published_or_final_version / Public Health / Master / Master of Public Health

Clinical and epidemiological studies have provided a large body of evidence supporting a link between HIV and other sexually transmitted co-infections. Co-infections have been associated with promoting HIV transmission and acquisition. One of the closest studied interactions is the co-infection with N. gonorrhoeae, the etiological agent of gonorrhea, yet a clear understanding of this relationship is still elusive. Studies aimed at deciphering how N. gonorrhoeae mediates these effects have provided mixed results with some suggesting co-infection promotes HIV replication, and others suggesting the opposite. The aim of this thesis is to uncover molecular mechanisms that explain these results through in vitro co-infection studies using a combination of mixed peripheral mononuclear blood cells (PBMCs) and isolated human cell types. The results presented here demonstrate that gonococcal co-infection profoundly inhibits HIV replication in co-infected PBMCs. This inhibition is due to both the release of anti-HIV IFN via TLR9-mediated activation of plasmacytoid dendritic cells (pDCs), and the activation of  T cells. In addition, I show that responses between CD4+ T cell lines, such as the Jurkat cell line, and primary CD4+ T cells can differ, which may explain some of the contrasting results seen in published literature. The results in this thesis have implications for understanding the relationship between gonococci and HIV, providing new insight into molecular and immunological interactions that influence viral transmission, and reveal new opportunities to combat HIV.

Clinical and epidemiological studies have provided a large body of evidence supporting a link between HIV and other sexually transmitted co-infections. Co-infections have been associated with promoting HIV transmission and acquisition. One of the closest studied interactions is the co-infection with N. gonorrhoeae, the etiological agent of gonorrhea, yet a clear understanding of this relationship is still elusive. Studies aimed at deciphering how N. gonorrhoeae mediates these effects have provided mixed results with some suggesting co-infection promotes HIV replication, and others suggesting the opposite. The aim of this thesis is to uncover molecular mechanisms that explain these results through in vitro co-infection studies using a combination of mixed peripheral mononuclear blood cells (PBMCs) and isolated human cell types. The results presented here demonstrate that gonococcal co-infection profoundly inhibits HIV replication in co-infected PBMCs. This inhibition is due to both the release of anti-HIV IFN via TLR9-mediated activation of plasmacytoid dendritic cells (pDCs), and the activation of  T cells. In addition, I show that responses between CD4+ T cell lines, such as the Jurkat cell line, and primary CD4+ T cells can differ, which may explain some of the contrasting results seen in published literature. The results in this thesis have implications for understanding the relationship between gonococci and HIV, providing new insight into molecular and immunological interactions that influence viral transmission, and reveal new opportunities to combat HIV.

Understanding the extent of infection control measures to be taken to protect immunosuppressed and other types of patients from airborne infection agents during construction is crucial knowledge for both healthcare and construction professionals. The number of aspergillosis-related fatalities due to dust transmission during construction activity has decreased with the improvement of antifungal therapy, however the illness is particularly debilitating and the treatment is not always successful. This experimental work is the first stage in a research program to develop better dust controls for construction at existing medical facilities to reduce the incidence of dust borne fungi, such as Aspergillus spp. To better protect at-risk patients from exposure to Aspergillus spp. and other airborne fungal infections, an experiment was conducted to determine what materials can be used to create a barrier for infection control to moderate particle transmission from the construction area to the treatment area. This study investigated the relationship between construction barriers and particle transmission. A new experimental procedure and equipment simulates the transmission of disturbed dust from construction activity across a barrier. The effective of the barrier is determined from measured particle count on filter. The results show that an effective barrier manufactured from simple and readily available building supplies stops the transmission of 12-micron dust particles under a standard set of conditions. The test provides a simple and cost effective method to compare transmission rates for dust.

