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2.  Effect of praziquantel treatment during pregnancy on cytokine responses to schistosome antigens: results of a randomised, placebo-controlled trial 
The Journal of infectious diseases  2008;198(12):1870-1879.
Praziquantel treatment of schistosomiasis boosts anti-schistosome responses, with ‘type 2 helper T-cell’ bias that may contribute to immunologically mediated killing and to protection against re-infection. Praziquantel treatment during pregnancy was recommended in 2002 but immunological effects of the treatment had not been investigated.
A cohort of 387 S. mansoni infected women was recruited within a larger trial of de-worming during pregnancy (ISRCTN32849447; Women were randomised to receive either praziquantel or placebo during pregnancy. Six weeks after delivery all women received praziquantel. Whole blood culture cytokine responses to S. mansoni worm and egg antigens were measured before and six weeks after each treatment.
Schistosome specific cytokine responses were suppressed during pregnancy. Praziquantel treatment during pregnancy caused significant boosts in gamma interferon (IFNγ), interleukin (IL)-2, IL-4, IL-5 IL-13 and IL-10 responses to schistosome worm antigen and IFNγ, IL-5 and IL-13 to schistosome egg antigen; but these boosts were not as substantial as those seen for treatment after delivery.
Pregnancy suppresses potentially beneficial boost in cytokine responses associated with praziquantel treatment. Further studies are needed on the long term effect of treating schistosomiasis during pregnancy on morbidity and resistance to reinfection among treated women and their offspring.
PMCID: PMC2892302  PMID: 18983246
Schistosomiasis; Schistosoma mansoni; human; praziquantel; treatment; pregnancy; cytokines; immunology; immune responses
3.  Plasmodium falciparum and helminth co-infection in a semi-urban population of pregnant women in Uganda 
The Journal of infectious diseases  2008;198(6):920-927.
Helminth infections and malaria are widespread in the tropics. Recent studies suggest helminth infections may increase susceptibility to malaria. If confirmed, this could be particularly important during pregnancy-induced immunosuppression.
To evaluate the geographical distribution of Plasmodium falciparum-helminth co-infection, and associations between parasite species in pregnant women in Entebbe, Uganda.
A cross-sectional study was conducted at baseline in a trial of anti-helminthics during pregnancy. Helminth and P.falciparum infections were quantified in 2507 asymptomatic women; socio-demographic and geographical details were recorded.
Hookworm and Mansonella perstans were associated with P.falciparum but the effect of hookworm was seen only in the absence of M.perstans (OR for P.falciparum, adjusted for age, tribe, socioeconomic status, HIV and location: hookworm without M.perstans 1.53 (95% CI 1.09-2.14); M.perstans without hookworm 2.33 (1.47-3.69), both hookworm and M.perstans, 1.85 (1.24-2.76)). No association was observed between Schistosoma mansoni, Trichuris or Strongyloides and P.falciparum.
Hookworm-P.falciparum and M.perstans-P.falciparum co-infection amongst pregnant women in Entebbe is more common than expected by chance. Further studies are needed to elucidate the mechanism of this association. Helminth-induced increased susceptibility to P.falciparum could have important consequences for pregnancy outcome and responses to malaria in infancy.
PMCID: PMC2886962  PMID: 18721060
Malaria; Helminth; Hookworm; Mansonella perstans; Plasmodium falciparum; Co-Infection; Spatial; Geographic Factors; Pregnancy; Uganda
4.  Rate and Amplification of Drug Resistance among Previously-Treated Patients with Tuberculosis in Kampala, Uganda 
Drug-resistant Mycobacterium tuberculosis has emerged as a global threat. In resource-constrained settings, patients with a history of tuberculosis (TB) treatment may have drug-resistant disease and may experience poor outcomes. There is a need to measure the extent of and risk factors for drug resistance in such patients.
From July 2003 through November 2006, we enrolled 410 previously treated patients with TB in Kampala, Uganda. We measured the prevalence of resistance to first- and second-line drugs and analyzed risk factors associated with baseline and acquired drug resistance.
