Infection with both Human Immunodeficiency Virus (HIV) and Mycobacterium tuberculosis is currently the world's leading cause of death due to infectious agents. We evaluated factors related to the development of tuberculosis (TB) in HIV-infected patients who were being treated at an infectious diseases hospital in Fortaleza, Ceará, Brazil. From January 2004 to December 2005, we made an epidemiological study through the analysis of the medical records of 171 patients, who were diagnosed as having both HIV and tuberculosis. Among these co-infected patients, most (81%, p=0.0006) were male. Co-infection was more frequent (87.8%) among patients over 40 years of age and those with lower educational levels (less than eight years of schooling). Forty-one percent of the patients in the study had not had a smear culture test for acid-fast bacilli (AFB). CD4 cell counts were lower than 200 cells/µ µ µ µ µL in 71.9% of the patients, the mean being 169 cells/µ µ µ µ µL. This type of data is important for establishing strategies to improve the control of tuberculosis in HIV-infected patients.
Mycobacterium microti, a member of the Mycobacterium tuberculosis complex, is phylogenetically closely related to M. tuberculosis, differing in a few biochemical properties. However, these species have different levels of virulence in different hosts; most notably M. microti shows lower virulence for humans than M. tuberculosis. This report presents genomic comparisons using DNA microarray analysis for an extensive study of the diversity of M. microti strains. Compared to M. tuberculosis H37Rv, 13 deletions were identified in 12 strains of M. microti, including the regions RD1 to RD10, which are also missing in Mycobacterium bovis BCG. In addition, four new deleted regions, named MiD1, RD1b, MiD2 and MiD3, were identified. DNA sequencing was used to define the extent of most of the deletions in one strain. Although RD1 of M. bovis BCG and M. microti is thought to be crucial for attenuation, in this study, three of the four M. microti strains that were isolated from immunocompetent patients had the RD1 deletion. In fact, only the RD3 deletion was present in all of the strains examined, although deletions RD7, RD8 and MiD1 were found in almost all the M. microti strains. These deletions might therefore have some relation to the different host range of M. microti. It was also noticeable that of the 12 strains studied, only three were identical; these strains were all isolated from immunocompetent humans, suggesting that they could have arisen from a single source. Thus, this study shows that it is difficult to ascribe virulence to any particular pattern of deletion in M. microti.
A case-control study was conducted to determine the presence of Mycobacterium
leprae DNA in nasal secretions of leprosy cases and nonleprosy
individuals in Fortaleza, Brazil. It included 185 cases identified by physicians at
the Dona Libânia National Reference Centre for Sanitary Dermatology (CDERM). A
control group (Co) (n = 136) was identified among individuals from CDERM not
diagnosed as leprosy cases. To augment the spatial analysis of M. leprae specific
repetitive element (RLEP) positive prevalence, an external group (EG) (n = 121), a
convenience sample of healthy students, were included. Polymerase chain reaction for
the RLEP sequence was conducted for all participants. Prevalence of RLEP positivity
for cases and Co were 69.2% and 66.9%, respectively, significantly higher than for EG
(28.1%), and reported elsewhere. Male sex, belonging to a lower socioeconomic status
(D/E), history of a previous contact with a case and being older, were associated
with being a leprosy case. Our geographical analysis demonstrated that the bacillus
is widespread among the healthy population, with clusters of RLEP positive
multibacillary cases concentrated in distinct areas of the city. Our results suggest
that in endemic areas, as in Fortaleza, surveillance for both nonhousehold leprosy
contacts and members of the general population living in cluster areas should be
implemented.
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