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.     

Feeding ecology of the armored shrew, from the north-eastern Democratic Republic of Congo

The diet of Scutisorex somereni (Soricomorpha: Soricidae) from forests in the Democratic Republic of Congo was investigated to elucidate its feeding ecology in the context of its unique spinal modifications. It ate a wide range of small and large invertebrates, including representatives of Coleoptera, Formicidae, Lepidoptera and Diptera larvae, Chilopoda, Diplopoda and Araneae, but the principal prey was Oligochaeta. All diet samples contained Oligochaeta and these contributed 38–45% of prey volume. While 64% of prey occurrences were <10 mm in length, 56% of prey volume comprised invertebrates >26 mm, mostly large Oligochaeta (some of >50 mm). Soil-dwelling prey comprised 46% by composition (59% by volume) of the diet. Besides its peculiar skeletal modifications, it has an exceptionally long intestine relative to its body size. It was concluded that S. somereni is primarily an earthworm-eating shrew and partially subterranean rather than truly fossorial in foraging mode. Its diet and foraging mode cannot explain the unique vertebral modifications of this zoological curiosity.     

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.     

Charcoal‐inferred Holocene fire and vegetation history linked to drought periods in the Democratic Republic of Congo

The impact of Holocene drought events on the presumably stable Central African rainforest remains largely unexplored, in particular the significance of fire. High‐quality sedimentary archives are scarce, and palynological records mostly integrate over large regional scales subject to different fire regimes. Here, we demonstrate a direct temporal link between Holocene droughts, palaeofire and vegetation change within present‐day Central African rainforest, using records of identified charcoal fragments extracted from soil in the southern Mayumbe forest (Democratic Republic of Congo). We find three distinct periods of local palaeofire occurrence: 7.8–6.8 ka BP, 2.3–1.5 ka BP, 0.8 ka BP – present. These periods are linked to well‐known Holocene drought anomalies: the 8.2 ka BP event, the 3rd millennium BP rainforest crisis and the Mediaeval Climate Anomaly. During and after these Holocene droughts, the Central African rainforest landscape was characterized by a fragmented pattern with fire‐prone open patches. Some fires occurred during the drought anomalies although most fires seem to lag behind them, which suggests that the open patches remained fire‐prone after the actual climate anomalies. Charcoal identifications indicate that mature rainforest patches did persist through the Early to Mid‐Holocene climatic transition, the subsequent Holocene thermal optimum and the third millennium BP rainforest crisis, until 0.8 ka BP. However, disturbance and fragmentation were probably more prominent near the boundary of the southern Mayumbe forest. Furthermore, the dominance of pioneer and woodland savanna taxa in younger charcoal assemblages indicates that rainforest regeneration was hampered by increasingly severe drought conditions after 0.8 ka BP. These results support the notion of a dynamic forest ecosystem at multicentury time scales across the Central African rainforest.     

黄河三角洲盐碱土壤中AM真菌的初步调查

2000年3月－2001年2月对黄河三角洲盐碱土壤中5种优势植物柽柳（Tamarix chinensis),芦苇（Phragmites communis),碱蓬（Suaeda glauca),獐毛（Aeluropus littralis var.sinensis) 和刺儿菜（Cirsium setosum)根围内丛枝菌根（arbuscular mycorrhiza,AM)真菌进行了长期定点调查,结果表明,AM真菌在这5种植物根围土壤内都有分布,但多样性较低,尤其在冬季,AM真菌种的丰度和孢子密度分别在夏季降低了18．0％和61．6％,不同深度土层中AM真菌的分布存在诸多差异。     

The Challenges of Research Informed Consent in Socio‐Economically Vulnerable Populations: A Viewpoint From the Democratic Republic of Congo

In medical research, the ethical principle of respect for persons is operationalized into the process of informed consent. The consent tools should be contextualized and adapted to the different socio‐cultural environment, especially when research crosses the traditional boundaries and reaches poor communities. We look at the challenges experienced in the malaria Quinact trial, conducted in the Democratic Republic of Congo, and describe some lessons learned, related to the definition of acceptable representative, the role of independent witness and the impact of socio‐economic vulnerability. To ensure children's protection, consent is required by the parents or, in their absence, by a legally mandated representative. In our setting, children's responsibility is often entrusted permanently or temporarily to relatives or friends without a tribunal mandate. Hence, a notion of ‘culturally acceptable representative’ under supervision of the local Ethics Committee may be more suitable. To ensure protection of illiterate subjects, an independent witness is required to confirm that the consent was freely given. However, in low‐literacy contexts, potential witnesses often don't have any previous relationship with patient and there may be power‐unbalance in their relationship, rather than genuine dialogue. In poor communities, trial participation may be seen as an opportunity to secure access to healthcare. Poverty may also lead to ‘competition’ to access the research‐related benefits, with a risk of disturbance at societal or household level. Adjusting consent procedures to sociocultural and socioeconomic realities is essential for fulfilling the underlying ethical principles. This requires a collaborative dialogue between researchers, regulators and ethics committees.     

