Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 19 de 19
Filter
1.
Toxins (Basel) ; 14(12)2022 12 01.
Article in English | MEDLINE | ID: mdl-36548732

ABSTRACT

Epidemiological studies have reported a strong association between liver injury and incidences of hepatocellular carcinoma in sections of humans globally. Several preclinical studies have shown a strong link between cyanotoxin exposure and the development of nonalcoholic steatohepatitis, a precursor of hepatocellular carcinoma. Among the emerging threats from cyanotoxins, new evidence shows cylindrospermopsin release in freshwater lakes. A known hepatotoxin in higher concentrations, we examined the possible role of cylindrospermopsin in causing host gut dysbiosis and its association with liver pathology in a mouse model of toxico-pharmacokinetics and hepatic pathology. The results showed that oral exposure to cylindrospermopsin caused decreased diversity of gut bacteria phyla accompanied by an increased abundance of Clostridioides difficile and decreased abundance of probiotic flora such as Roseburia, Akkermanssia, and Bacteroides thetaiotamicron, a signature most often associated with intestinal and hepatic pathology and underlying gastrointestinal disease. The altered gut dysbiosis was also associated with increased Claudin2 protein in the intestinal lumen, a marker of gut leaching and endotoxemia. The study of liver pathology showed marked liver inflammation, the release of damage-associated molecular patterns, and activation of toll-like receptors, a hallmark of consistent and progressive liver damage. Hepatic pathology was also linked to increased Kupffer cell activation and stellate cell activation, markers of progressive liver damage often linked to the development of liver fibrosis and carcinoma. In conclusion, the present study provides additional evidence of cylindrospermopsin-linked progressive liver pathology that may be very well-linked to gut dysbiosis, though definitive evidence involving this link needs to be studied further.


Subject(s)
Carcinoma, Hepatocellular , Gastrointestinal Microbiome , Liver Neoplasms , Animals , Mice , Humans , Carcinoma, Hepatocellular/metabolism , Kupffer Cells/metabolism , Kupffer Cells/pathology , Gastrointestinal Microbiome/physiology , Dysbiosis , Liver/metabolism , Liver Cirrhosis/pathology , Liver Neoplasms/metabolism , Inflammation/metabolism
2.
Sci Rep ; 12(1): 11516, 2022 07 07.
Article in English | MEDLINE | ID: mdl-35799048

ABSTRACT

A strong association between exposure to the common harmful algal bloom toxin microcystin and the altered host gut microbiome has been shown. We tested the hypothesis that prior exposure to the cyanotoxin microcystin-LR may alter the host resistome. We show that the mice exposed to microcystin-LR had an altered microbiome signature that harbored antibiotic resistance genes. Host resistome genotypes such as mefA, msrD, mel, ant6, and tet40 increased in diversity and relative abundance following microcystin-LR exposure. Interestingly, the increased abundance of these genes was traced to resistance to common antibiotics such as tetracycline, macrolides, glycopeptide, and aminoglycosides, crucial for modern-day treatment of several diseases. Increased abundance of these genes was positively associated with increased expression of PD1, a T-cell homeostasis marker, and pleiotropic inflammatory cytokine IL-6 with a concomitant negative association with immunosurveillance markers IL-7 and TLR2. Microcystin-LR exposure also caused decreased TLR2, TLR4, and REG3G expressions, increased immunosenescence, and higher systemic levels of IL-6 in both wild-type and humanized mice. In conclusion, the results show a first-ever characterization of the host resistome following microcystin-LR exposure and its connection to host immune status and antimicrobial resistance that can be crucial to understand treatment options with antibiotics in microcystin-exposed subjects in clinical settings.


Subject(s)
Gastrointestinal Microbiome , Immunosenescence , Microcystins , Animals , Anti-Bacterial Agents/pharmacology , Drug Resistance, Bacterial , Homeostasis , Interleukin-6 , Mice , Microcystins/toxicity , Toll-Like Receptor 2
3.
Toxicology ; 461: 152901, 2021 09.
Article in English | MEDLINE | ID: mdl-34416350

