Ancient dental pulp: Masterpiece tissue for paleomicrobiology.

INTRODUCTION: Dental pulp with special structure has become a good reference sample in paleomicrobiology-related blood-borne diseases, many pathogens were detected by different methods based on the diagnosis of nucleic acids and proteins. OBJECTIVES: This review aims to propose the preparation process from ancient teeth collection to organic molecule extraction of dental pulp and summary, analyze the methods that have been applied to detect septicemic pathogens through ancient dental pulps during the past 20 years following the first detection of an ancient microbe. METHODS: The papers used in this review with two main objectives were obtained from PubMed and Google scholar with combining keywords: "ancient," "dental pulp," "teeth," "anatomy," "structure," "collection," "preservation," "selection," "photography," "radiography," "contamination," "decontamination," "DNA," "protein," "extraction," "bone," "paleomicrobiology," "bacteria," "virus," "pathogen," "molecular biology," "proteomics," "PCR," "MALDI-TOF," "LC/MS," "ELISA," "immunology," "immunochromatography," "genome," "microbiome," "metagenomics." RESULTS: The analysis of ancient dental pulp should have a careful preparation process with many different steps to give highly accurate results, each step complies with the rules in archaeology and paleomicrobiology. After the collection of organic molecules from dental pulp, they were investigated for pathogen identification based on the analysis of DNA and protein. Actually, DNA approach takes a principal role in diagnosis while the protein approach is more and more used. A total of seven techniques was used and ten bacteria (Yersinia pestis, Bartonella quintana, Salmonella enterica serovar Typhi, Salmonella enterica serovar Paratyphi C, Mycobacterium leprae, Mycobacterium tuberculosis, Rickettsia prowazeki, Staphylococcus aureus, Borrelia recurrentis, Bartonella henselae) and one virus (Anelloviridae) were identified. Y. pestis had the most published in quantity and all methods were investigated for this pathogen, S. aureus and B. recurrentis were identified by three different methods and others only by one. The combining methods interestingly increase the positive rate with ELISA, PCR and iPCR in Yersinia pestis diagnosis. Twenty-seven ancient genomes of Y. pestis and one ancient genome of B. recurrentis were reconstructed. Comparing to the ancient bone, ancient teeth showed more advantage in septicemic diagnosis. Beside pathogen identification, ancient pulp help to distinguish species. CONCLUSIONS: Dental pulp with specific tissue is a suitable sample for detection of the blood infection in the past through DNA and protein identification with the correct preparation process, furthermore, it helps to more understand the pathogens of historic diseases and epidemics.

Mycobacterial disease in patients with chronic granulomatous disease: A retrospective analysis of 71 cases.

BACKGROUND: Chronic granulomatous disease (CGD) is a rare primary immunodeficiency caused by inborn errors of the phagocyte nicotinamide adenine dinucleotide phosphate oxidase complex. From the first year of life onward, most affected patients display multiple, severe, and recurrent infections caused by bacteria and fungi. Mycobacterial infections have also been reported in some patients. OBJECTIVE: Our objective was to assess the effect of mycobacterial disease in patients with CGD. METHODS: We analyzed retrospectively the clinical features of mycobacterial disease in 71 patients with CGD. Tuberculosis and BCG disease were diagnosed on the basis of microbiological, pathological, and/or clinical criteria. RESULTS: Thirty-one (44%) patients had tuberculosis, and 53 (75%) presented with adverse effects of BCG vaccination; 13 (18%) had both tuberculosis and BCG infections. None of these patients displayed clinical disease caused by environmental mycobacteria, Mycobacterium leprae, or Mycobacterium ulcerans. Most patients (76%) also had other pyogenic and fungal infections, but 24% presented solely with mycobacterial disease. Most patients presented a single localized episode of mycobacterial disease (37%), but recurrence (18%), disseminated disease (27%), and even death (18%) were also observed. One common feature in these patients was an early age at presentation for BCG disease. Mycobacterial disease was the first clinical manifestation of CGD in 60% of these patients. CONCLUSION: Mycobacterial disease is relatively common in patients with CGD living in countries in which tuberculosis is endemic, BCG vaccine is mandatory, or both. Adverse reactions to BCG and severe forms of tuberculosis should lead to a suspicion of CGD. BCG vaccine is contraindicated in patients with CGD.

