Importance of Cough and M. tuberculosis Strain Type as Risks for Increased Transmission within Households

Rationale

The degree to which tuberculosis (TB) is transmitted between persons is variable. Identifying the factors that contribute to transmission could provide new opportunities for TB control. Transmission is influenced by host, bacterial and environmental factors. However, distinguishing their individual effects is problematic because measures of disease severity are tightly correlated, and assessing the virulence of Mycobacterium tuberculosis isolates is complicated by epidemiological and clinical confounders.

Objectives

To overcome these problems, we investigated factors potentially associated with TB transmission within households.

Methods

We evaluated patients with smear-positive (≥2+), pulmonary TB and classified M. tuberculosis strains into single nucleotide polymorphism genetic cluster groups (SCG). We recorded index case, household contact, and environmental characteristics and tested contacts with tuberculin skin test (TST) and interferon-gamma release assay. Households were classified as high (≥70% of contacts with TST≥10 mm) and low (≤40%) transmission. We used logistic regression to determine independent predictors.

Result

From March 2008 to June 2012, we screened 293 TB patients to enroll 124 index cases and their 731 contacts. There were 23 low and 73 high transmission households. Index case factors associated with high transmission were severity of cough as measured by a visual analog cough scale (VACS) and the Leicester Cough Questionnaire (LCQ), and cavitation on chest radiograph. SCG 3b strains tended to be more prevalent in low (27.3%) than in high (12.5%) transmission households (p = 0.11). In adjusted models, only VACS (p<0.001) remained significant. SCG was associated with bilateral disease on chest radiograph (p = 0.002) and marginally associated with LCQ sores (p = 0.058), with group 3b patients having weaker cough.

Conclusions

We found differential transmission among otherwise clinically similar patients with advanced TB disease. We propose that distinct strains may cause differing patterns of cough strength and cavitation in the host leading to diverging infectiousness. Larger studies are needed to verify this hypothesis.     

Clinical and Parasitological Protection in a Leishmania infantum-Macaque Model Vaccinated with Adenovirus and the Recombinant A2 Antigen

Background

Visceral leishmaniasis (VL) is a severe vector-born disease of humans and dogs caused by Leishmania donovani complex parasites. Approximately 0.2 to 0.4 million new human VL cases occur annually worldwide. In the new world, these alarming numbers are primarily due to the impracticality of current control methods based on vector reduction and dog euthanasia. Thus, a prophylactic vaccine appears to be essential for VL control. The current efforts to develop an efficacious vaccine include the use of animal models that are as close to human VL. We have previously reported a L. infantum-macaque infection model that is reliable to determine which vaccine candidates are most worthy for further development. Among the few amastigote antigens tested so far, one of specific interest is the recombinant A2 (rA2) protein that protects against experimental L. infantum infections in mice and dogs.

Methodology/Principal Findings

Primates were vaccinated using three rA2-based prime-boost immunization regimes: three doses of rA2 plus recombinant human interleukin-12 (rhIL-12) adsorbed in alum (rA2/rhIL-12/alum); two doses of non-replicative adenovirus recombinant vector encoding A2 (Ad5-A2) followed by two boosts with rA2/rhIL-12/alum (Ad5-A2+rA2/rhIL12/alum); and plasmid DNA encoding A2 gene (DNA-A2) boosted with two doses of Ad5-A2 (DNA-A2+Ad5-A2). Primates received a subsequent infectious challenge with L. infantum. Vaccines, apart from being safe, were immunogenic as animals responded with increased pre-challenge production of anti-A2-specific IgG antibodies, though with some variability in the response, depending on the vaccine formulation/protocol. The relative parasite load in the liver was significantly lower in immunized macaques as compared to controls. Protection correlated with hepatic granuloma resolution, and reduction of clinical symptoms, particularly when primates were vaccinated with the Ad5-A2+rA2/rhIL12/alum protocol.

Conclusions/Significance

The remarkable clinical protection induced by A2 in an animal model that is evolutionary close to humans qualifies this antigen as a suitable vaccine candidate against human VL.     

A reusable amperometric biosensor based on a novel silver-epoxy electrode for immunoglobulin detection

A renewable immunosensor consisting of an `epoxygraphite' biocomposite containing silver and tetracyanoquinodimethane (TCNQ) is described. These compounds enhance conductivity allowing the use of a smaller potential (0.28 v) which, in turn, enhances selectivity. This sensor, which may be renewed by simple polishing of its surface, was employed to detect human IgG using peroxidase-coupled anti-human IgG.     

