WHO’s Regional Office for the Eastern Mediterranean (EMRO) is seeking to expand its list of experts on cutaneous leishmaniasis, a major infectious disease of poverty. Experts added to the list would be considered as potential consultants for current and future assignments in the region. At EMRO’s request TropIKA.net is publishing below the office’s call for expressions of interest.

Call for expression of interest: Consultant/expert roster for the cutaneous leishmaniasis control programme

Background
The World Health Organization (WHO) Regional Office for the Eastern Mediterranean provides technical support in the planning and implementation of national programmes for the control of cutaneous leishmaniasis and facilitates regional/international cooperation on control of the disease.

Call for expression of interest
In view of strengthening and scaling up its technical support to countries on the control of cutaneous leishmaniasis, the Regional Office would like to expand its expert database to compile a list of potential consultants for current and future assignments in the Eastern Mediterranean Region.

Fields of expertise should include one or more of the following categories related to cutaneous leishmaniasis.

1. Epidemiology, prevention and control
2. Clinical and laboratory diagnosis
3. Case management and treatment follow‐up
4. Entomology and mammology
5. Public health policy development and assessment for harmonization of prevention
and control measures.

Applicants are requested to send their CV either in English or French (preferably using the WHO CV template available through the WHO e‐Recruitment system at http://www.who.int/employment/vacancies/en) along with a cover letter indicating field(s) of expertise; which period of the year you are most likely available; the minimum time frame to be contacted; and the maximum length of assignment that you could accept.

The documents should be sent to ctd@emro.who.int by 30 September 2010.

The excellent Citizens News Service, based in India, continues to publish interesting and important contributions on tuberculosis.

Recent articles include an examination of the neglect of women in many TB control programmes. Dr Ann Ginsberg, Chief Medical Officer at TB Alliance and a member of the Board of Directors of the Aeras Global TB Vaccine Foundation, told Citizens News that TB has a profound effect on women and their families. The burden of the disease is greater on the woman of the house; she has to bear the physical, mental and economic trauma of the disease. The woman may be sick herself or have sick children or a sick husband to take care of them. Women suffering from TB are often unable to care for their children and have trouble performing household chores. They may have to walk miles to get the treatment which has severe side effects. The health of children with an infected mother is also greatly affected. In addition there is no one to bring money in the family, as the disease leads to a loss of work and loss of wages. The article includes a podcast of the interview with Dr Ginsberg.

Involving communities in TB control is the subject of another article, which focuses on discussions on this theme at a recently concluded meeting held in Addis Ababa, Ethiopia - “Open Forum 4: Critical Path to TB Regimen: New Hope of Life for TB Patients”. Citizens News has also published other reports from this meeting.

Many key research findings on malaria appear in the journals of leading publisher Elsevier. These journals include the Lancet, Lancet Infectious Diseases, Transactions of the Royal Society of Tropical Medicine and Hygiene, and the International Journal for Parasitology. Elsevier has now launched a new knowledge hub, www.malarianexus.com, where the latest malaria research papers in its journals will be highlighted. The new website will also publish feature articles and interviews with malaria researchers.

The feature articles and interviews will be freely accessible to all for a limited time after publication. Unfortunately, however, only the abstracts of the research articles highlighted will be available through www.malarianexus.com. Those wishing to read the articles in full will have to take out subscriptions to the Elsevier journals in which they appear.

Abstracts of articles are of course already accessible on the journals’ own websites and on PubMed, so Elsevier is not providing free or open access to research through this new initiative. Nevertheless, visitors to www.malarianexus.com may find it convenient to have new papers in Elsevier journals highlighted in one place, and the features and interviews are likely to be of value. (Currently available is an intereview with John Beier of the Abess Center, Professor in the Department of Epidemiology and Public Health (DEPH) at the Miller School of Medicine, and Co-Director of the Center for Global Health Sciences in DEPH.)

Registration (free) is required to use www.malaria.nexus.com.

The European Commission has been conducting a consultation on the future of the European and Developing Countries Clinical Trials Partnership (EDCTP) - see report on TropIKA.net. A preliminary analysis of the comments received during the consultation has now been published.

EDCTP was established in 2003 “to accelerate the development of new or improved drugs, vaccines and microbicides against HIV/AIDS, malaria and tuberculosis, with a focus on phase II and III clinical trials in sub-Saharan Africa”. It has sought to bring together 16 European and 46 sub-Saharan countries. During its lifetime the initiative has come in for criticism from several quarters. The consultation was intended “to invite the views and opinions of EDCTP stakeholders, experts active in the fields and the wider public on the need for and nature of a new EDCTP initiative”. A number of statements were provided in the consultation, on which the views of respondents were sought.