A enfermagem é uma profissão voltada para o cuidado das pessoas nas diferentes fases da vida, o ato de cuidar é a essência no fazer da enfermeira, e, possui uma inquietação com o conjunto de prioridade de pesquisa em seu meio. Neste sentido, a saúde materna considerada um indicador sensível à qualidade de vida de uma população é uma delas. O presente estudo é uma revisão integrativa da literatura que teve como objetivo descrever as infecções mais frequentes que a mulher está exposta durante o período puerperal, investigadas em publicações nacional e internacional da área da saúde, além de identificar o nível de evidência cientifica de cada artigo. Para a seleção dos estudos foram utilizadas três bases de dados, ScienceDirect, Pubmed e Lilacs. O recorte temporal foi de 2009 a 2013 e, a amostra foi composta por 19 artigos, relacionado à infecção puerperal. Os dados foram coletados da segunda quinzena de setembro à primeira de outubro. A análise dos estudos permitiu identificar que mais da metade das publicações foi no Brasil. Dois estudos identificaram enfermeiros como autores. A maioria dos periódicos de veiculação dos estudos era da área medica. Doze estudos apresentaram delineamento não experimental, três eram estudo de caso e quatro apresentaram delineamento experimental. As principais infecções puerperais encontradas foram a endometrite, a infecção urinária, a infecção do sítio cirúrgico, a sepse puerperal, a mastite, a cervicite. Os resultados mostraram que são necessárias mais pesquisas com delineamento experimental, principalmente no que tange a área da enfermagem. A avaliação rigorosa da puérpera no pós-parto, a adequada conduta para prevenção da infecção puerperal e/ou manejo das intervenções no cuidado da paciente com morbidade infecciosa, alicerçam ações indispensáveis da enfermeira na obtenção de um atendimento de enfermagem mais seguro, de qualidade, que promova o protagonismo da mulher nesta etapa importante de sua vida e lhe proporcione autonomia em relação aos seus direitos sexuais e reprodutivos contribuindo para a redução da mortalidade materna. / Nursing is a profession focused on the care of people at different stages of life, the act of caring is the essence in making the nurse, and has a concern with the search priority set in their midst. In this sense, the maternal considered a sensitive indicator of the quality of life of a population is one. This study is an integrative literature review that aimed to describe the most common infections that a woman is exposed during the postpartum period, investigated in national and international publications in the health field, and identify the level of scientific evidence of each article. For the selection of studies have used three databases, ScienceDirect, Pubmed and Lilacs. The time frame was 2009 to 2013 and the sample consisted of 19 articles related to puerperal infection. Data were collected from the second half of September to the first of October. The studies identified that more than half of the papers in Brazil. Two studies identified nurses as authors. Most of the studies serving journals was the medical area. Twelve studies showed no experimental design, three were case study and four presented experimental design. The main puerperal infections were found endometritis, urinary infection, surgical site infection, puerperal sepsis, mastitis, the cervicitis. The results showed that more research is needed with experimental design, especially regarding the area of nursing. Rigorous evaluation of women postpartum, the appropriate approach to prevention of puerperal infection and / or management of interventions in patient care with infectious morbidity, underpin essential actions nurse in obtaining a safer nursing care, quality, to promote the role of women in this important stage of his life and it provides autonomy in relation to their sexual and reproductive rights contributing to the reduction of maternal mortality.

L. pneumophila est l'agent responsable de la légionellose, une pneumonie sévère associée à 10% de mortalité. Cette bactérie intracellulaire a acquis la capacité de survivre et de se répliquer dans des cellules humaines. Notamment, L. pneumophila sécrète un grand nombre d'effecteurs par son système de sécrétion de type IV, qui interagissent avec différentes voies cellulaires, dont l'autophagie. L'autophagie est une voie de dégradation conservée qui permet aux cellules eucaryotes de réguler l'homéostasie cellulaire et d'éliminer les agents pathogènes intracellulaires. Néanmoins, nombre d'entre eux ont évolué pour manipuler cette voie à leur propre avantage. Même si l'interaction entre L. pneumophila et l'autophagie a été rapportée, aucun modèle clair n'est déterminé. Dans cette étude, nous montrons qu'une infection à L. pneumophila induit une stimulation globale de l'autophagie, mais que ce phénotype dépend des souches utilisées, et notamment de la présence de certains effecteurs. De plus, l'inhibition de l'autophagie est liée à un défaut de réplication intracellulaire suggérant que cette voie est bénéfique à la bactérie. Afin de rechercher les déterminants génétiques impliqués dans cette interaction, nous avons identifié des effecteurs communs sécrétés par le système de sécrétion de type IV entre L. pneumophila et Coxiella burnetii, une bactérie de l'ordre des Legionellales connue pour stimuler et détourner l'autophagie. La capacité des mutants de ces effecteurs à stimuler l'autophagie chez L. pneumophila a été analysée. Si aucun d'entre eux ne semble impliqué dans la modulation de l'autophagie, cette étude suggère