The prevalence of multidrug-resistant TB was 12.7% (95% confidence interval [95% CI], 9.6%–16.3%). Resistance to second-line drugs was low. Factors associated with multidrug-resistant TB at enrollment included a history of treatment failure (odds ratio, 23.6; 95% CI, 7.7–72.4), multiple previous TB episodes (odds ratio, 15.6; 95% CI, 5.0–49.1), and cavities present on chest radiograph (odds ratio, 5.9; 95% CI, 1.2–29.5). Among a cohort of 250 patients, 5.2% (95% CI, 2.8%–8.7%) were infected with M. tuberculosis that developed additional drug resistance. Amplification of drug resistance was associated with existing drug resistance at baseline (P<.01) and delayed sputum culture conversion (P<.01).
The burden of drug resistance in previously treated patients with TB in Uganda is sizeable, and the risk of generating additional drug resistance is significant. There is an urgent need to improve the treatment for such patients in low-income countries.
PMCID: PMC2883442  PMID: 18808360
5.  Uptake of HIV and syphilis testing of pregnant women and their male partners in a programme for prevention of mother-to-child HIV transmission in Uganda 
To describe uptake of HIV and syphilis testing in a prevention of mother-to-child HIV transmission programme in Uganda.
Analysis of data from routine HIV and syphilis testing at Entebbe Hospital antenatal services.
A total of 20 738 women attended antenatal services. Exactly 62.8% of women, but only 1.8% of their male partners, accepted testing for HIV; 82.2% of women, but only 1.1% of their male partners accepted syphilis testing. Partners of women with positive HIV results were more likely to come for subsequent testing. Of 200 couples whose partners accepted HIV-testing within 30 days of one another, 19 (9.5%) were HIV-discordant, representing 65.5% of couples with at least one partner HIV-positive. HIV prevalence was 12.6% for women and 10.8% for men; syphilis prevalence was 4.0% for women and 6.2% for men.
Uptake of HIV and syphilis testing was fairly good among pregnant women attending antenatal clinics at Entebbe Hospital, but very low among their male partners. The level of HIV-discordant couples was high. These clinics should be made more couples-friendly to identify both HIV-positive men for treatment and discordant couples for HIV prevention.
PMCID: PMC2592475  PMID: 18331533
HIV; PMTCT; Uganda; pregnant; couple; syphilis
6.  Skin prick test reactivity to common allergens among women in Entebbe, Uganda 
The objectives of this study were to estimate the prevalence of atopic sensitization, and to identify common aeroallergens associated with atopic sensitization among women in Entebbe, Uganda, and to determine risk factors for atopic sensitization among those with and without a history of asthma or eczema. A case–control study was conducted within a trial of deworming in pregnancy, approximately 2 years after the intervention. Skin prick test reactivity was assessed among 20 women with a history of asthma, 25 with history of eczema and 95 controls. Overall prevalence of reactivity was estimated by adjusting for the prevalence of asthma in the whole cohort. Overall skin prick test prevalence was: any allergen 30.7%, Blomia tropicalis 10.9%, Dermatophagoides mix 16.8%, cockroach 15.8%. The prevalence of a positive skin prick test was significantly associated with a history of asthma (70% to any allergen vs. 32%, P = 0.002) but not with a history of eczema (44% vs. 36%, P = 0.49). Women with Mansonella perstans had significantly reduced odds for atopic sensitization (adjusted odds ratio 0.14, 95% CI 0.03–0.69); women with a history of asthma were less likely to have hookworm (adjusted odds ratio 0.24, 95% CI 0.07–0.81) but this association was weaker for women with a history of eczema. [Clinical Trial No. ISRCTN32849447]
PMCID: PMC2628422  PMID: 18321545
Worms; Allergy; Atopy; Skin prick test; Mansonella perstans; Uganda

Results 1-6 (6)