Reporting viral load and CD4 counts is a critical first step in calculating community viral load. In August 2011, CDC released Guidance on Community Viral Load: Measures, Definitions, and Methods for Calculation to describe the concept of community viral load and provide definitions of and methods for calculating community viral load and related measures. The Guidance proposes common language for viral load (VL) measurements, which include four measures of viral load for an HIV-infected population.

Today is National Black HIV/AIDS Awareness Day (NBHAAD). The theme for this observance day, “I Am My Brother/Sister’s Keeper: Fight HIV/AIDS!” holds much significance as we reflect on opportunities to bring an end to the spread of HIV in the United States.

UNICEF held a photography workshop with 20 students in South Africa’s poorest province.

Part II of II: UNICEF held a photography workshop for 16 young people in the West Bank of the Occupied Palestinian Territory.

Part I of II: UNICEF held a photography workshop for 16 young people in the West Bank of the Occupied Palestinian Territory.

Nineteen of Mongolia's 21 provinces continue to face emergency conditions caused by heavy snow and extreme cold.

TB and MDR/XDR-TB in the EU and EEA countries: managed or mismanaged?

Eur Respir J. 2012 Feb 9;

Authors: Migliori GB, Sotgiu G, D'Ambrosio L, Centis R, Lange C, Bothamley G, Cirillo DM, De Lorenzo S, Guenther G, Kliiman K, Muetterlein R, Spinu V, Villar M, Zellweger JP, Sandgren A, Huitric E, Manissero D

Abstract
In spite of the growing awareness of emerging drug-resistant M. tuberculosis, the extent of inappropriate tuberculosis (TB) case-management may be underestimated, even in Europe.We evaluated TB case-management in the EU/EEA countries, with special focus on multi- and extensively drug-resistant (MDR/XDR) TB, using a purposely developed, standardised survey tool.National reference centres in five countries representing different geographical, socio-economical and epidemiological patterns of TB in Europe were surveyed. Forty consecutive, original clinical TB case-records (30 MDR-/XDR-TB) in each of the 5 countries were reviewed. The findings were recorded and, through the survey tool, compared with previously agreed and identified international standards.Deviations from international standards of TB care were observed in the areas of surveillance (no information available on patient outcomes), infection control (lack of respiratory isolation rooms/procedures, and negative-pressure ventilation rooms), clinical management of TB, MDR-TB and HIV co-infection (inadequate bacteriological diagnosis, regimen selection and treatment duration), laboratory support and diagnostic/treatment algorithms.Gaps between present international standards of care and the management of MDR/XDR-TB patients were identified. Training, increased awareness, promotion of standards, and allocation of appropriate resources are necessary to ensure appropriate care and management as well as to prevent further emergence of drug-resistance.

PMID: 22323578 [PubMed - as supplied by publisher]

Surgical Face Masks Worn By Multidrug-Resistant Tuberculosis Patients: Impact on Infectivity of Air on a Hospital Ward.

Am J Respir Crit Care Med. 2012 Feb 9;

Authors: Dharmadhikari AS, Mphahlele M, Stoltz A, Venter K, Mathebula R, Masotla T, Lubbe W, Pagano M, First M, Jensen PA, van der Walt M, Nardell EA

Abstract
RATIONALE AND OBJECTIVES: Drug-resistant tuberculosis transmission in hospitals threatens staff and patient health. Surgical face masks used by TB patients are believed to reduce transmission, but have not been rigorously tested. We sought to quantify their efficacy when worn by multidrug resistant tuberculosis (MDR-TB) patients. METHODS: Over 3 months, 17 pulmonary MDR-TB patients occupied an MDR-TB ward in South Africa and wore face masks on alternate days. Ward air was exhausted to two identical chambers each housing 90 pathogen-free guinea pigs that breathed ward air either when patients wore surgical face masks (intervention group) or when patients did not wear masks (control group). Efficacy was based on differences in guinea pig infections in each chamber. MEASUREMENTS AND MAIN RESULTS: 69/90 control guinea pigs (76.6%; 95% CI: 68 - 85%) became infected, compared to 36/90 intervention guinea pigs (40%; 95% CI: 31 - 51%), representing a 56% (95% CI: 33% - 70.5%) decreased risk of tuberculosis transmission when patients used masks. CONCLUSIONS: Surgical face masks on MDR-TB patients significantly reduced transmission and offer an adjunct measure for reducing TB transmission from infectious patients.

PMID: 22323300 [PubMed - as supplied by publisher]

Microcolonies in fluoroquinolone agar proportion susceptibility testing of Mycobacterium tuberculosis: an indicator of drug resistance.

