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1.
J Vet Res ; 67(1): 55-60, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37008763

RESUMO

Introduction: Mycobacterium bovis and Mycobacterium avium subsp. paratuberculosis, respectively the causative agents of bovine tuberculosis (bTB) and bovine paratuberculosis (PTB), share a high number of antigenic proteins. This characteristics makes the differential diagnosis of the diseases difficult. The interferon gamma (IFN-γ), C-X-C motif chemokine ligand 10 (CXCL10), matrix metallopeptidase 9 (MMP9), interleukin 22 (IL-22) and thrombospondin 1 (THBS1) bovine genes have already been shown to be accurate transcriptional biomarkers of bTB. In order to improve the diagnosis of bTB and PTB, in the present study we evaluated the risk of false positivity of these bTB biomarkers in cattle with PTB. Material and Methods: The transcription of these genes was studied in 13 PTB-infected cattle, using Mycobacterium avium subsp. paratuberculosis (MAP)-stimulated peripheral blood mononuclear cells (PBMC). Results: Overall, the levels of IFN-γ, CXCL10, MMP9 and IL-22 transcripts in MAP-stimulated PBMC failed to differentiate animals with PTB from healthy animals. However, as bTB-afflicted cattle do, the MAP-infected group also displayed a lower level of THBS1 transcription than the non-infected animals. Conclusion: The results of this study add new specificity attributes to the levels of transcription of IFN-γ, CXCL10, MMP9 and IL-22 as biomarkers for bTB.

2.
Rev Argent Microbiol ; 44(3): 155-64, 2012.
Artigo em Espanhol | MEDLINE | ID: mdl-23102462

RESUMO

Purified Protein Derivatives (PPDs) are non-defined antigens prepared from mycobacteria cultures. They are usually employed to evaluate the specific cellular immune response both in animals and humans. Bovine and avian PPDs are usually employed as antigens in mycobacterial infections such as tuberculosis and paratuberculosis. Nevertheless, PPD from Mycobacterium avium subsp. paratuberculosis, (PPDj) is neither commonly used nor frequently available. However, PPD from Mycobacterium avium subsp. avium is in fact used. We aimed to obtain and evaluate the performance of a PPDj from a local isolate of MAP using the ãInterferon-release assay. The stimulation of ãInterferon-release was significantly different between infected and control cattle when this antigen, named PPDj-IB, was used. Stimulation in the infected animals was similar with both antigens (PPDa and PPDj-IB). However, some animals were positively stimulated with PPDj-IB and not with PPDa. We demonstrated by Western blot that two antigenic molecules, lipoarabinoman and APA/ModD antigen were differentially represented in both PPDs. This could explain the difference in stimulation induction of yIFN observed at individual level. Although PPDj-IB could not improve PPDa performance, we could easily produce an effective purified protein derivative for in vitro assays.


Assuntos
Doenças dos Bovinos/diagnóstico , Mycobacterium avium subsp. paratuberculosis/química , Paratuberculose/diagnóstico , Tuberculina/isolamento & purificação , Animais , Antígenos de Bactérias/imunologia , Argentina , Western Blotting , Bovinos , Doenças dos Bovinos/sangue , Doenças dos Bovinos/microbiologia , Ensaio de Imunoadsorção Enzimática , Fezes/microbiologia , Interferon gama/metabolismo , Lipopolissacarídeos/análise , Ativação Linfocitária/efeitos dos fármacos , Linfócitos/metabolismo , Mycobacterium avium subsp. paratuberculosis/imunologia , Paratuberculose/sangue , Paratuberculose/microbiologia , Kit de Reagentes para Diagnóstico/veterinária , Especificidade da Espécie , Tuberculina/química
3.
J Immunol Methods ; 500: 113182, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34762914

RESUMO

Serology tests for SARS-CoV-2 have proven to be important tools to fight against the COVID-19 pandemic. These serological tests can be used in low-income and remote areas for patient contact tracing, epidemiologic studies and vaccine efficacy evaluations. In this study, we used a semi-stable mammalian episomal expression system to produce high quantities of the receptor-binding domain-RBD of SARS-CoV-2 in a simple and very economical way. The recombinant antigen was tested in an in-house IgG ELISA for COVID-19 with a panel of human sera. A performance comparison of this serology test with a commercial test based on the full-length spike protein showed 100% of concordance between tests. Thus, this serological test can be an attractive and inexpensive option in scenarios of limited resources to face the COVID-19 pandemic.


