Tuberculin Test in Children with Malnutrition

Tuberculin tests with Heaf''s multiple-puncture method, as well as intradermal tests with varying strengths of old tuberculin, were carried out on 402 children with severe malnutrition. From the radiological and bacteriological findings 51 children (12.5%) were considered to have active tuberculosis. The Heaf test was positive in only 11 of these children, but the intradermal test using 100 tuberculin units was positive in a further 18. This confirms previous findings that tuberculin sensitivity is impaired in malnourished children, and suggests that a higher dose of tuberculin is more likely to elicit a positive response.     

Interpretation of Positive Reactions to Heaf Tuberculin Test in London Schoolchildren

A study of 289 children aged 12-14 years found to be Heaf test positive at routine testing was made to determine the likely cause of the positive tests. Only 12% of children grade 1 Heaf positive were likely to have had a previous infection with Mycobacterium tuberculosis, 49% were likely to have had infections with atypical mycobacteria, and in 39% no cause for the positive Heaf test was found.The positive Heaf test seems to us to be too sensitive. Both a negative and grade 1 positive should be regarded as not significant and these children given B.C.G. vaccine. Heaf grades 2, 3, and 4 should be regarded as significant and the children investigated for M. tuberculosis infection.     

Audit of a tuberculosis contact tracing clinic.

OBJECTIVE--To determine the efficiency of tuberculosis contact tracing in South Glamorgan 1987-9. DESIGN--Review of records of contact tracing clinic and of data from the Mycobacterium Reference Unit. The clinic''s practice was compared with 1983 British Thoracic Society''s recommendations. SETTING--Health authority tuberculosis control programme. MAIN OUTCOME MEASURES--Proportion of contacts screened, follow up attendance rates, number of secondary cases detected, and quality of record keeping. RESULTS--101 index patients and 611 contacts were identified. 596 (97.5%) contacts were screened, of whom 139 should not have been. Of 356 contacts requiring a Heaf test, 237 were tested, seven refused the test, and 112 had chest radiography without a Heaf test. 95 contacts were unnecessarily tested. 87 contacts had chest radiography unnecessarily and seven should have had radiography but did not. 34 contacts were given follow up appointments inappropriately and seven were overlooked for follow up. Tuberculosis was diagnosed in five asymptomatic contacts, all at initial screening and all close contacts of index patients with pulmonary disease. CONCLUSION--Inadequacy of data, non-adherence to contact tracing guidelines, and failure to define the term highly infectious index case resulted in many contacts being unnecessarily screened or followed up. IMPLICATIONS--The efficiency of tracing contacts would be improved by specifying smear results and ethnic origin of the index case on the notification form, clearly classifying contacts as close or causal, and clearly defining the term highly infectious.     

Epidemiologic aspects of an emerging focus of visceral leishmaniasis in Tbilisi, Georgia

Background

Over the last 15 years, visceral leishmaniasis (VL) has emerged as a public health concern in Tbilisi, the capital of Georgia.

Methodology/Principal Findings

Seroepidemiological surveys were conducted to determine the prevalence and incidence of infection in children and dogs within the main focus of VL, and to identify risk factors associated with human infection. Of 4,250 children investigated, 7.3% were positive by direct agglutination test in a baseline survey; an apparent incidence rate of 6.0% was estimated by one year follow-up. None of the seropositive children progressed to VL during the survey. Increased seropositivity at one year was predicted by presence at baseline of clustered flying insects (OR = 1.49; P = 0.001), perceived satisfactory sanitation (OR = 1.65; P<0.001), stray dogs (OR = 1.33; P = 0.023), and by persistent fever during the 6 months prior to baseline survey (OR = 14.2; P<0.001). Overall, 18.2% (107/588) of domestic and 15.3% (110/718) of stray dogs were seropositive by the rk39 dipstick test. Clinical VL signs were found in 1.3% of domestic and 2.9% of stray, seropositive dogs. Parasites isolated from human and dog samples were identified by PCR and phylogenetic analysis of the Leishmania 70 kDa heat-shock protein (HSP70) gene as Leishmania infantum.

Conclusions/Significance

There is an active focus of L. infantum transmission in Tbilisi with a high prevalence of human and canine infections.     