ABSTRACT

Nonalcoholic fatty liver disease (NAFLD) has been shown to be associated with extrahepatic comorbidities including neuronal inflammation and Alzheimer's-like pathology. Environmental and genetic factors also act as a second hit to modulate severity and are expected to enhance the NAFLD-linked neuropathology. We hypothezied that environmental microcystin-LR (MC-LR), a toxin produced by harmful algal blooms of cyanobacteria, exacerbates the neuroinflammation and degeneration of neurons associated with NAFLD. Using a mouse model of NAFLD, exposed to MC-LR subsequent to the onset of fatty liver, we show that the cyanotoxin could significantly increase proinflammatory cytokine expression in the frontal cortex and cause increased expression of Lcn2 and HMGB1. The above effects were NLRP3 inflammasome activation-dependent since the use of NLRP3 knockout mice abrogated the increase in inflammation. NLRP3 was also responsible for decreased expression of the blood-brain barrier (BBB) tight junction proteins Occludin and Claudin 5 suggesting BBB dysfunction was parallel to neuroinflammation following microcystin exposure. An increased circulatory S100B release, a hallmark of astrocyte activation in MC-LR exposed NAFLD mice also confirmed BBB integrity loss, but the astrocyte activation observed in vivo was NLRP3 independent suggesting an important role of a secondary S100B mediated crosstalk. Mechanistically, conditioned medium from reactive astrocytes and parallel S100B incubation in neuronal cells caused increased inducible NOS, COX-2, and higher BAX/ Bcl2 protein expression suggesting oxidative stress-mediated neuronal cell apoptosis crucial for neurodegeneration. Taken together, MC-LR exacerbated neuronal NAFLD-linked comorbidities leading to cortical inflammation, BBB dysfunction, and neuronal apoptosis.


Subject(s)
Blood-Brain Barrier/drug effects , Marine Toxins/toxicity , Microcystins/toxicity , NLR Family, Pyrin Domain-Containing 3 Protein/genetics , Non-alcoholic Fatty Liver Disease/physiopathology , Animals , Apoptosis/drug effects , Blood-Brain Barrier/pathology , Disease Models, Animal , Environmental Exposure/adverse effects , Inflammasomes/metabolism , Inflammation/pathology , Male , Mice , Mice, Inbred C57BL , Mice, Knockout , Neuroinflammatory Diseases/physiopathology , Oxidative Stress/drug effects , S100 Calcium Binding Protein beta Subunit/metabolism
4.
Article in English | MEDLINE | ID: mdl-32781293

ABSTRACT

Clinical studies implicated an increased risk of intestinal fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). Our previous studies have shown that microcystin-LR (MC-LR) exposure led to altered gut microbiome and increased abundance of lactate producing bacteria and intestinal inflammation in underlying NAFLD. This led us to further investigate the effects of the MC-LR, a PP2A inhibitor in activating the TGF-ß fibrotic pathway in the intestines that might be mediated by increased lactate induced redox enzyme NOX2. Exposure to MC-LR led to higher lactate levels in circulation and in the intestinal content. The higher lactate levels were associated with NOX2 activation in vivo that led to increased Smad2/3-Smad4 co-localization and high alpha-smooth muscle actin (α-SMA) immunoreactivity in the intestines. Mechanistically, primary mouse intestinal epithelial cells treated with lactate and MC-LR separately led to higher NOX2 activation, phosphorylation of TGFßR1 receptor and subsequent Smad 2/3-Smad4 co-localization inhibitable by apocynin (NOX2 inhibitor), FBA (a peroxynitrite scavenger) and DMPO (a nitrone spin trap), catalase and superoxide dismutase. Inhibition of NOX2-induced redox signaling also showed a significant decrease in collagen protein thus suggesting a strong redox signaling induced activation of an ectopic fibrotic manifestation in the intestines. In conclusion, the present study provides mechanistic insight into the role of microcystin in dysbiosis-linked lactate production and subsequently advances our knowledge in lactate-induced NOX2 exacerbation of the cell differentiation and fibrosis in the NAFLD intestines.


Subject(s)
Fibrosis/pathology , Intestinal Mucosa/metabolism , Intestines/drug effects , Lactic Acid/metabolism , Microcystins/toxicity , NADPH Oxidase 2/metabolism , Non-alcoholic Fatty Liver Disease/metabolism , Animals , Cell Line , Enzyme Inhibitors/toxicity , Fibrosis/enzymology , Fibrosis/etiology , Intestinal Mucosa/drug effects , Intestines/enzymology , Intestines/pathology , Lactic Acid/blood , Male , Mice , Mice, Inbred C57BL , Mice, Knockout , NADPH Oxidase 2/antagonists & inhibitors , Non-alcoholic Fatty Liver Disease/blood , Non-alcoholic Fatty Liver Disease/enzymology , Non-alcoholic Fatty Liver Disease/pathology , Phosphorylation
5.
Environ Toxicol Pharmacol ; 80: 103457, 2020 Nov.
Article in English | MEDLINE | ID: mdl-32687983

