Could Fungicides Lead to Azole Drug Resistance in a Cross-Resistance Manner among Environmental Cryptococcus Strains?

Current Fungal Infection Reports - Acquired resistance among fungal strains is a growing concern. The reasons for the emergence of this phenomenon, with great clinical implications, are only...     

Azole Resistance in Aspergillus fumigatus—Current Epidemiology and Future Perspectives

Azole resistance in Aspergillus fumigatus isolates is increasingly reported in different nosologic contexts with variable prevalence in different countries. Mutations in the target of triazoles are widely described in azole-resistant clinical isolates. The recovery of mutated/resistant isolates is described either in patients undergoing long-term azole treatment or after inhalation of environmentally acquired resistant isolates. Acquisition in patients during azole therapy highlights the capacity of this fungus to adapt to its environment, but it has a low impact in terms of public health, as interhuman transmission of A. fumigatus is uncommon. Environmentally acquired resistant isolates may propagate and affect populations at risk. The use of triazoles as first-line therapy or prophylaxis could lead to selection of resistant isolates in patients, because most isolates harbor azole cross-resistance. Although mold-active triazoles have provided major progress in the prophylaxis and treatment of Aspergillus infection, the increase of azole resistance could question their use in humans.     

Forward Genetic Approach to Uncover Stress Resistance Genes in Mice — A High-throughput Screen in ES Cells

Phenotype-driven genetic screens in mice is a powerful technique to uncover gene functions, but are often hampered by extremely high costs, which severely limits its potential. We describe here the use of mouse embryonic stem (ES) cells as surrogate cells to screen for a phenotype of interest and subsequently introduce these cells into a host embryo to develop into a living mouse carrying the phenotype. This method provides (1) a cost effective, high-throughput platform for genetic screen in mammalian cells; (2) a rapid way to identify the mutated genes and verify causality; and (3) a short-cut to develop mouse mutants directly from these selected ES cells for whole animal studies. We demonstrated the use of paraquat (PQ) to select resistant mutants and identify mutations that confer oxidative stress resistance. Other stressors or cytotoxic compounds may also be used to screen for resistant mutants to uncover novel genetic determinants of a variety of cellular stress resistance.     

LC-MS/MS in the Clinical Laboratory – Where to From Here?

Liquid chromatography-tandem mass spectrometry (LC-MS/MS) has seen enormous growth in clinical laboratories during the last 10-15 years. It offers analytical specificity superior to that of immunoassays or conventional high performance/pressure liquid chromatography (HPLC) for low molecular weight analytes and has higher throughput than gas chromatography-mass spectrometry (GC-MS). Drug/Toxicology and Biochemical Genetics/Newborn Screening laboratories were at the vanguard of clinical LC-MS/MS use, but have been eclipsed by Endocrine laboratories. In USA reference/referral laboratories, most steroids and biogenic amines are now assayed by LC-MS/MS, and the technology has started to penetrate into smaller laboratories. Assays for mineralo- and gluco-corticoids and their precursors, sex steroids, metanephrines and 25-hydroxy vitamin D highlight the advantages of LC-MS/MS.However, several limitations of LC-MS/MS have become apparent, centring on the interacting triangle of sensitivity - specificity - throughput. While sample throughput is higher than for conventional HPLC or GC-MS, it lags behind automated immunoassays. Techniques which improve throughput include direct sample injection, LC-multiplexing and samplemultiplexing. Measures to improve specificity and sensitivity include sample clean-up and optimising chromatography to avoid interferences and ion suppression due to sample-matrix components. Next generation instrumentation may offer additional benefits.The next challenge for clinical LC-MS/MS is peptide/protein analysis. The quest for multi-biomarker profiles for various diseases has largely failed, but targeted peptide and protein testing by LC-MS/MS, directed at analytical and clinical questions that need to be answered, is proving highly successful. We anticipate that this will result in similar growth of clinical protein/peptide LC-MS/MS as has been seen for low molecular weight applications.     

THE MYELOPROLIFERATIVE DISORDERS—Current Clinical and Laboratory Considerations

The various hemopoietic and supportive cells of the marrow may proliferate beyond physiologic boundaries in response to a number of stimuli.In certain instances, the stimuli are known, and upon their removal the myeloproliferation returns to normal boundaries. These, the reactive myeloproliferations, are best represented by the leukemoid states and the secondary polycythemias.In other cases, the stimuli responsible for the myeloproliferation remain unknown and the clinical disease ends fatally. These, the neoplastic myeloproliferations, include the granulocytic, monocytic and red cell leukemias, as well as the polycythemia vera and myelofibrosis syndrome.In clinical practice it is important to identify the various myeloproliferative syndromes. This task has been facilitated by cytochemical tests that have recently become available, among which the estimation of the leukocyte alkaline phosphatase (LAP) in peripheral blood is a technically simple and extremely useful example.The LAP is normal in secondary polycythemias and decidedly elevated in polycythemia vera, myelofibrosis and leukemoid states. It is greatly decreased in the granulocytic leukemias.     

