Vertebral destruction in tuberculous spondylitis correlates with Toll-like Receptor 4 (TLR-4) levels: a cross-sectional study.

Background: Tuberculous (TB) spondylitis is a hazardous infectious disease causing significant spinal deformity. Increased toll-like receptor-4 (TLR-4) activity promotes more extensive infections in patients with TB spondylitis, so it has the potential to be used as a biomarker to predict the severity. This study aims to determine the relationship between TLR-4 levels and the degree of vertebral destruction in TB spondylitis patients. Materials and methods: A cross-sectional study was conducted from May to October 2023. A total of 27 TB spondylitis samples were then measured for TLR-4 serum levels. Vertebral destruction is assessed based on the Spine At Risk Signs (SARS) criteria on X-ray and MRI examinations. Moreover, the degree of sensory and motor impairment was also assessed in this study. The Spearman correlation test assessed the correlation between TLR-4 levels and vertebral destruction. Results: Most of the samples in this study were less than 30 years old (10 people, 37%), female (14 people, 51.9%), had spinal destruction at 1 level (11 people, 40.7%), had paraplegia (8 people, 29.6%), and had hypoesthesia (11 people, 40.7%). TLR-4 levels had a mean value of 8254.1±1076.1 ng/ml. TLR-4 levels were positively correlated with the degree of vertebral destruction (r=0.599, P=0.001), motor disorders (r=0.632.x, P=0.000), and sensory disorders (r=0.574, P=0.002). Conclusion: TLR-4 levels are associated with the severity of vertebral destruction in TB spondylitis, so it has the potential to be used as a prognostic biomarker.

Single-nucleotide polymorphism of interleukin-10 promoter (IL-10 -819C/T) in leprosy patients with and without erythema nodosum leprosum, and healthy household contacts.

Leprosy, caused by Mycobacterium leprae, is a chronic infectious disease that impacts the skin and peripheral nerves, causing long-term disability. The invasion of M. leprae into the body triggers immunologic responses and single single-nucleotide polymorphisms in cytokine-encoding genes may influence predisposition and susceptibility, possibly predicting the incidence of leprosy reactions. The aim of this study was to assess the gene polymorphism of interleukin-10 promoter IL-10 -819C/T in leprosy patients, leprosy patients with erythema nodosum leprosum (ENL) reaction, and household contacts. A total of 54 individuals were included, with 18 in each group. Skin smear and histopathologic examinations were used to confirm the diagnosis of leprosy and ENL. The polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) technique was used to determine the polymorphism. The results confirmed the presence of polymorphism of which all TT, CT, and CC genotypes presented. The TT genotype was most prevalent in household contacts (94.4%) followed by ENL (50%), and leprosy patients (44.4%). The CT genotype was most frequently detected in leprosy patients (50%), followed by ENL cases (44.4%), and household contacts (5.56%). In contrast, CC was mostly presented in ENL cases (5.56%), only 1% in leprosy patients, and absent among household contacts. Although the most prevalent allele in all three groups was the T allele, the C allele presented in 27% and 30% of ENL and leprosy patients, respectively and only 5% in household contact individuals. This study suggests that the polymorphism variations of IL-10 -819C/T are higher in leprosy and ENL patients compared to household contacts. Since this data is preliminary, larger studies are needed.

Effects of probiotics on immunity and iron homeostasis: A mini-review.

Iron deficiency remains a major problem in both developed and developing countries. Iron supplementation has been used as a standard intervention for the prevention and treatment of iron deficiency anemia (IDA). There are many factors affecting the efficacy, including stunting, infections or inflammations, and genetics. Recently, some studies have been conducted to further investigate the effects of probiotics on immunity and iron homeostasis. This mini review discusses about some important factors that can improve the management of IDA.

Coexistence of tuberculous chancre on a chronic nonhealing wound and bilateral submandibular scrofuloderma.

Cutaneous tuberculosis is caused by Mycobacterium tuberculosis with varied clinical features depending on the dissemination route and host immune status. Scrofuloderma is a type of cutaneous tuberculosis that often occurs in locations where there is an infected lymph node or bone underneath, whereas tuberculous chancre often appears in sites that are prone to trauma. Although several cases have been reported, the coexistence of more than one type of cutaneous tuberculosis is very rare. We report a 21-year-old immunocompetent male with a chronic nonhealing lesion on the left tibia followed by bilateral purulent ulcers on the submandibular area. Acid-fast bacilli examination was positive for M. tuberculosis, and the patient was diagnosed with tuberculous chancre and scrofuloderma, respectively. This case showed the importance of high clinical suspicion of cutaneous tuberculosis and the possibility of the coexistence of more than one type of cutaneous tuberculosis in order to avoid misdiagnosis and delay in treatment.

Relationship between Vitamin D Level and Serum TNF-α Concentration on the Severity of Chronic Obstructive Pulmonary Disease.