ABSTRACT

Evidence from pediatric studies show that infants and children are at risk for early exposure to microcystin. The present report tests the hypothesis that early life exposure to microcystin (MC), a principal component of harmful algal blooms followed by a juvenile exposure to high-fat diet feeding potentiate the development of nonalcoholic fatty liver disease phenotype in adulthood. Results showed classical symptoms of early NAFLD linked inflammation. Cytokines and chemokines such as CD68, IL-1ß, MCP-1, and TNF-α, as well as α-SMA were increased in the groups that were exposed to MC-LR with the high-fat diet compared to the vehicle group. Also, mechanistically, NLRP3 KO mice showed a significant decrease in the inflammation and NAFLD phenotype and resisted the metabolic changes such as insulin resistance and glucose metabolism in the liver. The data suggested that MC-LR exposure and subsequent NLRP3 inflammasome activation in childhood could impact liver health in juveniles.


Subject(s)
Inflammasomes/metabolism , Insulin Resistance , Marine Toxins/toxicity , Microcystins/toxicity , Non-alcoholic Fatty Liver Disease/chemically induced , Water Pollutants, Chemical/toxicity , Animals , Diet, High-Fat/adverse effects , Liver/drug effects , Liver/immunology , Male , Mice , Mice, Inbred C57BL , NLR Family, Pyrin Domain-Containing 3 Protein/metabolism , Non-alcoholic Fatty Liver Disease/immunology , Non-alcoholic Fatty Liver Disease/metabolism
6.
Environ Toxicol Pharmacol ; 73: 103281, 2020 Jan.
Article in English | MEDLINE | ID: mdl-31706246

ABSTRACT

NAFLD often results in cardiovascular, intestinal and renal complications. Previous reports from our laboratory highlighted NAFLD induced ectopic inflammatory manifestations in the kidney that gave rise to glomerular inflammation. Extending our studies, we hypothesized that existing inflammatory conditions in NAFLD could make the kidneys more susceptible to environmental toxicity. Our results showed that exposure of Microcystin-LR (MC) in NAFLD mice caused a marked increase in cellular scarring with a concomitant increase in mesangial cell activation as observed by increased α-SMA in the extracellular matrix surrounding the glomeruli. Renal tissue surrounding the glomeruli also showed increased NOX2 activation as shown by greater co-localization of p47 Phox and its membrane component gp91Phox both in the mesangial cell and surrounding tissue. Mechanistically, mesangial cells incubated with apocynin, nitrone spin trap DMPO and miR21 inhibitor showed significantly decreased α-SMA, miR21 levels and proinflammatory cytokine release in the supernatant. In parallel, mice lacking miR21, known to be activated by NOX2, when exposed to MC in NAFLD showed decreased mesangial cell activation. Strikingly, phenyl boronic acid incubated cells that were exposed to MC showed significantly decreased mesangial cell activation showing that peroxynitrite might be the major reactive species involved in mediation of the activation process, release of proinflammatory micro RNAs and cytokines that are crucial for renal toxicity. Thus, in conclusion, MC exposure causes NOX2 activation that leads to mesangial cell activation and toxicity via release of peroxynitrite that also represses PTEN by the upregulation of miR21 thus amplifying the toxicity.


Subject(s)
Microcystins/toxicity , Non-alcoholic Fatty Liver Disease , Water Pollutants, Chemical/toxicity , Animals , Inflammation , Kidney/drug effects , Kidney/metabolism , Kidney Diseases , Mice , MicroRNAs , Signal Transduction
7.
Am J Physiol Gastrointest Liver Physiol ; 317(4): G408-G428, 2019 10 01.
Article in English | MEDLINE | ID: mdl-31393787