[History of human epidemic and endemic diseases in the southwest Indian Ocean]. / Histoire des épidémies et des endémoépidémies humaines dans le sud-ouest de l'océan Indien.

Smallpox has been known in the Mascarene Islands since 1729, and in 1898, the vaccinogenic and anti-rabies Institute of Tananarive, the future Pasteur Institute of Madagascar, was created to combat it. Cholera first arrived in the Mascarenes in 1819, but did not affect the Comoros Islands and Madagascar until the current pandemic. Bubonic plague has beset the ports of Madagascar and the Mascarenes since 1898. Girard and Robic developed the anti-plague vaccine in 1931 at the Pasteur Institute of Madagascar. The Mascarenes lost their reputation as Eden when malaria arrived in 1841, and this disease remains prominent in Madagascar and Comoros. Leprosy has been known in La Réunion since 1726 and is still very present in Mayotte, Anjouan, and Madagascar. Leptospirosis is a public health problem, except in Madagascar and the Comoros. Dengue, chikungunya, and Rift Valley fever are also present. HIV/AIDS is not a major concern, except in Mauritius, where it was spread by injection drug use, in the Seychelles and in Madagascar's largest cities. Madagascar is the principal site worldwide of chromoblastomycosis, first described there in 1914.

Neglected tropical diseases of Oceania: review of their prevalence, distribution, and opportunities for control.

Among Oceania's population of 35 million people, the greatest number living in poverty currently live in Papua New Guinea (PNG), Fiji, Vanuatu, and the Solomon Islands. These impoverished populations are at high risk for selected NTDs, including Necator americanus hookworm infection, strongyloidiasis, lymphatic filariasis (LF), balantidiasis, yaws, trachoma, leprosy, and scabies, in addition to outbreaks of dengue and other arboviral infections including Japanese encephalitis virus infection. PNG stands out for having the largest number of cases and highest prevalence for most of these NTDs. However, Australia's Aboriginal population also suffers from a range of significant NTDs. Through the Pacific Programme to Eliminate Lymphatic Filariasis, enormous strides have been made in eliminating LF in Oceania through programs of mass drug administration (MDA), although LF remains widespread in PNG. There are opportunities to scale up MDA for PNG's major NTDs, which could be accomplished through an integrated package that combines albendazole, ivermectin, diethylcarbamazine, and azithromycin, in a program of national control. Australia's Aboriginal population may benefit from appropriately integrated MDA into primary health care systems. Several emerging viral NTDs remain important threats to the region.

The pattern of bacterial isolates and drug sensitivities of infected ulcers in patients with leprosy in ALERT, Kuyera and Gambo hospitals, Ethiopia.