A new species of Curimatopsis Steindachner (Characiformes: Curimatidae) from the Rio Nhamundá, Amazon basin

A new species of Curimatopsis is described from the Rio Nhamundá, Amazon basin in northern Brazil. The new species is distinguished from congeners by the presence of a distinctive concentration of dark pigmentation over the entire lower lobe of the caudal fin, reticulate pattern of body pigmentation, lower jaw longer than and overlapping the anterior portion of the upper jaw, crescent‐shaped posterior nostril and by morphometric and meristic data. Comments on the phylogenetic position of the new species within Curimatopsis are also provided.     

Land use change emission scenarios: anticipating a forest transition process in the Brazilian Amazon

Following an intense occupation process that was initiated in the 1960s, deforestation rates in the Brazilian Amazon have decreased significantly since 2004, stabilizing around 6000 km² yr^?1 in the last 5 years. A convergence of conditions contributed to this, including the creation of protected areas, the use of effective monitoring systems, and credit restriction mechanisms. Nevertheless, other threats remain, including the rapidly expanding global markets for agricultural commodities, large‐scale transportation and energy infrastructure projects, and weak institutions. We propose three updated qualitative and quantitative land‐use scenarios for the Brazilian Amazon, including a normative ‘Sustainability’ scenario in which we envision major socio‐economic, institutional, and environmental achievements in the region. We developed an innovative spatially explicit modelling approach capable of representing alternative pathways of the clear‐cut deforestation, secondary vegetation dynamics, and the old‐growth forest degradation. We use the computational models to estimate net deforestation‐driven carbon emissions for the different scenarios. The region would become a sink of carbon after 2020 in a scenario of residual deforestation (~1000 km² yr^?1) and a change in the current dynamics of the secondary vegetation – in a forest transition scenario. However, our results also show that the continuation of the current situation of relatively low deforestation rates and short life cycle of the secondary vegetation would maintain the region as a source of CO₂ – even if a large portion of the deforested area is covered by secondary vegetation. In relation to the old‐growth forest degradation process, we estimated average gross emission corresponding to 47% of the clear‐cut deforestation from 2007 to 2013 (using the DEGRAD system data), although the aggregate effects of the postdisturbance regeneration can partially offset these emissions. Both processes (secondary vegetation and forest degradation) need to be better understood as they potentially will play a decisive role in the future regional carbon balance.     

Morinda citrifolia Linn. Reduces Parasite Load and Modulates Cytokines and Extracellular Matrix Proteins in C57BL/6 Mice Infected with Leishmania (Leishmania) amazonensis

The absence of an effective vaccine and the debilitating chemotherapy for Leishmaniasis demonstrate the need for developing alternative treatments. Several studies conducted with Morinda citrifolia have shown various biological activities, including antileishmanial activity, however its mechanisms of action are unknown. This study aimed to analyze the in vivo activity of M. citrifolia fruit juice (Noni) against Leishmania (Leishmania) amazonensis in C57BL/6 mice. M. citrifolia fruit juice from the Brazilian Amazon has shown the same constitution of other juices produced around the world and liquid chromatography–mass spectrometry analysis identified five compounds: deacetylasperulosidic acid, asperulosidic acid, rutin, nonioside B and nonioside C. Daily intragastric treatment with Noni was carried out after 55 days of L. (L.) amazonensis infection in C57BL/6 mice. Parasitic loads, cytokine and extracellular protein matrix expressions of the lesion site were analyzed by qPCR. Histopathology of the lesion site, lymph nodes and liver were performed to evaluate the inflammatory processes. Cytokines and biochemical parameters of toxicity from sera were also evaluated. The Noni treatment at 500 mg.kg^-1.day^-1 for 60 days decreased the lesion size and parasitic load in the footpad infected with L. (L.) amazonensis. The site of infection also showed decreased inflammatory infiltrates and decreased cytokine expressions for IL-12, TNF-α, TGF-β and IL-10. On the other hand, Noni treatment enhanced the extracellular matrix protein expressions of collagen IV, fibronectin and laminin in the infected footpad as well collagen I and II, fibronectin and laminin in the mock-infected footpads. No toxicity was observed at the end of treatment. These data show the efficacy of Noni treatment.