Thesis (M.S.)--University of Wisconsin--Madison, 1967. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Includes bibliographical references (leaves 190-238). / Bacille Calmette-Guerin (BCG), the only currently available tuberculosis vaccine, is the most widely administered vaccine in the Expanded Programme on Immunisation (EPI). Despite this, many gaps in our knowledge of BCG-induced T cell responses exist. The primary objective of this study was to comprehensively delineate T cell immunity induced by BCG vaccination of newborns and to longitudinally assess BCG-specific T cell responses over the first year of life.

Thesis--Copenhagen. / Summary in Danish. Bibliography: p. 94-108.

Thesis--Copenhagen. / Summary in Danish. Bibliography: p. 94-108.

Thesis (M. Phil.)--University of Hong Kong, 2008. / Includes bibliographical references (p. 117-147) Also available in print.

Bibliography: leaves 215-226. / This study evaluates the costs and effectiveness of preventive and curative procedures currently available for Tuberculosis (TB) control purposes. The procedures examined are as follows : i) BCG vaccinations; ii) Secondary chemoprophylaxis; iii) Health education; iv) Mass screening campaigns; v) Investigation of contacts of infectious TB cases and symptomatic persons, i.e. suspects; and vi) Treatment regimens for notified TB patients. The analysis is largely based on data from the records of 300 randomly selected TB patients, treated at clinics in the Cape Divisional Council area in 1983. The major finding of this study is that resources available for TB control should be reallocated in the direction of secondary chemoprophylaxis, BCG vaccination administration in the Black and Coloured populations, investigation of contacts and suspects, and ambulatory treatment of notified TB patients. Conversely, vaccinating the White population, mass screening campaigns and hospitalisation of TB patients should be given relatively less emphasis in the overall TB control programme. In addition, the proportion of patients confirmed as TB cases by means of bacteriological examinations should be increased to reduce misdiagnosis.