Assuntos
Teste Sorológico para COVID-19/métodos , COVID-19/diagnóstico , SARS-CoV-2/fisiologia , Glicoproteína da Espícula de Coronavírus/metabolismo , Enzima de Conversão de Angiotensina 2/metabolismo , COVID-19/economia , Teste Sorológico para COVID-19/economia , Custos e Análise de Custo , Ensaio de Imunoadsorção Enzimática , Engenharia Genética , Humanos , Imunoglobulina G/genética , Imunoglobulina G/metabolismo , Ligação Proteica , Domínios e Motivos de Interação entre Proteínas/genética , Glicoproteína da Espícula de Coronavírus/genética
4.
J Immunol Methods ; 491: 112941, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33321133

RESUMO

Detection of specific antibodies would be a useful test strategy for bovine tuberculosis (bTB) as a complement to the single skin test. We developed a lateral flow immunochromatography (LFIC) test for rapid bTB detection based on the use of a conjugate of gold nanoparticles with a recombinant G protein. After evaluating 3 Mycobacterium bovis (MB) antigens: ESAT-6, CFP-10 and MPB83 for the control line, we selected MPB83 given it was the most specific. The performance of the test was analyzed with 820 bovine sera, 40 sera corresponding to healthy animals, 5 sera from animals infected with Mycobacterium avium subsp. paratuberculosis (MAP) and 775 sera of animals from herds with bTB. All these sera were also submitted to a validated bTB-ELISA using whole-cell antigen from MB. From the 775 sera of animals from herds with bTB, 87 sera were positive by the bTB-ELISA, 45 were positive by LFIC and only 5 animals were positives by skin test (TST). To confirm bTB infection in the group of TST (-), bTB-ELISA (+) and LFIC (+) animals, we performed postmortem examination in 15 randomly selected animals. Macroscopically, these 15 animals had numerous small and large yellow-white granulomas, characteristic of bTB, and the infection was subsequently confirmed by PCR in these tissues with lesions (gold standard). No false positive test result was detected with the developed LFIC either with the sera from healthy animals or from animals infected with MAP demonstrating that it can be a useful technique for the rapid identification of animals infected with bTB.


Assuntos
Anticorpos Antibacterianos/sangue , Cromatografia de Afinidade/métodos , Tuberculose Bovina/diagnóstico , Animais , Antígenos de Bactérias/imunologia , Proteínas de Bactérias/imunologia , Bovinos , Ensaio de Imunoadsorção Enzimática , Proteínas de Membrana/imunologia , Tuberculose Bovina/imunologia
5.
Lancet Infect Dis ; 7(3): 225-32, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17317604

RESUMO

A 12-year-old girl with protracted tuberculous meningitis received standard chemotherapy and dexamethasone and had a progressive cerebrospinal fluid neutrophilia, raised protein and depressed glucose levels. Her temperature was raised for 5 months until a second course of dexamethasone was given. At week 15, multiple tuberculomas and hydrocephalus were detected followed by acute hydrocephalus (week 58), which required a ventricular-peritoneal shunt. Tuberculomas resolved after a second course of dexamethasone but recurred 15 months later. Immunological investigations were normal including integrity of the type 1 cytokine pathway. From month 24, interferon-gamma was given subcutaneously (initially 50 microg/m(2)) and continued for 19 months. Within 2 weeks she responded clinically followed by a reduction in inflammatory signs on magnetic resonance imaging scan (but not in the tuberculomas). At month 44, when chemotherapy was stopped, the cerebrospinal fluid/serum albumin quotient was 57x10(-3) (normal <6.0x10(-3)), which supports continuing major impairment of the blood-brain barrier. Gene expression in peripheral blood mononuclear cells before and during treatment with interferon-gamma, assessed by gene array analysis, showed reduction in a number of cytokine and chemokine genes. The response to interferon-gamma might have been secondary to downregulation of certain cytokine and chemokine genes.


