The impact of maternal infection with Mycobacterium tuberculosis on the infant response to bacille Calmette–Guérin immunization

Bacille Calmette–Guérin (BCG) immunization provides variable protection against tuberculosis. Prenatal antigen exposure may have lifelong effects on responses to related antigens and pathogens. We therefore hypothesized that maternal latent Mycobacterium tuberculosis infection (LTBI) influences infant responses to BCG immunization at birth. We measured antibody (n = 53) and cellular (n = 31) responses to M. tuberculosis purified protein derivative (PPD) in infants of mothers with and without LTBI, in cord blood and at one and six weeks after BCG. The concentrations of PPD-specific antibodies declined between birth (median [interquartile range (IQR)]) 5600 ng ml⁻¹ [3300–11 050] in cord blood) and six weeks (0.00 ng ml⁻¹ [0–288]). Frequencies of PPD-specific IFN-γ-expressing CD4⁺T cells increased at one week and declined between one and six weeks (p = 0.031). Frequencies of IL-2- and TNF-α-expressing PPD-specific CD4⁺T cells increased between one and six weeks (p = 0.019, p = 0.009, respectively). At one week, the frequency of PPD-specific CD4⁺T cells expressing any of the three cytokines, combined, was lower among infants of mothers with LTBI, in crude analyses (p = 0.002) and after adjusting for confounders (mean difference, 95% CI −0.041% (−0.082, −0.001)). In conclusion, maternal LTBI was associated with lower infant anti-mycobacterial T-cell responses immediately following BCG immunization. These findings are being explored further in a larger study.     

Behavioral Ecology of Sympatric Chimpanzees and Gorillas in Bwindi Impenetrable National Park,Uganda: Diet

Via a field study of chimpanzees (Pan troglodytes schweinfurthii) and gorillas (Gorilla gorilla beringei) in Bwindi Impenetrable National Park, Uganda, we found that their diets are seasonally similar, but diverge during lean seasons. Bwindi chimpanzees fed heavily on fruits of Ficus sp., which were largely ignored by the gorillas. Bwindi gorilla diet was overall more folivorous than chimpanzee diet, but was markedly more frugivorous than that of gorillas in the nearby Virunga Volcanoes. During 4 mo of the year Bwindi gorilla diet included more food species than that of the chimpanzees. Three factors in particular—seasonal consumption of fibrous foods by gorillas, interspecific differences in preferred fruit species, and meat consumption by chimpanzees—contributed to dietary divergence between the two species. When feeding on fruits, gorillas ate Myrianthus holstii more frequently than chimpanzees did, while chimpanzees included more figs in their annual diet. Chimpanzee diet included meat of duikers and monkeys; gorilla frequently consumed decaying wood.     

A Preliminary Study of the Temporal and Spatial Biomass Patterns of Herbaceous Vegetation Consumed by Mountain Gorillas in an Afromontane Rain Forest

Although many animal species consume herbaceous vegetation found in African tropical forests, little is known of the temporal and spatial availability of these plants. From September 2004 to August 2005 we conducted a study that quantified the temporal and spatial biomass availability of 20 species of herbs frequently consumed by endangered mountain gorillas at two locations (Buhoma and Ruhija) in Bwindi Impenetrable National Park, Uganda. In general, the biomass of herbs varied over the study period, but these changes were relatively small. For 12 of 18 and nine of 11 species in Buhoma and Ruhija, respectively, herb biomass differed significantly among habitat types. Of the nine species found in both locations, seven species had a higher biomass at Ruhija, one species had a higher biomass at Buhoma, and one species showed no difference. These results demonstrate that herb biomass varied little temporally but spatial differences in herb biomass were more pronounced. Future studies should investigate the variables that may influence herb phenological patterns such as rainfall, light, soil quality, previous disturbance regimes, and animal foraging and trampling damage.     

Determining Mycobacterium tuberculosis Infection among BCG-Immunised Ugandan Children by T-SPOT.TB and Tuberculin Skin Testing

Background

Children with latent tuberculosis infection (LTBI) represent a huge reservoir for future disease. We wished to determine Mycobacterium tuberculosis (M.tb) infection prevalence among BCG-immunised five-year-old children in Entebbe, Uganda, but there are limited data on the performance of immunoassays for diagnosis of tuberculosis infection in children in endemic settings. We therefore evaluated agreement between a commercial interferon gamma release assay (T-SPOT.TB) and the tuberculin skin test (TST; 2 units RT-23 tuberculin; positive defined as diameter ≥10 mm), along with the reproducibility of T-SPOT.TB on short-term follow-up, in this population.

