Bacterial versus non-bacterial infections: a methodology to support use-case-driven product development of diagnostics.

Acute febrile illness (AFI) is one of the most common reasons for seeking medical care in low-income and middle-income countries. Bacterial infections account for a relatively small proportion of AFIs; however, in the absence of a simple diagnostic test to guide clinical decisions, healthcare professionals often presume that a non-malarial febrile illness is bacterial in origin, potentially resulting in inappropriate antibiotic use. An accurate differential diagnostic tool for AFIs is thus essential, to both limit antibiotic use to bacterial infections and address the antimicrobial resistance crisis that is emerging globally, without resorting to multiple or complex pathogen-specific assays. The Biomarker for Fever-Diagnostic (BFF-Dx) study is one of the largest fever biomarker studies ever undertaken. We collected samples and classified disease aetiology in more than 1900 individuals, distributed among enrolment centres in three countries on two continents. Identical protocols were followed at each study site, and the same analyses were conducted in each setting, enabling like-with-like comparisons to be made among the large sample set generated. The BFF-Dx methodology can act as a model for other researchers, facilitating wider utility of the work in the future. The established sample collection is now accessible to researchers and companies and will facilitate the development of future fever-related diagnostic tests. Here, we outline the methodology used to determine the sample populations and to differentiate bacterial versus non-bacterial AFIs. Future publications will set out in more detail the study's demographics, the causes of fever identified and the performance of selected biomarkers.

GloPID-R report on Chikungunya, O'nyong-nyong and Mayaro virus, part I: Biological diagnostics.

The GloPID-R (Global Research Collaboration for Infectious Disease Preparedness) Chikungunya (CHIKV), O'nyong-nyong (ONNV) and Mayaro virus (MAYV) Working Group is investigating the natural history, epidemiology and medical management of infection by these viruses, to identify knowledge gaps and to propose recommendations for direct future investigations and rectification measures. Here, we present the first report dedicated to diagnostic aspects of CHIKV, ONNV and MAYV. Regarding diagnosis of the disease at the acute phase, molecular assays previously described for the three viruses require further evaluation, standardized protocols and the availability of international standards representing the genetic diversity of the viruses. Detection of specific IgM would benefit from further investigations to clarify the extent of cross-reactivity among the three viruses, the sensitivity of the assays, and the possible interfering role of cryoglobulinaemia. Implementation of reference panels and external quality assessments for both molecular and serological assays is necessary. Regarding sero-epidemiological studies, there is no reported high-throughput assay that can distinguish among these different viruses in areas of potential co-circulation. New specific tools and/or improved standardized protocols are needed to enable large-scale epidemiological studies of public health relevance to be performed. Considering the high risk of future CHIKV, MAYV and ONNV outbreaks, the Working Group recommends that a major investigation should be initiated to fill the existing diagnostic gaps.

Epidemiology of acute febrile illness in Latin America.

BACKGROUND: The causes of acute febrile illness (AFI) in Latin America are diverse and their complexity increases as the proportion of fever due to malaria decreases, as malaria control measures and new pathogens emerge in the region. In this context, it is important to shed light on the gaps in the epidemiological characteristics and the geographic range for many AFI aetiologies. OBJECTIVES: To review studies on community-acquired fever aetiology other than malaria in Latin America, and to highlight knowledge gaps and challenges needing further investigation. SOURCES: PubMed from 2012 to April 2018. CONTENT: We found 17 eligible studies describing 13 539 patients. The median number of pathogens tested per individual was 3.5 (range 2-17). A causative pathogen could be determined for 6661 (49.2%) individuals. The most frequently reported pathogen during the study periods was dengue virus (DENV) (14 studies), followed by chikungunya virus (nine studies) and Zika virus (seven studies). Among the studies reporting concurrent infections, 296 individuals (2.2%) were found to have co-infections. In-hospital mortality was reported in eight (47%) studies, ranging between 0% and 18%. IMPLICATIONS: DENV fever is the febrile illness most frequently reported, reflecting its importance, while chikungunya and zika viruses present increasing trends since their emergence in the region. Studies with systematic and harmonized approaches for detection of multiple pathogens are needed and would probably reveal a higher burden of neglected pathogens such as Rickettsia spp. and arenaviruses. The lack of point-of-care tests and harmonized approach limits the care provided by health professionals and the efficacy of surveillance for AFI in the region.

