Impact of the Human Bacterial Environment on Mycobacteriosis and Allergy

My work describes two sectors of the human bacterial environment: 1. The sources of exposure to infectious non-tuberculous mycobacteria. 2. Bacteria in dust, reflecting the airborne bacterial exposure in environments protecting from or predisposing to allergic disorders. Non-tuberculous mycobacteria (NTM) transmit to humans and animals from the environment. Infection by NTM in Finland has increased during the past decade beyond that by Mycobacterium tuberculosis. Among the farm animals, porcine mycobacteriosis is the predominant NTM disease in Finland. Symptoms of mycobacteriosis are found in 0.34 % of slaughtered pigs. Soil and drinking water are suspected as sources for humans and bedding materials for pigs. To achieve quantitative data on the sources of human and porcine NTM exposure, methods for quantitation of environmental NTM are needed. We developed a quantitative real-time PCR method, utilizing primers targeted at the 16S rRNA gene of the genus of Mycobacterium. With this method, I found in Finnish sphagnum peat, sandy soils and mud high contents of mycobacterial DNA, 106 to 107 genome equivalents per gram. A similar result was obtained by a method based on the Mycobacterium-specific hybridization of 16S rRNA. Since rRNA is found mainly in live cells, this result shows that the DNA detected by qPCR mainly represented live mycobacteria. Next, I investigated the occurrence of environmental mycobacteria in the bedding materials obtained from 5 pig farms with high prevalence (>4 %) of mycobacteriosis. When I used for quantification the same qPCR methods as for the soils, I found that piggery samples contained non-mycobacterial DNA that was amplified in spite of several mismatches with the primers. I therefore improved the qPCR assay by designing Mycobacterium-specific detection probes. Using the probe qPCR assay, I found 105 to 107 genome equivalents of mycobacterial DNA in unused bedding materials and up to 1000 fold more in the bedding collected after use in the piggery. This result shows that there was a source of mycobacteria in the bedding materials purchased by the piggery and that mycobacteria increased in the bedding materials during use in the piggery. Allergic diseases have reached epidemic proportions in urbanized countries. At the same time, childhood in rural environment or simple living conditions appears to protect against allergic disorders. Exposure to immunoreactive microbial components in rural environments seems to prevent allergies. I searched for differences in the bacterial communities of two indoor dusts, an urban house dust shown to possess immunoreactivity of the TH2-type and a farm barn dust with TH1-activity. The immunoreactivities of the dusts were revealed by my collaborators, in vitro in human dendritic cells and in vivo in mouse. The dusts accumulated >10 years in the respiratory zone (>1.5 m above floor), thus reflecting the long-term content of airborne bacteria at the two sites. I investigated these dusts by cloning and sequencing of bacterial 16S rRNA genes from dust contained DNA. From the TH2-active urban house dust, I isolated 139 16S rRNA gene clones. The most prevalent genera among the clones were Corynebacterium (5 species, 34 clones), Streptococcus (8 species, 33 clones), Staphylococcus (5 species, 9 clones) and Finegoldia (1 species, 9 clones). Almost all of these species are known as colonizers of the human skin and oral cavity. Species of Corynebacterium and Streptococcus have been reported to contain anti-inflammatory lipoarabinomannans and immunmoreactive