During the ten-week period in which the consultation was open, 235 contributions were received. Only a quarter of them were from Africa. Strong majority views emerged in several areas. Over 80% of respondents wanted to see a continued high level of support for trials in malaria, TB and HIV/AIDS. Nevertheless, 65% agreed that EDCTP should extend its remit to include other infectious diseases. In response to a question that if a new EDCTP initiative were to be extended which areas should be prioritised, 71% of respondents favoured public health.

So far, EDCTP has only supported Phase 2 and Phase 3 trials, but 79% or respondents would like to see this broadened to include Phase 1 and Phase 4.

Eighty-seven percent of people agreed that a new EDCTP initiative should review the way it handles proposals and publish revised procedural guidelines on its website. Majorities also were found in favour of statements that capacity building, networking and advocacy should be priority areas for EDCTP.

“Ensuring access to the products of research findings” and improvements in the governance procedures of EDCTP were amongst other issues rated as important by most of the respondents.

Of the four defined policy options, 71% of respondents favoured ‘Expanded Scope’.

Although a final analysis of the consultation is still awaited, it would seem clear that the majority view is in favour of both the reform and the expansion of this programme. The preliminary analysis may be accessed online.

Allison Phillips - Program Manager of the Malaria Elimination Initiative - writes to TropIKA.net…

The Global Health Group at the University of California, San Francisco is seeking candidates for two new positions:

1. Malaria Elimination Initiative Lead to provide ongoing leadership, development, scientific and programmatic direction to the Malaria Elimination Initiative, including the work of the Malaria Elimination Group (MEG). More information and contact details can be found here.

2. Malaria Elimination Initiative Economist to lead a new and exciting program of work to research and analyze the costs, cost-benefits, financial requirements and innovative financing mechanisms that can best support elimination and the prevention of reintroduction. More information and contact details can be found here.

Both appointees will be a member of the academic staff or adjunct faculty of the University of California, San Francisco.

The Global Health Group (GHG) is an “Action Tank” led by Sir Richard Feachem, formerly the founding executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, that works across the spectrum from analysis, through policy formulation and consensus building, to catalyze implementation in collaborating low- and middle-income countries.

The Malaria Elimination Initiative (MEI) is one of three initiatives at the GHG. The MEI works with a wide range of partners to gather, analyze and disseminate evidence on malaria elimination, to inform strategic decision-making. The MEI also formed and convenes the Malaria Elimination Group (MEG).

It seems that last year’s 100th anniversary of the discovery of Chagas disease (and the surrounding publicity) has resulted in increased interest in this common but much neglected condition. The latest development is the publication, by the journal Nature, of a special Chagas disease supplement. Thanks to funding from private and non-profit sponsors, Nature has (unusually) made the articles in the supplement available with free access.

The articles are as follows:

Feature: Chagas disease 101 — Julie Clayton
Opinion: Chagas disease: a new worldwide challenge — José Rodrigues Coura & Pedro Albajar Viñas
Feature: Who, how, what and where?
Feature: Country by country — Anna Petherick
Feature: Chagas disease: pushing through the pipeline — Julie Clayton
Feature: The promise of T. cruzi genomics — Julie Clayton
Feature: Chagas disease in the Chaco — Anna Petherick
Feature: Campaigning for Chagas disease — Anna Petherick

In addition to publishing these new articles, the supplement provides links to five previously published Nature articles on Chagas disease that have now been made available on a free access basis.

One of the key issues addressed during last month’s XVIII International AIDS Conference (AIDS 2010), held in Vienna, was how to deal with tuberculosis in people living with HIV. A quarter of all deaths among people with AIDS are caused by TB.

The need to provide TB treatment promptly to people who have both infections was discussed by the New York Times in its coverage of AIDS 2010. But there is also increasing acceptance of the view that isoniazid preventive therapy (IPT) for TB should be given to all people known to have HIV. An article in Citizens News looks further at this issue, with comments from Dr Jonathan E Golub, Assistant Professor at John Hopkins’ Centre for Tuberculosis Research.

However, TB-HIV coinfection raises other issues, including the need for integration of treatment programmes. Also in Citizens News, is an article from Dr Sugata Mukhopadhyay, who asks “When a virus (HIV) and bacteria (TB) can work so well together why can’t we?”