Sexually acquired Zika virus: a systematic review.

BACKGROUND: Zika virus (ZIKV) is transmitted to humans primarily by Aedes mosquito bites. However, circumstantial evidence points to a sexual transmission route. OBJECTIVES: To assess the sexually acquired ZIKV cases and to investigate the shedding of ZIKV in genital fluids. DATA SOURCES: PubMed, Scopus, Pro-MED-mail and WHO ZIKV notification databases from inception to December 2016. SELECTION CRITERIA: Reports describing ZIKV acquisition through sex and studies reporting the detection or isolation of ZIKV in the genital fluids were included. RISK-OF-BIAS ASSESSMENT: The risk of bias was assessed using the National Institute of Health Tool. RESULTS: Eighteen studies reporting on sex-acquired ZIKV and 21 describing the presence of ZIKV in genital fluids were included. The overall risk of bias was moderate. Sexual transmission was male-female (92.5%), female-male (3.7%) and male-male (3.7%). Modes of sexual transmission were unprotected vaginal (96.2%), oral (18.5%) and anal (7.4%) intercourse. The median time between onset of symptoms in the index partner and presumed sexual transmission was 13 days (range 4-44 days). ZIKV RNA was detected in semen as late as 188 days (range 3-188 days) following symptom onset, and infectious virus was isolated in semen up to 69 days after symptom onset. No study reported ZIKV isolation from female genital samples, but detection did occur up to 13 days after symptom onset. CONCLUSIONS: ZIKV is potentially sexually transmitted and persists in male genital secretions for a prolonged period after symptom onset. PROSPERO systematic review registration number CRD42016041475.

Head morphometry and isoenzymatic profile of two Triatoma infestans Klug, 1834 (Hemiptera, Reduviidae) populations.

The triatomine bug Triatoma infestans was probably originated in Bolivia and dispersed passively over large areas of South America, where it is the major vector of Trypanosoma cruzi. In its probable origin area this species shows two different patterns of behaviour, being found both in sylvatic and human related habitats. Such behaviour is not observed in other areas of its distribution, where it is exclusive to human related habitats. The main objective of the present study was to evaluate head morphometry characters and isoenzymes patterns of two T. infestans populations, one collected in Minas Gerais (Brazil) and other in the Cochabamba Valley (Bolivia), in order to elucidate the factors that could have an implication with the different colonization behaviour. The two populations presented differences in both morphometric (head size) and isoenzymes (specially PGM enzyme profile). The insects from the colonies reared for several years in laboratory conditions, showed reduction in head size starting from the third generation, maintaining this same size in all generations after, until 10 years after generation. The laboratory rearing conditions could be similar to human associated habitats, inducing certain level of genetic homogeneity. Our results showed increase of genetic homogeneity in Brazilian and laboratory-reared colonies from Bolivia, that may be due to a selection process due to passive dispersion, followed by several founder effects episodes and genetic drift.

Ostrich (Struthio camelus) gastric diseases in Minas Gerais, Brazil, from 1997 to 2009 / Doenças gástricas de avestruzes em Minas Gerais

Descrevem-se as doenças gástricas de avestruzes diagnosticadas em um Laboratório de Doenças das Aves, Belo Horizonte-MG, entre 1997 e 2009. As afecções gástricas corresponderam a 46,2% de todos os casos de doença, com quadros que incluíram impactação (83,3%), infecções e parasitoses (16,7%). As impactações foram causadas por material não alimentar diversificado e as infecções e parasitoses incluíram o fungo Macrorhabdus ornithogaster (megabacteria) e o nematódeo Libyostrongylus douglassii.