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory disease and disturbed bacterial clearance. Vitamin D deficiency is sometimes observed in COPD patients and as significant roles in increasing inflammation of airway obstruction and systemic obstruction, increasing pro-inflammatory cytokine including TNF-α, reduction of bacterial clearance and increase exacerbation risk due to infection. Also, vitamin D plays significant roles in the metabolism of calcium and mineralisation of bones and regulation system of immune. TNF-α also has essential roles in pathogenesis and inflammation of COPD. Several studies that investigate the relationship between vitamin D level and serum TNF-α concentration in COPD patients are relatively uncommon, including in Indonesia. AIM: This study aimed to assess the relationship between vitamin D level and TNF-α concentration in patients on the severity of the chronic obstructive pulmonary disease. METHODS: This study was a hospital-based descriptive cross-sectional study. Total samples were 50 COPD patients with the average age of older than 60 years during their enrollments at the Department of Pulmonology and Respiratory Medicine of the Dr Wahidin Sudirohusodo General Hospital Makassar in September 2018-January 2019. All procedures of the present study were reviewed and approved by the Research Ethics Committee of Medicine Faculty of Hasanuddin University. The severity of COPD was assessed according to the combination of COPD assessment stages that referred to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guideline 2015 that consisted of the combination of scoring COPD Assessment Test (CAT), the modified Medical Research Council (mMRC) questionnaire and results of the spirometry measurement. Assessment of airway obstruction levels referred to the GOLD spirometry criteria. Determination of thoracic photographs was conducted to verify the COPD diagnosis of the severity of COPD. Determination of serum TNF-α concentration and vitamin D3 [1,25(OH)2D3] level used the ELISA method. RESULTS: The majority of COPD patients were observed in the category of older than 60 years old accounted for 34 COPD patients (68%), and the majority of COPD patients were males accounted for 47 males with COPD (94%). The majority of COPD patients were observed in the group of D (38%). All the study subjects observed in this study were smokers, and 82% of them were in the category of heavy smokers. 21 study subjects had higher concentration of serum TNF-α (tertile 3 = 0.21-1.83 pg/dl), 20 study subjects and lower level of vitamin D (tertile 1 = 182.1-364.5 pg/dl). The majority of the study subjects (38%) were in the category of severe COPD (category D of the severity of COPD at the tertile 3) according to the GOLD Combine Assessment. Given the relationship between vitamin D level and serum TNF-α concentration on the airway obstruction, there were significant positive correlations between the increase of vitamin D levels and the increase of serum TNF-α concentrations on airway obstruction. Given the relationship between vitamin D level and serum TNF-α concentration on the severity of COPD, there were significant positive correlations between the increase of vitamin D levels (tertiles 1, 2 and 3) and the increase of serum TNF-α concentrations on the severity of COPD at p-value < 0.05. Overall, there were non-linear relationships between vitamin D level and serum TNF-α concentration on the severity of COPD. CONCLUSIONS: Serum TNF-α concentration was positively associated with airway obstruction level and severity of COPD. Low level of vitamin D was negatively associated with airway obstruction level and severity of COPD. Vitamin D3 level (1,25(OH)2D) was negatively associated with serum TNF-α concentration and airway obstruction level and severity of COPD.

Presence of a mutation in ponA1 of Neisseria gonorrhoeae in numerous clinical samples resistant to various beta-lactams and other, structurally unrelated, antimicrobials.

The number of resistant strains in patients with Neisseria gonorrhoeae urethritis has been increasing, making effective treatment difficult. Chromosomally mediated penicillin-resistant N. gonorrhoeae arise through alterations in penicillin-binding proteins (PBPs) and a decrease in outer membrane permeability. To understand the occurrence of penicillin resistance in patients with N. gonorrhoeae infection, we performed this study. In addition, we studied minimum inhibitory concentrations (MICs) of antimicrobials against N. gonorrhoeae strains. We measured the MICs of penicillin G, other beta-lactams, and other kinds of antimicrobials against 53 clinical N. gonorrhoeae isolates from male patients with urethritis in Hyogo and Osaka, Japan. The ponA genes, encoding PBP 1 of these isolates, were sequenced. Of the 53 isolates tested, 41 strains showed some resistance to penicillin G. A mutation in the ponA (ponA1) gene was identified in 46 isolates. There was a tendency that ponA mutant (ponA1) in N. gonorrhoeae led to higher antimicrobial MICs of beta-lactam antimicrobial agents (including penicillin) than those of non-ponA mutants. However, we found lower than expected MICs of penicillin and beta-lactams even in ponA mutants. Therefore, we consider that detailed investigations for the further understanding of the effect of other genes, such as penC (which is reported to be related to ponA1 in achieving high-level penicillin resistance) should be our next step.