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      A Second Population-Based Cohort Study in Cameroon Confirms the Temporal Relationship Between Onchocerciasis and Epilepsy

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          Abstract

          To confirm our earlier evidence of a temporal and dose–response relationship between onchocerciasis and epilepsy, we conducted another cohort study in a different setting in Cameroon. Individuals whose Onchocerca volvulus microfilarial density ( Ov-MFD) was measured in 1992–1994 when they were children were revisited in 2019 to determine if they acquired epilepsy. With reference to individuals with no microfilariae in 1992–1994, the relative risks of acquiring epilepsy were 0.96, 2.76, 3.67, and 11.87 in subjects with initial Ov-MFD of 1–7, 8–70, 71–200, and > 200 microfilariae per skin snip, respectively. This study further demonstrates reproducibility using the Bradford Hill’s criteria for causality.

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          Most cited references10

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          Infection prevalence and ecotypes of Anaplasma phagocytophilum in moose Alces alces , red deer Cervus elaphus , roe deer Capreolus capreolus and Ixodes ricinus ticks from Norway

          Background The geographical expansion of the tick Ixodes ricinus in northern Europe is a serious concern for animal and human health. The pathogen Anaplasma phagocytophilum is transmitted by ticks and causes emergences of tick-borne fever (anaplasmosis) in livestock. The transmission dynamics of the different ecotypes of A. phagocytophilum in the ecosystems is only partly determined. Red deer and roe deer contribute to circulation of different ecotypes of A. phagocytophilum in continental Europe, while the role of moose for circulation of different ecotypes is not fully established but an important issue in northern Europe. Methods We determined infection prevalence and ecotypes of A. phagocytophilum in moose (n = 111), red deer (n = 141), roe deer (n = 28) and questing ticks (n = 9241) in Norway. Results As previously described, red deer was exclusively linked to circulation of ecotype I, while roe deer was exclusively linked to circulation of ecotype II. Surprisingly, we found 58% ecotype I (n = 19) and 42% of ecotype II (n = 14) in moose. Both ecotypes were found in questing ticks in areas with multiple cervid species present, while only ecotype I was found in ticks in a region with only red deer present. Hence, the geographical distribution of ecotypes in ticks followed the distribution of cervid species present in a given region and their link to ecotype I and II. Conclusions Moose probably function as reservoirs for both ecotype I and II, indicating that the ecotypes of A. phagocytophilum are not entirely host-specific and have overlapping niches. The disease hazard depends also on both host abundance and the number of immature ticks fed by each host. Our study provides novel insights in the northern distribution and expansion of tick-borne fever.
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            Epidemiology, causes, and treatment of epilepsy in sub-Saharan Africa.

            Epilepsy is a common neurological disease in tropical countries, particularly in sub-Saharan Africa. Previous work on epilepsy in sub-Saharan Africa has shown that many cases are severe, partly a result of some specific causes, that it carries a stigma, and that it is not adequately treated in many cases. Many studies on the epidemiology, aetiology, and management of epilepsy in sub-Saharan Africa have been reported in the past 10 years. The prevalence estimated from door-to-door studies is almost double that in Asia, Europe, and North America. The most commonly implicated risk factors are birth trauma, CNS infections, and traumatic brain injury. About 60% of patients with epilepsy receive no antiepileptic treatment, largely for economic and social reasons. Further epidemiological studies should be a priority to improve understanding of possible risk factors and thereby the prevention of epilepsy in Africa, and action should be taken to improve access to treatment.
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              The temporal relationship between onchocerciasis and epilepsy: a population-based cohort study

              Many studies have suggested that onchocerciasis might be associated with epilepsy. Therefore, we did a cohort study to assess the incidence of epilepsy relative to Onchocerca volvulus skin microfilarial density (MFD) measured during childhood and to assess the possibility of a temporal relationship.
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                Author and article information

                Journal
                Open Forum Infect Dis
                Open Forum Infect Dis
                ofid
                Open Forum Infectious Diseases
                Oxford University Press (US )
                2328-8957
                June 2020
                02 June 2020
                02 June 2020
                : 7
                : 6
                : ofaa206
                Affiliations
                [1 ] UMI 233, Institut de Recherche pour le Développement (IRD), Université Montpellier , INSERM Unité 1175, Montpellier, France
                [2 ] Centre for Research on Filariasis and other Tropical Diseases (CRFilMT) , Yaoundé, Cameroon
                [3 ] Neurology Department, Central Hospital/Faculty of Medicine & Biomedical Sciences, The University of Yaoundé I, (FMBS-UYI) , Yaoundé, Cameroon
                [4 ] Brain Research Africa Initiative, BRAIN , Geneva, Switzerland/Yaoundé, Cameroon
                Author notes
                Correspondence: Michel Boussinesq, MD, PhD, UMI 233—TransVIHMI, IRD, 911 Avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France ( michel.boussinesq@ 123456ird.fr ).
                Author information
                http://orcid.org/0000-0002-8779-977X
                Article
                ofaa206
                10.1093/ofid/ofaa206
                7304933
                32587878
                b1d7df1f-2f7e-4a3d-a599-0d5f1420ef24
                © The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 08 March 2020
                : 26 May 2020
                : 28 May 2020
                : 19 June 2020
                Page count
                Pages: 5
                Funding
                Funded by: Helen Keller International;
                Funded by: Institut de Recherche pour le Développement, DOI 10.13039/100012947;
                Categories
                Brief Report
                AcademicSubjects/MED00290

                onchocerciasis,epilepsy,causal relationship,africa,cohort
                onchocerciasis, epilepsy, causal relationship, africa, cohort

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