Assuntos
Antituberculosos/uso terapêutico , Interferon gama/uso terapêutico , Tuberculose Meníngea/tratamento farmacológico , Tuberculose Meníngea/fisiopatologia , Anti-Inflamatórios/uso terapêutico , Antituberculosos/administração & dosagem , Líquido Cefalorraquidiano/química , Líquido Cefalorraquidiano/citologia , Quimiocinas/biossíntese , Quimiocinas/genética , Criança , Dexametasona/uso terapêutico , Feminino , Febre , Expressão Gênica , Glucose/líquido cefalorraquidiano , Humanos , Hidrocefalia/cirurgia , Interferon gama/administração & dosagem , Leucócitos Mononucleares/imunologia , Neutropenia , Tuberculoma , Tuberculose Meníngea/complicações
6.
FEMS Microbiol Lett ; 248(2): 147-52, 2005 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-15979818

RESUMO

Tuberculosis in seals is caused by Mycobacterium pinnipedii, a member of the Mycobacterium tuberculosis complex. In this study, we evaluated the extent of genetic variability among Mycobacterium bovis and M. pinnipedii by microarray-based comparative genomics. We identified two deletions that are exclusive to M. pinnipedii: PiD1 that removes the orthologues of the M. tuberculosis genes Rv3530c and Rv3531c, and PiD2 that encompasses genes Rv1977 and Rv1978. Interestingly, a deletion overlapping the previously described RD2 region was identified in some isolates of Mycobacterium microti and further characterised.


Assuntos
Marcadores Genéticos , Genoma Bacteriano , Mycobacterium/genética , Otárias/microbiologia , Variação Genética , Mycobacterium/isolamento & purificação , Análise de Sequência com Séries de Oligonucleotídeos , Especificidade da Espécie
7.
J Vet Diagn Invest ; 17(3): 232-8, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15945378

RESUMO

The confirmatory diagnosis of Mycobacterium bovis (M. bovis) in animal samples is carried out by culture in Stonebrink media. However, culture is very slow because of the extremely long duplication time of the bacillus and difficult because of the scarcity of bacilli in diagnostic samples. This study describes the development of a single-tube touch-down polymerase chain reaction (PCR) protocol for the detection of M. bovis using primers that target the IS6110 element. Spiked water and milk as well as routine diagnostic samples (milk and nasal swabs) from M. bovis-positive cattle were tested. This protocol allows the rapid and sensitive detection of M. bovis in bovine samples by enhancing the sensitivity of standard PCR amplification.


Assuntos
Mycobacterium bovis/isolamento & purificação , Reação em Cadeia da Polimerase/veterinária , Tuberculose Bovina/diagnóstico , Animais , Bovinos , Feminino , Leite/microbiologia , Cavidade Nasal/microbiologia , Reação em Cadeia da Polimerase/métodos , Sensibilidade e Especificidade
8.
Microbes Infect ; 6(2): 182-7, 2004 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-14998516

RESUMO

P27 lipoprotein was previously described as an antigen in the Mycobacterium tuberculosis complex, encoded by the lprG gene, also named Rv1411 in the TubercuList (http://genolist.pasteur.fr/TubercuList) gene bank. It forms an operon with Rv1410 that encodes for an efflux pump, P55. A mutant of the H37Rv strain of M. tuberculosis not producing P27 (strain DeltaP27) was obtained by two-step mutagenesis using the counterselectable marker sacB and a thermosensitive origin of replication in the shuttle plasmid pPR27. By RT-PCR, we observed no lprG or Rv1410 mRNA in the DeltaP27 mutant strain compared with the wild type and complemented strains. Western blot experiments using anti-P27 polyclonal sera showed that the P27 protein was present both in the parental and in a complemented strain, in which the entire lprG-Rv1410 operon was reintroduced, but absent in the mutant strain. The three strains showed similar growth kinetics and characteristics in culture broth. To study the effect of the lprG mutation on M. tuberculosis virulence, BALB/c mice were inoculated to determine bacterial loads in spleens. At days 15 and 35 after infection, decreases of 1.5 and 2.5 logs in the bacterial load were found, respectively, in animals inoculated with the DeltaP27 mutant strain or with the wild type. This attenuation was reverted in the complemented strain. These results demonstrated that lprG gene is required for growth of M. tuberculosis in immunocompetent mice. The reversion of attenuation in the complemented strain indicates that the attenuated phenotype resulted from disruption of the lprG-Rv1410 operon.