Eur J Clin Microbiol Infect Dis. 2012 Feb 10;

Authors: Blackman A, May S, Devasia RA, Maruri F, Stratton C, Sterling TR

Abstract
Microcolony growth of Mycobacterium tuberculosis on agar proportion susceptibility testing is neither well-defined nor previously reported with fluoroquinolone susceptibility testing. We describe here M. tuberculosis microcolony growth with fluoroquinolones, and assess its clinical significance. We screened 797 M. tuberculosis isolates for ofloxacin resistance (2.0 μg/mL) by agar proportion; 19 ofloxacin-resistant and 38 ofloxacin-susceptible isolates were selected for more detailed susceptibility testing with ofloxacin, ciprofloxacin, levofloxacin (all at 2.0 μg/mL) and moxifloxacin (0.5 μg/mL). The 57 isolates were also tested at two concentrations both above and below the critical concentrations. Microcolonies were defined as colonies 0.2-0.4 mm in diameter; confirmed microcolonies were present on repeat testing. Of the 57 isolates tested in detail, 7 grew microcolonies, of which 2 (0.3% of all isolates tested) had confirmed microcolonies on repeat testing (6 tests performed, and microcolonies were present on at least 4). Both M. tuberculosis isolates were ofloxacin-resistant on screening, and had ofloxacin minimum inhibitory concentration (MIC) >8 μg/mL. The five other isolates were ofloxacin-susceptible on screening, but had regular colony growth (i.e., resistance) at the drug concentration that initially resulted in microcolonies (ofloxacin 0.5 or 1.0 μg/mL). Microcolonies were observed infrequently with fluoroquinolone susceptibility testing, but when confirmed, they were associated with drug resistance.

PMID: 22322359 [PubMed - as supplied by publisher]

Production and Evaluation of Antibodies and Phage Display-Derived Peptide Ligands for Immunomagnetic Separation of Mycobacterium bovis.

J Clin Microbiol. 2012 Feb 8;

Authors: Stewart LD, McNair J, McCallan L, Thompson S, Kulakov LA, Grant IR

Abstract
This study describes the development and optimisation of an immunomagnetic separation (IMS) method to isolate Mycobacterium bovis cells from lymph node tissues. Gamma-irradiated whole M. bovis AF2122/97 cells and ethanol-extracted surface antigens of such cells were used to produce M. bovis-specific polyclonal and monoclonal antibodies in rabbits and mice. They were also used to generate M. bovis-specific peptide ligands by phage display biopanning. The various antibodies and peptide ligands obtained were coated onto MyOne Tosylactivated Dynabeads (Invitrogen), singly or in combination, and evaluated for IMS. Initially, M. bovis capture from Middlebrook 7H9 broth suspensions (concentration range, 10(5) - 10 CFU/ml) was evaluated by IMS combined with an M. bovis-specific touchdown PCR. IMS-PCR results, and subsequently IMS-culture results, indicated that the beads with greatest immunocapture capability for M. bovis in broth were those coated simultaneously with a monoclonal antibody and a biotinylated 12-mer peptide. These dually-coated beads exhibited minimal capture (mean 0.36 % recovery) of twelve other Mycobacterium spp. occasionally encountered in veterinary TB diagnostic laboratories. When applied to various M. bovis-spiked lymph node matrices the optimised IMS method demonstrated excellent detection sensitivity (limits of detection 50% of 3.16 and 57.7 CFU/ml of lymph node tissue homogenate for IMS-PCR and IMS-culture, respectively). The optimised IMS method, therefore, has the potential to improve isolation of M. bovis from lymph nodes and hence diagnosis of bovine tuberculosis.

PMID: 22322353 [PubMed - as supplied by publisher]

Epidemiological significance of the domestic Black Pig (Sus scrofa) in the maintenance of Bovine Tuberculosis in Sicily.

