Evolution of a morphological novelty occurred before genome compaction in a lineage of extreme parasites.

Intracellular parasitism results in extreme adaptations, whose evolutionary history is difficult to understand, because the parasites and their known free-living relatives are so divergent from one another. Microsporidia are intracellular parasites of humans and other animals, which evolved highly specialized morphological structures, but also extreme physiologic and genomic simplification. They are suggested to be an early-diverging branch on the fungal tree, but comparisons to other species are difficult because their rates of molecular evolution are exceptionally high. Mitochondria in microsporidia have degenerated into organelles called mitosomes, which have lost a genome and the ability to produce ATP. Here we describe a gut parasite of the crustacean Daphnia that despite having remarkable morphological similarity to the microsporidia, has retained genomic features of its fungal ancestors. This parasite, which we name Mitosporidium daphniae gen. et sp. nov., possesses a mitochondrial genome including genes for oxidative phosphorylation, yet a spore stage with a highly specialized infection apparatus--the polar tube--uniquely known only from microsporidia. Phylogenomics places M. daphniae at the root of the microsporidia. A comparative genomic analysis suggests that the reduction in energy metabolism, a prominent feature of microsporidian evolution, was preceded by a reduction in the machinery controlling cell cycle, DNA recombination, repair, and gene expression. These data show that the morphological features unique to M. daphniae and other microsporidia were already present before the lineage evolved the extreme host metabolic dependence and loss of mitochondrial respiration for which microsporidia are well known.

A feasible lifestyle program for early intervention in patients with chronic obstructive pulmonary disease (COPD): a pilot study in primary care.

AIM: To evaluate the feasibility of a lifestyle program for early intervention in patients with COPD in a primary care population. METHODS: The study was performed in a Primary Health Care Centre in Western Sweden. During a four-week period, all smokers between 40-70 years of age were invited to answer a questionnaire and to perform spirometry. The intervention program included a specially designed smoking cessation program and programs for physical activity and diet. RESULTS: 84 smokers were included. 42% fulfilled the criteria for COPD. All of the COPD patients were in GOLD stage I and II. Among the COPD subjects, 38% were underweight and 56% had a low fat-free mass - both together indicating malnutrition and the need for nutritional treatment. By the end of the intervention program, 47% of the COPD patients had stopped smoking. CONCLUSIONS: The intervention program was feasible and effective with a very high smoking cessation rate.

Diagnosis of asthma in primary health care: a pilot study.

Some patients with an asthma diagnosis have a poor controlled asthma. One explanation may be an incorrect diagnosis. Aim. The aim of the study was to diagnose and classify patients with non-infectious lower respiratory tract problems in primary health care using internationally applied diagnostic criteria and diagnostic tests. Patients and Methods. New adult patients visiting a primary health care centre due to lower airway problems were included. The diagnostic tests included FEV1, FVC, PEF, two questionnaires, methacholine test, and skin prick test. Results. The patients (n = 43) could be divided into four groups: asthma (28%), asthma-like disorder (44%), idiopathic cough (12%), and a nonreversible bronchial obstructive group (16%). The asthma and asthma-like groups showed similar patterns of airway symptoms and trigger factors, not significantly separated by a special questionnaire. Phlegm, heavy breathing, chest pressure/pain, cough, and wheezing were the most common symptoms. Physical exercise and scents were the dominating trigger factors. Conclusions. Nonobstructive asthma-like symptoms seem to be as common as bronchial asthma in primary health care. Due to the similarities in symptoms and trigger factors the study supports the hypothesis that asthma and nonobstructive asthma-like disorders are integrated in the same "asthma syndrome," including different mechanisms, not only bronchial obstruction.

Management of chronic obstructive pulmonary disease (COPD) in primary care: a questionnaire survey in western Sweden.

AIM: To assess the primary care management of chronic obstructive pulmonary disease (COPD) in relation to COPD guidelines. METHOD: A postal questionnaire was sent out to all Primary Health Care Centres (PHCCs) in western Sweden (n=232). The response rate was 75%. RESULTS: A majority of the PHCCs had a nurse and physician responsible for COPD care. They used spirometry equipment regularly, but only 50% reported that they calibrated it at least weekly. Less than 30% of the PHCCs reported access to a dietician, occupational therapist or physiotherapist. There was a structured smoking cessation program in 50% of the PHCCs. Larger PHCCs were more likely to use spirometry equipment regularly and to have specific personnel for COPD care. CONCLUSION: There is a need to establish structured programs for COPD care including smoking cessation programs for COPD patients with special trained staff. Larger PHCCs have a better infrastructure for providing guideline-defined COPD care.

Disseminated infection with encephalitozoon intestinalis in AIDS patients: report of 2 cases.

Microsporidiosis must be regarded as a late opportunistic infection when HIV is advanced. In this article we describe 2 cases of disseminated infection with Encephalitozoon intestinalis. The first case had a local intestinal infection for > 1 y before it disseminated and microsporidia were found intracellularly in sputum. In the second case, spores were initially found in conjunctival cells, sinus lavage, sputum and urine. This patient had clinical symptoms and radiological findings from the central nervous system. Signs of cerebral lymphoma developed after treatment of the opportunistic microsporidial infection.