The Cyanobacterial Role in the Resistance of Feather Mosses to Decomposition—Toward a New Hypothesis

Cyanobacteria-plant symbioses play an important role in many ecosystems due to the fixation of atmospheric nitrogen (N) by the cyanobacterial symbiont. The ubiquitous feather moss Pleurozium schreberi (Brid.) Mitt. is colonized by cyanobacteria in boreal systems with low N deposition. Here, cyanobacteria fix substantial amounts of N₂ and represent a potential N source. The feather moss appears to be resistant to decomposition, which could be partly a result of toxins produced by cyanobacteria. To assess how cyanobacteria modulated the toxicity of moss, we measured inhibition of bacterial growth. Moss with varying numbers of cyanobacteria was added to soil bacteria to test the inhibition of their growth using the thymidine incorporation technique. Moss could universally inhibit bacterial growth, but moss toxicity did not increase with N₂ fixation rates (numbers of cyanobacteria). Instead, we see evidence for a negative relationship between moss toxicity to bacteria and N₂ fixation, which could be related to the ecological mechanisms that govern the cyanobacteria – moss relationship. We conclude that cyanobacteria associated with moss do not contribute to the resistance to decomposition of moss, and from our results emerges the question as to what type of relationship the moss and cyanobacteria share.     

The New Species Concept in Dermatophytes—a Polyphasic Approach

The dermatophytes are among the most frequently observed organisms in biomedicine, yet there has never been stability in the taxonomy, identification and naming of the approximately 25 pathogenic species involved. Since the identification of these species is often epidemiologically and ethically important, the difficulties in dermatophyte identification are a fruitful topic for modern molecular biological investigation, done in tandem with renewed investigation of phenotypic characters. Molecular phylogenetic analyses such as multilocus sequence typing have had to be tailored to accommodate differing the mechanisms of speciation that have produced the dermatophytes that are commonly seen today. Even so, some biotypes that were unambiguously considered species in the past, based on profound differences in morphology and pattern of infection, appear consistently not to be distinct species in modern molecular analyses. Most notable among these are the cosmopolitan bane of nails and feet, Trichophyton rubrum, and the endemic African agent of childhood tinea capitis, Trichophyton soudanense, which are effectively inseparable in all analyses. The molecular data require some reinterpretation of results seen in conventional phenotypic tests, but in most cases, phylogenetic insight is readily integrated with current laboratory testing procedures.     

Is It Always Unethical to Use a Placebo in a Clinical Trial?

Background to the debate: Placebos are used in trials to conceal whether a treatment is being given or not and hence to control for the psychosomatic effects of offering treatment. Placebo-controlled trials are controversial. Critics of such trials argue that if a proven effective therapy exists, a placebo should not be used. But proponents argue that placebo trials are still crucial to prove the efficacy and safety of many treatments.     

HEADACHE—Pharmacological Approach to Treatment

The great majority of headaches a physician treats in office practice can be divided into two main categories, muscular contraction headache of tension type and vascular headaches of the migraine type.The most satisfactory symptomatic therapy for tension headache is by the use of a nonnarcotic analgesic agent combined with a tranquilizer or sedative. On the other hand, symptomatic relief of migraine is best obtained by the use of a suppository of ergotamine tartrate and caffeine combined with an antiemetic or antispasmodic.Interval treatment of patients with tension and migraine headache centers on helping the patient understand his emotional problems. Prophylactic drug therapy for patients with tension headache includes the limited use of tranquilizers and sedatives. Recently, striking benefits in some patients with migraine have been achieved by the prophylactic use of the antiserotonin drug methysergide (UML 491).     

Do We Need to Detect Isoniazid Resistance in Addition to Rifampicin Resistance in Diagnostic Tests for Tuberculosis?

Background

Multidrug-resistant tuberculosis (MDR-TB) is resistant to both rifampicin (RIF) and isoniazid (INH). Whereas many TB diagnostics detect RIF-resistance, few detect INH-monoresistance, which is common and may increase risk of acquired MDR-TB. Whether inclusion of INH-resistance in a first-line rapid test for TB would have an important impact on MDR-TB rates remains uncertain.

Methods

We developed a transmission model to evaluate three tests in a population similar to that of India: a rapid molecular test for TB, the same test plus RIF-resistance detection (“TB+RIF”), and detection of RIF and INH-resistance (“TB+RIF/INH”). Our primary outcome was the prevalence of INH-resistant and MDR-TB at ten years.

Results

Compared to the TB test alone and assuming treatment of all diagnosed MDR cases, the TB+RIF test reduced the prevalence of MDR-TB among all TB cases from 5.5% to 3.8% (30.6% reduction, 95% uncertainty range, UR: 17–54%). Despite using liberal assumptions about the impact of INH-monoresistance on treatment outcomes and MDR-TB acquisition, expansion from TB+RIF to TB+RIF/INH lowered this prevalence only from 3.8% to 3.6% further (4% reduction, 95% UR: 3–7%) and INH-monoresistant TB from 15.8% to 15.1% (4% reduction, 95% UR: (-8)-19%).

Conclusion

When added to a rapid test for TB plus RIF-resistance, detection of INH-resistance has minimal impact on transmission of TB, MDR-TB, and INH-monoresistant TB.     