ABSTRACT

Nonalcoholic fatty liver disease (NAFLD) is an emerging global pandemic. Though significant progress has been made in unraveling the pathophysiology of the disease, the role of protein phosphatase 2A (PP2A) and its subsequent inhibition by environmental and genetic factors in NAFLD pathophysiology remains unclear. The present report tests the hypothesis that an exogenous PP2A inhibitor leads to hepatic inflammation and fibrogenesis via an NADPH oxidase 2 (NOX2)-dependent pathway in NAFLD. Results showed that microcystin (MC) administration, a potent PP2A inhibitor found in environmental exposure, led to an exacerbation of NAFLD pathology with increased CD68 immunoreactivity, the release of proinflammatory cytokines, and stellate cell activation, a process that was attenuated in mice that lacked the p47phox gene and miR21 knockout mice. Mechanistically, leptin-primed immortalized Kupffer cells (a mimicked model for an NAFLD condition) treated with apocynin or nitrone spin trap 5,5 dimethyl-1- pyrroline N-oxide (DMPO) had significantly decreased CD68 and decreased miR21 and α-smooth muscle actin levels, suggesting the role of NOX2-dependent reactive oxygen species in miR21-induced Kupffer cell activation and stellate cell pathology. Furthermore, NOX2-dependent peroxynitrite generation was primarily responsible for cellular events observed following MC exposure since incubation with phenylboronic acid attenuated miR21 levels, Kupffer cell activation, and inflammatory cytokine release. Furthermore, blocking of the AKT pathway attenuated PP2A inhibitor-induced NOX2 activation and miR21 upregulation. Taken together, we show that PP2A may have protective roles, and its inhibition exacerbates NAFLD pathology via activating NOX2-dependent peroxynitrite generation, thus increasing miR21-induced pathology.NEW & NOTEWORTHY Protein phosphatase 2A inhibition causes nonalcoholic steatohepatitis (NASH) progression via NADPH oxidase 2. In addition to a novel emchanism of action, we describe a new tool to describe NASH histopathology.


Subject(s)
Enzyme Inhibitors/toxicity , MicroRNAs/metabolism , NADPH Oxidase 2/metabolism , Non-alcoholic Fatty Liver Disease/chemically induced , Non-alcoholic Fatty Liver Disease/metabolism , Protein Phosphatase 2/antagonists & inhibitors , Animals , Antigens, CD/biosynthesis , Antigens, Differentiation, Myelomonocytic/biosynthesis , Cytokines/metabolism , Hepatic Stellate Cells/drug effects , Kupffer Cells/drug effects , Kupffer Cells/metabolism , Liver Cirrhosis/chemically induced , Liver Cirrhosis/pathology , Male , Mice , Mice, Inbred C57BL , Mice, Knockout , MicroRNAs/genetics , Microcystins/toxicity , NADPH Oxidase 2/genetics , NADPH Oxidases/metabolism , Peroxynitrous Acid/metabolism
8.
Sci Rep ; 9(1): 8742, 2019 06 19.
Article in English | MEDLINE | ID: mdl-31217465

ABSTRACT

With increased climate change pressures likely to influence harmful algal blooms, exposure to microcystin, a known hepatotoxin and a byproduct of cyanobacterial blooms can be a risk factor for NAFLD associated comorbidities. Using both in vivo and in vitro experiments we show that microcystin exposure in NAFLD mice cause rapid alteration of gut microbiome, rise in bacterial genus known for mediating gut inflammation and lactate production. Changes in the microbiome were strongly associated with inflammatory pathology in the intestine, gut leaching, tight junction protein alterations and increased oxidative tyrosyl radicals. Increased lactate producing bacteria from the altered microbiome was associated with increased NOX-2, an NADPH oxidase isoform. Activationof NOX2 caused inflammasome activation as shown by NLRP3/ASCII and NLRP3/Casp-1 colocalizations in these cells while use of mice lacking a crucial NOX2 component attenuated inflammatory pathology and redox changes. Mechanistically, NOX2 mediated peroxynitrite species were primary to inflammasome activation and release of inflammatory mediators. Thus, in conclusion, microcystin exposure in NAFLD could significantly alter intestinal pathology especially by the effects on microbiome and resultant redox status thus advancing our understanding of the co-existence of NAFLD-linked inflammatory bowel disease phenotypes in the clinic.


Subject(s)
Environmental Exposure/adverse effects , Gastrointestinal Microbiome/drug effects , Intestinal Diseases , Microcystins/administration & dosage , NADPH Oxidase 2/metabolism , Non-alcoholic Fatty Liver Disease , Animals , Disease Models, Animal , Inflammation/chemically induced , Inflammation/enzymology , Inflammation/microbiology , Inflammation/pathology , Intestinal Diseases/chemically induced , Intestinal Diseases/enzymology , Intestinal Diseases/microbiology , Intestinal Diseases/pathology , Male , Mice , Mice, Knockout , Microcystins/pharmacology , Non-alcoholic Fatty Liver Disease/enzymology , Non-alcoholic Fatty Liver Disease/microbiology , Non-alcoholic Fatty Liver Disease/pathology
9.
Article in English | MEDLINE | ID: mdl-33869675

