005

Cordylobia anthropophaga (Diptera: Calliphoridae) outside Africa: a case of furuncular myiasis in a child returning from Congo.

International travel to tropical countries accounts for an increasing incidence of imported diseases. An unusual case of furuncular myiasis due to Cordylobia anthropophaga (Blanchard) is reported in northern France in a 9-mo-old infant, after a 4-mo stay in Congo. A review has been made of the major cases of imported furuncular myiasis due to Cordylobia, as well as identification of second larval instars and management of the myiasis.

Animals↗
PubMed2001

Spatial distribution of Eucalyptus roots in a deep sandy soil in the Congo: relationships with the ability of the stand to take up water and nutrients.

Spatial statistical analyses were performed to describe root distribution and changes in soil strength in a mature clonal plantation of Eucalyptus spp. in the Congo. The objective was to analyze spatial variability in root distribution. Relationships between root distribution, soil strength and the water and nutrient uptake by the stand were also investigated. We studied three, 2.35-m-wide, vertical soil profiles perpendicular to the planting row and at various distances from a representative tree. The soil profiles were divided into 25-cm2 grid cells and the number of roots in each of three diameter classes counted in each grid cell. Two profiles were 2-m deep and the third profile was 5-m deep. There was both vertical and horizontal anisotropy in the distribution of fine roots in the three profiles, with root density decreasing sharply with depth and increasing with distance from the stump. Roots were present in areas with high soil strength values (> 6,000 kPa). There was a close relationship between soil water content and soil strength in this sandy soil. Soil strength increased during the dry season mainly because of water uptake by fine roots. There were large areas with low root density, even in the topsoil. Below a depth of 3 m, fine roots were spatially concentrated and most of the soil volume was not explored by roots. This suggests the presence of drainage channels, resulting from the severe hydrophobicity of the upper soil.

Calcium↗
PubMed2002

Konzo outbreak, in the south-west of the Democratic Republic of Congo, 1996.

In August 1996, cases of poliomyelitis were reported in Kahemba zone, in the south-west of the Democratic Republic (DR) of Congo. The diagnosis was reviewed and charged to Konzo, a spastic paraparesis attributed to food cyanide intoxication. In order to describe the phenomena, a community-based survey took place and found 237 people affected. The highest prevalence was found in the most isolated part of the zone. The patients suffered from an isolated non-progressive spastic paraparesis of abrupt onset. Children and women were the most affected groups, especially women after childbirth. Most of the patients developed the disease after 1990 with 101 cases in 1996. Cassava processing was the same over time and in all the villages. The study did not fully explain the increased number of cases in 1996 but suggested that complementary investigations regarding micronutrient intakes, especially vitamin A, would be necessary.

Adolescent↗
PubMed1998

Evidence of stable HIV seroprevalences in selected populations in the Democratic Republic of the Congo.

OBJECTIVE: To determine current data on HIV infection and to document changes and trends of HIV seroprevalence in selected populations over time in the Democratic Republic of the Congo (DRC; former Zaïre). METHODS: In February 1997, a large serosurvey was conducted on selected population groups from Kinshasa (capital city), Mbuji-May (southeast) and Bwamanda (northwest). Samples obtained from pregnant women, tuberculosis patients, commercial sex workers, blood donors and sexually transmitted disease patients were screened for the presence of HIV antibodies by a rapid assay and a commercial enzyme-linked immunosorbent assay. All reactive specimens were confirmed and discriminated by a line immunoassay, and were further tested for the presence of HIV-1 group O antibodies. Our results were compared to data reported in previous studies in Kinshasa. RESULTS: Of a total 1970 samples collected, 219 (11.1%) were HIV-1-reactive and seven (0.3%) were dually reactive to HIV-1 and HIV-2. No case of HIV-1 group O or HIV-2 infection was diagnosed. HIV seroprevalence in pregnant women was 3.1% (16 out of 511), 6.3% (19 out of 300) and 1.5% (one out of 65) in Kinshasa, Mbuji-Mayi, and Bwamanda, respectively. HIV seroprevalence in tuberculosis patients was 26% (52 out of 200), 28% (17 out of 60), and 35.3% (29 out of 83), respectively. HIV seroprevalence among blood donors was 3.1% in Kinshasa and 2.8% in Mbuji-Mayi. Compared with data from previous studies performed in Kinshasa, no substantial change in HIV infection rates was observed among the selected population groups. CONCLUSIONS: Our results show that HIV prevalence rates have remained relatively unchanged in selected populations despite the political instability and poor environment observed since 1991 in DRC. It also shows the presence, still at very low rate, of dual HIV-1/HIV-2 seropositivity and a growing problem of HIV infection in rural areas. In contrast to other Central African countries, no HIV-1 group O infections were detected in DRC.

Adult↗
PubMed1998

Contribution of AIDS to the general mortality in Central Africa: evidence from a morgue-based study in Brazzaville, Congo.