Thesis (MScMedSc)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Individuals latently infected with Mycobacterium tuberculosis (M.tb) contain the infection without showing signs of illness. Steroid hormones such as glucocorticoids (GCs) however can lead to reactivation of TB. Currently two different injectable contraceptives are available in South Africa, medroxyprogesterone acetate (MPA) and norethisterone enanthate (NET). MPA is able to bind to and activate the glucocorticoid receptor (GR) and possesses selective GC activity, a pharmacological characteristic absent in NET. The aim of this study was to investigate the immune modulatory effects of the two contraceptives MPA and NET on immune responses to mycobacteria in vitro and in vivo. Human peripheral blood mononuclear cells (PBMCs) were infected with BCG (M. bovis Bacille Calmette-Guérin) and treated with MPA, NET, progesterone or cortisol and cytokine expression was measured in order to determine whether the synthetic progestins mimic endogenous progesterone or the GC cortisol. MPA, but not NET suppressed the expression of IFN-γ, IL-1α, IL-1β, IL-2, IL-12p40 and IL-13 similarly to cortisol. Furthermore expression of miRNAs, small double stranded RNA molecules that bind to complementary sequences in mRNAs of target genes and cause their degradation, was determined under the different experimental conditions. The expression of several miRNAs including miR-30c, miR-222, miR-454 and miR-331-3p were differentially influenced by MPA, cortisol and/or NET in PBMCs stimulated with BCG. For example, BCG induced the expression of miR-454 (p=0.003) which was then inhibited to basal levels by cortisol (p=0.008), MPA (p=0.002) and NET (p=0.002). These results demonstrate that steroid hormones including the contraceptives MPA and NET can modulate immune responses to mycobacteria at the miRNA level. To determine the effect of MPA and NET on BCG-induced expression of miRNAs in vivo a mouse model was used. C57BL/6 mice were injected weekly with either MPA or NET using a dose equivalent to humans and then infected with BCG. Mice treated with MPA had a higher spleen bacterial load 21 days after infection compared to both NET treated and control mice (p=0.023). In whole blood, MPA and NET treatment suppressed the BCG-induced production of miR-100 and miR-509-3p to basal levels. In contrast to NET, MPA induced expression of miR-99a expression independent of BCG infection. In the lung, the site of disease, a total number of 22 out of 377 miRNAs tested were differentially expressed 21 days after infection. The results of this study indicate that both synthetic progestins altered the immune response to BCG at the level of cytokine expression as well as the miRNA level. MPA was found to mimic cortisol by inhibiting secretion of inflammatory cytokines whereas NET appeared to have more progestogenic properties. Each of the steroid hormones was observed to induce a characteristic miRNA expression profile, both in vitro as well as in vivo, although not identical. These results highlight that the two contraceptives – although used interchangeably by women in developing countries - are pharmacologically unique and differentially modulate immune responses to mycobacteria. These data support the urgent need for further research into the link between hormonal contraceptives and susceptibility to infectious diseases. / AFRIKAANSE OPSOMMING: Individue wat latent met Mycobacterium tuberculosis ( M.tb ) geïnfekteer is, onderdruk die infeksie en wys geen simptome van die siekte nie. Steroïed hormone soos glukokortikoïede (GKe) kan egter tot die heraktivering van TB lei. Daar is tans twee verskillende inspuitbare voorbehoedmiddels beskikbaar in Suid-Afrika, medroksiprogesteroon-asetaat (MPA) en noretisteroon enantaat (NET). MPA is staat om aan die glukokortikoïed reseptor (GR) te bind en dit te aktiveer. MPA beskik ook selektiewe GK aktiwiteit, 'n farmakologiese eienskap wat afwesig is in NET. Die doel van hierdie studie was om die immuun-regulerende effekte van die twee voorbehoedmiddels, MPA en NET, op immuunresponse teen mikobakterieë in vitro en in vivo te ondersoek. Menslike perifêre bloed mononukleêre selle (PBMSe) is met BCG geïnfekteer en met MPA, NET, progesteroon of kortisol behandel. Sitokien uitdrukking was gemeet om vas te stel of die sintetiese progestiene, endogene progesteroon of die GK kortisol naboots. MPA, maar nie NET, onderdruk die produksie van IFN-γ, IL- 1α, IL- 1β, IL- 2, IL- 12p40 en IL- 13 soortgelyk aan kortisol. Verder is uitdrukking van miRNAs, klein dubbelstring RNS molekules wat aan komplimentêre volgorde in mRNAs van teiken gene bind en wat hul degradering veroorsaak, bepaal in elk van die verskillende eksperimentele toestande. Die uitdrukking van verskeie miRNAs insluitende miR-30c, miR-222, miR-454 en miR-331-3p is differensieël beïnvloed deur MPA, kortisol en/of NET in PBMSe wat met BCG gestimuleer is. Byvoorbeeld, BCG veroorsaak die uitdrukking van miR-454 wat dan geïnhibeer word tot agtergrondvlakke deur kortisol, MPA en NET. Hierdie resultate toon dat steroïed hormone, insluitend die voorbehoedmiddels MPA en NET, die immuunrespons teen mikobakterieë op miRNA-vlak affekteer. Om die effek van MPA en NET op BCG-geïnduseerde uitdrukking van miRNAs in vivo te bepaal, is ʼn muismodel gebruik. C57BL/6 muise is weekliks met 'n dosis van MPA of NET, ekwivalent aan dosisse gebruik in die mens, ingespuit en met BCG geïnfekteer. Muise wat met MPA behandel is, het 'n hoër bakteriële lading in die milt 21 dae na infeksie in vergelyking met NET-behandelde muise en kontrole muise. In hul bloed, onderdruk MPA en NET behandeling die BCG-geïnduseerde produksie van miR-100 en miR-509-3p tot basale vlakke. In teenstelling met NET, induseer MPA die uitdrukking van miR-99a onafhanklik van BCG infeksie. In die long is 'n totaal van 23 miRNAs differensieël uitgedruk 21 dae na die infeksie. Die resultate van hierdie studie dui daarop dat beide sintetiese progestien die immuunrespons teen BCG verander op sitokien sowel as miRNA vlak. MPA boots hoofsaaklik kortisol na deur inhibering van sitokien-produksie terwyl NET meer progesterone eienskappe het. Op miRNA vlak veroorsaak elk van die steroïed hormone 'n kenmerkende miRNA uitdrukkingsprofiel, beide in vitro asook in vivo. Hierdie resultate beklemtoon dat die twee voorbehoedmiddels - alhoewel hulle afwisselend gebruik word deur vroue in ontwikkelende lande - farmakologies uniek is en differensieël die immuunrespons reguleer teen Mycobacterium. Hierdie data ondersteun die dringende behoefte aan verdere navorsing in verband met hormonale voorbehoedmiddels en vatbaarheid vir aansteeklike siektes.