ALCOHOLISM—Medical Team Approach to Treatment

Various approaches to the treatment of alcoholism have been evaluated by the Los Angeles Rehabilitation Clinic since it began operating more than four years ago. A team approach similar to that used in the outpatient treatment of other chronic disabling diseases has been formulated. With the permission of the California State Department of Public Health (Division of Alcoholic Rehabilitation) preliminary figures of the follow-up study conducted by this department are presented and would tend to support the conclusion that alcoholism can be successfully treated on an outpatient basis.     

Cephalothin—Its In Vitro Antibacterial Spectrum as Studied in a Diagnostic Laboratory

Of 655 bacterial strains isolated in a routine clinical diagnostic laboratory, 564 (86 per cent) were found sensitive to cephalothin by disk sensitivity test. However, the fraction of sensitive Gram-negative bacilli and enterococci declined sharply at concentrations approximating those obtained in serum after the usual recommended dosages. Gram-positive bacteria remained sensitive throughout the entire range of testing concentrations.Unless very high dosages are used, cephalothin cannot be considered a broad-spectrum antibacterial agent for use while cultures are pending. Even with very high dosages all strains of Pseudomonas spp. and significant fractions of other Gram-negative bacillary species remain resistant to cephalothin.If used alone, the high potency cephalothin disk may yield inadequate information and should be supplemented by a lower potency disk, standardized measurements of zone diameters, or a screening plate.     

Is There a Twelfth Protein-Coding Gene in the Genome of Influenza A? A Selection-Based Approach to the Detection of Overlapping Genes in Closely Related Sequences

Protein-coding genes often contain long overlapping open-reading frames (ORFs), which may or may not be functional. Current methods that utilize the signature of purifying selection to detect functional overlapping genes are limited to the analysis of sequences from divergent species, thus rendering them inapplicable to genes found only in closely related sequences. Here, we present a method for the detection of selection signatures on overlapping reading frames by using closely related sequences, and apply the method to several known overlapping genes, and to an overlapping ORF on the negative strand of segment 8 of influenza A virus (NEG8), for which the suggestion has been made that it is functional. We find no evidence that NEG8 is under selection, suggesting that the intact reading frame might be non-functional, although we cannot fully exclude the possibility that the method is not sensitive enough to detect the signature of selection acting on this gene. We present the limitations of the method using known overlapping genes and suggest several approaches to improve it in future studies. Finally, we examine alternative explanations for the sequence conservation of NEG8 in the absence of selection. We show that overlap type and genomic context affect the conservation of intact overlapping ORFs and should therefore be considered in any attempt of estimating the signature of selection in overlapping genes.     

Life Span Evolution in Eusocial Workers—A Theoretical Approach to Understanding the Effects of Extrinsic Mortality in a Hierarchical System

While the extraordinary life span of queens and division of labor in eusocial societies have been well studied, it is less clear which selective forces act on the short life span of workers. The disparity of life span between the queen and the workers is linked to a basic issue in sociobiology: How are the resources in a colony allocated between colony maintenance and reproduction? Resources for somatic maintenance of the colony can either be invested into quality or quantity of workers. Here, we present a theoretical optimization model that uses a hierarchical trade-off within insect colonies and extrinsic mortality to explain how different aging phenotypes could have evolved to keep resources secure in the colony. The model points to the significance of two factors. First, any investment that would generate a longer intrinsic life span for workers is lost if the individual dies from external causes while foraging. As a consequence, risky environments favor the evolution of workers with a shorter life span. Second, shorter-lived workers require less investment than long-lived ones, allowing the colony to allocate these resources to sexual reproduction or colony growth.     

Passive Detection of Biological Aerosols in the Atmosphere with a Fourier Transform Instrument (FTIR)—the Results of the Measurements in the Laboratory and in the Field

Fourier Transform Infrared Radiation (FTIR) spectroscopy is one of the most powerful methods for the detection of gaseous constituents, aerosols, and dust in planetary atmospheres. Infrared spectroscopy plays an important role in searching for biomarkers, organics and biological substances in the Universe. The possibility of detection and identifications with FTIR spectrometer of bio-aerosol spores (Bacillus atrophaeus var. globigii=BG) in the atmosphere is discussed in this paper. We describe the results of initial spectral measurements performed in the laboratory and in the field. The purpose of these experiments was to detect and to identify bio-aerosol spores in two conditions: 1) In a closed chamber where the thermal contrast between the background and aerosols was large, and 2) In open air where the thermal contrast between the background and aerosols was small. The extinction spectrum of BG spores was deduced by comparing our measurements with models, and other measurements known from the literature. Our theoretical and experimental studies indicate that, during passive remote sensing measurements, it is difficult-but possible to detect and to identify bio-aerosol clouds by their spectral signatures. The simple spectral analysis described in the paper can be useful for the detection of various kinds of trace aerosols-not only in the Earth's atmosphere, but also during planetary missions in the environments of other astronomical objects such as planets, comets etc. We expect that the interpretation of data from spectrometric sounding of Venus and Mars during the current missions Mars and Venus Express, and later during the Rosetta mission will benefit from our experimental work and numerical modelling.