J Clin Microbiol. 2012 Feb 8;

Authors: Di Marco V, Mazzone P, Capucchio MT, Boniotti MB, Aronica V, Russo M, Fiasconaro M, Cifani N, Corneli S, Biasibetti E, Biagetti M, Pacciarini ML, Cagiola M, Pasquali P, Marianelli C

Abstract
Bovine tuberculosis (bTB) is an emerging disease among wild animals in many parts of the world. Wildlife reservoir hosts may thus represent a potential source of infection for livestock and humans. We investigated the role played by the Sicilian black pig, an autochthonous free or semi-free ranging domestic pig breed, as a potential source of bTB infection in an area where bTB prevalence in cattle is high.We initially performed a preliminary field study to assess the occurrence of bTB in such animals. We sampled 119 pigs at abattoir, and found 6.7% and 3.4% of them to be affected by gross tuberculous-like lesions (TBL) and M. bovis culture positive, respectively. We then proceeded to investigate the dissemination and characteristics of lesions in a second field study performed on 100 animals sampled from infected herds. Here, tissues collected at abattoir were examined macroscopically, microscopically and by culture tests. Most pigs with TBL showed generalized lesions affected ones in both gross and histological examinations (53% and 65.5%, respectively). Head lymph nodes were the most frequently affected in both localized and generalized TB cases observed macroscopically and microscopically. M. bovis was the most frequently isolated etiologic agent. The molecular characterization of isolates from both field studies by spoligotyping and analysis of 12 MIRU-VNTR loci, followed by their comparison to isolates of cattle origin, suggested a potential transmission of mycobacteria from domestic animals to black pigs and vice versa. Our findings, along with ethological, ecological, and management considerations, suggest that the black pig might act as a bTB reservoir in the ecosystem under study. However, additional studies will be necessary to establish the true epidemiological significance of the Sicilian black pig.

PMID: 22322347 [PubMed - as supplied by publisher]

[Surgical treatment strategies for severe cervicothoracic kyphosis].

Zhonghua Yi Xue Za Zhi. 2011 Oct 25;91(39):2779-81

Authors: Ma J, Jia LS, Shao J, Song J, Zhou XH

Abstract
OBJECTIVE: To analyze the outcomes of surgical treatment for severe cervicothoracic kyphosis.
METHODS: A retrospective study was performed for a total of 7 patients with severe cervicothoracic kyphosis. There were congenital malformation (n = 5) and cervicothoracic tuberculosis (n = 2). The mean preoperative Cobb angle of kyphosis was 89.3° (range: 72 - 103°). The average JOA (Japanese Orthopedic Association) score of neurological function was 11.2 ± 1.2 points. Preoperative halo-pelvic traction was performed and maintained for 25 - 40 days according to the patient conditions. Then posterior instrumented fusion was performed.
RESULTS: The average postoperative JOA score was 15.4 ± 1.6 points. The mean immediate postoperative Cobb angle was 53.4° (range: 45 - 67°). A mean correction rate of 40.2% was achieved. All patients were followed up for a mean of 18 months (range: 10 - 24). And a mean correction loss of 2.5° was observed at the final follow-up. Two patients had transient upper limb pain during distraction. There were no intra-operative or post-operative occurrences of spinal cord injury and other neurological complications.
CONCLUSION: Halo-pelvic traction plus posterior spondylodesis may be a safe and effective therapy of severe cervicothoracic kyphotic deformity.

PMID: 22322060 [PubMed - in process]

Novel metal based anti-tuberculosis agent: Synthesis, characterization, catalytic and pharmacological activities of copper complexes.

Eur J Med Chem. 2012 Jan 18;

Authors: Joseph J, Nagashri K, Janaki GB

Abstract
Copper complexes of molecular formulae, [CuL(1)(OAc)], [CuL(2)(H(2)O)], [CuL(3)(H(2)O)], [CuL(4)(H(2)O)], [CuL(5)(H(2)O)] where L(1)-L(5) represents Schiff base ligands [by the condensation of 3-hydroxyflavone with 4-aminoantipyrine (L(1))/o-aminophenol (L(2))/o-aminobenzoic acid (L(3))/o-aminothiazole (L(4))/thiosemicarbazide (L(5))], have been prepared. They were characterized using analytical and spectral techniques. The DNA binding properties of copper complexes were studied using electronic absorption spectra and viscosity measurements. Superoxide dismutase and antioxidant activities of the copper complexes have also been studied. Furthermore, the copper complexes have been found to promote pUC18 DNA cleavage in the presence of oxidant. Anti-tuberculosis activity was also performed.

PMID: 22321994 [PubMed - as supplied by publisher]

[A scoring model for a differential diagnosis of tuberculous and non-tuberculous pleurisy].