Macrorhabdus ornithogaster in ostrich, rhea, canary, zebra finch, free range chicken, turkey, guinea-fowl, columbina pigeon, toucan, chuckar partridge and experimental infection in chicken, japanese quail and mice

Since 2000, Macrorhabdus ornithogaster "megabacteriosis" has been diagnosed in the avian diseases laboratory in a diversity of avian species and varied spectrum of disease. The disease in some species (chickens, turkeys, guinea fowls) was clinically characterized by emaciation, prostration, loss of appetite, cachexia and death, with a typically chronic course. A more acute disease was observed in finches (canary-Serinus and zebra-Taeniopygia) and budgerigars (Melopsittacus undulatus). The large rod shaped organism, visible from 100 times magnification, with and without staining, could be detected in sick and also in reasonably normal individuals of some species, such as chickens, turkeys, quails and pigeons. In rheas (Rhea americana), ostriches (Struthio camelus), canaries, zebra-finches, guinea-fowl (Numida meleagris) and budgerigars. The disease was severe, causing to up to 100 percent mortality. The infection could be detected in some species along with other infectious or disease problems, such as endoparasites (helminths, coccidia) and ectoparasitism (order Mallophaga or/and order Acarina). The cultivation of M. ornithogaster was successfully achieved in solid and liquid media, originated from chickens (four isolates), guinea fowl (1 isolate), chuckar partridge (1 isolate) and canary (1 isolate). A very interesting finding at microscopy was motility of M. ornithogaster, as detected both in cultures obtained on agar for pathogenic fungi and passaged into thioglycolate broth, as well as on samples observed in wet preparations from in vivo. Differences in colony aspects were noted among the isolates. Experimental infections were attempted in chicken and japanese quail, using a chicken isolate, allowing the detection of the organism in the proventriculus and liver in apparently normal birds. One chicken isolate was injected intraperitoneally in Balb/c mice and resulted in 100 percent mortality.

Desde 2000, diversos casos de infecção e doença por Macrorhabdus ornithogaster (megabacteria) foram diagnosticados no Setor de Doenças das Aves (Escola de Veterinária da UFMG). A doença clínica foi caracterizada por emagrecimento, prostração, perda do apetite, caquexia e morte, em curso crônico, embora com forma mais aguda em canários e periquitos. O microrganismo grande, em forma de bastão, visível a partir de 100 aumentos sem e com coloração, pode também ser detectado em aves de aspecto clínico normal, principalmente galinhas, perus, codornas e pombos. Em emas (Rhea), avestruzes (Struthio camelus), canários, mandarins, galinhas da Angola (Numida meleagris) e periquitos Australianos (Melopsittacus undulatus), a severidade da doença foi sempre maior, ocasionando até 100 por cento de mortalidade em alguns plantéis. Na maioria das espécies a doença foi detectada em aves com endo e/ou ectoparasitismo. O cultivo de M. ornithogaster foi obtido em meio sólido (ágar para fungos patogênicos) e subcultivado em meio líquido (thioglicolato), do proventriculo de galinha, galinha da Angola, perdiz de chuckar e canário. O resultado mais surpreendente na microscopia de M. ornithogaster foi a presença de motilidade, detectada tanto de cultivos in vitro quanto de preparações úmidas de in vivo. Diferenças nos aspectos das colônias foram notadas entre os isolados. Infecções experimentais em galinha (SPF) e codorna japonesa permitiram a detecção do organismo nos proventrículos das aves de aspecto normal. Nas codornas, à necropsia notaram-se hemorragias hepáticas. A infecção experimental em camundongos via intraperitoneal resultou em 100 por cento de mortalidade, também com lesões hepáticas. Aspectos do cultivo, a importância da doença, as espécies de aves susceptíveis e seu papel na epidemiologia são discutidos.