beta-glucans respectively. Streptococcus mitis, found in the urban house dust is known as an inducer of TH2 polarized immunity, characteristic of allergic disorders. I isolated 152 DNA clones from the TH1-active farm barn dust and found species quite different from those found from the urban house dust. Among others, I found DNA clones representing Bacillus licheniformis, Acinetobacter lwoffii and Lactobacillus each of which was recently reported to possess anti-allergy immunoreactivity. Moreover, the farm barn dust contained dramatically higher bacterial diversity than the urban house dust. Exposure to this dust thus stimulated the human dendritic cells by multiple microbial components. Such stimulation was reported to promote TH1 immunity. The biodiversity in dust may thus be connected to its immunoreactivity. Furthermore, the bacterial biomass in the farm barn dust consisted of live intact bacteria mainly. In the urban house dust only ~1 % of the biomass appeared as intact bacteria, as judged by microscoping. Fragmented microbes may possess bioactivity different from that of intact cells. This was recently shown for moulds. If this is also valid for bacteria, the different immunoreactivities of the two dusts may be explained by the intactness of dustborne bacteria. Based on these results, we offer three factors potentially contributing to the polarized immunoreactivities of the two dusts: (i) the species-composition, (ii) the biodiversity and (iii) the intactness of the dustborne bacterial biomass. The risk of childhood atopic diseases is 4-fold lower in the Russian compared with the Finnish Karelia. This difference across the country border is not explainable by different geo-climatic factors or genetic susceptibilities of the two populations. Instead, the explanation must be lifestyle-related. It has already been reported that the microbiological quality of drinking water differs on the two sides of the borders. In collaboration with allergists, I investigated dusts collected from homes in the Russian Karelia and in the Finnish Karelia. I found that bacterial 16S rRNA genes cloned from the Russian Karelian dusts (10 homes, 234 clones) predominantly represented Gram-positive taxa (the phyla Actinobacteria and Firmicutes, 67%). The Russian Karelian dusts contained nine-fold more of muramic acid (60 to 70 ng mg-1) than the Finnish Karelian dusts (3 to 11 ng mg-1). Among the DNA clones isolated from the Finnish side (n=231), Gram-negative taxa (40%) outnumbered the Gram-positives (34%). Out of the 465 DNA clones isolated from the Karelian dusts, 242 were assigned to cultured validly described bacterial species. In Russian Karelia, animal-associated species e.g. Staphylococcus and Macrococcus were numerous (27 clones, 14 unique species). This finding may connect to the difference in the prevalence of allergy, as childhood contacts with pets and farm animals have been connected with low allergy risk. Plant-associated bacteria and plant-borne 16S rRNA genes (chloroplast) were frequent among the DNA clones isolated from the Finnish Karelia, indicating components originating from plants. In conclusion, my work revealed three major differences between the bacterial communtites in the Russian and in the Finnish Karelian homes: (i) the high prevalence of Gram-positive bacteria on the Russian side and of Gram-negative bacteria on the Finnish side and (ii) the rich presence of animal-associated bacteria on the Russian side whereas (iii) plant-associated bacteria prevailed on the Finnish side. One or several of these factors may connect to the differences in the prevalence of allergy.