ABSTRACT

Spinal cord injury (SCI) affects approximately 200,000 individuals per year worldwide. There are more than 27 million people worldwide living with long-term disability due to SCI. Historically, it was thought that the central nervous system (CNS) had little ability for regeneration; however, more recent studies have demonstrated potential for repair within the CNS. Because of this, there exists a renewed interest in the discovery of novel approaches to promote regeneration in the CNS including the spinal cord. It is important to know the roles of the microRNAs (miRNAs) in modulation of pathogenesis in SCI and the potentials of the miRNA-based clinical interventions for controlling post-injury symptoms and improving functional recovery. The miRNAs, which are non-coding RNAs with an average of 22 nucleotides in length, are post-transcriptional gene regulators that cause degradation of the target mRNAs and thus negatively control their translation. This review article focuses on current research related to miRNAs and their roles in modulating SCI symptoms, asserting that miRNAs contribute to critical post-SCI molecular processes including neuroplasticity, functional recovery, astrogliosis, neuropathic pain, inflammation, and apoptosis. In particular, miR-96 provides a promising therapeutic opportunity to improve the outcomes of clinical interventions, including the way SCI injuries are evaluated and treated.

10.
Int J Antimicrob Agents ; 35(5): 478-81, 2010 May.
Article in English | MEDLINE | ID: mdl-20189357

ABSTRACT

Tigecycline resistance remains rare amongst Enterobacteriaceae in the UK, as elsewhere, but has been associated with upregulation of the AcrAB efflux system. Using isolates of an Enterobacter cloacae strain that developed tigecycline resistance in vivo during ciprofloxacin therapy as well as laboratory-selected mutants, we investigated the role of this pump and the global regulator RamA in tigecycline resistance. Laboratory mutants were selected from a susceptible clinical isolate in vitro by exposure to increasing concentrations of tigecycline. Expression of the acrAB operon and the ramA gene was monitored by real-time reverse-transcription polymerase chain reaction (RT-PCR). Overexpression of ramA was achieved using the pBAD expression vector, whilst insertional inactivation of acrB with a gentamicin resistance cassette was achieved with the bacteriophage lambda Red recombination system. Increased tigecycline minimum inhibitory concentrations in the clinical isolate and a laboratory mutant were associated with increases in acrAB and ramA transcripts. Induction of increased ramA expression resulted in increased acrAB expression, whilst insertional inactivation of acrB restored full susceptibility to tigecycline. Treatment with ciprofloxacin, a substrate of AcrAB in E. cloacae, possibly selected for cross-resistance to tigecycline as a result of RamA-mediated AcrAB upregulation.


Subject(s)
Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Ciprofloxacin/therapeutic use , Drug Resistance, Bacterial , Enterobacter cloacae/drug effects , Enterobacteriaceae Infections/microbiology , Minocycline/analogs & derivatives , Bacterial Proteins/genetics , Bacterial Typing Techniques , Bacteriophage lambda/genetics , DNA Fingerprinting , DNA, Bacterial/chemistry , DNA, Bacterial/genetics , Electrophoresis, Gel, Pulsed-Field , Enterobacter cloacae/isolation & purification , Enterobacteriaceae Infections/drug therapy , Gene Expression Profiling , Humans , Male , Membrane Transport Proteins/genetics , Microbial Sensitivity Tests , Minocycline/pharmacology , Molecular Sequence Data , Mutagenesis, Insertional , Mutation , Reverse Transcriptase Polymerase Chain Reaction , Selection, Genetic , Sequence Analysis, DNA , Tigecycline , United Kingdom
12.
BMC Pulm Med ; 10: 7, 2010 Feb 22.
Article in English | MEDLINE | ID: mdl-20170555