Assuntos
Lipoproteínas/deficiência , Proteínas de Membrana Transportadoras/deficiência , Mycobacterium tuberculosis/patogenicidade , Óperon/genética , Virulência/genética , Animais , Proteínas de Bactérias/genética , Proteínas de Bactérias/fisiologia , Teste de Complementação Genética , Lipoproteínas/genética , Lipoproteínas/fisiologia , Proteínas de Membrana Transportadoras/genética , Proteínas de Membrana Transportadoras/fisiologia , Camundongos , Camundongos Endogâmicos BALB C , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/crescimento & desenvolvimento , Tuberculose/microbiologia
9.
Tuberculosis (Edinb) ; 84(3-4): 159-66, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15207485

RESUMO

Mycobacterium microti is the agent of tuberculosis in wild voles and has been used as a live vaccine against tuberculosis in man and cattle. To explore the M. microti genome in greater detail, we used a M. tuberculosis H37Rv genomic DNA microarray to detect gene deletions among M. microti isolates. A number of deletions were identified that correlated with those described previously (Infect. Immun. 70 (2002) 5568) but a novel M. microti deletion was also found (MiD4) which removes 5 genes that code for ESAT-6 family antigens and PE-PPE proteins. Southern blot experiments showed that this region was also deleted from M. pinnipedii, a mycobacterium isolated from seals that is closely related to M. microti. Genes encoding ESAT-6 antigens and PE-PPE proteins appear to be frequently deleted from M. microti, and the implications of this are discussed.


Assuntos
Antígenos de Bactérias/genética , Proteínas de Bactérias/genética , Deleção de Genes , Genes Bacterianos/genética , Mycobacterium/genética , Sequência de Bases , Southern Blotting , DNA Bacteriano/genética , Genoma , Humanos , Dados de Sequência Molecular , Mycobacterium tuberculosis/genética , Análise de Sequência com Séries de Oligonucleotídeos/métodos , Fases de Leitura Aberta/genética , Especificidade da Espécie
10.
Vet Immunol Immunopathol ; 143(1-2): 75-82, 2011 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-21752474

RESUMO

Comparative genomics of Mycobacterium spp. have revealed conservative genes and respective proteins differently expressed in mycobacteria that could be used as targets for the species-specific immunodiagnostics. The alanine and proline-rich antigen Apa is a mycobacterial protein that present significant variability in primary sequence length and composition between members of M. avium and M. tuberculosis complexes. In this study, the recombinant Apa protein encoded by the MAP1569/ModD gene of M. avium subsp. paratuberculosis (Map) was used to generate a panel of monoclonal antibodies which were shown to recognize the most important veterinary pathogens of the M. avium complex, specifically Map and M. avium subsp. hominissuis, and which did not cross-react with M. bovis or M. tuberculosis. The produced antibodies were demonstrated to be a useful tool for the species-specific immunofluorescence or immunohistochemical detection of Map in experimentally infected cell cultures or intestinal tissues from cattle with bovine paratuberculosis and, additionally, they may be employed for the discrimination of pathogenic M. avium subspecies via Western blotting.


