Multi Drug Resistant Tuberculosis in Mosango,a Rural Area in the Democratic Republic of Congo

Multidrug Resistant Tuberculosis (MDR-TB) is a serious threat which jeopardizes the worldwide efforts to control TB. The Democratic Republic of Congo (DRC) is one of 27 countries with a high burden of MDR-TB. Data on the magnitude, trends, and the distribution of MDR-TB in DRC are scanty. Kinshasa, the capital city of DRC which accounts for 20% of all TB cases nationwide, is notifying more than 80% of all MDR suspects. We report here a cluster of MDR-TB cases that was investigated in the Mosango health district, in the Bandundu south Province, DRC in 2008. Phenotypic Drug Sensitivity Testing and DNA sequencing were performed on 18 sputum specimens collected from 4 MDR-TB suspects and 5 household contacts. Sequencing data confirmed that the 4 suspects were indeed Rifampicin resistant cases. Sequencing of the rpoB gene showed that 3 cases (patients A, B and D) had a single mutation encoding a substitution to 526Tyr, 531Trp and 526Leu respectively. Patient C had a double mutation encoding a change to 531Leu and 633Leu. Two of the investigated cases died within 4 months of a second-line treatment course. Results highlight the need to enhance adequate laboratory services within the country for both clinical as well as surveillance purposes.     

Ocular Pentastomiasis in the Democratic Republic of the Congo

Ocular pentastomiasis is a rare infection caused by the larval stage of pentastomids, an unusual group of crustacean-related parasites. Zoonotic pentastomids have a distinct geographical distribution and utilize reptiles or canids as final hosts. Recently, an increasing number of human abdominal infections have been reported in Africa, where pentastomiasis is an emerging, though severely neglected, tropical disease. Here we describe four ocular infections caused by pentastomids from the Democratic Republic of the Congo. Two cases underwent surgery and an Armillifer grandis infection was detected by morphological and molecular approaches. Thus far, 15 other cases of ocular pentastomiasis have been reported worldwide. Twelve cases were caused by Armillifer sp., recorded almost exclusively in Africa, where such infections occur as a consequence of hunting and consuming snakes, their final hosts. Seven further cases were caused by Linguatula serrata, a cosmopolitan pentastomid whose final hosts are usually canids. Intraocular infections caused permanent visual damage in 69% and a total loss of vision in 31% of reported cases. In contrast, ocular adnexal cases had a benign clinical course. Further research is required to estimate the burden, therapeutic options and pathogenesis of this neglected disease.     

Retention in a NGO supported antiretroviral program in the Democratic Republic of Congo

Background

Retention of patients in ART care is a major challenge in sub-Saharan programs. Retention is also one of the key indicators to evaluate the success of ART programs.

Methods and Findings

A retrospective review of 1500 randomly selected medical charts of adult ART patients from a local non-governmental (NGO) supported ART program in the Democratic Republic of Congo (DRC). Retention was defined as any visit to the clinic in the 4 months prior to the abstraction date. Retention over time and across different sites was described. The relationship between patient characteristics and retention rates at 1 year was also examined. 1450 patients were included in the analysis. The overall retention rates were 81.4% (95% CI: 79.3–83.4), 75.2% (95% CI: 72.8–77.3), 65.0% (95% CI: 62.3–67.6) and 57.2% (95% CI: 54.0–60.3) at 6 months, 1 year, 2 years and 3 years respectively. The retention rates between sites varied between 62.1% and 90.6% at 6 months and between 55.5% and 86.2% at 1 year. During multivariable analysis weight below 50 kg (aHR: 1.33, 95%CI: 1.05–1.69), higher WHO stage at initiation (aHR: 1.22, 95%CI 0.85–1.76 for stage 3 and aHR: 2.98, 95%CI: 1.93–4.59 for stage 4), and male sex (aHR: 1.32, 95%CI: 1.05–1.65) remained as significant risk factors for attrition during the first year after ART initiation. Other independent risk factors were year of initiation (aHR: 1.73, 95%CI: 1.26–2.38 for the year 2007 and aHR: 3.06, 95%CI: 2.26–4.14 for the period 2008–2009), and site.

Conclusions

Retention is a major problem in DRC, while coverage of patients on ART is still very low. With the flattening of funding for HIV care and treatment in sub-Saharan Africa, and with decreasing funding worldwide, maximizing retention during the much needed scaling-up will even be more important.     