ABSTRACT

BACKGROUND: Previous health economic studies recommend either a dual screening strategy [tuberculin skin test (TST) followed by interferon-gamma-release assay (IGRA)] or a single one [IGRA only] for latent tuberculosis infection (LTBI), the former largely based on claims that it is more cost-effective. We sought to examine that conclusion through the use of a model that accounts for the additional costs of adverse drug reactions and directly compares two commercially available versions of the IGRA: the Quantiferon-TB-Gold-In-Tube (QFT-GIT) and T-SPOT.TB. METHODS: A LTBI screening model directed at screening contacts was used to perform a cost-effectiveness analysis, from a UK healthcare perspective, taking into account the risk of isoniazid-related hepatotoxicity and post-exposure TB (2 years post contact) using the TST, QFT-GIT and T-SPOT.TB IGRAs. RESULTS: Examining costs alone, the TST/IGRA dual screening strategies (TST/T-SPOT.TB and TST/QFT-GIT; 162,387 pounds and 157,048 pounds per 1000 contacts, respectively) cost less than their single strategy counterparts (T-SPOT.TB and QFT-GIT; 203,983 pounds and 202,921 pounds per 1000 contacts) which have higher IGRA test costs and greater numbers of persons undergoing LTBI treatment. However, IGRA alone strategies direct healthcare interventions and costs more accurately to those that are truly infected.Subsequently, less contacts need to be treated to prevent an active case of TB (T-SPOT.TB and QFT-GIT; 61.7 and 69.7 contacts) in IGRA alone strategies. IGRA single strategies also prevent more cases of post-exposure TB. However, this greater effectiveness does not outweigh the lower incremental costs associated with the dual strategies. Consequently, when these costs are combined with effectiveness, the IGRA dual strategies are more cost-effective than their single strategy counterparts. Comparing between the IGRAs, T-SPOT.TB-based strategies (single and dual; 39,712 pounds and 37,206 pounds per active TB case prevented, respectively) were more cost-effective than the QFT-GIT-based strategies (single and dual; 42,051 pounds and 37,699 pounds per active TB case prevented, respectively). Using the TST alone was the least cost-effective (47,840 pounds per active TB case prevented). Cost effectiveness values were sensitive to changes in LTBI prevalence, IGRA test sensitivities/specificities and IGRA test costs. CONCLUSION: A dual strategy is more cost effective than a single strategy but this conclusion is sensitive to screening test assumptions and LTBI prevalence.


Subject(s)
Enzyme-Linked Immunosorbent Assay/economics , Mass Screening/economics , Tuberculin Test/economics , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/economics , Contact Tracing/economics , Contact Tracing/methods , Cost-Benefit Analysis , Decision Trees , Health Care Costs , Humans , Incidence , Interferon-gamma/metabolism , Mass Screening/methods , Prevalence , Sensitivity and Specificity , Tuberculosis, Pulmonary/epidemiology , United Kingdom/epidemiology
13.
J Infect ; 59(3): 167-87, 2009 Sep.
Article in English | MEDLINE | ID: mdl-19643501

ABSTRACT

SUMMARY AND KEY RECOMMENDATIONS: The aim of these guidelines is to describe a practical but evidence-based approach to the diagnosis and treatment of central nervous system tuberculosis in children and adults. We have presented guidance on tuberculous meningitis (TBM), intra-cerebral tuberculoma without meningitis, and tuberculosis affecting the spinal cord. Our key recommendations are as follows: 1. TBM is a medical emergency. Treatment delay is strongly associated with death and empirical anti-tuberculosis therapy should be started promptly in all patients in whom the diagnosis of TBM is suspected. Do not wait for microbiological or molecular diagnostic confirmation. 2. The diagnosis of TBM is best made with lumbar puncture and examination of the cerebrospinal fluid (CSF). Suspect TBM if there is a CSF leucocytosis (predominantly lymphocytes), the CSF protein is raised, and the CSF:plasma glucose is <50%. The diagnostic yield of CSF microscopy and culture for Mycobacterium tuberculosis increases with the volume of CSF submitted; repeat the lumbar puncture if the diagnosis remains uncertain. 3. Imaging is essential for the diagnosis of cerebral tuberculoma and tuberculosis involving the spinal cord, although the radiological appearances do not confirm the diagnosis. A tissue diagnosis (by histopathology and mycobacterial culture) should be attempted whenever possible, either by biopsy of the lesion itself, or through diagnostic sampling from extra-neural sites of disease e.g. lung, gastric fluid, lymph nodes, liver, bone marrow. 4. Treatment for all forms of CNS tuberculosis should consist of 4 drugs (isoniazid, rifampicin, pyrazinamide, ethambutol) for 2 months followed by 2 drugs (isoniazid, rifampicin) for at least 10 months. Adjunctive corticosteroids (either dexamethasone or prednisolone) should be given to all patients with TBM, regardless of disease severity. 5. Children with CNS tuberculosis should ideally be managed by a paediatrician with familiarity and expertise in paediatric tuberculosis or otherwise with input from a paediatric infectious diseases unit. The Children's HIV Association of UK and Ireland (CHIVA) provide further guidance on the management of HIV-infected children (www.chiva.org.uk). 6. All patients with suspected or proven tuberculosis should be offered testing for HIV infection. The principles of CNS tuberculosis diagnosis and treatment are the same for HIV infected and uninfected individuals, although HIV infection broadens the differential diagnosis and anti-retroviral treatment complicates management. Tuberculosis in HIV infected patients should be managed either within specialist units by physicians with expertise in both HIV and tuberculosis, or in a combined approach between HIV and tuberculosis experts. The co-administration of anti-retroviral and anti-tuberculosis drugs should follow guidance issued by the British HIV association (www.bhiva.org).