Buruli ulcer, caused by Mycobacterium ulcerans is a serious condition that seems to be increasing in several parts of Africa. It is also found in southeastern Australia. How the infection is transmitted is unclear, though it is generally believed that M. ulcerans is an aquatic pathogen and that humans are infected through contact with certain aquatic environments (swamps and slow-flowing water). But now Australian research [1] has suggested that wild mammals may play an important role.

The researchers collected a range of environmental samples from a small town endemic for the disease and from areas with few or no reported incident cases. M. ulcerans DNA was detected in soil, sediment, water residue, aquatic plant biofilm and terrestrial vegetation collected in the endemic area, with higher levels in the faeces of two species of possum than in other samples. (Possums are small arboreal marsupial mammals, native to Australia.)

Systematic testing of possum faeces detected M. ulcerans DNA in 41% of faecal samples collected in the endemic town, compared with less than 1% of faecal samples collected from non-endemic areas. Capture and clinical examination of live possums in the endemic area revealed that 38% and 24% of the two species respectively had laboratory-confirmed M. ulcerans skin lesions and/or M. ulcerans-positive faeces. Whole genome sequencing also revealed an extremely close genetic relationship between human and possum M. ulcerans isolates.

These findings raise the possibility that mammals are an environmental reservoir for Buruli ulcer infection but further research will be necessary, particularly in Africa. The Australian researchers note that there has been research in West Africa, which failed to detect M. ulcerans in the organs or faeces of rodents and shrews, but clearly the issue deserves further attention.

Reference
1. Fyfe JAM, Lavender CJ, Handasyde KA, Legione AR, O’Brien CR, et al. (2010). A Major Role for Mammals in the Ecology of Mycobacterium ulcerans. PLoS Negl Trop Dis 4(8): e791. Available online: http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000791
2. Vandelannoote K, Durnez L, Amissah D, Gryseels S, Dodoo A, et al. (2010). Application of real-time PCR in Ghana, a Buruli ulcer-endemic country, confirms the presence of Mycobacterium ulcerans in the environment. FEMS Microbiol Lett 304: 191–194.
3. Durnez L, Suykerbuyk P, Nicolas V, Barriere P, Verheyen E, et al. (30 April 2010) The role of terrestrial small mammals as reservoir of Mycobacterium ulcerans in Benin. Appl Environ Microbiol.

Anyone who studies the life sciences beyond a certain level is required to learn the details of the metabolic pathway known as the Krebs cycle. Named after its discoverer Hans Krebs and also called the tricarboxylic acid (TCA) cycle, the process is central to metabolism and provides most of the energy used by the vast majority of living things …but not the malaria parasite. Recently published research by US molecular biologists [1] has confirmed earlier suspicions that Plasmodium falciparum meets its energy needs by a very different process.

An article in US News features an interview with one of the research team, Kellen Olszewski, who explains that the breakdown of sugar by the malaria parasite is completely disconnected from the Krebs cycle; it is instead fed by the amino acids glutamine and glutamate and is a branched rather than a cyclical pathway: “The parasite has basically taken the standard textbook circular cycle and broken it in half, running one half in the normal direction and the other backwards. This turns the textbook model on its head”.

Nothing similar has so far been found in any other parasite. The research represents a major step forward in understanding of energy and biosynthetic processes in Plasmodium parasites. This new knowledge may in time make possible the identification of potential drug targets, leading to the development of new malaria treatments.

Reference
1. Olszewski KL, Mather MW, Morrisey JM, Garcia BA, Vaidya AB, Rabinowitz JD, Llinás M (2010). Branched tricarboxylic acid metabolism in Plasmodium falciparum. Nature; 466(7307):774-778.

Protecting women against malaria is regarded as a priority. Pregnant women are more vulnerable to the disease, which can also harm their unborn children. However, research in Mumbai, India apparently suggests that men there are more likely than women to have malaria. The records were analysed of 30,000 patients presenting to hospitals with malaria-like symptoms. [Men were in the majority, for which there could be several possible explanations.] It was found that 12% of men but only 6% of women were infected.

Dr Shobhona Sharma, one of the researchers, told the Hindustan Times that: “In children, both sexes are affected by the parasite in the same manner, but the moment one goes to the pubertal age group, men tend to show and experience the symptoms more than women. We think the hormones testosterone and oestrogen may be influencing the way immune cells react when exposed to the parasite”.

The research team’s work has yet to be formally published but the same group, using mice, have reported a gender difference in response to malaria infection [1].

Reference
1. Basant A, Rege M, Sharma S, Sonawat HM (2010). Alterations in urine, serum and brain metabolomic profiles exhibit sexual dimorphism during malaria disease progression. Malar J;9:110.