A New Approach in Dispensing Tuberculin PPD and in Performing a Multi-Puncture Tuberculin Test

A simple and low-cost kit for single-dose tuberculin testing is described. For those who perform occasional tuberculin tests only, this kit is proposed as a substitute for the Heaf apparatus used in carrying out a multi-puncture test. No difference in the tuberculin skin reactions could be observed when the needle multi-puncture test was compared with the Heaf test in BCG-sensitized guinea pigs and in 12 volunteers. A comparative study on 37 student nurses, using the needle multi-puncture method and the intracutaneous method (Mantoux test), showed that with the needle multi-puncture method more positive reactors were detected than with the Mantoux test using 1:2000 dilution of OT. However, more positive reactors were obtained with the Mantoux test using 1:100 dilution of OT. It is felt that the singledose kit can be a valuable asset when only few skin tests are performed.     

Description of Males of Heterodera zeae

The male ofHeterodera zeae, the corn cyst nematode, is described and illustrated for the first time. Specimens were obtained from a culture originating from cysts collected in Kent County, Maryland, at the site of the first known infestation of H. zeae in the United States.     

Seropositivity of Toxoplasma gondii and Toxocara spp. in Children with Cryptogenic Epilepsy,Benha, Egypt

The present study aimed to investigate the possible association of Toxoplasma gondii and Toxocara spp. infections with cryptogenic epilepsy in children. The study was carried out between June 2014 and March 2015. Total 90 children (40 with cryptogenic epilepsy, 30 with non-cryptogenic epilepsy, and 20 healthy control children) were evaluated to determine the anti-Toxocara and anti-T. gondii IgG seropositivity using ELISA kits. Epileptic cases were selected from those attending the pediatrics outpatient clinic of Benha University Hospital, Pediatrics Neurology Unit, and from Benha Specialized Hospital of children. The results showed that the level of anti-T. gondii IgG seropositivity was significantly higher among children with cryptogenic epilepsy (20%) than among children with non-cryptogenic children (0%). In healthy controls (10%), there was no association between toxocariasis seropositivity and cryptogenic epilepsy (only 5.7%; 4 out of 70 cases) among cases and 10% (2 out of 20) among controls. Among toxocariasis IgG positive cases, 3 (7.5%) were cryptogenic, and only 1 (3.3%) was non-cryptogenic. These statistically significant results support the association between T. gondii infection and cryptogenic epilepsy while deny this association with toxocariasis.     

Decreased Expression of miR-21, miR-26a,miR-29a,and miR-142-3p in CD4+ T Cells and Peripheral Blood from Tuberculosis Patients

The vast majority of Mycobacterium tuberculosis (M. tuberculosis) infected individuals are protected from developing tuberculosis and T cells are centrally involved in this process. MicroRNAs (miRNA) regulate T-cell functions and are biomarker candidates of disease susceptibility and treatment efficacy in M. tuberculosis infection. We determined the expression profile of 29 selected miRNAs in CD4⁺ T cells from tuberculosis patients and contacts with latent M. tuberculosis infection (LTBI). These analyses showed lower expression of miR-21, miR-26a, miR-29a, and miR-142-3p in CD4⁺ T cells from tuberculosis patients. Whole blood miRNA candidate analyses verified decreased expression of miR-26a, miR-29a, and miR-142-3p in children with tuberculosis as compared to healthy children with LTBI. Despite marked variances between individual donor samples, trends of increased miRNA candidate expression during treatment and recovery were observed. Functional in vitro analysis identified increased miR-21 and decreased miR-26a expression after re-stimulation of T cells. In vitro polarized Interleukin-17 positive T-cell clones showed activation-dependent miR-29a up-regulation. In order to characterize the role of miR-29a (a described suppressor of Interferon-γ in tuberculosis), we analyzed M. tuberculosis specific Interferon-γ expressing T cells in children with tuberculosis and healthy contacts but detected no correlation between miR-29a and Interferon-γ expression. Suppression of miR-29a in primary human T cells by antagomirs indicated no effect on Interferon-γ expression after in vitro activation. Finally, classification of miRNA targets revealed only a moderate overlap between the candidates. This may reflect differential roles of miR-21, miR-26a, miR-29a, and miR-142-3p in T-cell immunity against M. tuberculosis infection and disease.     