Subject(s)
Antitubercular Agents/therapeutic use , Tuberculosis, Meningeal/diagnosis , Tuberculosis, Meningeal/drug therapy , Adenosine Deaminase/cerebrospinal fluid , Adult , Antibiotics, Antitubercular/therapeutic use , Cerebrospinal Fluid/microbiology , Child , Ethambutol/therapeutic use , Humans , Isoniazid/therapeutic use , Mycobacterium tuberculosis/isolation & purification , Pyrazinamide/therapeutic use , Rifampin/therapeutic use , Spinal Puncture , Tuberculin Test , Tuberculoma, Intracranial/diagnosis , Tuberculoma, Intracranial/drug therapy , Tuberculosis, Spinal/diagnosis , Tuberculosis, Spinal/drug therapy
14.
Appl Environ Microbiol ; 72(2): 1226-30, 2006 Feb.
Article in English | MEDLINE | ID: mdl-16461670

ABSTRACT

Typing of F-specific RNA (FRNA) coliphages has been proposed as a useful method for distinguishing human from animal fecal contamination in environmental samples. Group II and III FRNA coliphages are generally associated with human wastes, but several exceptions have been noted. In the present study, we have genotyped and partially sequenced group III FRNA coliphage field isolates from swine lagoons in North Carolina (NC) and South Carolina (SC), along with isolates from surface waters and municipal wastewaters. Phylogenetic analysis of a region of the 5' end of the maturation protein gene revealed two genetically different group III FRNA subclusters with 36.6% sequence variation. The SC swine lagoon isolates were more closely related to group III prototype virus M11, whereas the isolates from a swine lagoon in NC, surface waters, and wastewaters grouped with prototype virus Q-beta. These results suggest that refining phage genotyping systems to discriminate M11-like phages from Q-beta-like phages would not necessarily provide greater discriminatory power in distinguishing human from animal sources of pollution. Within the group III subclusters, nucleotide sequence diversity ranged from 0% to 6.9% for M11-like strains and from 0% to 8.7% for Q-beta-like strains. It is demonstrated here that nucleotide sequencing of closely related FRNA strains can be used to help track sources of contamination in surface waters. A similar use of phage genomic sequence information to track fecal pollution promises more reliable results than phage typing by nucleic acid hybridization and may hold more potential for field applications.


Subject(s)
Coliphages/genetics , Coliphages/isolation & purification , Feces/virology , RNA Phages/genetics , RNA Phages/isolation & purification , Sus scrofa/virology , Water Microbiology , Animals , Base Sequence , Coliphages/classification , DNA, Viral/genetics , Genetic Variation , Humans , Molecular Sequence Data , North Carolina , Phylogeny , RNA Phages/classification , Sewage , South Carolina , Waste Disposal, Fluid , Water Pollution
15.
AIDS ; 19(17): 2038-41, 2005 Nov 18.
Article in English | MEDLINE | ID: mdl-16260914

ABSTRACT

The performance characteristics of the enzyme-linked immunospot assay (ELISPOT) assay (T-SPOT TB) for the diagnosis of latent tuberculosis infection in HIV-infected individuals are unknown. Given that ELISPOT enumerates Mycobacterium tuberculosis antigen-specific IFN-gamma-secreting T cells, HIV-associated immunosuppression might adversely affect test performance. However, we found that 28 out of 29 HIV-positive individuals (97%) gave evaluable test results, and performance was independent of the CD4 T-cell count. ELISPOT test performance appears to be independent of HIV-associated immunosuppression.


Subject(s)
HIV Infections/complications , T-Lymphocytes/immunology , Tuberculosis/diagnosis , Adult , CD3 Complex/immunology , CD4 Lymphocyte Count , Diagnostic Tests, Routine/methods , Enzyme-Linked Immunosorbent Assay/methods , Female , HIV Infections/immunology , Humans , Immune Tolerance/immunology , Interferon-gamma/immunology , Interleukin-2/immunology , Interleukin-4/immunology , Lymphocyte Count , Male , Phytohemagglutinins/immunology , RNA, Messenger/blood , RNA, Viral/blood , Tuberculosis/immunology
16.
J Public Health Manag Pract ; Suppl: S45-9, 2005 Nov.
Article in English | MEDLINE | ID: mdl-16205543