西双版纳热带森林附生维管植物的物种多样性与区系特征

附生植物是山地森林生态系统中重要的结构性成分。因受林冠调查技术限制, 人们对林冠附生植物知之甚少。本文在前人有关西双版纳植物区系研究的基础上, 结合野外调查和标本资料, 对该地区附生植物的物种组成与分布进行了整理。结果表明, 西双版纳热带森林附生维管植物共有29科134属486种, 约占全部维管植物的11%。附生兰科是最丰富的类群(69属293种), 其中以石斛属(Dendrobium) (49种)和石豆兰属(Bulbophyllum) (48种)物种数最多。蕨类是仅次于兰科的附生类群(13科38属97种), 其中水龙骨科(51种)占附生蕨类总数的50%以上。基于生活史和养分来源的划分标准, 该地区48%的附生物种属于兼性附生, 其次是以兰科为主的专性附生(46%), 半附生仅占6%。从区系上看, 西双版纳附生植物属的分布具有明显的热带亚洲性质。附生植物主要分布于资源受限的林冠生境, 对环境变化极为敏感, 在人为干扰日益加剧的背景下, 这类植物正面临严重威胁。因此, 需要加强对西双版纳林冠亚系统的保护。     

Genotypic variation in a foundation tree (Populus tremula L.) explains community structure of associated epiphytes

Community genetics hypothesizes that within a foundation species, the genotype of an individual significantly influences the assemblage of dependent organisms. To assess whether these intra-specific genetic effects are ecologically important, it is required to compare their impact on dependent organisms with that attributable to environmental variation experienced over relevant spatial scales. We assessed bark epiphytes on 27 aspen (Populus tremula L.) genotypes grown in a randomized experimental array at two contrasting sites spanning the environmental conditions from which the aspen genotypes were collected. We found that variation in aspen genotype significantly influenced bark epiphyte community composition, and to the same degree as environmental variation between the test sites. We conclude that maintaining genotypic diversity of foundation species may be crucial for conservation of associated biodiversity.     

Spatial patterns of light‐demanding tree species in the Yangambi rainforest (Democratic Republic of Congo)

Most Central African rainforests are characterized by a remarkable abundance of light‐demanding canopy species: long‐lived pioneers (LLP) and non‐pioneer light demanders (NPLD). A popular explanation is that these forests are still recovering from intense slash‐and‐burn farming activities, which abruptly ended in the 19th century. This “human disturbance” hypothesis has never been tested against spatial distribution patterns of these light demanders. Here, we focus on the 28 most abundant LLP and NPLD from 250 one‐ha plots distributed along eight parallel transects (~50 km) in the Yangambi forest. Four species of short‐lived pioneers (SLP) and a single abundant shade‐tolerant species (Gilbertiodendron dewevrei) were used as reference because they are known to be strongly aggregated in recently disturbed patches (SLP) or along watercourses (G. dewevrei). Results show that SLP species are strongly aggregated with clear spatial autocorrelation of their diameter. This confirms that they colonized the patch following a one‐time disturbance event. In contrast, LLP and NPLD species have random or weakly aggregated distribution, mostly without spatial autocorrelation of their diameter. This does not unambiguously confirm the “human disturbance” hypothesis. Alternatively, their abundance might be explained by their deciduousness, which gave them a competitive advantage during long‐term drying of the late Holocene. Additionally, a canonical correspondence analysis showed that the observed LLP and NPLD distributions are not explained by environmental variables, strongly contrasting with the results for the reference species G. dewevrei, which is clearly aggregated along watercourses. We conclude that the abundance of LLP and NPLD species in Yangambi cannot be unambiguously attributed to past human disturbances or environmental variables. An alternative explanation is that present‐day forest composition is a result of adaptation to late‐Holocene drying. However, results are inconclusive and additional data are needed to confirm this alternative hypothesis.     

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)....     

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.     

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.     

Development of Brachystegia‐Julbernardia woodland after clear‐felling in central Zambia: Evidence for high resilience

Question: Does the development of Brachystegia‐Julbernardia (miombo) woodland after felling, and under a variable fire regime, occur via a serai stage of fire‐tolerant species? Location: Four sites in central Zambia, Africa. Methods: Trees in replicate plots were clear‐cut and stumps and resprouts enumerated. Species recruited into the tree layer (> 2.0 m tall) were monitored for 11 years (1991–2001) and fire occurrence and herbaceous biomass assessed annually to determine fuel loads. Results: Fire frequency was variable at the study sites and fuel loads were generally too low to suppress woodland regeneration after felling. However, at one site a change from low to high fire frequency arrested woodland development and triggered a regression towards a ‘fire‐trap’ vegetation type in which a few fire‐tolerant species survived. There was no evidence to support the hypothesis that miombo woodland regeneration is facilitated by a sere of fire‐tolerant species. All regrowth after felling was from resprouting plants present before felling. Trees with a previous history of felling sprouted more vigorously than trees that had not been felled before. Species richness in the tree layer increased with time since felling because resprout species had different height growth rates. Conclusion: The resilience of miombo trees after clear‐felling is largely due to their capacity to regenerate vegetatively from resprouts and stumps after release from frequent fires. Coppicing is therefore recommended as a suitable management technique for miombo woodland in central southern Africa.     