INTRODUCTION: Leprosy remains a public health problem, mainly in Africa, Asia and Latin America. Leprosy has many complications that include leprosy reactions, development of plantar and hand ulcerations, lagophthalomus and corneal anesthesia. OBJECTIVES: In Ethiopia there is scarce information on the pattern of bacterial isolates and drug sensitivities of infected ulcers in patients with leprosy. This study was undertaken to identify the bacteriology of infected ulcers and to determine their antimicrobial susceptibility pattern. STUDY DESIGN: A descriptive cross-sectional study was conducted in 245 informed and consented leprosy patients with infected ulcers visiting ALERT, Kuyera and Gambo hospitals during the period August 2006 to May 2007. MATERIAL AND METHODS: Wound aspirate specimens were collected from ulcers of each patient aseptically and inoculated into standard bacteriological media. Antimicrobial susceptibility testing was performed for all isolates according to the criteria of the National Committee for Clinical Laboratory Standards (NCCLS) by disk diffusion method. RESULTS: Of the 245 patients investigated, 64.1% were males and 35.9% females (P < 0.05). The average age of the patients was 50 years (age range 13 to 92 years). According to Ridley-Jopling classifications, patients presented with TT (3.7%), BT, (31.4%), BL (44.5%) and LL (15.9%) types of leprosy. Plantar and hand ulcers were observed in 92.2% and 7.8% of patients, respectively. According the patients, the commonest cause of their ulcers was 'spontaneous' (56.7%). There were 44% Gram-positive and 56% Gram negative bacteria (P > 0.05). Proteus spp. accounted for 29.5% of the total isolates followed by Staphylococcus spp. (28.8%), beta-hemolytic streptococci (15.1%) and different types of Gram-negative bacteria (26.2%). Multiple organisms (two or three) were isolated from 19.6% patients. Of the 212 wound samples cultured anaerobically, 5.2% were positive for anaerobic culture. In this study both Gram-positive and Gram negative bacteria showed decreased sensitivity to most antimicrobial agents tested. CONCLUSION: Proteus spp. was the most common isolate from infected ulcers. Ciprofloxacin, norfloxacin and gentamicin were the most effective drugs against the tested bacteria mainly for Gram-negative bacteria. This refers to the in vitro-sensitivity during the study period. The results of this study may help inform clinicians about the selection of an antibiotic in situations where use of an antibiotic may be indicated.

[Understanding current practice of clinical medicine in the tropics (II). Bacterial and viral diseases. Malnutrition]. / Aspectos básicos en la práctica actual de la medicina clínica en el trópico (II). Enfermedades bacterianas y virales. Malnutrición.

In recent years, a significant number of physicians want to spend part of their medical training in health facilities in developing countries. In this setting, clinical skills are extremely important due to the limited available diagnostic resources. Bacterial diseases are common, but bacterial cultures are rarely accessible. In Africa, tuberculosis affects over 200 cases per 100,000 persons, and more than 22 million people live with HIV infection; both diseases are a serious public health problem. Malnutrition is endemic in many countries in Africa and is compounded by the continuous humanitarian and food crisis. In this paper, basic concepts of epidemiology, clinical features, diagnosis and treatment of major diseases that can be found in a rural health post in the tropics are discussed.

Enlarging the "Audacious Goal": elimination of the world's high prevalence neglected tropical diseases.

The high prevalence neglected tropical diseases (NTDs) exhibit a global disease burden that exceeds malaria, tuberculosis, and other better known global health conditions; they also represent a potent force in trapping the world's poorest people in poverty. Through extremely low cost national programs of disease mapping and mass drug administration (MDA) for the seven most common NTDs, integrated NTD control and elimination efforts are now in place in more than 14 countries through the support of the United States Agency for International Development (USAID), the British Department for International Development (DFID), and the Global Network for NTDs and its partners. The World Health Organization (WHO) estimates that in 2008 some 670 million people in 75 countries received NTD treatments through these and other sponsored programs. With continued successes the next decade could witness the global elimination of blinding trachoma, human Africa trypanosomiasis (HAT), lymphatic filariasis (LF), onchocerciasis, trachoma, and leprosy as public health problems, in addition to the eradication of dracunculiasis. For other high prevalence NTDs, including hookworm infection, schistosomiasis, Chagas disease and leishmaniasis, new drugs and vaccines may still be required. Increasingly it is recognized that the high prevalence NTDs exhibit extensive geographic overlap and polyparasitism is commonly found throughout the world's low income countries. Therefore, global elimination will also require integrated packages of drugs together with vaccine-linked chemotherapy. Ultimately, the global elimination of the high prevalence NTDs will require continued large-scale support from the U.S. Government and selected European governments, however, the emerging market economies, such as Brazil, China, India, Mexico, and Nigeria, and wealthy countries in the Middle East will also have to substantially contribute.