贵州省荔波发现百花锦蛇

2010年7月～2012年8月,在贵州省荔波南方喀斯特世界自然遗产地进行脊椎动物物种多样性调查时,分别在板寨、瑶山、翁昂和洞塘采集到游蛇科蛇类标本共5条,经分类鉴定为锦蛇属(Elaphe)的百花锦蛇(E.moellendorffi),为该物种在贵州省内首次发现,增加了其在国内的分布点.     

河南省栾川县伏牛山发现翼手目物种大菊头蝠

2011年3月至11月,在调查河南省洞栖蝙蝠过程中,分别在河南省信阳市新县沙窝镇胡山水库引水渠(N31°41′,E115°04′)、南阳市桐柏县桐柏山太白顶桃花洞(32°23′N,113°16′E)、洛阳市栾川县伏牛山龙峪湾矿洞(N33°42′,E111°45′)3地观察到大菊头蝠(Rhinolophus luctus),并各捕获1只个体共3只,对其外形和头骨特征进行了测量、描述,与其他地区的大菊头蝠进行了比较,经鉴定为大菊头蝠华南亚种(R.luctus lanous).标本现保存于河南师范大学标本馆.本文还探讨了大菊头蝠在河南省的分布状况.     

Analysis of a mathematical model for tuberculosis: What could be done to increase case detection

This paper presents qualitative and quantitative study of a TB mathematical model to test results from a survey carried out in Benin City, Nigeria. The purpose of the survey was to determine factors that could enhance the case detection rate of tuberculosis. Results from the survey identified four key factors that must be combined for an effective control of TB and increase the case detection rate: effective awareness programme, active cough identification, associated cost factor for treatment of identified cases and effective treatment. The overall effect of these factors on the basic reproduction number under treatment, R_T, of the TB model was considered. In all, a serious concentration on tuberculosis awareness programmes and active cough identification as a marker for someone having TB was shown to significantly reduce the value of the reproduction number, hereby reducing the severity of the disease in the presence of treatment.     

An extinct nestorid parrot (Aves,Psittaciformes, Nestoridae) from the Chatham Islands,New Zealand

We describe an extinct parrot from late Quaternary fossil bone deposits on the Chatham Islands, located c. 800 km east of mainland New Zealand. Mitochondrial DNA analyses and osteological characters confirm that the Chatham Islands parrot was a sister taxon to the New Zealand kaka (Nestor meridionalis Gmelin, 1788). The relatively large femur : humerus length ratio and broad pelvis of the Chatham Islands parrot indicate that it had a more terrestrial habit than the kaka. Stable dietary isotope analyses (δ ¹⁵N and δ ¹³C) of Chatham Islands parrot bones suggest that the species may have been mainly herbivorous, although further analyses are required to confirm this. The presence of Chatham Islands parrot bones in early midden deposits shows that the species persisted into the post‐settlement era, and became extinct possibly as a result of habitat loss, hunting pressure, and rat predation following initial Polynesian settlement of the islands (sometime between the 13^th and 16^th centuries AD). © 2014 The Linnean Society of London     

Convergent evolution of gigantism in the flora of an isolated archipelago

Animals often evolve conspicuous differences in body size after colonising isolated islands. However, far less is known about repeated patterns in the evolution of plant size on islands. We tested for convergent evolution of leaf area, seed size and plant stature in the flora of the Chatham Islands (i.e. Rēkohu), which are located 700 km off the east coast of New Zealand. First, we measured leaf area, seed size and plant stature from populations of 22 plant taxa on the Chatham Islands. These data were then compared to analogous measurements from their sister taxa on the mainland to test for evidence of island gigantism, and whether size changes differ between leaves, seeds and stature. Second, we collated data from the literature to test whether size changes in endemic taxa differed among plant growth forms or were correlated with divergence times. Results showed that all three plant traits tended to increase in size on the Chatham Islands. However, field data showed that size increases tended to be more consistent in seeds and leaves than in stature. Data from the literature indicated that size increases also differed among growth forms. Herbaceous species showed the strongest evidence of gigantism, followed by woody plants, while graminoids showed a weak trend towards dwarfism. Insular size increases in seeds and leaves were also positively related to divergence times, indicating that taxa which have resided on the Chatham Islands for longer periods show stronger evidence of gigantism than taxa which arrived more recently. Overall results illustrate that gigantism is a hallmark of the Chatham Island flora, providing a remarkable example of convergent evolution.     