d'autres fonctions pour ces effecteurs conservés / Legionella pneumophila is responsible for the legionellosis disease, a severe pneumonia associated with 10% mortality rate. This intracellular bacterium has evolved the ability to survive and replicate within human cells. Notably, L. pneumophila secretes a high number of type IV secretion system effectors that interfere with many cellular pathways including autophagy. Autophagy, a highly conserved degradative pathway, allows eukaryotic cells to regulate cell homeostasis and fight intracellular pathogens. Nevertheless numerous microorganisms have evolved strategies to subvert this mechanism to their own advantage. The interaction between L. pneumophila and autophagy has been reported but remains unclear. In this study, we show that L. pneumophila infection induces a global stimulation of autophagy, but importantly this autophagy stimulation depends on the bacterial strain. Moreover, we also observed that inhibition of autophagy results in decreased intracellular bacterial proliferation suggesting that host cell autophagy is benificial for L. pneumophila. In order to decipher the molecular determinants involved in the interaction with autophagy, we identified common effectors secreted by the type IV secretion system between L. pneumophila and Coxiella burnetii, a bacterium from the order Legionellale responsible for Q fever and known to stimulate and hijack host cell autophagy. Mutant of these common effectors in L. pneumophila were analysed. While, none of them seems to be implicated in autophagy modulation, this study suggests other functions for these conserved effectors

A enfermagem é uma profissão voltada para o cuidado das pessoas nas diferentes fases da vida, o ato de cuidar é a essência no fazer da enfermeira, e, possui uma inquietação com o conjunto de prioridade de pesquisa em seu meio. Neste sentido, a saúde materna considerada um indicador sensível à qualidade de vida de uma população é uma delas. O presente estudo é uma revisão integrativa da literatura que teve como objetivo descrever as infecções mais frequentes que a mulher está exposta durante o período puerperal, investigadas em publicações nacional e internacional da área da saúde, além de identificar o nível de evidência cientifica de cada artigo. Para a seleção dos estudos foram utilizadas três bases de dados, ScienceDirect, Pubmed e Lilacs. O recorte temporal foi de 2009 a 2013 e, a amostra foi composta por 19 artigos, relacionado à infecção puerperal. Os dados foram coletados da segunda quinzena de setembro à primeira de outubro. A análise dos estudos permitiu identificar que mais da metade das publicações foi no Brasil. Dois estudos identificaram enfermeiros como autores. A maioria dos periódicos de veiculação dos estudos era da área medica. Doze estudos apresentaram delineamento não experimental, três eram estudo de caso e quatro apresentaram delineamento experimental. As principais infecções puerperais encontradas foram a endometrite, a infecção urinária, a infecção do sítio cirúrgico, a sepse puerperal, a mastite, a cervicite. Os resultados mostraram que são necessárias mais pesquisas com delineamento experimental, principalmente no que tange a área da enfermagem. A avaliação rigorosa da puérpera no pós-parto, a adequada conduta para prevenção da infecção puerperal e/ou manejo das intervenções no cuidado da paciente com morbidade infecciosa, alicerçam ações indispensáveis da enfermeira na obtenção de um atendimento de enfermagem mais seguro, de qualidade, que promova o protagonismo da mulher nesta etapa importante de sua vida e lhe proporcione autonomia em relação aos seus direitos sexuais e reprodutivos contribuindo para a redução da mortalidade materna. / Nursing is a profession focused on the care of people at different stages of life, the act of caring is the essence in making the nurse, and has a concern with the search priority set in their midst. In this sense, the maternal considered a sensitive indicator of the quality of life of a population is one. This study is an integrative literature review that aimed to describe the most common infections that a woman is exposed during the postpartum period, investigated in national and international publications in the health field, and identify the level of scientific evidence of each article. For the selection of studies have used three databases, ScienceDirect, Pubmed and Lilacs. The time frame was 2009 to 2013 and the sample consisted of 19 articles related to puerperal infection. Data were collected from the second half of September to the first of October. The studies identified that more than half of the papers in Brazil. Two studies identified nurses as authors. Most of the studies serving journals was the medical area. Twelve studies showed no experimental design, three were case study and four presented experimental design. The main puerperal infections were found endometritis, urinary infection, surgical site infection, puerperal sepsis, mastitis, the cervicitis. The results showed that more research is needed with experimental design, especially regarding the area of nursing. Rigorous evaluation of women postpartum, the appropriate approach to prevention of puerperal infection and / or management of interventions in patient care with infectious morbidity, underpin essential actions nurse in obtaining a safer nursing care, quality, to promote the role of women in this important stage of his life and it provides autonomy in relation to their sexual and reproductive rights contributing to the reduction of maternal mortality.