Bacterial contamination of the hands of doctors: a study in the medicine and dermatology wards.

BACKGROUND: Doctors' hands are a common source of bacterial contamination. Often, these organisms are found to be virulent species with multidrug-resistance patterns. These are the sources of nosocomial infections in many patients. AIMS: The present study was undertaken to find out the prevalence of bacterial contamination in the hands of doctors in the Medicine and Dermatology wards of a tertiary care hospital. METHODS: The hands of 44 doctors were swabbed and cultured at entry to ward and at exit. Then, tap water and alcohol swab wash techniques were used and further swabs were done at each step. Thus, each doctor was sampled four-times for the study. The antibiotic-sensitivity pattern of the organisms was determined by the disc-diffusion method. RESULTS: There was a significant contamination of the doctors' hands at entry (59.1%) and at exit (90.9%). Overall, Staphylococcus was the predominant organism (59% at entry and 85% at exit); coagulase-negative ones were more prevalent at entry (32%) and coagulase-positive ones were more prevalent at exit (54%). There was no difference in the hand contamination rates of junior and senior doctors. Also, the contamination rates were similar in the Medicine and Dermatology wards. Among the gram negative organisms, Escherichia coli (4.5%), Pseudomonas (4.5%), Enterococci (13.6%) and Klebsiella (9%) were the main ones isolated. Gram negative organisms were significantly more prevalent at exit (P = 0.009) compared with their numbers at entry. Hand washing techniques reduced the contamination rates significantly, 76% with tap water wash and further 16.5% with alcohol swab. The removal rate for both groups of organisms was similar. Also, coagulase-positive and -negative Staphylococci showed equal rates of removal with hand washing (P = 0.9793). The organisms were found to be resistant to most of the commonly used antibiotics; the beta-lactam group was especially largely resistant both for gram positive and gram negative bacteria. Both cheaper ones like cloxacillin (50-100%) and very costly ones like cefepime (100%) were equally vulnerable to resistance. Even newer antibiotics like linezolid and vancomycin showed a significant resistance to Staphylococcus. In gram negative organisms, drugs like ceftazidime and gentamicin showed 100% resistance. CONCLUSION: This study shows the high level of contamination of doctors' hands. It emphasizes the need for proper hygienic measures in day to day practice in hospitals to reduce the level of nosocomial infections. Also, it shows that most of the commonly used antibiotics will be ineffective in nosocomial infections.

Mucocutaneous manifestations in children with human immunodeficiency virus infection.

Skin is one of the most frequently involved organs in human immunodeficiency virus (HIV) infection, and mucocutaneous manifestations may be one of the earliest markers of AIDS. The prevalence of cutaneous abnormalities in HIV approaches nearly 90%. Mucocutaneous manifestations may also act as a prognostic marker of HIV infection. Children are increasingly being affected by HIV infection and it is important to realize the presence of the infection early in the disease process as their immune status is not mature enough to handle the stress of various infections. Skin manifestations can serve as early markers and prognostic indicators of HIV infection. This review highlights the epidemiology, transmission, pathogenesis, and the mucocutaneous manifestations of HIV infection in children.

Health assessment of free-ranging three-banded (Tolypeutes matacus) and nine-banded (Dasypus novemcinctus) armadillos in the Gran Chaco, Bolivia.