USGS/NOAA Workshop on Mycobacteriosis in Striped Bass, May 7-10, 2006, Annapolis, Maryland

As a Federal trust species, the well-being of the striped bass (Morone saxatilis) population along the Eastern Seaboard is of major concern to resource users. Striped bass are an extremely valuable commercial and recreational resource. As a principal piscivore in Chesapeake Bay, striped bass directly or indirectly interact with multiple trophic levels within the ecosystem and are therefore very sensitive to biotic and abiotic ecosystem changes. For reasons that have yet to be defined, the species has a high intrinsic susceptibility to mycobacteriosis. This disease has been impacting Chesapeake Bay striped bass since at least the 1980s as indicated by archived tissue samples. However, it was not until heightened incidences of fish with skin lesions in the Pocomoke River and other tributaries of the Chesapeake Bay were reported in the summer and fall of 1996 and 1997 that a great deal of public and scientific interest was stimulated about concerns for fish disease in the Bay. (PDF contains 50 pages)

Mycobacteriosis in Chesapeake Bay Striped Bass (Morone saxatilis): The Interaction of Nutrition and Disease

Field and laboratory studies were conducted from 1998 - 2005 to examine the relationship between nutritional status and mycobacteriosis in Chesapeake Bay striped bass (Morone saxatilis). A review of DNA from archived tissue blocks indicated that the disease has been present since at least 1984. Field surveys and feeding trials were conducted from 1998-1999 to determine the nutritional condition of striped bass and the association with disease state. Proximate composition revealed elevated moisture (~ 80%) and low storage lipids (< 0.5% ww), characteristic of a poorly nourished population. These findings were not consistent with data collected in 1990-1991, or with experimentally fed fish. Mycobacteriosis explained little of the variance in chemical composition (p > 0.2); however elevated moisture and low lipid concentration were associated with fish with ulcerative lesions (p < 0.05). This suggests that age 3 and 4 striped bass were in poor nutritional health in 1998-1999, which may be independent from the disease process. Challenge studies were performed to address the hypothesis that disease progression and severity may be altered by nutritional status of the host. Intraperitoneal inoculation of 104 CFU M. marinum resulted in high mortality, elevated bacterial density, and poor granuloma formation in low ration (0.15% bw/d) groups while adequately fed fish (1% bw/d) followed a normal course of granulomatous inflammation with low mortality to a steady, equilibrium state. Further, we demonstrated that an active inflammatory state could be reactivated in fish through reductions in total diet. The energetic demand of mycobacteriosis, was insignificant in comparison to sham inoculated controls in adequately fed fish (p > 0.05). Declines in total body energy were only apparent during active, inflammatory stages of disease. Overall, these findings suggest that: 1) mycobacteriosis is not a new disease of Chesapeake Bay striped bass, 2) the disease has little energetic demand in the normal, chronic progression, and 3) poor nutritional health can greatly enhance the progression and severity, and reactivation of disease. The implications of this research are that management strategies focused on enhancing the nutritional state of striped bass could potentially alter the disease dynamics in Chesapeake Bay.

Experimental murine mycobacteriosis: evaluation of the functional activity of alveolar macrophages in thalidomide- treated mice

Thalidomide is a selective inhibitor of tumor necrosis factor-alpha (TNF-alpha), a cytokine involved in mycobacterial death mechanisms. We investigated the role of this drug in the functional activity of alveolar macrophages in the presence of infection induced by intranasal inoculation of Mycobacterium avium in thalidomide-treated and untreated adult Swiss mice. Sixty animals were inoculated with 5 x 10(6) M. avium by the respiratory route. Thirty animals received daily thalidomide (30 mg/kg mouse) and 30 received water by gavage up to sacrifice. Ten non-inoculated mice were used as a control group. Lots of animals from each group were evaluated until 6 weeks after inoculation. Infection resulted in an increased total number of inflammatory cells as well as increased activity of pulmonary macrophages. Histologically, intranasal inoculation of bacilli resulted in small mononuclear infiltrates located at the periphery of the organ. Culture of lung fragments revealed the presence of bacilli only at the beginning and at the end of the experimental period. Thalidomide administration did not affect the microbiological or histological features of the infection. Thalidomide-treated and untreated animals showed the same amount of M. avium colonies 3 weeks after infection. Although it did not affect bacillary clearance, thalidomide administration resulted in a decreased percent of spread cells and release of hydrogen peroxide, suggesting that factors other than TNF-alpha play a role in the killing of mycobacteria by alveolar macrophages. Thalidomide administration also reduced the number of spread cells among resident macrophages, suggesting a direct effect of the drug on this phenomenon.

Rapid molecular diagnosis of tuberculosis and other mycobacteriosis in smear-negative clinical specimens

Delay in diagnosis of pulmonary and other forms of tuberculosis (TB) can be fatal, particularly in HIV-infected patients. Hence, techniques based on nucleic acid amplification, which are both rapid and of high specificity and sensitivity, are now widely used and recommended for laboratories that diagnose TB. In the present study, diagnostic methods based on mycobacterial DNA amplification were evaluated in comparative trials alongside tradicional bacterial methods, using negative smear samples from patients with clinically-suspected TB (sputum samples from 25 patients with suspected pulmonary TB, urine samples from two patients with suspected renal TB and cerebrospinal fluid samples from one patient with suspected meningeal TB). A specificity of 100% was achieved with DNA amplification methods and tradicional culture/identification methods, in relation to clinical findings and treatment results. For the smear-negative sputa, conventional PCR for M. tuberculosis was positive in 62% of suspected lung TB case, showing the same sensitivity as bacterial identification. Both techniques failed in the detection of extra-pulmonary samples. Nested PCR showed, after species-specific amplification, a sensitivity of 100% for M. avium and 85% for M. tuberculosis. For extra-pulmonary smear-negative samples, only Nested PCR detected M. tuberculosis and all cases were confirmed clinically. Nested PCR, in which two-step amplification reactions are performed, can identify the two most important mycobacteria in human pathology quickly and directly from clinical spicimens.