published_or_final_version / Paediatrics and Adolescent Medicine / Master / Master of Philosophy

Two epidemiological studies, designed to expand our knowledge of morbidity and mortality indicators concerning malaria and Bacillus Calmette-Guerin vaccination in the Hospital Albert Schweitzer health district located in Central Haiti's Artibonite Valley, are presented. The hospital serves a rural population of 190,000 in its 610 square mile district. A large proportion of the rural population still relies on traditional healers in times of illness. Consequently, accurate morbidity and mortality data from individuals and communities in the district are scarce. The first study investigated an outbreak of axillary lymphadenitis and abscesses after Bacillus Calmette-Guerin vaccination among rural Haitian children treated at Hospital Albert Schweitzer from January 1986 through March 1991. Seventy-seven cases of vaccine-related complications were identified, all among children immunized before the age of 1 year. The proportions of children with complications were 0.017% for 1986 through 1989, 0.91% for 1990, and 2.2% for January through March 1991. The probable explanation for the increase is a change in the BCG strain or in the reactogenicity of the Pasteur strain. / Graduation date: 1994

The persistent increase of bovine tuberculosis (bTB) over the past twenty years has put a substantial strain on both the British economy and the welfare of livestock. However, the development of an effective bTB vaccine has been continually hindered by the lack of knowledge on the immune response following Mycobacterium bovis (M. bovis) infection. In collaboration with the TB Research Group at the Veterinary Laboratories Agency (VLA, Surrey), this thesis is part of a much wider strategy managed by the Department of Environment, Food and Rural Agency (DEFRA) aimed at elucidating the immunopathogenesis of M. bovis and to develop more effective infection control measures. The specific focus of this thesis was to enable a stronger understanding of the bovine immune response over different periods of M. bovis infection and to apply this new knowledge in evaluating the efficacy of a novel BCG vaccination. Time Course Study: Knowledge of time dependent cytokine expression following M. bovis infection would aid vaccine development by revealing potential correlates of protection. Interferon gamma (IFN-γ), tumour necrosis factor alpha (TNF-α), interleukin (IL) 4 and 10 expression were analysed using quantitative (q) PCR in formalin fixed bovine lymph nodes following five, twelve and nineteen weeks of M. bovis infection. A strong pro-inflammatory/ T helper 1 (TH1) lymphocyte response was evident at five weeks post M. bovis infection, represented by IFN-γ and TNF-α expression (log2 copies of 6.5 and 2.15, respectively) in the absence of IL4. Between five and twelve weeks of infection, a significant increase was observed in IL10 (log2 copies from 5.97 to 8.27, p<0.01, Mann Whitney test), accompanied by an increase in both IFN-γ (log2 7.53) and TNF-α (log2 3.94). This data conformed to a recently described aspect of TH1 lymphocytes, a ‘self-limiting’ nature in which cells produced both IFN-γ and IL10 with the aim of controlling the heightened pro-inflammatory response. The role of IL10 as an immunosuppressive became evident when comparing cytokine expression between four different types of thoracic lymph node; the left bronchial (LB), cranial mediastinal (CRM), caudal mediastinal (CM) and cranial tracheobronchial (CRT) nodes. The LB and CRM lymph nodes produced significantly higher levels of IFN-γ expression (log2 copies between 8.2 and 10) as compared to the CM and CRT (log2 copies between 2.6 and 5.5, p<0.001, Mann Whitney test). Further analysis of the data as a profile of cytokine expression for each lymph node type revealed that IFN-γ was dominantly expressed within the LB and CRM nodes, whereas within the CM and CRT nodes, IL10 was the dominant cytokine. The former nodes also displayed a higher level of pathological damage (represented by mean percentage area coverage of granuloma, 33.6 and 20%, respectively) as compared to the CM (13%) and the CRT lymph node types (10.8 %). This suggests conflicting roles for IFN-γ and IL10 in the development of immune-associated pathology. Following nineteen weeks of infection, the expression levels of IFN-γ, TNF-α and IL10 reduced (log2 6.22, 3.02 and 7.03, respectively) implying a loss of the cellular response. The later stages of bovine tuberculosis have been shown within the literature to display characteristics of a