Zhonghua Yi Xue Za Zhi. 2011 Sep 13;91(34):2392-6

Authors: Sun Q, Xiao HP, Sha W

Abstract
OBJECTIVE: To evaluate various clinical features and laboratory biochemical markers so as to develop a predictive model for differentiating tuberculous pleurisy (TBP) from non-tuberculous pleurisy (non-TBP).
METHODS: A total of 241 TBP patients and 212 non-TBP patients who were hospitalized between January 2007 and December 2009 at our hospital were studied retrospectively. Their symptoms and laboratory parameters were recorded. The statistically different variables were selected to undergo binary logistic regression to calculate a scoring system (range: 0 - 10) according to their β coefficients. A receiver operating characteristic (ROC) curve was used to calculate the best cut-off value. The performance of the model was tested in a sample of 82 new cases with pleural exudates.
RESULTS: Seven variables were selected in the present scoring model: temperature > 38°C (1.0 point), purified protein derivative testing positive (1.0 point), serum C-reactive protein ≥ 26 mg/L (1.5 points), pleural fluid lymphocyte percentage ≥ 85% (1.0 point), pleural fluid protein ≥ 49 g/L (1.0 point), pleural fluid adenosine deaminase ≥ 43 U/L (2.5 points) and serum and/or pleural fluid mycobacterium tuberculosis antibody positive (2.0 points). With a cut-off value of 6.0 points, the sensitivity, specificity and accuracy of differentiating TBP from non-TBP was 90.1%, 94.3% and 92.1% respectively. With the application of this model, 82 new pleural effusions showed a sensitivity of 94.1%, a specificity of 93.8% and an accuracy of 93.9%.
CONCLUSION: The scoring model provided a simple and feasible way of facilitating a differential diagnosis of TBP and non-TBP patients.

PMID: 22321783 [PubMed - in process]

Evaluation of 24-locus MIRU-VNTR in extrapulmonary specimens: Study from a tertiary centre in Mumbai.

Tuberculosis (Edinb). 2012 Feb 7;

Authors: Vadwai V, Shetty A, Supply P, Rodrigues C

Abstract
Genotyping of Mycobacterium tuberculosis isolates is a useful tool for epidemiological control of tuberculosis (TB) and phylogenetic exploration of the pathogen. There is a lack of information on the discriminatory power of standard 24-locus mycobacterial interspersed repetitive unit (MIRU) - variable number tandem repeats (VNTR) in India, which has the highest tuberculosis (TB) burden worldwide. Therefore, we assessed its utility on 69 M. tuberculosis (MTB) isolates from patients with extrapulmonary tuberculosis, in comparison to standard insertion sequence (IS) 6110-Restriction fragment length polymorphism (RFLP) fingerprinting and spoligotyping. IS6110-RFLP (HGDI, 0.9987) identified a single cluster of 3 (4.3%) single-copy IS6110 isolates. Spoligotyping showed 69.5% clustering (HGDI, 0.8857). In contrast, MIRU-VNTR analysis identified 69 (100%) unique strains (HGDI, 1.0000). Within the study limits, this observed high discriminatory power suggests that 24-locus MIRU-VNTR genotyping could potentially be used to study long-term transmission of MTB infection in Mumbai. Moreover, high congruence between the MIRU-VNTR-based and spoligotyping-based strain groupings suggests that CAS, EAI and Beijing are the predominant strain lineages in the Mumbai TB patient population. The Beijing lineage isolates were found to be more significantly associated with multi-drug resistance (p < 0.01) than CAS and EAI lineages.

PMID: 22321730 [PubMed - as supplied by publisher]

[The progress of drug resistance detection in Mycobacterium tuberculosis].

Zhonghua Jie He He Hu Xi Za Zhi. 2011 Oct;34(10):768-70

Authors: Zhu CT, Hu ZY

PMID: 22321713 [PubMed - in process]

[Analysis of the antimycobacterial activities of rifabutin and the relationship between drug-resistance and rpoB mutations of Mycobacterium tuberculosis].