[Cutaneous atypical mycobacteriosis due to Mycobacterium massiliense in a cat]

Fast growing mycobacteria are saprophytic bacteria that prevail in water and soil. They are opportunistic pathogens and may cause various infections if gaining entry into the body through a trauma. We herein describe the clinical presentation, pathology and diagnosis of the first case of cutaneous atypical mycobacteriosis due to Mycobacterium massiliense in a cat.

Alterações da expressão da proteína PHEX na Hanseníase

A hanseníase é uma doença infecciosa causada pelo Mycobacteruim leprae, um bacilo intracelular obrigatório, que prolifera principalmente na pele e nos nervos periféricos no interior de células como macrófagos e células de Schwann. A transmissão ocorre por meio das mucosas das vias respiratórias, provavelmente por aerossóis expelidos por indivíduos infectados. O homem é o seu hospedeiro natural sendo a multiplicação do bacilo muito lenta, com um período de geração estimado de 14 dias. Apesar da mínima variação no genoma do M. leprae, a doença é caracterizada por um espectro de formas clínicas bem definido, decorrente da capacidade de resposta imune do hospedeiro. Em pacientes classificados como multibacilares (MB) a doença é disseminada, com inúmeras lesões de pele e proliferação bacilar considerável. Nesses indivíduos ocorre hiporresponsividade celular ao M. leprae. Nas formas paucibacilares (PB), os pacientes apresentam uma ou poucas lesões, a carga bacilar é pequena e, às vezes não observada por meio da baciloscopia tradicional e ocorre resposta imune patógeno-específica. As incapacidades físicas nos pacientes decorrem da neuropatia e osteopatia e podem ser irreversíveis. Essas deformidades podem avançar mesmo após a diminuição da carga bacilar com o final do tratamento poliquimioterápico. A presente tese teve por objetivo estudar as implicações da proteína PHEX nas alterações fisiopatológicas da hanseníase, em especial as alterações ósseas. A proteína PHEX (Phosphate-regulating gene with Homologies to Endopeptidase on the X chromosome) é expressa em várias células humanas e, no primeiro artigo que compõe essa tese, demonstramos que o M.leprae leva à diminuição da expressão de PHEX em linhagens de células de Schwann e osteoblastos humanos. Este efeito foi igualmente causado por outras espécies de micobactérias. No segundo manuscrito ora submetido, observamos que em leucócitos sanguíneos de pacientes hansenianos também ocorreu modulação negativa de PHEX. Este efeito não se relacionou com a capacidade de produção de citocinas inflamatórias frente ao M. leprae in vitro ou com alterações bioquímicas. O efeito inibidor da mineralização ocasionado pela modulação negativa de PHEX talvez contribua para a doença óssea da hanseníase, auxiliando a explicar a capacidade do M. leprae de penetrar e sobreviver no osso.

Revisiting human IL-12Rβ1 deficiency: A survey of 141 patients from 30 countries

Interleukin-12 receptor β1 (IL-12Rβ1) deficiency is the most common form of Mendelian susceptibility to mycobacterial disease (MSMD). We undertook an international survey of 141 patients from 102 kindreds in 30 countries. Among 102 probands, the first infection occurred at a mean age of 2.4 years. In 78 patients, this infection was caused by Bacille Calmette-Guérin (BCG; n = 65), environmental mycobacteria (EM; also known as atypical or nontuberculous mycobacteria) (n = 9) or Mycobacterium tuberculosis (n = 4). Twenty-two of the remaining 24 probands initially presented with nontyphoidal, extraintestinal salmonellosis. Twenty of the 29 genetically affected sibs displayed clinical signs (69%); however 8 remained asymptomatic (27%). Nine nongenotyped sibs with symptoms died. Recurrent BCG infection was diagnosed in 15 cases, recurrent EM in 3 cases, recurrent salmonellosis in 22 patients. Ninety of the 132 symptomatic patients had infections with a single microorganism. Multiple infections were diagnosed in 40 cases, with combined mycobacteriosis and salmonellosis in 36 individuals. BCG disease strongly protected against subsequent EM disease (p = 0.00008). Various other infectious diseases occurred, albeit each rarely, yet candidiasis was reported in 33 of the patients (23%). Ninety-nine patients (70%) survived, with a mean age at last follow-up visit of 12.7 years ± 9.8 years (range, 0.5-46.4 yr). IL-12Rβ1 deficiency is characterized by childhood-onset mycobacteriosis and salmonellosis, rare recurrences of mycobacterial disease, and more frequent recurrence of salmonellosis. The condition has higher clinical penetrance, broader susceptibility to infections, and less favorable outcome than previously thought. © 2010 Lippincott Williams & Wilkins.