Some Differences between Plants of the Chatham Islands and the New Zealand Mainland

A number of Chatham Island plants show morphological differences from related plants on mainland New Zealand. These differences could have arisen as a result of freedom from moa browsing on the Chatham Islands. A possible test for this hypothesis is suggested.     

Evaluation of a serological test for tuberculosis.

The agglutination test of Nicholls was found to be ineffective in diagnosing active tuberculosis. A positive result (titre of 1/125 or more) was found in the serum of 74 (70%) out of 105 patients with newly diagnosed, smear-positive pulmonary tuberculosis; 61 (62%) out of 98 healthy family contacts; and 19 (63%) out of 30 patients with non-tuberculous conditions. These findings were not due to faulty technique since the results obtained at Hammersmith were similar to those obtained by Nicholls''s laboratory in the same serum samples. Twenty-seven of the tuberculous patients who had a negative result before treatment were retested two months after the start of chemotherapy but showed no evidence of a rising titre.     

High prevalence of Schistosoma mansoni infection and stunting among school age children in communities along the Albert-Nile,Northern Uganda: A cross sectional study

BackgroundKnowing the prevalence of schistosomiasis is key to informing programmes to control and eliminate the disease as a public health problem. It is also important to understand the impact of infection on child growth and development in order to allocate appropriate resources and effort to the control of the disease.MethodsWe conducted a survey to estimate the prevalence of schistosomiasis among school aged children in villages along the Albert-Nile shore line in the district of Pakwach, North Western Uganda. A total of 914 children aged between 10–15 years were screened for Schistosoma mansoni using the POC-CCA and Kato Katz (KK) techniques. The infection intensities were assessed by POC-CCA and KK as well as CAA tests. The KK intensities were also correlated with POC-CCA and with CAA intensity. Anthropometric measurements were also taken and multivariate analysis was carried out to investigate their association with infection status.ResultsThe prevalence of schistosomiasis using the POC-CCA diagnostic test was estimated at 85% (95% CI: 83–87), being highest amongst children living closer to the Albert-Nile shoreline. Visual scoring of the POC-CCA results was more sensitive than the Kato Katz test and was positively correlated with the quantified infection intensities by the CAA test. The majority of the children were underweight (BMI<18.5), and most notably, boys had significantly lower height for age (stunting) than girls in the same age range (p < 0.0001), but this was not directly associated with S. mansoni infection.ConclusionHigh prevalence of S. mansoni infection in the region calls for more frequent mass drug administration with praziquantel. We observed high levels of stunting which was not associated with schistosomiasis. There is a need for improved nutrition among the children in the area.     

北京市延庆县非结核病防治机构网络直报肺结核患者就诊及追踪分析

目的:分析2006-2010年北京市延庆县非结核病防治机构网络直报肺结核患者就诊及追踪情况,为进一步推进结核病防控工作提供依据。方法:对2006-2010年延庆县非结核病防治机构网络直报信息管理系统数据进行回顾性描述性分析。结果:2006-2010年延庆县非结核病防治机构网络直报患者主动就诊到位率为90.18%,追踪到位率为67.35%。在主动就诊到位的450例病人中,106人(23.56%)诊断为非结核,被诊断为初治痰涂片阳性、复治痰涂片阳性和初治痰涂片阴性患者分别占主动就诊到位病人的56.67%、1.78%和18.00%。结论:非结防机构是肺结核患者接受治疗的主要场所,在肺结核患者的发现中起着重要的作用。应针对非结核病防治机构网络直报工作中存在的问题采取相应的措施,以提高主动就诊率和追踪到位率。     

Multiple colonizations of a remote oceanic archipelago by one species: how common is long‐distance dispersal?

