Browsing by Author "Elliott, A. M."

Now showing 1 - 5 of 5
  • Thumbnail Image
    Item
    Effects of Deworming during Pregnancy on Maternal and Perinatal Outcomes in Entebbe, Uganda: A Randomized Controlled Trial
    (Clinical Infectious Diseases, 2010) Ndibazza, J.; Muhangi, L.; Akishule, D.; Kiggundu, M.; Ameke, C.; Oweka, J.; Kizindo, R.; Duong, T.; Kleinschmidt, I.; Muwanga, M.; Elliott, A. M.
    Helminth infections during pregnancy may be associated with adverse outcomes, including maternal anemia, low birth weight, and perinatal mortality. Deworming during pregnancy has therefore been strongly advocated, but its benefits have not been rigorously evaluated. In Entebbe, Uganda, 2507 pregnant women were recruited to a randomized, double-blind, placebocontrolled trial investigating albendazole and praziquantel in a 2 2 factorial design [ISRCTN32849447]. Hematinics and sulphadoxine-pyrimethamine for presumptive treatment of malaria were provided routinely. Maternal and perinatal outcomes were recorded. Analyses were by intention to treat. At enrollment, 68% of women had helminths, 45% had hookworm, 18% had Schistosoma mansoni infection; 40% were anemic (hemoglobin level, !11.2 g/dL). At delivery, 35% were anaemic; there was no overall effect of albendazole (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.79–1.15) or praziquantel (OR, 1.00; 95% CI, 0.83–1.21) on maternal anemia, but there was a suggestion of benefit of albendazole among women with moderate to heavy hookworm (OR, 0.45; 95% CI, 0.21–0.98; Pp.15 for interaction). There was no effect of either anthelminthic treatment on mean birth weight (difference in mean associated with albendazole: 0.00 kg; 95% CI, 0.05 to 0.04 kg; difference in mean associated with praziquantel: 0.01 kg; 95% CI, 0.05 to 0.04 kg) or on proportion of low birth weight. Anthelminthic use during pregnancy showed no effect on perinatal mortality or congenital anomalies. In our study area, where helminth prevalence was high but infection intensity was low, there was no overall effect of anthelminthic use during pregnancy on maternal anemia, birth weight, perinatal mortality, or congenital anomalies. The possible benefit of albendazole against anemia in pregnant women with heavy hookworm infection warrants further investigation.
  • Thumbnail Image
    Item
    Evaluation of Suspected Tuberculous Pleurisy: Clinical and Diagnostic findings in HIV-1-Positive and HIV-negative Adults in Uganda
    (The international journal of tuberculosis and lung disease, 2001) Luzze, H.; Elliott, A. M.; Joloba, M. L.; Odida, M.; Nakiyingi, J.; Mugerwa, R. D.; Okwera, A.
    To compare clinical and radiographic presentation, and diagnostic methods, in adults with tuberculous pleurisy who are negative and positive for the human immunodeficiency virus (HIV). Adults with suspected pleural tuberculosis were screened by clinical examination, thoracocentesis and closed pleural biopsy. Biopsy material was cultured on Middlebrook 7H-10 solid medium and in BACTEC 12B radiometric vials. Pleural fluid was cultured using Löwenstein-Jensen slants, BACTEC and Kirchner liquid medium. Of 156 individuals enrolled, 142 had tuberculosis, of whom 80% were HIV-positive. Among those with tuberculosis, HIV-positive patients had a more severe and longer illness. The size of effusions was similar in HIV-positive and HIV-negative patients. A higher proportion of HIV-positive patients had parenchymal infiltrates but this difference was not statistically significant. Pleural fluid lymphocytosis was present in all HIV-negative and 97% of the HIV-positive patients. HIV-positive patients had lower pleural fluid lymphocyte counts. Pleural fluid cultures were more often positive in HIV-positive patients. BACTEC and Kirchner liquid media gave higher yields than solid media. HIV-positive patients with tuberculous pleurisy had a more severe illness than HIV-negative patients. Mycobacterial cultures from HIV-positive patients were more often positive, suggesting more mycobacterial extension from the lungs into the pleural space. Liquid culture media were superior to solid media with regard to diagnostic yield and time until diagnosis.
  • Thumbnail Image
    Item
    Helminths are Positively associated with Atopy and Wheeze in Ugandan Fishing Communities: Results from a Cross-Sectional Survey
    (Allergy, 2016) Webb, E. L.; Nampijja, M.; Kaweesa, J.; Kizindo, R.; Namutebi, M.; Nakazibwe, E.; Oduru, G.; Kabubi, P.; Kabagenyi, J.; Nkurunungi, G.; Kizito, D.; Muhangi, L.; Akello, M.; Nerima, B.; Tukahebwa, E.; Elliott, A. M.