Overview of Animal Rabies in Kinshasa Province in the Democratic Republic of Congo

IntroductionRabies is one of the major public health problems mostly affecting developing countries in Africa and Asia where 99.9% of all rabies related human deaths are recorded each year. In Democratic Republic of Congo, repeated outbreaks have been reported. Despite this, there is little reliable epidemiological data about rabies in the country for the development of effective control strategies.

Materials and Methods

A retrospective study was carried out in Kinshasa Province during a period of five years (2009–2013) to describe the proportion of rabid animals and the species involved in rabies transmission and maintenance. The survey also aimed at describing the spatial-temporal distribution of rabies. To gather information, the daily registers of institutions involved in rabies diagnosis were reviewed and each rabies case was traced back to area of occurrence for collection of geographic coordinates.

Results and Discussion

A total of 5,053 attacks were registered involving six animal species including dog, cat, monkey, rabbit, rat, and pig. Based on clinical observations, rabies was reported in dogs and cats while data obtained from the laboratory confirmed rabies cases included dogs, cats and a goat. The annual distribution showed a significant decrease of rabies cases from 2009 up to 2011 and a later increase up to 2013. There was no difference in rabies occurrence between seasons (p = 0.721). Rabies cases were three times higher in peri-urban zone than in urban zone OR = 3.4 (95% CI: 2.3–5.1). The positive proportion of rabies was 2.6% (95% CI: 2.1–3) based on clinical evidence and 65.9% (95% CI: 50–79.5) for laboratory confirmed cases.

Conclusion and Suggestion

This study confirms the endemicity of rabies in Kinshasa where occurrence of rabies cases was related to human population density and lifestyle. In order to control rabies, there is need to set up a surveillance program and implement efficient mass vaccination campaigns of susceptible animals.     

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.     

Census of gorillas in northern Republic of Congo

We censused gorilla populations in northern Congo from February to April 1989 and June 1990. The objective was to provide the first quantitative data from a variety of sites on gorilla populations from a country that had unknown but potentially high populations. The method used was a census of nests along strip transects. A total of 401.0 km of transects was sampled in four different study areas. The overall density calculated for all transects was 0.4 nesting gorillas/km². The highest density, 1.2 nesting gorillas/km², was found in the vast Likouala swamp area of north central Congo. The two northern sites showed low densities of 0.1 and 0.2 nesting gorillas/km², respectively. The northwestern site showed an intermediate density of 0.6 nesting gorillas/km². The vegetation type with the highest density was swamp forest with 2.4 nesting gorillas/km². The limited sample presented shows that gorillas are widespread and common in northern Congo, even in the swamp forests previously considered unsuitable as gorilla habitat. It is probable that Congo holds the largest population of gorillas in Africa after Gabon. © 1992 Wiley-Liss, Inc.     

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.     

Population structure and spatial ecology of Kordofan giraffe in Garamba National Park,Democratic Republic of Congo

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Antiretroviral Treatment Program Retention among HIV-Infected Children in the Democratic Republic of Congo

Background

Retaining patients with HIV infection in care is still a major challenge in sub- Saharan Africa, particularly in the Democratic Republic of Congo (DRC) where the antiretroviral treatment (ART) coverage is low. Monitoring retention is an important tool for evaluating the quality of care.

Methods and Findings

A review of medical records of HIV -infected children was performed in three health facilities in the DRC: the Amo-Congo Health center, the Monkole Clinic in Kinshasa, and the HEAL Africa Clinic in Goma. Medical records of 720 children were included. Kaplan Meier curves were constructed with the probability of retention at 6 months, 1 year, 2 years and 3 years. Retention rates were: 88.2% (95% CI: 85.1%–90.8%) at 6 months; 85% (95% CI: 81.5%–87.6%) at one year; 79.4% (95%CI: 75.5%–82.8%) at two years and 74.7% (95% CI: 70.5%–78.5%) at 3 years. The retention varied across study sites: 88.2%, 66.6% and 92.5% at 6 months; 84%, 59% and 90% at 12 months and 75.7%, 56.3% and 85.8% at 24 months respectively for Amo-Congo/Kasavubu, Monkole facility and HEAL Africa. After multivariable Cox regression four variables remained independently associated with attrition: study site, CD4 cell count <350 cells/µL, children younger than 2 years and children whose caregivers were member of an independent church.

Conclusions

Attrition remains a challenge for pediatric HIV positive patients in ART programs in DRC. In addition, the low coverage of pediatric treatment exacerbates the situation of pediatric HIV/AIDS.