The Gran Chaco, Bolivia, has a total of seven species of armadillos with the three-banded (Tolypeutes matacus) and nine-banded (Dasypus novemcinctus) the most commonly hunted by the local Isoseño-Guarani people. Armadillos are known carriers of zoonotic pathogens, including Mycobacterium leprae, Toxoplasma gondii, and Trypanosoma cruzi; thus human handling and consumption of these species may have a significant public health impact. A health assessment that included physical examinations, hematology, plasma biochemical analyses, levels of exposure to selected infectious agents, and endoparasite and ectoparasite identification was performed on nine-banded and three-banded armadillos in the Gran Chaco, Bolivia. Based on clinical findings, the general health of these armadillos was rated as good. However, many of the nine-banded armadillos (64%) had abrasions and wounds, probably related to the capture method. The blood value results from a subset of these armadillos are presented as baseline values for free-ranging populations of both these species in Bolivia. Serologic antibody tests for M. leprae were negative in three-banded (n = 8) and nine-banded (n = 2) armadillos. Three-banded armadillos were antibody positive for Eastern equine encephalitis virus (8/8; 100%) and Saint Louis encephalitis virus (5/8; 62.5%). Two of 12 (16.7%) three-banded armadillos tested were antigen positive for Dirofilaria immitis. Nine-banded armadillos were antibody positive for T. gondii (3/9; 33.3%), Eastern equine encephalitis virus (5/8; 62.5%), and T. cruzi (2/9; 22.2%). Two of eight (25%) nine-banded armadillos were antigen positive for D. immitis. A number of endo- and ectoparasites were identified in/on both species of armadillos. Results from this study support the possibility that the handling and consumption of these species by the local Isoseño-Guarani people may have a public health impact.

Illness in returned travelers and immigrants/refugees: the 6-year experience of two Australian infectious diseases units.

BACKGROUND: Data comparing returned travelers and immigrants/refugees managed in a hospital setting is lacking. METHODS: We prospectively collected data on 1,106 patients with an illness likely acquired overseas who presented to two hospital-based Australian infectious diseases units over a 6-year period. RESULTS: Eighty-three percent of patients were travelers and 17% immigrants/refugees. In travelers, malaria (19%), gastroenteritis/diarrhea (15%), and upper respiratory tract infection (URTI) (7%) were the most common diagnoses. When compared with immigrants/refugees, travelers were significantly more likely to be diagnosed with gastroenteritis/diarrhea [odds ratio (OR) 8], malaria (OR 7), pneumonia (OR 6), URTI (OR 3), skin infection, dengue fever, typhoid/paratyphoid fever, influenza, and rickettsial disease. They were significantly less likely to be diagnosed with leprosy (OR 0.03), chronic hepatitis (OR 0.04), tuberculosis (OR 0.05), schistosomiasis (OR 0.3), and helminthic infection (OR 0.3). In addition, travelers were more likely to present within 1 month of entry into Australia (OR 96), and have fever (OR 8), skin (OR 6), gastrointestinal (OR 5), or neurological symptoms (OR 5) but were less likely to be asymptomatic (OR 0.1) or have anaemia (OR 0.4) or eosinophilia (OR 0.3). Diseases in travelers were more likely to have been acquired via a vector (OR 13) or food and water (OR 4), and less likely to have been acquired via the respiratory (OR 0.2) or skin (OR 0.6) routes. We also found that travel destination and classification of traveler can significantly influence the likelihood of a specific diagnosis in travelers. Six percent of travelers developed a potentially vaccine-preventable disease, with failure to vaccinate occurring in 31% of these cases in the pretravel medical consultation. CONCLUSIONS: There are important differences in the spectrum of illness, clinical features, and mode of disease transmission between returned travelers and immigrants/refugees presenting to hospital-based Australian infectious diseases units with an illness acquired overseas.

Quinolones in intracellular infections.

