Haptoglobin is an acute phase protein that scavenges haemoglobin in the event of intravascular or extravascular haemolysis. The protein exists in humans as three main phenotypes, Hp1-1, Hp2-2 and Hp2-1. Accumulated data on the protein's function has established its strong association with diseases that have inflammatory causes. These include parasitic (malaria), infectious (HIV, tuberculosis) and non-infectious diseases (diabetes, cardiovascular disease and obesity) among others. Phenotype-dependent poor disease outcomes have been linked with the Hp2-2 phenotype. The present review brings this association into perspective by looking at the functions of the protein and how defects in these functions associated with the Hp2 allele affect disease outcome. A model is provided to explain the mechanism, which appears to be largely immunomodulatory.

Although the high prevalence of blood-borne viral infections and syphilis in correctional facilities has been well documented globally, such data are sparse from Africa, and there has been no such data from Ghana. This study sought to estimate the prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis among prison inmates and officers at prisons in Nsawan and Accra, Ghana. Prisoners and officers in 3 of the 46 prisons in Ghana were surveyed from May 2004 to May 2005. Subjects voluntarily completed a risk-factor questionnaire and provided blood specimens for unlinked anonymous testing for the presence of antibodies to HIV, HCV and Treponema pallidum, the causative agent of syphilis, and the surface antigen of hepatitis B virus (HBsAg). Almost 16 % (3770) of the total of 23 980 prison inmates in Ghana were eligible, and 281 (7?5 %) of those eligible took part, whilst almost 23 % (1120) of the total of 4910 prison officers were eligible, and 82 (7?3 %) of those eligible took part. For the 281 inmates tested, HIV seroprevalence was 19?2 %, 17?4 % had HBsAg, HCV seroprevalence was 19?2 % and reactive syphilis serology was noted in 11 %. For the 82 officers tested, HIV seroprevalence was 8?5 %, 3?7 % had HBsAg, HCV seroprevalence was 23?2 % and reactive syphilis serology was noted in 4?9 %. The data indicate a higher prevalence of HIV and HCV in correctional facilities (both prison inmates and officers) than in the general population in Ghana, suggesting their probable transmission in prisons in Ghana through intravenous drug use, unsafe sexual behaviour and tattooing as pertains to prisons worldwide. INTRODUCTIONThe relation between incarceration and the high transmission of blood-borne viruses, such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis, in prisons has been known for several years (Catalan-Soares et al., 2000;Haber et al., 1999;Heimberger et al., 1993;Mutter et al., 1994;Stark et al., 1997), and injecting drug use is the most commonly reported risk factor (Alizadeh et al., 2005;Massad et al., 1999; Taylor et al., 2000; Wield et al., 2000). The other risk factors identified for the higher prevalence of these infections in prisoners are previous imprisonment, tattooing and high-risk sexual behaviours (Haber et al., 1999;Massad et al., 1999;Skoretz et al., 2004;Veeken, 2000). There is growing evidence that HIV, HBV and HCV infections have actually been transmitted to individuals while they were in prison (Haber et al., 1999; Hutchinson et al., 1998;Mutter et al., 1994;Skoretz et al., 2004;Stark et al., 1997;Taylor et al., 1995 Taylor et al., , 2000, although there is also evidence that some had the infection before they were sent to prison. Data on the prevalence of HIV, HBV, HCV and syphilis in prisons are scanty in Africa, and no such information exists on prisoners in Ghana. Outside the prison setting in Ghana, the prevalence of HIV infection is between 1?5 and 3?8 % among blood donors (Ampofo et...

