Accuracy of five algorithms to diagnose gambiense human African trypanosomiasis

Background

Algorithms to diagnose gambiense human African trypanosomiasis (HAT, sleeping sickness) are often complex due to the unsatisfactory sensitivity and/or specificity of available tests, and typically include a screening (serological), confirmation (parasitological) and staging component. There is insufficient evidence on the relative accuracy of these algorithms. This paper presents estimates of the accuracy of five algorithms used by past Médecins Sans Frontières programmes in the Republic of Congo, Southern Sudan and Uganda.

Methodology and Principal Findings

The sequence of tests in each algorithm was programmed into a probabilistic model, informed by distributions of the sensitivity, specificity and staging accuracy of each test, constructed based on a literature review. The accuracy of algorithms was estimated in a baseline scenario and in a worst-case scenario introducing various near worst-case assumptions. In the baseline scenario, sensitivity was estimated as 85–90% in all but one algorithm, with specificity above 99.9% except for the Republic of Congo, where CATT serology was used as independent confirmation test: here, positive predictive value (PPV) was estimated at <50% in realistic active screening prevalence scenarios. Furthermore, most algorithms misclassified about one third of true stage 1 cases as stage 2, and about 10% of true stage 2 cases as stage 1. In the worst-case scenario, sensitivity was 75–90% and PPV no more than 75% at 1% prevalence, with about half of stage 1 cases misclassified as stage 2.

Conclusions

Published evidence on the accuracy of widely used tests is scanty. Algorithms should carefully weigh the use of serology alone for confirmation, and could enhance sensitivity through serological suspect follow-up and repeat parasitology. Better evidence on the frequency of low-parasitaemia infections is needed. Simulation studies should guide the tailoring of algorithms to specific scenarios of HAT prevalence and availability of control tools.     

Substrate‐dependent control of MAPK phosphorylation in vivo

Phosphorylation of the mitogen‐activated protein kinase (MAPK) is essential for its enzymatic activity and ability to control multiple substrates inside a cell. According to the current models, control of MAPK phosphorylation is independent of its substrates, which are viewed as mere sensors of MAPK activity. Contrary to this modular view of MAPK signaling, our studies in the Drosophila embryo demonstrate that substrates can regulate the level of MAPK phosphorylation in vivo. We demonstrate that a twofold change in the gene dosage of a single substrate can induce a significant change in the phosphorylation level of MAPK and in the conversion of other substrates. Our results support a model where substrates of MAPK counteract its dephosphorylation by phosphatases. Substrate‐dependent control of MAPK phosphorylation is a manifestation of a more general retroactive effect that should be intrinsic to all networks with covalent modification cycles.     

Tracing the Origin of Dietary Protein in Tropical Dry Forest Birds1

Fundamental to our understanding of the ecology of animal communities in the tropics is knowledge of the effect of seasonal changes in the abundance of food sources in consumer diets. We determined stable‐isotope composition (¹³C/¹²C and ¹⁵N/¹⁴N) in whole blood of 14 resident avian species in a tropical dry forest to quantify the origin of their assimilated protein. We used a probabilistic approach (IsoSource) to estimate the relative contribution of C₃ plants, CAM‐C₄ plants, C₃ insects, and CAM‐C₄ insects during the dry and rainy seasons. IsoSource iteratively creates each possible combination of source contribution and produces a distribution of all feasible combinations that adequately predict the observed isotopic signature of the consumer. Granivore–frugivores and granivore–frugivore–insectivores were modeled as predominantly dependent upon plants whereas insectivorous birds were modeled to derive protein almost exclusively from insects. Between these extremes there were several species using mixed diets such as insectivore–frugivores or insectivore–granivores. In most species, virtually all assimilated food was of C₃ origin with the exception of Ruddy Ground‐Doves (Columbina talpacoti) in which CAM or C₄ plants contributed significantly. Seasonal changes in relative food source contribution were followed in eight species of birds. Of these species, White‐tipped Doves (Leptotila verreauxi), Grayish Saltators (Saltator coerulescens), and Social Flycatchers (Myiozetetes similis) increased their use of insects in the rainy season, in contrast to Great Kiskadees (Pitangus sulphuratus), which decreased their use of insects. Our study suggests that that diverse strategies are used by various avian species to obtain dietary proteins within seasonal habitats.     