Les macrophages sont en première ligne de la défense innée et jouent un rôle important dans l’initiation de la réponse immunitaire puisque régulant l’inflammation et permettant la clairance des pathogènes. Dans la mucoviscidose, ces phénomènes sont exacerbés et deviennent chronique sans pouvoir être résolus. Les objectifs de cette thèse ont été de déterminer des cibles potentielles responsables des altérations du macrophage dans la mucoviscidose. Dans le contexte inflammatoire, la forme soluble du CD14 (sCD14), dont la sécrétion est augmentée par les macrophages de patients atteints de la mucoviscidose, est caractérisé comme un DAMP puisqu’il contribue à l’entretien de l’inflammation au niveau tissulaire. Dans le contexte infectieux, l’activité de TRPV2, impliqué dans la phagocytose, est altérée. Dans la mucoviscidose, l’inflammation et l’infection sont aussi intimement liées par l’intermédiaire d’une altération des microstructures de la membrane plasmique impliquée dans la production du sCD14 et dans le processus de phagocytose. En conclusion, les modifications des fonctions du macrophage affaiblissent la défense innée des patients atteints de mucoviscidose et peuvent être impliqués dans la progression de la maladie. Par conséquent, les interventions visant à réduire l’inflammation et l’infection pourraient être bénéfiques afin de préserver la fonction pulmonaire des patients. Ainsi, les approches thérapeutiques visant à corriger les dysfonctions du macrophage de patients atteints de mucoviscidose pourrait fournir une meilleure résolution de l'infection et l'inflammation. / Macrophages play a significant role in the initiating stages of immune responses regulating inflammation and clearance of the pathogens. In cystic fibrosis, inability of the macrophage to act as a suppressor cell leading to chronic inflammation/infection cannot be resolved. The aims of this work was to find new targets responsible for alterations in cystic fibrosis macrophages. Regarding inflammation, the soluble form of CD14 (sCD14), find overproduced by cystic fibrosis macrophages, is characterized to be a DAMP as it contributes for maintenance of inflammation in tissues. Regarding infection, the activity of TRPV2, involved in phagocytic capacity of macrophage, is impaired. In cystic fibrosis, inflammation and infection were closely linked to the alteration of the plasma membrane microstructures involved in the production of sCD14 and in the phagocytosis process. In conclusion, the alterations of macrophage weaken innate defense of cystic fibrosis patients and may be involved in cystic fibrosis disease progression and lung damage. Consequently, interventions aimed to reduce ongoing infection and destructive inflammatory response may be beneficial in order to preserve their lung function. In this way, therapeutic approaches aimed to correct cystic fibrosis macrophages dysfunctions might provide improved resolution of infection and inflammation.