humoral rather than cell mediated response. However, within this study at nineteen weeks post infection IL4 (an important cytokine in the development of the humoral response) remained undetectable. The results from this study therefore confirm the importance of the cell mediated immune profile in response to M. bovis infection as well as the integral role of IFN-γ in both protection and pathology. It also further demonstrates the involvement of IL10 in controlling the IFN-γ response and highlights this cytokine as being potentially important in future immunologybased vaccination studies. BCG Vaccination Study: The current vaccine used against human tuberculosis, BCG, has provided variable results on protection against infection in experimental bovine studies. The BCG bacterium has lost a comparatively large quantity of genomic DNA through attenuation since its primary production in 1921, of which the majority represented genes encoding antigenic proteins. MPB70 and MPB83 are differentially expressed between BCG sub-strains due to a single nucleotide polymorphism in the alternative sigma factor K (SigK). BCG Pasteur has been shown to produce low levels of these antigenic proteins; however complementation of BCG Pasteur with a copy of sigK from BCG Russia resulted in up-regulating expression. It was therefore hypothesised that the recombinant BCG (sigK) Pasteur would prove more efficient in controlling M. bovis infection by inducing a stronger protective immune response post vaccination. IFN-γ, TNF-α, IL 4 and 10 expression were analysed using qPCR within the freshly dissected lymph nodes of five experimental cattle groups; BCG Pasteur vaccinated M. bovis challenged, BCG (sigK) Pasteur vaccinated challenged, non-vaccinated infected, non-vaccinated noninfected and BCG Pasteur vaccinated non-infected. Five weeks following infection, a strong IFN-γ mRNA response was detected in both the non-vaccinated and vaccinated cattle (mean log2 copies between 9.6 and 10.5 as compared to between 7.84 and 8.58 in the non-infected cattle). M. bovis infection also induced a significant reduction in IL10 mRNA levels in both vaccinated and non-vaccinated cattle (mean log2 14.4 in the infected groups compared to 15.5 in the non-infected cattle, p<0.005, Mann Whitney test) although there was little difference in TNF-α expression (mean log2 copies between 11.06 and 11.8 in all five groups). Interestingly, IL4 mRNA was detectable only within the two non-infected control groups (mean log2 12.4), further supporting the concept of a strong cell mediated response after five weeks of infection. Vaccination prior to challenge had an effect on IFN-γ mRNA levels only, as both the BCG Pasteur and BCG (sigK) Pasteur vaccinated groups displayed a smaller increase in IFN-γ mRNA following challenge (mean log2 10.3 and 9.6, respectively) as compared to the nonvaccinated group (mean log2 10.5). This reflected the role of vaccination in priming the immune response to enable more rapid elimination of the bacteria and subsequently inducing a lesser pro-inflammatory response. Interestingly, the BCG Pasteur vaccinated group appeared to control the immune response to a greater extent, as IFN-γ mRNA was significantly similar to that observed in the non-vaccinated non-infected group (mean log2 8.58, p>0.05, Mann Whitney test). In addition to the qPCR data, levels of IFN-γ and TNF-α protein (represented by the number of cells producing these proteins) were also analysed by immunohistochemistry. IFN-γ protein in the five experimental groups displayed the same pattern as that observed for IFN-γ mRNA expression (p<0.001, Spearmans correlation coefficient). However, analysis of TNF-α protein revealed significant differences between the five groups (p<0.005, Kruskal Wallis test) in contrast to that observed for the mRNA levels (p>0.05, Spearmans correlation coefficient) suggesting that posttranscriptional controls may play an important role in TNF-α translation. The difference in IFN-γ mRNA and protein expression between the two vaccination groups was also reflected within the pathological data. Although both BCGs reduced levels to below that of the non-vaccinated group (represented by mean percentage area coverage of granuloma, 59%), the BCG Pasteur group displayed less pathology (mean 6%) compared to the BCG (sigK) Pasteur cattle (mean 35%). It was suggested that the increased antigenic repertoire of the recombinant BCG (sigK) Pasteur did result in a stronger stimulation of the immune response post vaccination but that, as a consequence the bacterial threat was eliminated more rapidly.