OBJECTIVE: To accurately measure AIDS-related mortality relative to other causes and its impact on life expectancy in Brazzaville, Congo. DESIGN: Investigation of all deaths during a 1-month period in Brazzaville. METHODS: From 10 July to 9 August 1996, all bodies handled by Brazzaville's three morgues were examined by a physician. Relatives were interviewed on the circumstances of death, while additional clinical data were gathered from hospital files. Blood samples were systematically drawn from the bodies in two of the three morgues and tested for HIV antibodies. RESULTS: Amongst the 756 bodies examined at the three morgues, 149 (19.7%) AIDS cases were identified. HIV-1 prevalence was 26.2% (38 out of 145) amongst the subjects in the two morgues where HIV serology was systematically performed. AIDS was the leading cause of death in adults (age > or = 15 years), with 25.1% (122 out of 487) of the adults diagnosed with AIDS. The proportion of adult female AIDS cases was significantly higher than the proportion of male cases (30.2 versus 21.0%; P < 0.05). Moreover, female AIDS cases were significantly younger than male cases (median age, 32 versus 42 years; P < 0.00001). Overall AIDS mortality rate amongst adults was 2.8 per 1000 for men and 3.2 per 1000 for women. The impact of AIDS on life expectancy at birth is 4.3 years for women and 3.3 years for men. CONCLUSION: Our study provides a direct measure of AIDS contribution to mortality relative to other causes, using a rapid, low cost, reliable and replicable method. Clearly, the impact of AIDS is strongest on female life expectancy.

AIDS Serodiagnosis↗
PubMed2007

HIV and other sexually transmitted infections among female sex workers in Kinshasa, Democratic Republic of Congo, in 2002.

OBJECTIVE: The objective of this study was to determine the prevalence and risk factors of HIV and other sexually transmitted infections (STIs) among female sex workers (FSWs) in Kinshasa, Democratic Republic of the Congo, in 2002. STUDY DESIGN: A cross-sectional study was conducted among FSWs presenting for the first time at the STI clinic of Matonge, Kinshasa. The women were interviewed about sociodemographic characteristics, type of sex work, and sexual behavior. Blood was taken for HIV, syphilis, and herpes simplex virus type 2 serology. Vaginal secretions were collected on swabs for the diagnosis of gonorrhea, chlamydia, and trichomoniasis. RESULTS: The overall HIV prevalence was 12.4% but varied within the different categories of FSWs: 11.8% in hotel-based, 24.0% in home-based, and 20.0% in street-based FSWs; 10.0% in homeless FSWs; and 6.6% in Masquées (clandestine sex workers). The overall herpes simplex virus type 2 seroprevalence was 58.5%. CONCLUSIONS: The prevalence of HIV and other STIs seems to have stabilized since the beginning of the project in 1988.

Adolescent↗
PubMed2005

Distribution of HIV-1 variants in the Democratic Republic of Congo suggests increase of subtype C in Kinshasa between 1997 and 2002.

The Democratic Republic of Congo (DRC) is characterized by low and stable HIV prevalences and high HIV-1 genetic diversity and is most probably the epicenter of HIV-1 group M. Our major goal was to study the distribution of HIV-1 variants over a 5-year period against a background of political instability and civil war. A total of 288 HIV-1-positive samples collected in 2002 from sentinel population groups in an HIV serosurveillance study performed in 4 cities (Kinshasa [capital city], Mbuji-Mayi [south], Lubumbashi [southeast], and Kisangani [northeast]) were genetically characterized by sequencing and phylogenetic analysis of the V3-V5 env region. The results were compared with those obtained in 1997. Similarly, as in 1997, an extremely high genetic diversity of HIV-1 strains overall and a heterogeneous geographic distribution were seen in 2002. All subtypes and several circulating recombinant forms were present, high intrasubtype diversity was observed, and 5.6% of the samples could not be classified. In each geographic region of the DRC, the genetic diversity was significantly higher than in neighboring countries. Comparison of subtype distribution in similar population groups in Kinshasa in 1997 and 2002 revealed an overall increase of subtype C in Kinshasa from 2.1% to 9.7% and, more precisely, from 0% to 18.9% in female sex workers (P = 0.013). Genetic characterization of HIV-positive samples from sentinel surveys adds significant additional information on new trends in the HIV epidemic. These changes could have implications regarding the spread of HIV infection in the DRC as well on vaccine and/or treatment strategies.

Adult↗
PubMed1994

Detection of human antibodies to Crimean-Congo haemorrhagic fever virus using expressed viral nucleocapsid protein.

Diagnosis of Crimean-Congo haemorrhagic fever (CCHF) virus infections is hampered by the problems of handling this human pathogen, which requires the highest levels of biological containment. Recombinant antigens were examined for their potential as non-hazardous diagnostic reagents. The nucleocapsid (N) gene of the Greek AP92 isolate of CCHF virus was sequenced from cloned PCR products and the open reading frame was identified by homology to the N protein of a Chinese isolate of CCHF virus. The N protein was expressed to high levels in a baculovirus expression system. Three N protein-derived peptides were expressed in Escherichia coli as fusions with glutathione S-transferase and the antigenicities of these proteins and the baculovirus-expressed protein were tested by ELISA. When tested with laboratory animal sera representing all seven serogroups of nairoviruses, the only reactive sera were those raised to CCHF virus (Greek, Nigerian and Chinese isolates) and, more weakly, Hazara virus. When tested with a panel of known positive and negative human sera, the baculovirus-expressed N protein, and the peptide derived from the central region of the N protein, proved to be the best for identifying CCHF virus-specific IgG.

Amino Acid Sequence↗