Methodology/Principal Findings

We recruited 907 children of which 56 were household contacts of TB patients. They were tested with T-SPOT.TB at age five years and then re-examined with T-SPOT.TB (n = 405) and TST (n = 319) approximately three weeks later. The principal outcome measures were T-SPOT.TB and TST positivity. At five years, 88 (9.7%) children tested positive by T-SPOT.TB. More than half of those that were T-SPOT.TB positive at five years were negative at follow-up, whereas 96% of baseline negatives were consistently negative. We observed somewhat better agreement between initial and follow-up T-SPOT.TB results among household TB contacts (κ = 0.77) than among non-contacts (κ = 0.39). Agreement between T-SPOT.TB and TST was weak (κ = 0.28 and κ = 0.40 for T-SPOT.TB at 5 years and follow-up, respectively). Of 28 children who were positive on both T-SPOT.TB tests, 14 (50%) had a negative TST. Analysis of spot counts showed high levels of instability in responses between baseline and follow-up, indicating variability in circulating numbers of T cells specific for certain M.tb antigens.

Conclusions/Significance

We found that T-SPOT.TB positives are unstable over a three-week follow-up interval, and that TST compares poorly with T-SPOT.TB, making the categorisation of children as TB-infected or TB-uninfected difficult. Existing tools for the diagnosis of TB infection are unsatisfactory in determining infection among children in this setting.     

A comparison of two mountain gorilla habitats in Bwindi Impenetrable National Park, Uganda

Bwindi Impenetrable National Park, Uganda, is a small protected area (331 km²) within which there is large climatic and altitudinal variation. Therefore we compared habitat types and forest composition between two locations to investigate differences that may influence ecological conditions for large mammals, including endangered mountain gorillas. We demonstrate that there is considerable intersite variation in habitat types and spatial and temporal availability of vegetation resources of which the most apparent are the differences in species composition of plants and fruit availability. Buhoma (the lower altitude site) has a greater diversity of plant species and higher tree and shrub densities, yet has a much lower density of herbaceous vegetation eaten by gorillas compared with Ruhija. Fruit availability is significantly higher throughout the year in Buhoma compared with Ruhija. Both sites exhibit seasonal variation in fruit availability although they do not follow the same seasonal pattern, perhaps because of inherent asynchronous phenological differences amongst individual tree species. The results of this study are important because distribution and abundance of both terrestrial herbaceous vegetation and fruit resources are believed to influence aspects of feeding ecology for large mammals.     

Dietary Variability of Mountain Gorillas in Bwindi Impenetrable National Park,Uganda

Data on intraspecific dietary variability has important implications for understanding flexibility in foraging behavior, habitat utilization, population dynamics, and social behavior and may also assist in conservation efforts. We compared food availability and diet of a group of mountain gorillas (Gorilla beringei beringei) at a high altitude site and 2 groups at a low altitude site in Bwindi Impenetrable National Park, Uganda, from September 2001 to August 2002. Plant species diversity was greater at the low altitude site than at the high altitude site. The two groups at the low elevation consumed more plant species (140 species vs. 62 species), and a greater number of fruit species per mo (7 vs. 3 species) and per yr (36 vs. 11 species) than the high altitude group did. Furthermore, each group shared <51% of important fibrous food items in their diet with the 2 other groups. There is no significant difference in the proportion of days fruit remains were found in the dung among groups. Finally, according to Ivlev's electivity index, all groups positively selected the majority of food items in their diets. We attribute a large proportion of dietary variation between locations to differences in fruit availability and plant species composition between sites. Differences between groups at the low altitude site may be due to variation in food profitability—more profitable foods available to choose in the same area—within their overlapping home range, or group traditions. A comparison of our results with the diets of gorillas of the Virunga Volcanoes in Rwanda and Kahuzi-Biega, DRC shows that eastern gorilla populations have highly variable dietary patterns with limited overlap in species consumed among groups and populations.     

Chimpanzees in Bwindi-Impenetrable National Park, Uganda, use different tools to obtain different types of honey

Evidence of tool use for foraging for honey by chimpanzees in Bwindi-Impenetrable National Park, Uganda, is reported. These are the first records of tool use by chimpanzees in this region of the Albertine Rift. Tools of two types were found at sites of bee activity. Chimpanzees apparently use small stick tools to forage for the honey of a stingless bee [Meliponula bocandei (Trigonidae)] that nests in tree cavities and also in subterranean holes. They use significantly larger, thicker tools to assist in foraging for honey of African honeybees (Apis mellifera).     