The treatment of epidermal wounds, particularly chronic wounds, is one of the most ubiquitous medical challenges and has imposed a considerable financial burden on the global health care system. Several factors in epidermal wounds lead to severe medical conditions among which infection comprises a large number of mortalities. To tackle this issue, great efforts have been made in the last decades to incorporate antimicrobial agents into wound dressings in order to inhibit microorganism colonization. Additionally, various wound monitoring systems have been developed to detect and track infections using different indicators such as bacterial by-products. However, the integration of these infection sensors with wound dressings – most of which have benefited from electrochemical detectors – has been a major bottleneck due to the electrode failure in the wound environment and the need for electrical power supply. Other approaches have focused on the development of point-of-care devices that simplify the detection of infection. This study aims to address the aforementioned challenge by developing a multifunctional hydrogel-based wound dressing – made of alginate 1.5% (w/v) – for on-site infection monitoring via colourimetric and image processing methods. Taking advantage of wound acidity as an indicator of bacterial infection, the developed wound dressing was composed of an array of pH sensors, fabricated by 3-dimensional (3D) bioprinting. Brilliant Yellow and cabbage juice as two pH-responsive dyes were immobilized in the pH sensors to facilitate a wireless wound monitoring. In this system, Brilliant Yellow afforded a higher accuracy in image processing while cabbage juice provided a better visual observation of the wound condition. The functionality of the developed dressing in detecting bacterial infection was evaluated via an ex-vivo test on pig skin samples, infected by Pseudomonas aeruginosa, and the presence of bacteria was detected within 30 minutes after the placement of the dressings on the skin samples. Moreover, the inclusion of gentamicin-loaded components into the wound dressing facilitated the inhibition of bacterial growth, which was evaluated in vitro on the same strain of bacteria. In this experiment, 2 mg/ml of gentamicin in the hydrogel led to the eradication of P. aeruginosa. This incorporation of antibiotic delivery along with the simple colourimetric infection detection holds a great promise for managing acute and chronic wounds by inhibition of bacterial growth and monitoring infection in real-time without a need for dressing removal. / Graduate / 2018-08-16

Les Alphavirus sont des virus à ARN enveloppés, d’un diamètre de 70 nm, à structure icosaédrique à symétrie de type T=4 (Choi et al. 1991; Cheng et al. 1995; Garoff et al. 2004). Ces virus, dont la répartition est mondiale, sont capables d’infecter une grande variétés d’animaux vertébrés (mammifères, oiseaux, poissons). Ces virus sont des arbovirus, c’est-à_dire des virus transmis par des arthropodes. Dans le cas des Alphavirus, la vectorisation est faite par des moustiques appartenant à plusieurs espèces. A ce jour, 29 espèces d’Alphavirus ont été identifiés, dont au moins 6 sont pathogènes pour l’Homme. Chez l’Homme, certains Alphavirus sont responsables d'encéphalites, d'arthrites, de fièvres, d'éruptions cutanées et peuvent être fatals (Thiruvengadam et al. 1965; Pialoux et al. 2006).Le premier Alphavirus isolé fut l'Encephalite Equine de l'Ouest (WEEV), en 1930 (Meyer et al. 1931). Les virus de l'encéphalite de l'Est (VEEV) et le virus de l'Encephalite Equine du Vénézuéla (VEEV) furent isolés respectivement en 1933 et 1938 (Gibbs EP. 1976 ; Beck et al. 1938 ; Kubes et al. 1939). Le Virus Sindbis isolé en Egypte en 1952 (Taylor et al. 1955), fut le premier Alphavirus responsables d’arthrites à être isolé. La mise en évidence de l'existence du CHIKV se fera 1952 en Tanzanie (Robinson 1955) (Lumsden 1955). Suivent alors les découvertes de l'ensemble des autres Alphavirus. Le South Elephent Seal virus (SESV), identifié en 2000 sur l'île australienne de Macquarie, est à l’heure actuelle le dernier Alphavirus découvert. La phylogénétique des souches de Chikungunya permet d’identifier des clades différents pour les souches d’Afrique de l’Est, de l’Ouest ou d’Asie, et l’analyse phylogénétique est très proche du O’Nyong-Nyong (Powers et al. 2000), Le séquençage de différents isolats de l’épidémie de 2005, a permis de mettre en évidence chez certains d’entre eux une mutation dans la glycoprotéine de l'enveloppe plus précisément dans E1, (Schuffenecker et al. 2006). Cette mutation entraine la substitution d'une arginine en position 226 au lieu de la valine (A226V), est un élément clé pour déterminer le choix d'un nouveau vecteur pour la transmission