Assuntos
Antígenos de Bactérias , Doenças dos Bovinos/microbiologia , Mycobacterium avium subsp. paratuberculosis/imunologia , Paratuberculose/microbiologia , Animais , Anticorpos Antibacterianos , Anticorpos Monoclonais , Antígenos de Bactérias/genética , Proteínas de Bactérias/genética , Proteínas de Bactérias/imunologia , Bovinos , Doenças dos Bovinos/diagnóstico , Imunofluorescência , Genes Bacterianos , Macrófagos/microbiologia , Camundongos , Mycobacterium avium subsp. paratuberculosis/genética , Paratuberculose/diagnóstico , Especificidade da Espécie
11.
Rev. argent. microbiol ; Rev. argent. microbiol;44(3): 155-164, set. 2012. ilus, graf, tab
Artigo em Espanhol | LILACS | ID: lil-657627

RESUMO

Los derivados proteicos purificados (PPD) son mezclas antigénicas no definidas obtenidas de distintas micobacterias. Los PPD bovino (PPDb) y PPD aviar (PPDa) son los antígenos que se emplean para evaluar la respuesta inmunitaria celular en infecciones como tuberculosis y paratuberculosis en el bovino. El PPDa comercial se produce a partir de Mycobacterium avium subsp. avium, y no a partir de la subespecie paratuberculosis. En este trabajo se seleccionó una cepa local de Mycobacterium avium subsp. paratuberculosis cuyo patrón molecular por RFLP es el más frecuente entre los aislamientos de nuestro país que han sido estudiados, y a partir de esta, se obtuvo un derivado proteico purificado: PPDj-IB. Se emplearon tanto el PPDa comercial como el PPDj-IB como antígenos en la prueba de liberación de gamma-interferón en animales de un tambo con paratuberculosis y en animales control. Aun cuando ambos PPD fueron capaces de estimular diferencialmente la liberación de la citoquina en el tambo infectado (respecto de los tambos control), no hubo diferencias significativas en los niveles de estimulación producidos y solo dos animales fueron positivos mediante el empleo de PPDj-IB. A partir del análisis por Western blot se demostró que el contenido de lipoarabinomano y del antígeno Apa/ModD era distinto en los PDD evaluados. Estas diferencias podrían explicar, en parte, las diferencias en los niveles de estimulación en términos individuales. Si bien el empleo de PPDj-IB no mejoró significativamente los resultados de la prueba de liberación de ?IFN, es importante destacar que se logró producir en el laboratorio un PPD apto para su empleo en ensayos in vitro.


Purified Protein Derivatives (PPDs) are non-defined antigens prepared from mycobacteria cultures. They are usually employed to evaluate the specific cellular immune response both in animals and humans. Bovine and avian PPDs are usually employed as antigens in mycobacterial infections such as tuberculosis and paratuberculosis. Nevertheless, PPD from Mycobacterium avium subsp. paratuberculosis, (PPDj) is neither commonly used nor frequently available. However, PPD from Mycobacterium avium subsp. avium is in fact used. We aimed to obtain and evaluate the performance of a PPDj from a local isolate of MAP using the ãInterferon-release assay. The stimulation of ãInterferon-release was significantly different between infected and control cattle when this antigen, named PPDj-IB, was used. Stimulation in the infected animals was similar with both antigens (PPDa and PPDj-IB). However, some animals were positively stimulated with PPDj-IB and not with PPDa. We demonstrated by Western blot that two antigenic molecules, lipoarabinoman and APA/ModD antigen were differentially represented in both PPDs. This could explain the difference in stimulation induction of ?IFN observed at individual level. Although PPDj-IB could not improve PPDa performance, we could easily produce an effective purified protein derivative for in vitro assays.


Assuntos
Animais , Bovinos , Doenças dos Bovinos/diagnóstico , Mycobacterium avium subsp. paratuberculosis/química , Paratuberculose/diagnóstico , Tuberculina/isolamento & purificação , Argentina , Antígenos de Bactérias/imunologia , Western Blotting , Doenças dos Bovinos/sangue , Doenças dos Bovinos/microbiologia , Ensaio de Imunoadsorção Enzimática , Fezes/microbiologia , Interferon gama , Lipopolissacarídeos/análise , Ativação Linfocitária/efeitos dos fármacos , Linfócitos , Mycobacterium avium subsp. paratuberculosis/imunologia , Paratuberculose/sangue , Paratuberculose/microbiologia , Kit de Reagentes para Diagnóstico/veterinária , Especificidade da Espécie , Tuberculina/química , Tuberculina
12.
Microbiology (Reading) ; 145 ( Pt 4): 893-897, 1999 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-10220168