Diversity of soil oribatid mites (Acari: Oribatida) from High Katanga (Democratic Republic of Congo): a multiscale and multifactor approach

Although the soil is a major reservoir of biodiversity, our knowledge ofits mesofauna remains scanty, especially in the tropics. The diversity oforibatids (149 adult oribatid mite species) is analyzed for the first time in anAfrican soil and studied in three ecosystems of a regressive sere: forest,woodland and savanna. Savanna is the richest ecosystem overall, with 105collected species, whereas the mean number of species per relevé (diversity) is highest in forest. In barren soils, the number of species observedalong the sere drops regularly from the typical forest to the savanna. However,this pattern is complicated by other factors acting at different scales. Theincrease of oribatid richness parallels that of habitat complexity, from barrensoil to termitaria colonized by grasses and trees. On a finer scale, soilproperties also influence species richness, either indirectly through density(water content) or directly (total nitrogen, C/N ratio, organic matter), buttheir importance varies in relation to seasons. Most exclusive species (nearly90%) are housed in the two extreme types of vegetation, forest and savanna. On afiner scale, two habitats, the typical forest and the termitaria in the savanna,are remarkable by the number of exclusive species and are worth protectingthrough effective conservation measures.     

Prevalence of human African trypanosomiasis in the Democratic Republic of the Congo

Human African Trypanosomiasis (HAT) is a major public health problem in the Democratic Republic of the Congo (DRC). Active and passive surveillance for HAT is conducted but may underestimate the true prevalence of the disease. We used ELISA to screen 7,769 leftover dried blood spots from a nationally representative population-based survey, the 2007 Demographic and Health Survey. 26 samples were positive by ELISA. Three of these were also positive by trypanolysis and/or PCR. From these data, we estimate that there were 18,592 people with HAT (95% confidence interval, 4,883-32,302) in the DRC in 2007, slightly more than twice as many as were reported.     

Environmental Drivers of Monkeypox Transmission in the Democratic Republic of the Congo

EcoHealth - Monkeypox (MPX) is an emergent severe zoonotic disease resembling that of smallpox. To date, most cases of human MPX have been reported in the Democratic Republic of the Congo (DRC)....     

Identifying nascent wetland forest conversion in the Democratic Republic of the Congo

Wetlands cover large areas in the Democratic Republic of the Congo. However, their extent and distribution have not been accurately mapped. While wetland forests remain largely undisturbed, increasing threats by anthropogenic activities have been observed in areas with high population density per arable or exploitable land. The scarcity of terra firma forests in some territories of the Democratic Republic of the Congo has forced local communities to develop cropping methods that allow for cultivation in periodically flooded areas. Assessing wetlands extent and status is critical for long term conservation of these highly vulnerable ecosystems. In this study, we use multi-source and multi-resolution optical and radar remotely sensed data and elevation derived indices to map the wetlands of the Democratic Republic of the Congo. Results showed that wetlands are a significant part of the landscape in the country, covering an estimated 440,000 km² or 19.2 % of the total country area. By combining the wetlands map with a previously produced land cover depiction of the Democratic Republic of the Congo, a map including forested wetlands as a thematic class was derived. We investigated whether high terra firma population density and low percent remaining terra firma forest are related at the lowest administrative level (Sector); specifically, we tested these two variables as predictors of wetland forest cover loss. A polynomial regression relating population and primary terra firma forest to wetland forest cover loss yielded an r ² of 0.76, illustrating a nascent and significant land cover change dynamic. Areas most at risk for future wetland forest loss lie in the western Cuvette, and include (north–south) the Sud-Ubangi, Mongala, Equateur and Mai-Ndombe Districts. By quantifying available upland forest resources and overlaying with population density, it was possible to identify stressed areas inside of the forest domain (traditionally known for having generically high levels of forest resources). Results illustrate the need for addressing issues of wetland forest management and protection in the Democratic Republic of the Congo, especially where increasing populations are exhausting primary terra firma forest resources.     

The phenotype and genotype of rheumatoid arthritis in the Democratic Republic of Congo

Introduction

Little is known about rheumatoid arthritis in the black, particularly in Congolese, populations. Our objective was to describe the phenotype and genotype of rheumatoid arthritis (RA) in Congolese.

Methods

All consecutive rheumatoid arthritis (RA) patients attending Kinshasa University Hospital in a three-year time period were included. Demographics, clinical features and tobacco consumption were noted. Disease Activity Score (DAS)-28 based on the erythrocyte sedimentation rate (ESR), Health Assessment Questionnaire (HAQ), anti-citrullinated peptide antibodies (CCP) antibodies and rheumatoid factor (RF) were determined. Radiographs were scored according to Sharp-van der Heijde. On a subset of patients and controls HLA-DRB1 typing was performed.

