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Luis Pablo Cruz-Hervert,
Lourdes García-García,
Leticia Ferreyra-Reyes,
Miriam Bobadilla-del-Valle,
Bulmaro Cano-Arellano,
Sergio Canizales-Quintero,
Elizabeth Ferreira-Guerrero,
Renata Báez-Saldaña,
Norma Téllez-Vázquez,
Ariadna Nava-Mercado,
Luis Juárez-Sandino,
Guadalupe Delgado-Sánchez,
César Alejandro Fuentes-Leyra,
Rogelio Montero-Campos,
Rosa Areli Martínez-Gamboa, Peter M Small,
José Sifuentes-Osornio,
Alfredo Ponce-de-León
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ABSTRACT: worldwide, the frequency of tuberculosis among older people almost triples that observed among young adults.
to describe clinical and epidemiological consequences of pulmonary tuberculosis among older people.
we screened persons with a cough lasting more than 2 weeks in Southern Mexico from March 1995 to February 2007. We collected clinical and mycobacteriological information (isolation, identification, drug-susceptibility testing and IS6110-based genotyping and spoligotyping) from individuals with bacteriologically confirmed pulmonary tuberculosis. Patients were treated in accordance with official norms and followed to ascertain treatment outcomes, retreatment, and vital status.
eight hundred ninety-three tuberculosis patients were older than 15 years of age; of these, 147 (16.5%) were 65 years of age or older. Individuals ≥ 65 years had significantly higher rates of recently transmitted and reactivated tuberculosis. Older age was associated with treatment failure (OR=5.37; 95% CI: 1.06-27.23; P=0.042), and death due to tuberculosis (HR=3.52; 95% CI: 1.78-6.96; P<0.001) adjusting for sociodemographic and clinical variables.
community-dwelling older individuals participate in chains of transmission indicating that tuberculosis is not solely due to the reactivation of latent disease. Untimely and difficult diagnosis and a higher risk of poor outcomes even after treatment completion emphasise the need for specific strategies for this vulnerable group.
Age and Ageing 03/2012; 41(4):488-95. · 3.09 Impact Factor
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ABSTRACT: The fragmentation of clinical and public health systems results in divergent information collection practices, presenting challenges to standardization and EHR certification efforts. Data forms employed in public health jurisdictions nationwide reflect these differences in patient treatment, monitoring and evaluation, and follow-up, presenting challenges for data integration. To study these variations, we surveyed tuberculosis contact investigation forms from all fifty states, three municipalities and two countries. We apply statistics and cluster analysis to analyze the divergent content of contact investigation forms with the goal of characterizing normative practices and identifying a common core of data fields. We found widespread variation in data elements between states in the study, with the "Name" field being the only ubiquitous data element. Our method reveals distinct groupings of data fields employed in certain regions, allowing the simultaneous identification of core standard data fields as well as variations in practice.
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 01/2011; 2011:19-27.
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ABSTRACT: Mycobacterium tuberculosis is an obligate human pathogen capable of persisting in individual hosts for decades. We sequenced the genomes of 21 strains representative of the global diversity and six major lineages of the M. tuberculosis complex (MTBC) at 40- to 90-fold coverage using Illumina next-generation DNA sequencing. We constructed a genome-wide phylogeny based on these genome sequences. Comparative analyses of the sequences showed, as expected, that essential genes in MTBC were more evolutionarily conserved than nonessential genes. Notably, however, most of the 491 experimentally confirmed human T cell epitopes showed little sequence variation and had a lower ratio of nonsynonymous to synonymous changes than seen in essential and nonessential genes. We confirmed these findings in an additional data set consisting of 16 antigens in 99 MTBC strains. These findings are consistent with strong purifying selection acting on these epitopes, implying that MTBC might benefit from recognition by human T cells.