ABSTRACT

The unique vulnerability of the nation's ports to terrorist attacks and other major disasters requires development of specialized training approaches that integrate and connect critical stakeholders. In 2003, the University of South Carolina Center for Public Health Preparedness developed and held its first Coastal Terrorism workshop in conjunction with the National Oceanic and Atmospheric Administration. Key federal, regional, state, and coastal agency leaders were invited to the 2-day event to explore, in a no-risk environment, the crucial role that public health agencies would play in a covert biological agent incident aboard a cruise ship. The incident began as a possible outbreak of a Norwalk-like viral agent; however, as the scenario unfolded, evidence of a terrorist plot emerged. This immediately shifted the scenario from a public health-dominated incident to one directed by law enforcement. Communication and coordination issues surfaced illustrating potential conflicts between disciplines and jurisdictions in terms of roles and responsibilities of responding agencies. The goals of the workshop were to facilitate communication and interagency networking among coastal stakeholders while assessing their training and research needs and increasing their familiarity with resources and protocols regarding a bioterrorist coastal event. Positive systems changes were observed.


Subject(s)
Bioterrorism , Disaster Planning/organization & administration , Education/organization & administration , Public Health/methods , Disasters , Humans , South Carolina
17.
Nurse Educ Today ; 25(3): 181-8, 2005 Apr.
Article in English | MEDLINE | ID: mdl-15795020

ABSTRACT

This paper reports on a study of nursing graduates identified as high performers by their nursing unit managers. The study involved 17 graduates from two teaching hospitals, one in the inner city of Sydney and the other in regional New South Wales. The aim of this study was to identify the capabilities that were seen to be most important for successful nursing practice during the first 2-6 years following employment as registered nurses and to evaluate through backward mapping, the degree to which university programmes were developing these capabilities. This study is part of a larger scale study of a number of professional disciplines that will be used to shape the ongoing evolution of the undergraduate programmes in these disciplines at the University of Technology, Sydney (UTS). The results from this study provide evidence that while capability in technical skill is necessary for successful practice as a nurse, it is certainly not sufficient. A range of 'emotional intelligence' capabilities have been identified by both graduate nurses and their nursing unit managers as being significant factors for successful practice. It would be important that a curriculum provided a range of learning experiences that included content related to emotional intelligence, and it may be that by directing attention to the total undergraduate learning experience rather than just what is taught, that curriculum developers can do much to provide educational opportunities that encourage the capabilities identified.


Subject(s)
Curriculum , Education, Nursing , Nursing Staff, Hospital , Professional Competence , Program Development , Humans , Intelligence , Interpersonal Relations , New South Wales
19.
Sci Total Environ ; 284(1-3): 249-61, 2002 Feb 04.
Article in English | MEDLINE | ID: mdl-11846169

ABSTRACT

The objective of this study was to determine inorganic and organic contaminant concentrations in edible tissue of fish collected from eight coastal areas receiving wastewater discharges and from two reference locations. Trace metal residues were statistically similar regardless of the collection site. Zinc (100% detection in all samples), total mercury (100%), total arsenic (92%), copper (92%), and selenium (88%) were the more commonly detected trace metals. Mercury concentrations exceeded the Florida health-based standard of 0.5 microg/g for limited fish consumption in 30% of the total samples and averaged 0.40 (+/- 1 S.D. = 0.22, range < or = 0.08 to 0.85) microg/g wet weight. The average total PAH concentrations were 1.79 (+/- 1.60) ng/g (reference areas) and 2.17 (+/- 3.29) ng/g (wastewater-impacted areas). Pyrene was detected most frequently (63% of the total samples) and averaged 0.74 (+/- 0.35) ng/g wet wt. The average total PCB concentrations were 4.8 (+/- 7.1) ng/g (reference areas) and 31.6 (+/- 31.3) ng/g (wastewater-impacted areas) Concentrations of dieldrin and cis-chlordane were approximately eight times greater, respectively, in fish collected from wastewater receiving waters, whereas total DDT and total pesticide concentrations were not elevated in the same areas. Concentrations of total PCBs and all chlorinated pesticides were below US health-based standards. The lack of a published reference data base for fish tissue quality in near-coastal areas of the Gulf of Mexico restricts an assessment of the environmental significance of results from this and similar studies investigating the fate of point source contaminants.


Subject(s)
DDT/analysis , Fishes , Insecticides/analysis , Metals, Heavy/analysis , Polycyclic Aromatic Hydrocarbons/analysis , Water Pollutants, Chemical/analysis , Animals , Environmental Exposure , Mexico , Tissue Distribution , United States , Waste Disposal, Fluid , Water Movements
SELECTION OF CITATIONS
SEARCH DETAIL
...