Hidrolipoclasia con solución salina hipotónica versus isotónica en adiposidad localizada

Introducción: La hidrolipoclasia es una técnica de moldeamiento corporal consistente en la infiltración de una solución en el tejido adiposo con la consiguiente aplicación de ultrasonido para producir lisis en los adipocitos y reducción del tejido adiposo en el área de tratamiento. Sin embargo, existen múltiples variaciones a la técnica, entre ellas el tipo de solución utilizada. El objetivo de este estudio fue comparar los resultados con la técnica de hidrolipoclasia en cuanto a reducción de medidas con el uso de solución salina hipotónica versus isotónica. Metodología: Estudio descriptivo de corte transversal, se analizaron historias clínicas de pacientes a los que se les realizó hidrolipoclasia entre enero de 2013 y febrero 2014 en dos centros médicos estéticos de Bogotá. Se compararon dos técnicas (utilizando solución salina isotónica versus hipotónica) en cuanto a la disminución de medidas antropométricas tomadas antes y después del tratamiento. Los datos fueron analizados mediante la comparación de medias utilizando la prueba t de Student. Resultados: Se analizaron 37 historias clínicas, 19 pacientes sometidos a hidrolipoclasia con solución salina hipotónica y 18 con isotónica. Después de la realización de un procedimiento hubo una disminución estadísticamente significativa (p: 0,000) en todas las medidas antropométricas evaluadas, siendo mayor comparativamente en los pacientes tratados con solución hipotónica en cintura, perímetro abdominal y perímetro a nivel de crestas iliacas. Los efectos secundarios incluyeron equimosis y hematomas. No se presentaron complicaciones. Conclusión: La hidrolipoclasia es segura y eficaz en el manejo de adiposidad localizada, teniendo una mayor efectividad cuando se utiliza solución salina hipotónica.

Disseminated avian tuberculosis in captive Ara macao

Avian mycobacteriosis was diagnosed in a captive scarlet macaw (Ara macao) that presented multifocal granulomas on subcutaneous tissue, sciatic nerves, infraorbital sinus, trachea, air sacs, muscles, spleen and liver. Microscopically, central areas of caseous necrosis surrounded by epithelioid macrophage, multinucleated giant cells, and lymphocytes were observed. Acid-fast bacilli were demonstrated by Ziehl-Neelsen stain. Inoculation into Lowenstein-Jensen, Stonebrink and Petragnani media, yielded Mycobacterium spp, which was identified as Mycobacterium avium by polymerase chain reaction technique (PCR).