Nature Genetics 06/2010; 42(6):498-503. · 35.53 Impact Factor
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The Lancet 05/2009; 373(9678):1822-4. · 38.28 Impact Factor
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Ruth Hershberg,
Mikhail Lipatov, Peter M Small,
Hadar Sheffer,
Stefan Niemann,
Susanne Homolka,
Jared C Roach,
Kristin Kremer,
Dmitri A Petrov,
Marcus W Feldman,
Sebastien Gagneux
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ABSTRACT: Mycobacterium tuberculosis infects one third of the human world population and kills someone every 15 seconds. For more than a century, scientists and clinicians have been distinguishing between the human- and animal-adapted members of the M. tuberculosis complex (MTBC). However, all human-adapted strains of MTBC have traditionally been considered to be essentially identical. We surveyed sequence diversity within a global collection of strains belonging to MTBC using seven megabase pairs of DNA sequence data. We show that the members of MTBC affecting humans are more genetically diverse than generally assumed, and that this diversity can be linked to human demographic and migratory events. We further demonstrate that these organisms are under extremely reduced purifying selection and that, as a result of increased genetic drift, much of this genetic diversity is likely to have functional consequences. Our findings suggest that the current increases in human population, urbanization, and global travel, combined with the population genetic characteristics of M. tuberculosis described here, could contribute to the emergence and spread of drug-resistant tuberculosis.
PLoS Biology 01/2009; 6(12):e311. · 11.45 Impact Factor
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ABSTRACT: Mycobacterium tuberculosis (MTB) is one of the leading causes of morbidity and mortality worldwide and infects approximately 1/3 of the human population, but only 10% of all infected individuals will ever develop the disease and half of these may result in a rapid progression to disease during the first 2 years after being infected. On the other hand, some phenotypic differences among mycobacterial strains contribute to variations in the outcome of the infection, e.g., the hypervirulent phenotype described in the Beijing family has been associated with the production of a phenolic glycolipid, which reduces the production of Th1 cytokines in the experimental model and requires the activity of a polyketide synthase enzyme encoded by the pks15/1 gene.
We analyzed clinical isolates characterized by recent transmission and rapid progression to disease to identify factors that may influence such behavior from a rural and semi-urban community in eastern Mexico.
Using various typing tools, we were able to identify intrafamilial clusters which belonged to the East Asian lineage of MTB isolates (Beijing family) and another that belonged to the Indo-Oceanic lineage (Manila family). All isolates within these two clusters showed an intact pks15/1 gene sequence. Additionally, we identified three more family clusters that belonged to the Euro-American lineage and showed the typical 7-bp deletion of the pks15/1 gene. This 7-bp deletion was also found in the remaining 23 cases from non-family clusters.
This is the first report of cases caused by strains with an intact pks15/1 gene in Mexico. Interestingly, we identified the three main mycobacterial lineages described so far: East-Asian, Indo-Oceanic, and Euro-American in a human population with almost no present-day migration.
Archives of medical research 12/2008; 39(8):809-14. · 1.88 Impact Factor
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Bouke C de Jong,
Philip C Hill,
Alex Aiken,
Timothy Awine,
Martin Antonio,
Ifedayo M Adetifa,
Dolly J Jackson-Sillah,
Annette Fox,
Kathryn Deriemer,
Sebastien Gagneux,
Martien W Borgdorff,
Keith P W J McAdam,
Tumani Corrah, Peter M Small,
Richard A Adegbola
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ABSTRACT: There is considerable variability in the outcome of Mycobacterium tuberculosis infection. We hypothesized that Mycobacterium africanum was less likely than M. tuberculosis to transmit and progress to tuberculosis disease.
In a cohort study of patients with tuberculosis and their household contacts in The Gambia, we categorized 1808 HIV-negative tuberculosis contacts according to exposure to M. tuberculosis or M. africanum. Positive skin test results indicated transmission, and development of tuberculosis during 2 years of follow-up indicated progression to disease.
Transmission rates were similar, but rates of progression to disease were significantly lower in contacts exposed to M. africanum than in those exposed to M. tuberculosis (1.0% vs. 2.9%; hazard ratio [HR], 3.1 [95% confidence interval {CI}, 1.1-8.7]). Within M. tuberculosis sensu stricto, contacts exposed to a Beijing family strain were most likely to progress to disease (5.6%; HR relative to M. africanum, 6.7 [95% CI, 2.0-22]).
M. africanum and M. tuberculosis transmit equally well to household contacts, but contacts exposed to M. africanum are less likely to progress to tuberculosis disease than those exposed to M. tuberculosis. The variable rate of progression by lineage suggests that tuberculosis variability matters in clinical settings and should be accounted for in studies evaluating tuberculosis vaccines and treatment regimens for latent tuberculosis infection.