Aim  It is well established that many groups of plants and animals have undergone long-distance dispersal, but the extent to which this continues beyond initial colonization is largely unknown. To provide further insight into the frequency of gene flow mediated by long-distance dispersal, we investigated the origins of the fern Asplenium hookerianum on the Chatham Islands, and present a review of the contribution of molecular data to elucidating the origins of this archipelago's biota.
Location  Chatham Islands and New Zealand. A. hookerianum is scarce on the Chatham Islands but common in New Zealand, some 800 km to the west.
Methods  We compared chloroplast trnL–trnF DNA sequence data from Chatham Islands' A. hookerianum with extensive phylogeographic data for this genetically variable species in mainland New Zealand.
Results  Our sequencing revealed the presence of two haplotypes in Chatham Islands' A. hookerianum . These haplotypes differed by four mutational events and were each more closely related to haplotypes found in New Zealand than to each other.
Main conclusions  Despite the rarity of A. hookerianum on the Chatham Islands, its populations there appear to derive from at least two long-distance dispersal events from New Zealand, these possibly originating from different areas. We suggest that long-distance transoceanic dispersal, and the gene flow it can mediate, may be more common than is generally appreciated.     

Bovine tuberculosis in free-ranging carnivores from Michigan

During a survey of carnivores and omnivores for bovine tuberculosis conducted in Michigan (USA) since 1996, Mycobacterium bovis was cultured from lymph nodes pooled from six coyotes (Canis latrans) (four adult female, two adult male), two adult male raccoons (Procyon lotor), one adult male red fox (Vulpes vulpes), and one 1.5-yr-old male black bear (Ursus americanus). One adult, male bobcat (Felis rufus) with histologic lesions suggestive of tuberculosis was negative on culture but positive for organisms belonging to the Mycobacterium tuberculosis complex when tested by polymerase chain reaction. All the tuberculous animals were taken from three adjoining counties where M. bovis is known to be endemic in the free-ranging white-tailed deer (Odocoileus virginianus) population. There were two coyotes, one raccoon, one red fox, and one bobcat infected in Alpena county. Montmorency County had two coyotes and one raccoon with M. bovis. Two coyotes and a bear were infected from Alcona County. These free-ranging carnivores/omnivores probably became infected with M. bovis through consumption of tuberculous deer. Other species included in the survey were opossum (Didelphis virginiana), gray fox (Urocyon cinereoargenteus), and badger (Taxidea taxus); these were negative for M. bovis.     

Comparison of Mantoux and Tine Tuberculin Skin Tests in BCG-Vaccinated Children Investigated for Tuberculosis

Background

Tuberculin skin tests (TSTs) are long-established screening methods for tuberculosis (TB). We aimed to compare agreement between the intradermal Mantoux and multipuncture percutaneous Tine methods and to quantify risk factors for a positive test result.

Methodology/Principal Findings

1512 South African children younger than 5 years of age who were investigated for tuberculosis (TB) during a Bacille Calmette Guerin (BCG) trial were included in this analysis. Children underwent both Mantoux and Tine tests. A positive test was defined as Mantoux ≥15 mm or Tine ≥ Grade 3 for the binary comparison. Agreement was evaluated using kappa (binary) and weighted kappa (hierarchical). Multivariate regression models identified independent risk factors for TST positivity. The Mantoux test was positive in 430 children (28.4%) and the Tine test in 496 children (32.8%, p<0.0001), with observed binary agreement 87.3% (kappa 0.70) and hierarchical agreement 85.0% (weighted kappa 0.66). Among 173 children culture-positive for Mycobacterium tuberculosis, Mantoux was positive in 49.1% and Tine in 54.9%, p<0.0001 (kappa 0.70). Evidence of digit preference was noted for Mantoux readings at 5 mm threshold intervals. After adjustment for confounders, a positive culture, suggestive chest radiograph, and proximity of TB contact were risk factors for a positive test using both TST methods. There were no independent associations between ethnicity, gender, age, or over-crowding, and TST result.

Conclusions/Significance

The Tine test demonstrated a higher positive test rate than the Mantoux, with substantial agreement between TST methods among young BCG-vaccinated children. TB disease and exposure factors, but not demographic variables, were independent risk factors for a positive result using either test method. These findings suggest that the Tine might be a useful screening tool for childhood TB in resource-limited countries.