RESUMO

Southern blotting, sequence analysis and PCR experiments showed that Mycobacterium bovis and Mycobacterium bovis BCG lack a 12.7 kb fragment present in the genome of Mycobacterium tuberculosis. This region is 337 bp downstream of the RD2 region, which was previously described as being absent from some M. bovis BCG strains. The 12.7 kb fragment should be useful as a target for a PCR test to differentiate M. tuberculosis and M. bovis. An analysis of the 12.7 kb region suggests that it represents a deletion in M. bovis rather than an insertion in M. tuberculosis. The deletion removes most of the mce-3 operon, one of four highly related operons which may be involved in cell entry, and therefore it may contribute to differences in virulence or host range in the two species.


Assuntos
Genoma Bacteriano , Mycobacterium bovis/classificação , Mycobacterium bovis/genética , Mycobacterium tuberculosis/genética , Deleção de Sequência , Sequência de Bases , Southern Blotting , Dados de Sequência Molecular , Mycobacterium tuberculosis/classificação , Reação em Cadeia da Polimerase/métodos , Polimorfismo de Fragmento de Restrição , Análise de Sequência de DNA , Especificidade da Espécie
13.
Microbiology (Reading) ; 148(Pt 10): 2997-3006, 2002 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-12368433

RESUMO

mce3 is one of the four mce operons in Mycobacterium tuberculosis that encode exported proteins with a probable role in the virulence of this bacterium. Upstream of mce3 there is a putative regulatory gene (Rv1963) that harbours a double tetR-family signature. To study the role of this putative regulatory gene in the transcriptional regulation of the mce3 operon, Mycobacterium smegmatis mc(2)155 and M. tuberculosis H37Rv strains that harboured gene fusions between the mce3 promoter region and the Escherichia coli lacZ gene, either containing or not containing the Rv1963 gene, were used. The presence of the Rv1963 gene in the strains greatly reduced beta-galactosidase activity, suggesting that the Rv1963-encoded protein is a transcriptional repressor of the mce3 operon. Expression of mce3 by recombinant M. tuberculosis was increased when it was grown in a macrophage-like cell line (J774), compared to the level of expression seen when the recombinant bacterium was grown under in vitro conditions. However, no lifting of repression was induced. The mce3 promoter was defined by deletion and cloning of the Rv1963-Rv1964 intergenic region in a 200 bp DNA fragment harbouring the region upstream of the Rv1964 start codon. Gel-shift experiments determined that the Rv1963-binding site was located in this region. These results indicate that the mce3 operon is transcriptionally regulated and that under certain, unknown, conditions repression of gene expression could be lifted.


Assuntos
Proteínas de Bactérias/metabolismo , Regulação Bacteriana da Expressão Gênica , Mycobacterium tuberculosis/patogenicidade , Óperon , Proteínas Repressoras/genética , Proteínas de Bactérias/genética , Sequência de Bases , Linhagem Celular , Genes Reguladores , Humanos , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/metabolismo , Regiões Promotoras Genéticas , Proteínas Repressoras/metabolismo , Transcrição Gênica , Virulência/genética
14.
Medicina (B.Aires) ; Medicina (B.Aires);56(1): 45-7, ene.-feb. 1996. tab, graf
Artigo em Inglês | LILACS | ID: lil-163383

RESUMO

In order to determine the possible relationship among HIV patients coinfected with multidrug resistant tuberculosis strains who had been receiving clinical assistance in our Hospital, clinical and epidemiological information from 28 patients was collected. DNA fingerprinting by restriction fragment length polymorphism (RFLP) pattern was performed on the mycobacterial isolates from these patients, using the restriction enzyme Pvull and IS 6110 as genetic marker. A unique RFLP pattern was found in 10 isolates from 10 different patients who had a disease caused by a single strain. Our findings confirm RFLP as a reliable and useful tool to analyze TB transmission.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Surtos de Doenças , Impressões Digitais de DNA , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Pulmonar/transmissão , DNA Bacteriano/genética , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Síndrome da Imunodeficiência Adquirida/complicações , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/microbiologia
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