The Journal of Infectious Diseases 11/2008; 198(7):1037-43. · 6.41 Impact Factor
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ABSTRACT: Mycobacterium tuberculosis is a very important global pathogen. One quarter of the world's TB cases occur in India. The tuberculosis strains isolated from south Indian patients exhibit certain phenotypic characteristics like low virulence in guinea-pigs, resistance to isoniazid, thiophene-2-carboxylic acid hydrazide (TCH) and para-amino salicylic acid (PAS), and enhanced susceptibility to H2O2. Besides this, a large percentage of the isolates harbor only a single copy of IS 6110 which makes these strains distinct. Hence, we have studied the genotypic characteristics of these strains by using advanced techniques like Deletion Micro array, deletion PCR, allelic discrimination RT-PCR using several lineage specific markers and KatG G1388T (non-synonymous) polymorphism along with spoligotyping. The analysis of 1215 tuberculosis patient isolates from south India revealed that 85.2% belonged to the ancestral lineage of M. tuberculosis. Comparative whole-genome hybridization identified six new genomic regions within this lineage that were variably deleted.
Infection Genetics and Evolution 08/2008; 8(4):474-83. · 3.13 Impact Factor
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ABSTRACT: Microarrays are a promising technique for elucidating and interpreting the mechanistic roles of genes in the pathogenesis of infectious disease. Microarrays have been used to analyse the genetic polymorphisms of specific loci associated with resistance to antimicrobial agents, to explore the distribution of genes among isolates from the same and similar species, to understand the evolutionary relationship between closely related species and to integrate the clinical and genomic data. This technique has also been used to study host–pathogen interactions, mainly by identifying genes from pathogens that may be involved in pathogenicity and by surveying the scope of the host response to infection. The RNA expression profile of pathogens has been used to identify regulatory mechanisms that ensure gene expression in the appropriate environment, to hypothesize functions of hundreds of uncharacterized genes and to identify virulence genes that promote colonization or tissue damage. This information also has the potential to identify targets for drug design. Furthermore, microarrays have been used to investigate the mechanism of drug action and to delineate and predict adverse effects of new drugs. In this paper, we review the use of spotted and high-density oligonucleotide arrays to study the genetic polymorphisms of pathogens, host–pathogen interactions and whole-genome expression profiles of pathogens, as well as their use for drug discovery.
Cellular Microbiology 07/2008; 3(11):713 - 719. · 5.46 Impact Factor
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ABSTRACT: New tools for controlling tuberculosis are urgently needed. Despite our emerging understanding of the biogeography of Mycobacterium tuberculosis, the implications for development of new diagnostics, drugs, and vaccines is unknown. M tuberculosis has a clonal genetic population structure that is geographically constrained. Evidence suggests strain-specific differences in virulence and immunogenicity in light of this global phylogeography. We propose a strain selection framework, based on robust phylogenetic markers, which will allow for systematic and comprehensive evaluation of new tools for tuberculosis control.
The Lancet Infectious Diseases 06/2007; 7(5):328-37. · 17.39 Impact Factor
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ABSTRACT: The Beijing family of Mycobacterium tuberculosis strains has been associated with epidemic spread and an increased likelihood of developing drug resistance. The characteristics that predispose this family to such clinical outcomes have not been identified, although one potential candidate, the phenolic glycolipid PGL-tb, has been shown to mediate a fulminant lethal disease in mice and rabbits due to lipid-mediated immunosuppression. However, PGL-tb is not uniformly expressed throughout the Beijing lineage and may not be the only unique virulence trait associated with this family. In an attempt to define phenotypes common to all Beijing strains, we interrogated a carefully selected set of isolates representing the five extant lineages of the Beijing family. Comparison of lipid production in this set revealed that all Beijing strains accumulated large quantities of triacylglycerides in in vitro aerobic culture. This accumulation was found to be coincident with upregulation of Rv3130c, whose product was previously characterized as a triacylglyceride synthase. Rv3130c is a member of the DosR-controlled regulon of M. tuberculosis, and further examination revealed that several members of this regulon were upregulated throughout this strain family. The upregulation of the DosR regulon may confer an adaptive advantage for growth in microaerophilic or anaerobic environments encountered by the bacillus during infection and thus may be related to the epidemiological phenomena associated with this important strain lineage.