Intracellular parasites are those which spend most of their lives within host cells. The fluoroquinolones demonstrate favourable intracellular pharmacokinetics for the treatment of intracellular infections; these agents diffuse and accumulate in the phagocytes, mainly in the cytosol, and do not associate with cellular organelles. The fluoroquinolones are generally active against Salmonella spp. in vitro, and have been used successfully in the treatment of typhoid fever, Salmonella bacteraemia in patients with AIDS, and chronic enteric carriage. Fluoroquinolone monotherapy has also been found satisfactory in the treatment of tularaemia and Mediterranean spotted fever. Quinolones, alone or in combination with other agents, have also shown promise in animal models of legionellosis and in limited clinical studies. Quinolones, particularly ciprofloxacin and ofloxacin, have notable antimycobacterial activity. Both agents have been used in combination with other antimycobacterial drugs in the treatment of infections caused by Mycobacterium tuberculosis, M. avium-intracellulare complex, rapidly growing mycobacteria and M. leprae, and deserve consideration as part of a multi-drug regimen in otherwise untreatable mycobacterial infections. Clinical data regarding fluoroquinolone monotherapy in brucellosis indicate unacceptable failure rates which preclude the use of these agents in this indication. The quinolones have some efficacy in genital chlamydial infections, but may have limitations in this indication also. In conclusion, as a result of the in vitro activity of the quinolones and their favourable pharmacokinetics, these agents are now an important part of the armamentarium against intracellular infections.

Estudio de la incidencia de lepra provincia Holguín, año 1985

Se realiza un estudio de incidencia de lepra en nuestra provincia en el año 1985. Se revisan las encuestas epidemiológica de los enfermos diagnosticados en este período y se discuten las variables sexo y edad así como el comportamiento según sus diferentes formas clínicas. se estudia la fuente de infección por su importancia epidemiólogica destacándose los primeros síntomas de la enfermedad y las localizaciones más frecuentes en nuestra incidencia. se resumen los resultados en cuadros estadísticos para su discusión y comparación con la literatura revisada. Se hacen conclusiones

[History of the changes in infectious diseases]. / Erkenntnisse zum Wandel von Infektionskrankheiten.

The spectrum of infectious diseases is not at all constant, it changes. This statement is relevant for the great epidemics as well as for nosocomial infections and simple infectious processes. The epidemiological situation of plague, lepra, cholera and diphtheria is discussed. As concerns nosocomial infections four periods are separated: the time before Semmelweis and Lister, the period of the introduction of antiseptic/aseptic measurements to the hospitals and the chemotherapy-time (period until 1965) and the time afterwards. The spectrum of nosocomial infections and its changes as observed in the Cologne area are presented. But also the types of a certain bacterial species are changing as discussed on the example of S. aureus phagetype 80/81. As far as known factors involved in these changes are mentioned. The increasing use of plastic materials in medicine (i.e. intravenous catheters, Spitz-Holtershunts, hipps, valves, etcetera) is the cause of infectious complications, S. epidermidis being the dominant organism.

[Incidence of bacterial diseases (author's transl)]. / Incidence des affections bactériennes.

Bacterial diseases world incidence figure is not easily reckoned on account of the lack of reliability from original notifications. However the present situation is characterized by: --the regression of diseases under International Health Regulations; --the great diffusion of sexually transmitted diseases; --the keeping-up of the activity of digestive or respiratory transmitted disease, including tuberculosis.

Communicable disease in the South Pacific Islands, 1.

An outline is given of the pattern of communicable disease in the South Pacific, as far as it is known. Surveillance and research are imcomplete and the World Health Organization is assisting in carrying these out. Reporting and laboratory diagnosis of communicable disease are inadequate and sometimes inaccurate. This is being improved. Medical checks for intending migrants from the South Pacific are, in a number of cases, inadequately performed in the country of origin and this situation should be altered. The risks to surrounding developed countries from migrants, temporary workers and returning travellers are not tremendous but they cannot be neglected and vigilance has to be maintained. Tuberculosis importation does present risks, as does that of typhoid. Malaria importation carries risks for Northern Australia. Leprosy poses little real risk to Australia or New Zealand and neither does filariasis. Cholera would have to be watched for closely should there ever be a South Pacific outbreak, but the developed countries around the South Pacific which are cholera-non-receptive can control occasional cases. Other than malaria, tuberculosis, typhoid and possibly dengue, problems are thus mainly in the diagnosis and treatment of individuals.