Superoxide dismutase in Cryptococcus neoformans varieties gattii, grubi, and neoformans.

Some clear dissimilarities occur among the varieties of Cryptococcus neoformans but there are few studies about the differences among individual yeast antioxidant enzymes. The total superoxide dismutase (SOD) activities and the copper, zinc-depend SOD (Cu,ZnSOD) and manganese-dependent SOD (MnSOD) isoenzymes of five reference C. neoformans strains belonged to A, B, C, AD and D serotypes (Table I) and other nine C. neoformans isolates (Table II) were determined. There were significant differences (p < 0.01 and p < 0.05) in total SOD activity among the varietie gattii (serotype C) and the other varieties. Cu,ZnSOD showed difference (p < 0.05) between A and D serotypes. These results point out a variety and serotype-independent SOD activity in C. neoformans reference strains and the other isolates that were evaluated.

Superoxide dismutase in Cryptococcus neoformans varieties gattii, grubi, and neoformans

Some clear dissimilarities occur among the varieties of Cryptococcus neoformans but there are few studies about the differences among individual yeast antioxidant enzymes. The total superoxide dismutase (SOD) activities and the copper, zinc-depend SOD (Cu,ZnSOD) and manganese-dependent SOD (MnSOD) isoenzymes of five reference C. neoformans strains belonged to A, B, C, AD and D serotypes (Table I) and other nine C. neoformans isolates (Table II) were determined. There were significant differences (p < 0.01 and p < 0.05) in total SOD activity among the varietie gattii (serotype C) and the other varieties. Cu,ZnSOD showed difference (p < 0.05) between A and D serotypes. These results point out a variety and serotype-independent SOD activity in C. neoformans reference strains and the other isolates that were evaluated.

Atividade antimicrobiana de Struthanthus vulgaris (erva-de-passarinho) / Antimicrobial activity of Struthantus vulgaris (erva-de-passarinho)

As plantas do gênero Struthanthus são conhecidas como ervas-de-passarinho e parasitam pomares no Brasil, principalmente os de laranjeiras e goiabeiras. Na medicina popular são usadas nas afecções das vias respiratórias. O extrato hidroetanólico a 70 por cento de folhas frescas de Struthanthus vulgaris apresentou atividade antimicrobiana contra amostras bacterianas Gram positiva e Gram negativa. Este extrato não apresentou, nas condições testadas, atividade contra fungos. As amostras bacterianas mais sensíveis ao extrato foram Bacillus cereus (ATCC 11778), Micrococcus luteus (ATCC 9341), Staphylococcus aureus (ATCC 6538), S. epidermidis (ATCC 12228) e P. aeruginosa (ATCC 27853), usando o método de difusão em agar. As frações obtidas, pela partição líquido-líquido do extrato hidroetanólico a 70 por cento, com solventes de polaridades crescentes (clorofórmio, acetato de etila, n-butanol e água), apresentaram diferentes atividades inibitórias. A fração que apresentou a maior atividade contra bactéria Gram positiva (B. cereus) e Gram negativa (P. aeruginosa) foi aquela obtida com n-butanol. Nessa fração foram detectados flavonóides, taninos condensados (proantocianidinas) e saponinas.

Struthantus vulgaris (mistletoe) is one of the most common hemiparasite species in Brazil. It occurs as a parasite of orchards, mainly in orange and guava trees. Some authors mention Struthantus use in traditional medicine for respiratory diseases treatment. Fresh leaves concentrated hydroalcoholic extract showed antimicrobial activity against Gram positive and Gram negative bacterial samples. In tested conditions, these extracts did not show activity against fungi. The more susceptible bacterial samples to fresh leaves hydroalcoholic extract were Bacillus cereus (ATCC 11778), Micrococcus luteus (ATCC 9341), Staphylococcus aureus (ATCC 6538), S. epidermidis (ATCC 12228) and Pseudomonas aeruginosa (ATCC 27853). The method used for assessment of antimicrobial activity was agar diffusion. Fractions obtained from fresh leaves concentrated alcoholic extracts with increasing polarity solvents (chloroform, ethyl acetate, n-butanol and water) showed different inhibitory activities. n-Butanol fraction showed greater activity against Gram positive bacteria (B. cereus) and Gram negative bacteria (P. aeruginosa). In this fraction, flavonoids, condensed tannins (proanthocyanidins) and saponins, were found.