A phylogenetic reassessment of Hyalenna Forbes and Dircenna Doubleday, with a revision of Hyalenna (Lepidoptera: Nymphalidae: Ithomiinae)

Abstract.  A morphological study of adults and immature stages and a cladistic analysis were conducted to clarify the relationships amongst members of the sister nymphalid butterfly genera Dircenna Doubleday and Hyalenna Forbes. Two species formerly included in Dircenna , Ithomia paradoxa Staudinger and Dircenna hugia Schaus, clustered with Ithomia perasippa , the type species of Hyalenna . Therefore, the first two species are transferred from Dircenna to Hyalenna ( comb.n .). Hyalenna and Dircenna as now conceived are both monophyletic and well supported by morphological apomorphies and branch support measures. The taxonomy and classification of Hyalenna are reviewed and seven species and twenty-four taxa are recognized, including one new species, Hyalenna buckleyi sp.n. , and eleven new subspecies: Hyalenna paradoxa incachaca ssp.n. , H. perasippa valencia ssp.n. , H. perasippa ortygiosa ssp.n. , H. perasippa solitaria ssp.n. , H. buckleyi pomacocha ssp.n. , H. alidella exsulans ssp.n. , H. alidella cinereola ssp.n. , H. alidella vesca ssp.n. , H. sulmona balsamica ssp.n. , H. sulmona hyalina ssp.n. and H. sulmona tersa ssp.n. A key for the identification of all taxa, and illustrations of male and female genitalia for all species and adult specimens of all taxa (where known), are presented. The natural history of each species is summarized and the immature stages of H. paradoxa and H. sulmona are described for the first time.     

Effects of testosterone on nuclear ribonucleoprotein components of prostate epithelial cells

Summary— The changes of the nuclear components caused by castration and testosterone injection were studied in epithelial cells of the ventral prostate of the rat. Castration drastically diminishes the nuclear and nucleolar volume, as well as the fraction of the nuclear volume occupied by non-nucleolar ribonucleoprotein (RNP) fibrils. However, in castrated animals the frequency of perichromatin granules (PCG) is 79% higher than in controls. Testosterone injection causes a reduction of the number of PCG to 33% of the castrated level in 15 min, and increases the non-nucleolar RNP fibrils. Other parameters such as nuclear and nucleolar volume and the relative volume of the compact chromatin present only small changes in a period of 2 h following the hormone administration. High resolution quantitative autoradiography demonstrates that the transportation of previously synthesized RNA increases steeper than the RNA synthesis. All these effects are similar to those caused by ovariectomy and estradiol injection on the nuclear structures of endometrial epithelial cells. These similarities and other observations suggest that PCGs contain mRNA, of a few genes, stored in the nucleus by a restriction of its transportation to the cytoplasm.     

Symbiosis and insect diversification: an ancient symbiont of sap-feeding insects from the bacterial phylum Bacteroidetes

Several insect groups have obligate, vertically transmitted bacterial symbionts that provision hosts with nutrients that are limiting in the diet. Some of these bacteria have been shown to descend from ancient infections. Here we show that the large group of related insects including cicadas, leafhoppers, treehoppers, spittlebugs, and planthoppers host a distinct clade of bacterial symbionts. This newly described symbiont lineage belongs to the phylum Bacteroidetes. Analyses of 16S rRNA genes indicate that the symbiont phylogeny is completely congruent with the phylogeny of insect hosts as currently known. These results support the ancient acquisition of a symbiont by a shared ancestor of these insects, dating the original infection to at least 260 million years ago. As visualized in a species of spittlebug (Cercopoidea) and in a species of sharpshooter (Cicadellinae), the symbionts have extraordinarily large cells with an elongate shape, often more than 30 mum in length; in situ hybridizations verify that these correspond to the phylum Bacteroidetes. "Candidatus Sulcia muelleri" is proposed as the name of the new symbiont.