Laboratory confirmation of Buruli ulcer disease in Togo, 2007-2010

Background

Since the early 1990s more than 1,800 patients with lesions suspicious for Buruli ulcer disease (BUD) have been reported from Togo. However, less than five percent of these were laboratory confirmed. Since 2007, the Togolese National Buruli Ulcer Control Program has been supported by the German Leprosy and Tuberculosis Relief Association (DAHW). Collaboration with the Department for Infectious Diseases and Tropical Medicine (DITM), University Hospital, Munich, Germany, allowed IS2404 PCR analysis of diagnostic samples from patients with suspected BUD during a study period of three years.

Methodology/Principal Findings

The DAHW integrated active BUD case finding in the existing network of TB/Leprosy Controllers and organized regular training and outreach activities to identify BUD cases at community level. Clinically suspected cases were referred to health facilities for diagnosis and treatment. Microscopy was carried out locally, external quality assurance (EQA) at DITM. Diagnostic samples from 202 patients with suspected BUD were shipped to DITM, 109 BUD patients (54%) were confirmed by PCR, 43 (29.9%) by microscopy. All patients originated from Maritime Region. EQA for microscopy resulted in 62% concordant results.

Conclusions/Significance

This study presents a retrospective analysis of the first cohort of clinically suspected BUD cases from Togo subjected to systematic laboratory analysis over a period of three years and confirms the prevalence of BUD in Maritime Region. Intensified training in the field of case finding and sample collection increased the PCR case confirmation rate from initially less than 50% to 70%. With a PCR case confirmation rate of 54% for the entire study period the WHO standards (case confirmation rate ≥50%) have been met. EQA for microscopy suggests the need for intensified supervision and training. In January 2011 the National Hygiene Institute, Lomé, has assumed the role of a National Reference Laboratory for PCR confirmation and microscopy.     

Hepcidin is an antibacterial, stress-inducible peptide of the biliary system

Background/Aims

Hepcidin (gene name HAMP), an IL-6-inducible acute phase peptide with antimicrobial properties, is the key negative regulator of iron metabolism. Liver is the primary source of HAMP synthesis, but it is also produced by other tissues such as kidney or heart and is found in body fluids such as urine or cerebrospinal fluid. While the role of hepcidin in biliary system is unknown, a recent study demonstrated that conditional gp130-knockout mice display diminished hepcidin levels and increased rate of biliary infections.

Methods

Expression and localization of HAMP in biliary system was analyzed by real time RT-PCR, in-situ hybridization, immunostaining and –blotting, while prohepcidin levels in human bile were determined by ELISA.

Results

Hepcidin was detected in mouse/human gallbladder and bile duct epithelia. Biliary HAMP is stress-inducible, in that it is increased in biliary cell lines upon IL-6 stimulation and in gallbladder mucosa of patients with acute cholecystitis. Hepcidin is also present in the bile and elevated prohepcidin levels were observed in bile of primary sclerosing cholangitis (PSC) patients with concurrent bacterial cholangitis compared to PSC subjects without bacterial infection (median values 22.3 vs. 8.9; p = 0.03). In PSC-cholangitis subjects, bile prohepcidin levels positively correlated with C-reactive protein and bilirubin levels (r = 0.48 and r = 0.71, respectively). In vitro, hepcidin enhanced the antimicrobial capacity of human bile (p<0.05).

Conclusion

Hepcidin is a stress-inducible peptide of the biliary epithelia and a potential marker of biliary stress. In the bile, hepcidin may serve local functions such as protection from bacterial infections.     

Cyclism revisited: extinction and ‘Achilles’ Heels' keep diversification in check on macroevolutionary time scales

Mass extinctions of varying magnitude prune the continuous diversification predicted by Darwinian evolutionary processes. They are caused by events that are too rare to become adaptatively accommodated. Their effects depend not only on the nature and magnitude of the triggering event but also on the state of the biosphere at the particular time. This is most clearly shown by the existence of Golden Ages preceding all Phanerozoic mass extinctions. These coincide with greenhouse periods, in which doomed clades gave rise to heteromorphs, deviating in strange ways from established bauplans. When critically examined, the seemingly ‘decadent’ morphologies of Schindewolf's ‘typolytic stages’ turn out to have been highly functional. The paradoxical link between adaptive peaks and evolutionary failure can now be explained. Specialisation tends to increase vulnerability (1) by narrowing niches and (2) by the retention of clade-specific conservative features that happen to become fatal Achilles’ Heels for entire clades in the face of a particular perturbation. Following extinctions, the availability of open niches favoured relatively rapid diversification of more innovative clades and their rise to ecological dominance (Schindewolf's ‘typogenetic stage’). Although the long-term changes can be observed only in the fossil record, Golden Biotopes in the present biosphere show that the Darwinian process may also be promoted by ecological isolation. As a result, clade histories do resemble individual biographies, but for ecological rather than orthogenetic reasons. This insight may help us to deal with the present mass extinction caused by our own species.     

Cirsium Stoderianum

Ohne Zusammenfassung     

Zur Kenntnis der Korrelationskrümmung von Avena sativa

Ohne ZusammenfassungMit 2 Textabbildungen.     

Untersuchungen zur Theorie der pflanzlichen Tropismen

Zusammenfassung Bei Schäften vonTaraxacum, Hypokotylen vonImpatiens undCucurbita, sowie Hypo- und Epikotylen vonHelianthus überdauert die geotropische Krümmungsfähigkeit die Periode des Wachstums. Die genannten Objekte sind noch nach dem Erlöschen des Wachstums fähig, ansehnliche, wenn auch in der Regel nicht vollständige geotropische Krümmungen auszuführen.In einem Stadium mehr oder weniger kurz vor dem Wachstumsstillstand übertrifft die Intensität der Krümmung die des Wachstums sehr erheblich.Bei Hypo- und Epikotylen vonHelianthus verläuft die Krümmung nach Sistierung des Wachstums unter Verkürzung der Oberflanke. Die Verkürzung unterbleibt, wenn die Oberflanke schon als Unterflanke reagiert hat.Die ermittelten Beziehungen zwischen geotropischer Krümmung und Wachstum lassen sich ohne Hilfsannahmen mit der Wuchsstofftheorie nicht in Einklang bringen.