ou Aedes albopictus (qui le transmet sur l'île de La Réunion) par rapport au vecteur Aedes aegypti (Tsetsarkin et al. 2007). Cette mutation a ensuite été également trouvée en Inde en 2007. (Arankalle et al. 2007; Kumar et al. 2008; Santhosh et al. 2008).Le tableau clinique classique débute souvent par l’apparition brutale d’une forte fièvre (40°C) pendant 3 / 10 jours accompagnée de frissons intermittents (Deller et al.1967). La fièvre est, dans certains cas, bi-phasique, c’est-à-dire qu’elle diminue durant un ou deux jours, avant de remonter brutalement. Elle est généralement suivie d’érythèmes, de courbatures douloureuses ou myalgies et douleurs musculaires (Ozden et al. 2007) en particulier celles impliquant la douleur au niveau des extrémités (poignés, phalanges et chevilles) (Robinson 1955; Jadhav et al. 1965; Thiruvengadam et al. 1965). Egalement migraine, éruptions cutanées maculo-papuleuses parfois prurigineuses. L'éruption touchant le thorax et le visage les mains et les pieds, chez les enfants ont été observées des éruptions de type bulleux accompagné par un détachement cutané (Talarmin et al. 2007). L'évolution de la maladie régresse progressivement. Il n’y a aucun traitement antiviral efficace contre le CHIKV. Le traitement est donc essentiellement symptomatique et composé d'antalgiques non salicylés, de paracétamol et d'anti-inflammatoires non stéroïdiens. Ce travail se compose de deux parties : 1 partie sur l’étude phylogénétique du CHIKV et 1 partie sur l'étude des molécules antivirales. [...] / The Alphavirus RNA viruses are enveloped with a diameter of 70 nm, icosahedral structure with symmetry of type T = 4 (Choi et al. 1991; Cheng et al. 1995; Garoff et al. 2004). These viruses, whose distribution is worldwide, can infect a wide variety of vertebrates (mammals, birds, fish). These viruses are arboviruses, is à_dire viruses transmitted by arthropods. In the case of Alphavirus, the vectorization is done by mosquitoes from several species.To date, 29 species of Alphavirus have been identified, including at least six are pathogenic for humans. In humans, some are responsible for Alphavirus encephalitis, arthritis, fever, rash and can be fatal (Thiruvengadam et al. 1965; Pialoux et al. 2006).The first was isolated Alphavirus Equine Encephalitis West (Weeve) in 1930 (Meyer et al. 1931). The encephalitis virus Eastern (VEEV) and virus Venezuelan equine encephalitis (VEEV) were isolated respectively in 1933 and 1938 (Gibbs EP. 1976; Beck et al. 1938; Kubes et al. 1939 ). Sindbis virus isolated in Egypt in 1952 (Taylor et al. 1955), was the first Alphavirus responsible for arthritis to be isolated. The demonstration of the existence of CHIKV in Tanzania will be 1952 (Robinson 1955) (Lumsden 1955). Then follow the discoveries of all other Alphavirus. The South Elephent Seal virus (SESV), identified in 2000 on the Australian island of Macquarie is now the last Alphavirus discovered. The phylogenetic strains of Chikungunya can identify different clades for strains of East African, Western or Asian, and phylogenetic analysis is very close O'Nyong-Nyong (Powers and al. 2000), The sequencing of different isolates of the epidemic of 2005, helped to highlight some of them a mutation in the envelope glycoprotein more specifically in E1 (Schuffenecker et al. 2006). This mutation causes the substitution of an arginine at position 226 instead of valine (A226V), is a key element in determining the choice of a new vector for the transmission or Aedes albopictus (which transmits on the island of La meeting) with respect to the vector Aedes aegypti (Tsetsarkin et al. 2007). This mutation was later also found in India in 2007. (Arankalle et al. 2007; Kumar et al. 2008; Santhosh et al. 2008).The classic presentation often begins with sudden onset of high fever (40°C) for 3 / 10 days intermittent chills (Deller and al.1967). Fever is, in some cases, bi-phasic, that is to say, it decreases during a day or two before rising sharply. It is usually followed by erythema, pain or stiffness of muscle pain and muscle aches (Ozden et al. 2007) especially those involving pain in the extremities (wrists, ankles and knuckles) (Robinson 1955; Jadhav et al. 1965; Thiruvengadam et al. 1965). Also headache, rash maculopapular itchy sometimes. The rash affecting the chest and face hands and feet, children were seen eruptions like bullous skin accompanied by a detachment (Talarmin et al. 2007). The evolution of the disease regresses gradually. There is no antiviral therapy effective against CHIKV. Treatment is essentially symptomatic and consists of non-analgesic salicylates, paracetamol and anti-inflammatory drugs. This work consists of two parts: one part on the phylogenetic study of CHIKV and one part of the study of antiviral molecules. [...]