Results

A total of 114 females and 14 males aged 51.2 ± 14.9 were included. Mean duration of symptoms was four years. Moderate tobacco consumption was reported in a minority of patients. DAS-28 at first visit was >5.1 and HAQ ≥0.5 in all patients. X-rays showed joint erosions and/or joint space narrowing, mostly of a moderate grade in 55.8% of patients. Anti-CCP and/or RF were present in 48.6% of patients with available data (n = 72) and in 3.0% of controls (n = 67). Radiographic changes and nodules were more frequent in RF or anti-CCP positive patients. One copy of the shared epitope was found in 13 patients (35.1%) and 3 controls (12.5%). Two copies were found in one patient (2.7%) and in one control (4.2%).

Conclusion

Congolese patients with RA consult long after disease onset. Despite this delay, the majority presents without major damage and is RF, anti-CCP and SE negative. We put forward the hypothesis that besides different environmental factors there is probably also a particular genetic risk profile in Congolese patients, different from the HLA-DRB1 shared epitope.     

High prevalence of Taenia solium cysticerosis in a village community of Bas-Congo, Democratic Republic of Congo

Cysticercosis results from tissue infection with the larval stage of the pig tapeworm Taenia solium. Infection of the brain may cause neurocysticercosis, the most frequent cause of acquired epilepsy in developing countries. Information on human cysticercosis in the Democratic Republic of Congo (DRC) is scarce and outdated. We believe this is the first reported study on human cysticercosis and epilepsy in a village community of DRC. The proportion of villagers seropositive by ELISA for T. solium circulating antigen was 21.6%, the highest figure reported to date. The adjusted prevalence of active epilepsy in the community was 12.7 in 1,000.     

Multi-Scales Analysis of Primate Diversity and Protected Areas at a Megadiverse Region

In this paper, we address the question of what proportion of biodiversity is represented within protected areas. We assessed the effectiveness of different protected area types at multiple scales in representing primate biodiversity in the Brazilian Legal Amazon. We used point locality data and distribution data for primate species within 1°, 0.5°, and 0.25° spatial resolution grids, and computed the area of reserves within each cell. Four different approaches were used – no reserves (A), exclusively strict use reserves (B), strict and sustainable use reserves (C), and strict and sustainable use reserves and indigenous lands (D). We used the complementarity concept to select reserve networks. The proportions of cells that were classified as reserves at a grid resolution of 1° were 37%, 64%, and 88% for approaches B, C and D, respectively. Our comparison of these approaches clearly showed the effect of an increase in area on species representation. Representation was consistently higher at coarser resolutions, indicating the effect of grain size. The high number of irreplaceable cells for selected networks identified based on approach A could be attributed to the use of point locality occurrence data. Although the limited number of point occurrences for some species may have been due to a Wallacean shortfall, in some cases it may also be the result of an actual restricted geographic distribution. The existing reserve system cannot be ignored, as it has an established structure, legal protection status, and societal recognition, and undoubtedly represents important elements of biodiversity. However, we found that strict use reserves (which are exclusively dedicated to biodiversity conservation) did not effectively represent primate species. This finding may be related to historical criteria for selecting reserves based on political, economic, or social motives.     

Ranging Patterns of Chimpanzees in a Montane Forest of Kahuzi,Democratic Republic of Congo

I studied ranging patterns of a semihabituated unit-group of chimpanzees for 60 mo at Kahuzi. They had a total home range of 12.81 km² and a mean annual home range of 7.55 km². Considering the low density of chimpanzees in the area vis-à-vis chimpanzees in arid areas, their home range is very small. Kahuzi chimpanzees used the home range in a clumped pattern, frequently visiting the core area and only rarely entering peripheral areas. The monthly range changes with fruit availability, increasing during periods of fruit scarcity. There was no consistent seasonal difference in the size of the home range. However, use of different habitat types may vary seasonally. While there was no seasonal effect in the use of primary forest, the chimpanzees showed a statistically consistent seasonal difference in their use of secondary forest, visiting it mainly during the dry season when fig trees were in fruit. Since the primary forest provides them with more food fruits, chimpanzees tended to use more frequently the small patches of primary forest in their home range. Thus, the size and distribution of small fragmented primary forests may be an important factor influencing the ranging pattern of chimpanzees at Kahuzi.     

Using phytostabilisation to conserve threatened endemic species in southeastern Democratic Republic of the Congo

Outcrops in the southeastern Democratic Republic of the Congo (DRC) are recognized as some of the largest copper–cobalt orebodies in the world. They support a unique vegetation with nearly 600 metallophytes that include rare and endemic species. Mineral exploitation has increased considerably in the region since the 1900s, affecting both environmental and public health. Phytostabilisation of polluted areas represents an opportunity to decrease the bioavailability of heavy metals in the highly polluted soils that result from ore extraction. Such a technique has been successfully implemented near Lubumbashi with the grass Microchloa altera. However, long-term maintenance requires a good understanding of interspecific relationships, such as competition and facilitation. This study tested the establishment success of four herbaceous species from the Katangan Copperbelt by assessing the potential role of Microchloa altera as a nurse species. Two annual and two perennial species were sown in an experiment designed to study the influence of soil amendment and vegetation cover on seedling emergence, growth, and survival. These variables were monitored during the vegetation growing season as well as resprouting success for perennials. Microchloa altera showed a distinct effect on the emergence and survival of annual and perennial species and negatively affected the growth of individuals belonging to both groups of species.     