Journal of Bacteriology 05/2007; 189(7):2583-9. · 3.83 Impact Factor
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ABSTRACT: We sought to determine whether patients who had therapy failure with increasingly drug-resistant strains of tuberculosis had primary or acquired drug resistance, by genotyping the initial and subsequent drug-resistant clinical isolates of Mycobacterium tuberculosis collected from patients by the Shanghai Centers for Disease Control and Prevention over the course of a 5-year period. The vast majority of patients (27/32) had primary drug resistance, indicating transmission of a drug-resistant strain of M. tuberculosis. Only 16% (5/32) had acquired drug resistance because of a poor treatment regimen or nonadherence to an adequate regimen. Our findings highlight the urgency of increasing efforts to interrupt the transmission of drug-resistant tuberculosis in communities and facilities in Shanghai, China.
The Journal of Infectious Diseases 04/2007; 195(6):864-9. · 6.41 Impact Factor
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ABSTRACT: Mathematical models predict that the future of the multidrug-resistant tuberculosis epidemic will depend on the fitness cost of drug resistance. We show that in laboratory-derived mutants of Mycobacterium tuberculosis, rifampin resistance is universally associated with a competitive fitness cost and that this cost is determined by the specific resistance mutation and strain genetic background. In contrast, we demonstrate that prolonged patient treatment can result in multidrug-resistant strains with no fitness defect and that strains with low- or no-cost resistance mutations are also the most frequent among clinical isolates.
Science 07/2006; 312(5782):1944-6. · 31.20 Impact Factor
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ABSTRACT: Understanding the ecology of drug-resistant pathogens is essential for devising rational programs to preserve the effective lifespan of antimicrobial agents and to abrogate epidemics of drug-resistant organisms. Mathematical models predict that strain fitness is an important determinant of multidrug-resistant Mycobacterium tuberculosis transmission, but the effects of strain diversity have been largely overlooked. Here we compared the impact of resistance mutations on the transmission of isoniazid-resistant M. tuberculosis in San Francisco during a 9-y period. Strains with a KatG S315T or inhA promoter mutation were more likely to spread than strains with other mutations. The impact of these mutations on the transmission of isoniazid-resistant strains was comparable to the effect of other clinical determinants of transmission. Associations were apparent between specific drug resistance mutations and the main M. tuberculosis lineages. Our results show that in addition to host and environmental factors, strain genetic diversity can influence the transmission dynamics of drug-resistant bacteria.
PLoS Pathogens 07/2006; 2(6):e61. · 9.13 Impact Factor
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Bouke C de Jong,
Philip C Hill,
Roger H Brookes,
Sebastien Gagneux,
David J Jeffries,
Jacob K Otu,
Simon A Donkor,
Annette Fox,
Keith P W J McAdam, Peter M Small,
Richard A Adegbola
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ABSTRACT: Mycobacterium africanum, a member of the M. tuberculosis complex that is infrequently found outside of western Africa, is the cause of up to half of the tuberculosis cases there.
We genotyped mycobacterial isolates obtained from a study of patients with tuberculosis and their household contacts and compared T cell responses and tuberculin skin test results by infecting genotype.
The T cell response to early secreted antigenic target, 6 kDa (ESAT-6), was attenuated in patients with tuberculosis (odds ratio [OR], 0.41 [95% confidence interval {CI}, 0.19-0.89]; P = .024) and household contacts (OR, 0.56 [95% CI, 0.38-0.83]; P = .004) infected with M. africanum, compared with the response in those infected with M. tuberculosis. In these same groups, responses to culture filtrate protein, 10 kDa (CFP-10), were nonsignificantly attenuated (P = .22 and P = .16, respectively), as were tuberculin skin test results (P = .30 and P = .46, respectively). Sequencing of region of difference 1 of M. africanum revealed that Rv3879c is a pseudogene in M. africanum; however, this finding does not provide an obvious mechanism for the attenuated ESAT-6 response.
This is the first evidence, to our knowledge, that strain differences affect interferon- gamma -based T cell responses. Our findings highlight the need to test new diagnostic candidates against different strains of mycobacteria. Integrating additional immunologic and genomic comparisons of M. tuberculosis and M. africanum into further studies may provide fundamental insights into the interactions between humans and mycobacteria.
The Journal of Infectious Diseases 06/2006; 193(9):1279-86. · 6.41 Impact Factor
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ABSTRACT: We describe a microevolutionary event of a prevalent strain of Mycobacterium tuberculosis that caused two outbreaks in San Francisco. During the second outbreak, a direct variable repeat was lost. We discuss the mechanisms of this change and the implications of analyzing multiple genetic loci in this context.