Search for Mycobacterium leprae in wild mammals

Leprosy is still a worldwide public health problem. Brazil and India show the highest prevalence rates of the disease. Natural infection of armadillos Dasypus novemcinctus with Mycobacterium leprae has been reported in some regions of the United States. Identification of bacilli is difficult, particularly due to its inability to grow in vitro. The use of molecular tools represents a fast and sensitive alternative method for diagnosis of mycobacteriosis. In the present study, the diagnostic methods used were bacilloscopy, histopathology, microbiology, and PCR using specific primers for M. leprae repetitive sequences. PCR were performed using genomic DNA extracted from 138 samples of liver, spleen, lymph nodes, and skin of 44 D. novemcinctus, Euphractus sexcinctus, Cabassous unicinctus, and C. tatouay armadillos from the Middle Western region of the state of São Paulo and from the experimental station of Empresa Brasileira de Pesquisa Agropecuária (EMBRAPA) Pantanal, located in Pantanal da Nhecolândia of Mato Grosso do Sul state. Also, the molecular analysis of 19 samples from internal organs of other road killed species of wild animals, such as Nasua nasua (ring-tailed coati), Procyon cancrivoros (hand-skinned), Cerdocyon thous (dog-pity-bush), Cavia aperea (restless cavy), Didelphis albiventris (skunk), Sphigurrus spinosus (hedgehog), and Gallictis vittata (ferret) showed PCR negative data. None of the 157 analyzed samples had shown natural mycobacterial infection. Only the armadillo inoculated with material collected from untreated multibacillary leprosy patient presented PCR positive and its genomic sequencing revealed 100% identity with M. leprae. According to these preliminary studies, based on the used methodology, it is possible to conclude that wild mammals seem not to play an important role in the epidemiology of leprosy in the Middle Western region of the São Paulo state and in the Pantanal of Mato Grosso do Sul state.

Lipossomas: Estrategia biotecnologica para liberacao controlada e direcionamento intracelular de farmacos com efeito antimicobacteriano

This text highlights the state of research related with the application of liposomes in the control of drug delivery and drug target to intracellular bacterial diseases, such as the tuberculosis. Liposome have several pharmaceutical applications and this article is primarily focused on the potential of this agregate on drug encapsalation especially antimycobacterial compounds. Case studies in which liposomes have successfully been used to improve pharmacological drug effect are presented. Mechanisms involved in intracellular drug delivery, possibilities of application, research and development efforts to address these objectives are discussed.

Ocorrência de micobactérias em amostras de leite bovino provenientes de tanques de expansão individuais e coletivos de propriedades rurais e do comércio informal na região sudeste do estado de São Paulo

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Pesquisa de Micobacterium Leprae e outras microbactérias em Tatus Selvagens

Pós-graduação em Doenças Tropicais - FMB

Fatores de risco para hanseníase em portadores de HIV e AIDS em áreas de alta endemicidade na Amazônia

Em um país onde a hanseníase é endêmica e onde a infecção pelo HIV continua expandindo-se e interiorizando-se, espera-se encontrar um aumento da prevalência de indivíduos convivendo simultaneamente com hanseníase e HIV/aids. Com o objetivo de identificar fatores de risco para a hanseníase em portadores de HIV/aids e descrever aspectos clínicos e epidemiológicos, realizou-se um estudo de caso controle envolvendo 33 pacientes co-infectados (HIV/hanseníase) e 90 controles (HIV/aids sem hanseníase). Na amostra estudada o sexo masculino foi mais freqüente tanto nos coinfectados quanto nos controles, prevaleceram jovens e adultos jovens em ambos os grupos, Belém foi a área de procedência mais freqüente entre co-infectados e controles, não houve diferença entre renda familiar de co-infectados e controles, os pacientes co-infectados apresentavam-se, em sua maioria, no estágio de aids com grande oscilação de células CD4 periféricas. As formas clínicas mais freqüentem ente encontradas, entre os co-infectados, foram as paucibacilares, sendo a média de células CD4+ no sangue periférico significativamente maior no grupo de co-infectados. Os prováveis fatores de risco para hanseníase relacionados à infecção pelo HIV (situação clínica, situação de imunodeficiência laboratorial e co-morbidades com outras micobacterioses) não foram estatisticamente significantes. Os fatores de risco para hanseníase já descritos na literatura, tais quais contatos intradomiciliares e antecedentes familiares de hanseníase, demonstraram ser significativamente os fatores de risco para a hanseníase em indivíduos com HIV/aids, aumentando em 45 vezes e 21 vezes, respectivamente, a chance de adoecer do mal de Hansen. A recidiva não se configurou como fator de risco para a Hanseníase em pacientes HIV/aids. A maioria dos coinfectados apresentaram sinais e sintomas de hanseníase 6 meses após o inicio da TARV, confirmando estudos anteriores que sugerem ser a hanseníase uma doença associada à reconstituição imunológica no paciente portador de HIV/aids. Estudos subseqüentes fazem-se necessários para complementar este e os anteriores sobre esta tão intrigante e desafiante co-infecção.