f Two-hundred eighty matched bulk stool and anatomically designed flocked rectal swab samples were collected from children admitted to the hospital with acute diarrhea in Botswana. Their parents were asked about the acceptability of the swab collection method compared with bulk stool sampling. All samples underwent identical testing with a validated 15-target (9 bacterial, 3 viral, and 3 parasite) commercial multiplex PCR assay. The flocked swabs had a 12% higher yield for bacterial pathogen targets (241 versus 212; P ‫؍‬ 0.003) compared with that of stool samples, as well as similar yields for viral targets (110 versus 113; P ‫؍‬ 0.701) and parasite targets (59 versus 65; P ‫؍‬ 0.345). One hundred sixty-four of the flocked swab-stool pairs were also tested with separate laboratory-developed bacterial and viral multiplex assays, and the flocked rectal swabs had a performance that was similar to that seen with commercial assay testing. Almost all parents/guardians found the swabs acceptable. Flocked rectal swabs significantly facilitate the molecular diagnosis of diarrheal disease in children. Diarrheal disease remains a leading cause of global childhood morbidity and mortality, yet access to diagnostic laboratory testing is rarely available in much of the world. One of the barriers to diagnosing diarrheal disease, either for clinical or surveillance purposes, is the difficulty and time delays in obtaining and transporting a bulk stool specimen. Several investigators have sought to overcome this barrier through the use of rectal swab specimens for culture, molecular, and antigen testing, with variable results (1-5). Flocked swabs designed for respiratory and genitourinary sampling have been shown to acquire better samples than those acquired with more traditional spun fiber swabs (6, 7). We used a specially designed flocked rectal swab (FLOQSwabs; Copan Italia, Brescia, Italy) developed specifically for the diagnosis of diarrheal disease in children (Fig. 1) and then compared matched flocked rectal swabs to bulk stool samples in a clinical setting. The samples were collected from children admitted to the hospital in Botswana with severe acute gastroenteritis and tested using a U.S. FDAcleared commercial multiplex PCR assay in order to assess performance across a broad number of bacterial, viral, and parasitic pathogens.(These data were presented in part at the 29th Annual Clinical Virology Symposium, Daytona Beach, FL, 28 April to 1 May 2013, and at the Annual Pediatric Academic Society Meeting, Vancouver, Canada, 5 May 2014.) MATERIALS AND METHODSChildren Ͻ13 years of age who were admitted to the hospital with a diagnosis of acute gastroenteritis were enrolled prospectively at the Princess Marina Hospital in Gaborone, Botswana. Princess Marina Hospital is the largest referral hospital in Botswana.Clinical data were collected, and both the pediatric flocked rectal swab and bulk stool samples were obtained from each child as soon as possible after enrollment. The swab and stool samples were collected simultaneousl...

BackgroundBotswana is one of eight SADC countries targeting malaria elimination by 2018. Through spirited upscaling of control activities and passive surveillance, significant reductions in case incidence of Plasmodium falciparum (0.96 – 0.01) was achieved between 2008 and 2012. As part of the elimination campaign, active detection of asymptomatic Plasmodium species by a highly sensitive method was deemed necessary. This study was carried out to determine asymptomatic Plasmodium species carriage by nested PCR in the country, in 2012.MethodA cross-sectional study involving 3924 apparently healthy participants were screened for Plasmodium species in 14 districts (5 endemic: Okavango, Ngami, Tutume, Boteti and Bobirwa; and 9 epidemic: North East, Francistown, Serowe-Palapye, Ghanzi, Kweneng West, Kweneng East, Kgatleng, South East, and Good Hope). Venous blood was taken from each participant for a nested PCR detection of Plasmodium species.ResultsThe parasite rates of asymptomatic Plasmodium species detected were as follows: Plasmodium falciparum, 0.16 %; Plasmodium vivax, 4.66 %; Plasmodium malariae, (Pm) 0.16 %; Plasmodium ovale, 0 %, mixed infections (P. falciparum and P. vivax), 0.055 %; and (P. vivax and P. malariae), 0.027 %, (total: 5.062 %). The high proportion of asymptomatic reservoir of P. vivax was clustered in the East, South Eastern and Central districts of the country. There appeared to be a correlation between the occurrence of P. malariae infection with P. vivax infection, with the former only occurring in districts that had substantial P. vivax circulation. The median age among 2–12 year olds for P. vivax infection was 5 years (Mean 5.13 years, interquartile range 3–7 years). The odds of being infected with P. vivax decreased by 7 % for each year increase in age (OR 0.93, 95 % CI 0.87–1.00, p = 0.056).ConclusionWe have confirmed low parasite rate of asymptomatic Plasmodium species in Botswana, with the exception of P.vivax which was unexpectedly high. This has implication for the elimination campaign so a follow up study is warranted to inform decisions on new strategies that take this evidence into account in the elimination campaign.

We have investigated the genetic basis for the Hp0 phenotype amongst 123 randomly selected Ghanaians. A total of 17 individuals were determined to be Hp0 phenotype, based on the classical method for Hp phenotyping of Hb-supplemented plasma. Out of the 17 Hp0 individuals, nine subjects were further classified as ahaptoglobinaemic and eight as hypohaptoglobinaemic by Western blots and double immunodiffusion. We identified three previously known base substitutions (A-55G, A-61C and T-104A) and three new ones (C-101G, T-191G and C-242T) within the 5' flanking region of the Hp gene. The A-61C base substitution significantly decreased transcriptional activity and was associated strongly with Hp2 allele and ahaptoglobinaemia. The C-101G substitution was similar in transcriptional activity to the wild-type and was associated with Hp1S allele and hypohaptoglobinaemia. The Hpdel allele seen in Asian populations was absent. We conclude that the Hp0 phenotype in Ghana has a genetic basis that differs significantly from that seen in Asia.