Journal of Clinical Microbiology 05/2006; 44(4):1558-60. · 4.15 Impact Factor
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Sebastien Gagneux,
Kathryn DeRiemer,
Tran Van,
Midori Kato-Maeda,
Bouke C de Jong,
Sujatha Narayanan,
Mark Nicol,
Stefan Niemann,
Kristin Kremer,
M Cristina Gutierrez,
Markus Hilty,
Philip C Hopewell, Peter M Small
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ABSTRACT: Mycobacterium tuberculosis remains a major cause of morbidity and mortality worldwide. Studies have reported human pathogens to have geographically structured population genetics, some of which have been linked to ancient human migrations. However, no study has addressed the potential evolutionary consequences of such longstanding human-pathogen associations. Here, we demonstrate that the global population structure of M. tuberculosis is defined by six phylogeographical lineages, each associated with specific, sympatric human populations. In an urban cosmopolitan environment, mycobacterial lineages were much more likely to spread in sympatric than in allopatric patient populations. Tuberculosis cases that did occur in allopatric hosts disproportionately involved high-risk individuals with impaired host resistance. These observations suggest that mycobacterial lineages are adapted to particular human populations. If confirmed, our findings have important implications for tuberculosis control and vaccine development.
Proceedings of the National Academy of Sciences 03/2006; 103(8):2869-73. · 9.68 Impact Factor
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Robert Freeman,
Midori Kato-Maeda,
Kirsten A Hauge,
Kathleen L Horan,
Eyal Oren,
Masahiro Narita,
Carolyn K Wallis,
Don Cave,
Charles M Nolan, Peter M Small,
Gerard A Cangelosi
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ABSTRACT: Beginning in mid-2002, a large tuberculosis outbreak occurred among homeless persons in King County, Washington. In order to further monitor the outbreak following its peak in 2003, Mycobacterium tuberculosis isolates from all new King County tuberculosis (TB) patients in 2004 and the first half of 2005 (n = 220) were genotyped by using a rapid comparative genomics-based (genomic deletion-typing) approach, with confirmation by mycobacterial interspersed repetitive units and repetitive-sequence-based PCR (rep-PCR). Results were compared to retrospective genotypic data from 1995 to 2003. The outbreak strain SBRI9, which was not seen among King County homeless persons prior to 2002, accounted for 16 out of 30 TB cases (53%) within this population in 2002. This trend continued with 27 out of 35 cases (77%) caused by the outbreak strain in 2003, 11 out of 13 cases (85%) caused by the outbreak strain in 2004, and 4 out of 10 cases (40%) caused by the outbreak strain in the first 5 months of 2005. Thus, the outbreak strain remained well established within this homeless population throughout the study period. At least four SBRI9 cases were in people who had previously been infected by other strains. The novel PCR-based strain-typing approach used in this investigation proved to be cost-effective and very rapid. In most cases, it was possible to analyze DNA extracted directly from primary isolation (Mycobacterium growth indicator tube) cultures submitted by clinical laboratories, a feature that markedly reduced the delay between diagnosis and strain typing results. This rapid turnaround facilitated public health efforts to prevent new outbreaks involving this strain.
Journal of Clinical Microbiology 12/2005; 43(11):5550-4. · 4.15 Impact Factor
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AIDS 11/2005; 19(15):1714-5. · 6.24 Impact Factor
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ABSTRACT: Beijing/W strains of Mycobacterium tuberculosis are geographically widespread and hypervirulent. To enhance our understanding of their origin and evolution, we sought phylogenetically informative large sequence polymorphisms (LSPs) within the Beijing/W family. Comparative whole-genome hybridization of Beijing/W strains revealed 21 LSPs, 7 of which were previously unreported. We show that some of these LSPs are unique event polymorphisms that can be used to define and subdivide the Beijing/W family. One LSP (RD105) was seen in all Beijing/W strains and thus serves as a useful marker for the identification of this family of strains. Additional LSPs (RD142, RD150, and RD181) further divided this family into four monophyletic subgroups, demonstrating a deeper population structure than previously appreciated. All Beijing/W strains were also observed to have an intact pks15/1 gene that is involved in the biosynthesis of a phenolic glycolipid, a putative virulence factor. A simple PCR assay using these Beijing/W strain-defining deletions will facilitate molecular epidemiological studies and may assist in the identification of the molecular basis of phenotypes associated with this important lineage of M. tuberculosis.
Journal of Clinical Microbiology 08/2005; 43(7):3185-91. · 4.15 Impact Factor