Zhonghua Jie He He Hu Xi Za Zhi. 2011 Oct;34(10):762-5

Authors: Han XQ, Huang HR, Li YJ, Yu X, Gao JT, Bi ZQ, Chu NH, Li L, Ma Y

Abstract
OBJECTIVE: To compare the antimycobacterial activities of rifampicin (RFP) and rifabutin (RBT), and to evaluate the correlation between RBT resistance and genetic alterations in the rpoB gene.
METHODS: The microplate-based alamar blue assay (MABA) method was performed to detect the antimycobacterial activities of RFP and RBT in 168 strains of Mycobacterium tuberculosis (M. tuberculosis). Meanwhile, we also analyzed the 81 bp core region of rpoB gene by DNA sequencing. The rate of gene mutations was analyzed by chi-square test.
RESULTS: RBT was sensitive for all of the 66 RFP-sensitive strains with no mutations in 81 bp core region of rpoB gene. But of the 102 RFP-resistant strains, 76 strains were also resistant to RBT. Cross resistance between RFP and RBT was 74.5% (76/102). Alterations at codons 516, 526, 531 in the rpoB gene correlated with resistance to both RFP and RBT. While point mutations at codons 511 and 533 possibly influenced the susceptibility to RFP but not to RBT. The mutation rate (92.1%, 70/76) of rpoB gene of RBT-resistant strains was significantly higher than that (23.9%, 22/92) of RBT-sensitive strains (χ(2) = 78.12, P < 0.05).
CONCLUSIONS: RBT was more active against M. tuberculosis as compared to RFP. The RFP-resistant strains with MIC ≤ 4 mg/L were still susceptible to RBT. Our results suggest that analysis of genetic alterations in the rpoB gene is useful for predicting RFP-resistance, and may have implications for evaluating RBT-resistance.

PMID: 22321711 [PubMed - in process]

Challenging Treatment of Multiple Late Complications After Endovascular Aneurysm Repair.

Ann Vasc Surg. 2012 Feb 8;

Authors: Vakhitov D, Suominen V, Pimenoff G, Uurto I, Saarinen J, Salenius JP

Abstract
BACKGROUND: To report a case of multiple additional procedures after successful endovascular treatment of abdominal aortic aneurysm. METHODS: An endovascular abdominal aortic aneurysm repair with a bifurcated aortic Vanguard endograft successfully performed in 1999 resulted in multiple complications, including endoleaks and a row separation, treated endovascularly. Subsequently, tuberculosis sepsis and prosthesis infection resulted in long-term antibiotic treatment. Additional graft leaks, aneurysm sack growth, and sack ruptures were also treated endovascularly because the patient consistently denied open repair. Endovascular procedures, however, did not solve the problem, turning to be increasingly challenging. The patient finally approved open graft removal and aortobifemoral reconstruction that were successfully performed 11 years after the initial endograft implantation. RESULTS: The patient has recovered from surgery well and is asymptomatic. No evidence of bacterial colonization was found according to the specimen taken during the laparotomy. CONCLUSION: Vanguard and other first-generation aortic endografts are associated with high incidence of complications and reinterventions. Open surgery is a method of choice in similar cases.

PMID: 22321484 [PubMed - as supplied by publisher]

Anti-tuberculosis prophylaxis following renal transplantation: acceptable variations?

Transpl Infect Dis. 2012 Feb 9;

Authors: Field M, Clarke A, Kelleher M, Hamsho A, Mellor S, Ready A, Inston N, van Dellen D

Abstract
BACKGROUND: Guidelines suggest tuberculosis (TB) prophylaxis in renal transplant recipients originating in endemic areas or in those at risk from non-endemic countries. Concern remains that these guidelines may fail to provide adequate prophylaxis for a cohort of patients who remain at potential risk. We aimed to determine variation patterns among different transplant units within the United Kingdom (UK) with regard to TB prophylaxis policy. METHODS: The renal pharmacist at each of the 25 UK renal transplant centers was contacted. Specific information was obtained relating to drug prophylaxis given, duration of treatment, as well as which transplant recipients were eligible for treatment. RESULTS: A 96% response rate (24/25 centers) was achieved. Prophylaxis regimens varied from no prophylaxis to isoniazid 300 mg given life-long. The most common duration of treatment was 6 months post transplantation (at 7 centers). Variations existed in the concurrent use of pyridoxine. A wide discrepancy was seen in the determination of who should receive prophylaxis, with no clear association with frequency of TB incidence in the region. CONCLUSIONS: A marked discrepancy exists among national renal transplant units in pharmacologic prophylaxis for TB, as well in the selection of individuals for this treatment.

PMID: 22321406 [PubMed - as supplied by publisher]

Universal post-arrival screening for child refugees in Australia: Isn't it time?

J Paediatr Child Health. 2012 Feb;48(2):99-102

Authors: Patradoon-Ho PS, Ambler RW

Abstract
It is known that the refugee population in Australia is at risk of tuberculosis (TB) and children with TB infection can develop active disease with devastating consequence. Currently, in New South Wales (NSW) and possibly other Australian States and Territories, there are different and complex health-screening pathways for newly arrived refugees. This is compounded by various factors, such as social and language difficulties for refugees to access healthcare and limited pre-embarkation screening. In this Viewpoint article, we present a child refugee in Australia with TB and use this case to reason why a universal post-arrival health screening programme should be established.

PMID: 22320270 [PubMed - in process]