    Parasitic helminths are potent immunomodulators and chronic infections may protect against allergy-related disease and atopy. We conducted a cross-sectional survey to test the hypothesis that in heavily helminth-exposed fishing villages on Lake Victoria, Uganda, helminth infections would be inversely associated with allergy-related conditions. A household survey was conducted as baseline to an anthelminthic intervention trial. Outcomes were reported wheeze in last year, atopy assessed both by skin prick test (SPT) and by the measurement of allergen-specific IgE to dust mites and cockroach in plasma. Helminth infections were ascertained by stool, urine and haemoparasitology. Associations were examined using multivariable regression. Two thousand three hundred and sixteen individuals were surveyed. Prevalence of reported wheeze was 2% in under-fives and 5% in participants ≥5 years; 19% had a positive SPT; median Dermatophagoides-specific IgE and cockroach-specific IgE were 1440 and 220 ng/ml, respectively. S. mansoni, N. americanus, S. stercoralis, T. trichiura, M. perstans and A. lumbricoides prevalence was estimated as 51%, 22%, 12%, 10%, 2% and 1%, respectively. S. mansoni was positively associated with Dermatophagoides-specific IgE [adjusted geometric mean ratio (aGMR) (95% confidence interval) 1.64 (1.23, 2.18)]; T. trichiura with SPT [adjusted odds ratio (aOR) 2.08 (1.38, 3.15)]; M. perstans with cockroach-specific IgE [aGMR 2.37 (1.39, 4.06)], A. lumbricoides with wheeze in participants ≥5 years [aOR 6.36 (1.10, 36.63)] and with Dermatophagoides-specific IgE [aGMR 2.34 (1.11, 4.95)]. No inverse associations were observed. Contrary to our hypothesis, we found little evidence of an inverse relationship between helminths and allergy-related outcomes, but strong evidence that individuals with certain helminths were more prone to atopy in this setting.
  • Thumbnail Image
    Item
    The Medical Research Council (UK)/Uganda Virus Research Institute Uganda Research Unit on AIDS – ‘25 years of research through partnerships
    (Tropical Medicine & International Health, 2015) Kaleebu, Pontiano; Kamali, A.; Seeley, J.; Elliott, A. M.; Katongole-Mbidde, E.
    For the past 25 years, the Medical Research Council/Uganda Virus Research Institute UgandaResearch Unit on AIDS has conducted research on HIV-1, coinfections and, more recently, on non-communicable diseases. Working with various partners, the research findings of the Unit havecontributed to the understanding and control of the HIV epidemic both in Uganda and globally, andinformed the future development of biomedical HIV interventions, health policy and practice. In thisreport, as we celebrate our silver jubilee, we describe some of these achievements and the Unit’smultidisciplinary approach to research. We also discuss the future direction of the Unit; an exemplarof a partnership that has been largely funded from the north but led in the south
  • Thumbnail Image
    Item
    Schistosoma Mansoni-specific Immune Responses and Allergy in Uganda
    (Parasite immunology, 2018) Nkurunungi, G.; Kabagenyi, J.; Nampijja, M.; Sanya, R. E.; Walusimbi,  B.; Nassuuna, J.; Webb, E. L.; Elliott, A. M.
    Low allergy-related disease (ARD) prevalence in low-income countries may be partly attributed to helminth infections. In the Schistosoma mansoni (Sm)-endemic Lake Victoria islands (Uganda), we recently observed positive helminth-allergy associations, despite low ARD prevalence. To understand how Sm-induced cytokine and antibody profiles might influence allergic response profiles in this population, we assessed Schistosoma worm (SWA)- and egg antigen (SEA)-specific Th1 (IFN-γ), Th2 (IL-5, IL-13) and regulatory (IL-10) cytokine profiles (n = 407), and total (n = 471), SWA-, SEA- and allergen (house dust mite [HDM] and cockroach)-specific (as)IgE and IgG4 profiles (n = 2117) by ELISA. Wheeze was inversely associated with SWA-specific IFN-γ (P < .001) and IL-10 (P = .058), and SEA-specific IL-5 (P = .004). Conversely, having a detectable asIgE response was positively associated with SWA-specific IL-5 (P = .006) and IL-10 (P < .001). Total, SWA-, SEA- and allergen-specific IgE and IgG4 responses were higher among Sm Kato-Katz positive (SmKK+) and skin prick test (SPT)+ individuals compared to SmKK- and SPT- individuals. However, total and asIgG4/IgE ratios were lower among SPT+ and wheezing individuals. We conclude that, in this population, helminth-induced antibody and cytokine responses may underlie individual positive helminth-atopy associations, while the overall IgG4-IgE balance may contribute to the low overall prevalence of clinical allergies in such settings.