Ocorrência de Candida albicans em intestinos de bovinos / Occurrence of Candida albicans in bovine intestines

Foram realizadas a identificaçäo e a sorotipagem de C. albicans isoladas de fezes de bovinos em amamentaçäo natural. Para o isolamento, utilizou-se o meio seletivo e diferencial de Pagano Levin, adicionado de bifenilo na concentraçäo final de 0,1 por cento. De 210 bovinos inicialmente considerados, 70 adultos, 68 bezerros após o desmame e 72 bezerros em fase de amamentaçäo natural, observou-se positividade para C. albicans somente em nove amostras de fezes de bezerros em fase de amamentaçäo (12,5 por cento). A determinaçäo do sorotipo por meio de provas de aglutinaçäo direta em lâmina, com soros monoespecíficos, revelou que a totalidade das amostras isoladas pertencia ao sorotipo A. O bifenilo na concentraçäo de 0,1 por cento mostrou-se inibitório para a maioria dos bolores sem, aparentemente, afetar a viabilidade de C. albicans. O isolamento de C. albicans somente a partir de fezes de bezerros em amamentaçäo, provavelmente, está relacionado à dieta láctea.

A proposed 3D structure for crotamine based on homology building, molecular simulations and circular dichroism.

Crotamine, isolated from the venom of the South American rattlesnake Crotalus durissus terrificus is a strongly basic 42-amino acid polypeptide belonging to the small basic myotoxin family. As no tridimensional structure is available for this myotoxin subfamily, despite its important pharmacological interest, we propose in this paper a theoretical 3D model for crotamine. Starting from a homology modelling procedure, followed by intensive molecular dynamics (MD) simulations in water and complementary CD experiments, the designed 3D model is the first example of a tridimensional structure in this family of small basic myotoxins. Crotamine, therefore, belongs to a newly identified structural family presenting a common fold also found in beta-defensin and antopleurine-B. The proposed 3D model will be used for future calculations about crotamine aggregation and interaction with membranes.

Characterization of Rhodnius neglectus from two regions of Brazil using isoenzymes, genitalia morphology and morphometry.

Among the triatomines considered as secondary in the epidemiology of Chagas disease, Rhodnius neglectus is frequently captured in artificial ecotopes, especially peridomiciliary ones, rarely producing colonies indoors. Nevertheless, the presence of breeding colonies in houses was unquestionably demonstrated in some areas of the State of Goiás, Brazil. Previous isoenzyme comparisons of this species with morphologically close triatomines, such as R. prolixus, R. robustus or R. nasutus, did not produce definitive conclusions because of doubt about the geographical origin of the R. neglectus. We present here, for the first time, the isoenzyme profile of topotypes of R. neglectus. In addition, wild caught specimens from the type locality, Uberaba (Minas Gerais, Brazil), were compared to wild caught specimens from Jaraguá (Goiás, Brazil), where R. neglectus is more frequently reported invading houses. We used isoenzyme, morphology and morphometry analysis. Neither morphological nor enzymatic differences were found between areas, but metric, size-related divergence was evidenced between them.

Evaluation of the allergenicity of spore and mycelia extracts of Pisolithus tinctorius.