Minerals in the Foods Eaten by Mountain Gorillas (Gorilla beringei)

Minerals are critical to an individual’s health and fitness, and yet little is known about mineral nutrition and requirements in free-ranging primates. We estimated the mineral content of foods consumed by mountain gorillas (Gorilla beringei beringei) in the Bwindi Impenetrable National Park, Uganda. Mountain gorillas acquire the majority of their minerals from herbaceous leaves, which constitute the bulk of their diet. However, less commonly eaten foods were sometimes found to be higher in specific minerals, suggesting their potential importance. A principal component analysis demonstrated little correlation among minerals in food items, which further suggests that mountain gorillas might increase dietary diversity to obtain a full complement of minerals in their diet. Future work is needed to examine the bioavailability of minerals to mountain gorillas in order to better understand their intake in relation to estimated needs and the consequences of suboptimal mineral balance in gorilla foods.     

How selective are elephants as agents of forest tree damage in Bwindi Impenetrable National Park,Uganda?

Elephants are locally concentrated in Bwindi Impenetrable National Park. Vegetation damage attributable to elephants appears to be increasing and may result in the modification of the forest. We examined the implied selectivity of stem damage due to elephants. We followed 26.84 km of recent elephant trails and used 122 plots to document tree damage in relation to species, stem sizes and locations. Of 897 trees (DBH ≥2 cm), 542 (60.4%) were intact, 22 (2.5%) debarked, 274 (30.5%) toppled and 172 (19.2%) had broken branches. Small trees were more likely to be pushed over or have their branches broken, whereas large trees were more commonly debarked. The species most frequently selected for damage included mid‐successional species such as Newtonia buchananii, Myrianthus holstii and Chrysophyllum albidum. These species may be vulnerable to increasing elephant numbers. Our analyses using general linear models indicate that elephants are selective concerning where, how and what tree stems they damage. We found a higher incidence of elephant damage per‐tree stem in open areas than in more closed areas, suggesting feedback in which elephants maintain open habitats that may be conducive for other species such as mountain gorillas. More work is needed to better determine how changing elephant numbers may influence Bwindi's conservation values.     

Capacity-Building and Clinical Competence in Infectious Disease in Uganda: A Mixed-Design Study with Pre/Post and Cluster-Randomized Trial Components

Trial Design

Best practices for training mid-level practitioners (MLPs) to improve global health-services are not well-characterized. Two hypotheses were: 1) Integrated Management of Infectious Disease (IMID) training would improve clinical competence as tested with a single arm, pre-post design, and 2) on-site support (OSS) would yield additional improvements as tested with a cluster-randomized trial.

Methods

Thirty-six Ugandan health facilities (randomized 1∶1 to parallel OSS and control arms) enrolled two MLPs each. All MLPs participated in IMID (3-week core course, two 1-week boost sessions, distance learning). After the 3-week course, OSS-arm trainees participated in monthly OSS. Twelve written case scenarios tested clinical competencies in HIV/AIDS, tuberculosis, malaria, and other infectious diseases. Each participant completed different randomly-assigned blocks of four scenarios before IMID (t0), after 3-week course (t1), and after second boost course (t2, 24 weeks after t1). Scoring guides were harmonized with IMID content and Ugandan national policy. Score analyses used a linear mixed-effects model. The primary outcome measure was longitudinal change in scenario scores.

Results

Scores were available for 856 scenarios. Mean correct scores at t0, t1, and t2 were 39.3%, 49.1%, and 49.6%, respectively. Mean score increases (95% CI, p-value) for t0–t1 (pre-post period) and t1–t2 (parallel-arm period) were 12.1 ((9.6, 14.6), p<0.001) and −0.6 ((−3.1, +1.9), p = 0.647) percent for OSS arm and 7.5 ((5.0, 10.0), p<0.001) and 1.6 ((−1.0, +4.1), p = 0.225) for control arm. The estimated mean difference in t1 to t2 score change, comparing arm A (participated in OSS) vs. arm B was −2.2 ((−5.8, +1.4), p = 0.237). From t0–t2, mean scores increased for all 12 scenarios.

Conclusions

Clinical competence increased significantly after a 3-week core course; improvement persisted for 24 weeks. No additional impact of OSS was observed. Data on clinical practice, facility-level performance and health outcomes will complete assessment of overall impact of IMID and OSS.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01190540","term_id":"NCT01190540"}}NCT01190540