Diet of Grauer's Gorillas in the Montane Forest of Kahuzi,Democratic Republic of Congo

We describe the diet of a semihabituated group of Grauer's gorillas (Gorilla beringei graueri) inhabiting the montane forest of Kahuzi-Biega National Park, Democratic Republic of Congo, based on direct observations, feeding remains in their fresh trails, and fecal samples collected over 9 yr. We examined fruit availability in their habitat; consumption of fruit, vegetative, and animal food; and daily intake of vegetative plant food using a transect, fruit monitoring trails, fecal analysis, and tracing of the animal's daily trails between consecutive nest sites. The fruit food repertoire of Kahuzi gorillas resembles that of western and eastern lowland gorillas inhabiting lowland tropical forests, while their vegetative food repertoire resembles that of mountain gorillas inhabiting montane forests. Among 236 plant foods (116 species), leaves, pith, and barks constitute the major parts (70.2%), with fruit making up the minor part (19.7%). About half (53.2%) of the total fecal samples included fruit remains. The gorillas used leaves, stems and other vegetative plant parts as staples. Their fruit intake was similar to that reported for mountain gorillas in Bwindi. They ate animal foods, including earthworms, on rare occasions. Variation in fruit consumption was positively associated with variation in fruit production. The gorillas ate fig fruits frequently; fig intake is positively correlated with that of other fruits, and figs were not fallback foods. They relied heavily on bamboo shoots on a seasonal basis; however, no bamboo shoots were available for several years after a major flowering event. Our results support the argument that variation in gorilla diets mostly reflects variation in vegetational composition of their habitats.     

Human Exposure to Wild Animals in the Sankuru Province of the Democratic Republic of the Congo

Due to the high level of biological diversity in the Congo Basin and human population dependence on bushmeat, the DRC represents an ideal location for expanding knowledge on wild animal exposures and thus the potential for transmission of zoonotic pathogens. However, limited information exists on patterns and extent of contact with wildlife in such communities. Using a cross-sectional study, 14 villages in the Sankuru Province of the DRC were surveyed between August and September 2007. Villagers ≥ 1 year of age and at home of the time of the survey were eligible and enrolled to describe and assess factors associated with animal exposures (both activity and type of animal). Among respondents, 91% reported exposure to rodents, 89% to duikers, 78% to non-human primates (NHPs), and 32% reported contact with bats in the month prior to the survey. The most frequently reported activities included eating (95%), cooking (70%), and butchering or skinning of animals (55%). The activities and animals to which subjects had contact varied by sex and age. Moreover, we observed a high correlation of the same activities across animal types. In this and other populations that rely on bushmeat, there is a high frequency of exposure to multiple animal species through various modalities. In the event of future zoonotic disease outbreaks, effective public health interventions and campaigns that mitigate the risk of animal contact during outbreaks need to be broad to include various modes of contact and should be directed to both men and women across all age groups. As available information is limited, further studies are necessary to better understand the complex relationships and exposures individuals have with animals.     

Female sociality during the daytime birth of a wild bonobo at Luikotale,Democratic Republic of the Congo

Parturition is one of the most important yet least observed events in studies of primate life history and reproduction. Here, I report the first documented observation of a bonobo (Pan paniscus) birth event in the wild, at the Luikotale Bonobo Project field site, Democratic Republic of the Congo. The nulliparous mother’s behaviour before, during and after parturition is described, along with reactions of other community members to the birth and the neonate. Data were collected through focal-animal observations, and the events postpartum were photo-documented. The behaviour and spatial distribution of party members were recorded using scan samples. Parturition occurred during the late morning in a social context, with parous females in close proximity to the parturient mother. Placentophagia occurred immediately after delivery, and the parturient shared the placenta with two of the attending females. I compare this observation with reports of parturition in captive bonobos, and highlight the observed female sociality and social support during the birth event. Plausible adaptive advantages of parturition occurring in a social context are discussed, and accrued observations of birth events in wild and free-ranging primates suggest that females may give birth within proximity of others more frequently than previously thought. This account contributes rare empirical data for examining the interface between female sociality and parturition, and the evolution of parturitional behaviours in primates.