The antigenic and allergenic chemical analysis of spore and mycelia extracts of Pisolithus tinctorius was carried out. The spores were collected from basidiocarps in plantations of Eucalyptus spp and the mycelia from culture in MNM medium. With basis on the fungus growth curve, the mycelia masses were obtained after 10, 20, 30, and 40 days of incubation, which correspond, respectively, to the beginning, middle and end of the log phase, and beginning of the decline phase. The mycelia masses, together with the spores, were submitted to the action of three extractors (Coca, Tris-HCl, and ammonium bicarbonate). The contents of carbohydrates and proteins were determined. The SDS-PAGE electrophoretical analysis revealed separate fractions in these extracts, besides common fractions, in function of cultivation time and extraction methods. The selected extracts for the allergic tests were the ones with the highest number of fractions. The prick-tests were conducted in 374 patients--rural workers, eucalyptus plantation workers, and college students. The positivity to the "prick test" with the antigenic extract of P. tinctorius was, respectively, 3.78%, 28.20% and 6.40%. Most prick-test positive patients (82.75%) also presented symptoms of respiratory allergy (asthma and rhinitis). There was no reactivity difference when the spore and mycelia extracts were employed. The analysis of the positive patients' sera revealed the presence of IgE specific to the P. tinctorius antigens. Since Pisolithus tinctorius is found as mycorrhiza of Eucalyptus spp, and this plant is used in reforestation in most countries, the importance of that fungus should be regarded as a possible cause of respiratory allergies, especially in occupationally exposed workers.

Serologic characterization of Paracoccidioides brasiliensis E2 antigen.

1. The behavior of the specific E2 antigen of Paracoccidioides brasiliensis was studied by agarose gel counterimmunoelectrophoresis. When the gel was read immediately after the electrophoretic run no precipitation band was visible. Visualization of the complex was possible only after incubation of the gel at room temperature overnight. 2. At alkaline pH, the E2 antigen migrates in the direction of the cathode, as do the immunoglobulins. The higher sensitivity of counterimmunoelectrophoresis when compared to double immunodiffusion for the diagnosis of paracoccidioidomycosis is due to the presence of antibodies directed against antigens which migrate to the anode. 3. The use of specific antiserum to E2 antigen as reference permits the double immunodiffusion method to be a very sensitive test for the specific serodiagnosis of paracoccidioidomycosis.

Serologic characterization of Paracoccidioides brasiliensis E2 antigen

1. The behavior of the specific E2 antigen of paracoccidioides brasiliensis was studied by agarose gel counterimmonoelectrophoresis. When immunoelectrophoresis. When the gel was read immediately after the electrophoretic run no precipitation band was visible. Visualization of the complex was possible only after incubation of the gel at room temperature overnight. 2. At alkaline pH, the, the E2 antigen migrates in the direvtion of the cathodem as do the immunoglobulins. The higher sensitivity of counterimmunoelectrophoresis when compared to double immunodiffusion for the diagnosis of paracoccidioidomycosis is due to the presence of antibodies directed agaisnt antigens which migrate to the anode. 3. The use of specific antiserum to E2 antigen reference permits the double immunodiffusion method to be a very sensitive test for the specific serodiagnosis of paracoccidioidomycosis

Oral yeasts in patients with cancer of the mouth, before and during radiotherapy.

The yeasts of patients with oral cancer has been studied before and during Xr-therapy. Gram and PAS smears revealed an increase of yeast-like structures, during treatment, from 56% to 66% of the cases. Before radiotherapy oral yeasts were isolated from 56% of the patients with cancer represented by Candida albicans (30%); C. tropicalis (12%); C. glabrata and C. krusei (4%), besides six other different species (2%). During radiotherapy yeasts were isolated in 72% of the cases, as follow: C. albicans (36%); C. tropicalis (16%); Rhodotorula rubra (6%); C. kefyr; C. krusei and Pichia farinosa (4%), besides other nine species (2%). C. albicans serotype A represented 93% of the isolated samples, before treatment and 88.8% during Xr-therapy.