Made available in DSpace on 2014-06-11T19:27:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-03-14Bitstream added on 2014-06-13T20:16:36Z : No. of bitstreams: 1 pedro_hsp_me_sjrp.pdf: 1004378 bytes, checksum: d89276d95fd4738ef5918762497df5ea (MD5) / São José do Rio Preto (SJRP), localizada na região Noroeste do Estado de São Paulo, Sudeste do Brasil, é considerada Município prioritário pelo Programa Nacional de Controle da Tuberculose e da AIDS. O objetivo deste trabalho foi avaliar retrospectivamente pacientes infectados pelo HIV com pelo menos um isolamento de Mycobacterium sp., atendidos em unidades de saúde de referência de SJRP e região, bem como descrever seus aspectos clínicos e sócio–demográficos. Foram avaliados no período de janeiro de 2000 a dezembro de 2006, 198 indivíduos soropositivos para o HIV com culturas positivas no Instituto Adolfo Lutz de SJRP. Houve uma correlação positiva entre a tuberculose e o registro de detenção (p=0.021). O uso do tabaco reduziu o tempo de vida entre o diagnóstico e o óbito (p=0.05). Houve associação entre o isolamento de M. tuberculosis (MT) e os níveis de linfócitos TCD4+ bem como o achado difuso para RX de tórax (p=0.014 e 0.000, respectivamente). Aproximadamente 11% de todas as cepas de MT mostraram resistência a pelo menos uma droga, enquanto 3.1% foram multiresistentes. Micobactérias não tuberculosas (MNT) totalizaram 35.19% de todos os isolamentos e a maioria das espécies pertence ao complexo Mycobacterium avium (MAC; 22.3%), seguido por M. fortuitum (5.2%) e M.gordonae (3.1%). Conclui-se que a população HIV estudada tem alta prevalência de colonização por MNT. Em um país com extensão continental como o Brasil, o conhecimento das diferenças regionais na distribuição de MNT em populações infectadas pelo HIV pode contribuir para o controle e tratamento dessas infecções oportunistas. / São José do Rio Preto city (SJRP), Northwestern São Paulo State, Southeast Brazil, is considered “priority” by the National Programs of Tuberculosis and AIDS Control. Our purpose was to retrospectively evaluate Mycobacterium sp. isolated from HIV-infected patients attending the HIV/TB reference health care units from SJRP and region, as well as to describe their clinical and socio-demographic aspects. One hundred and ninetyeigth HIV-seropositive individuals provided 287 positives cultures from January 2000 to December 2006. There was a positive correlation between tuberculosis and prison record (p=0.021) and tobacco use reduced the mean lifetime from tuberculosis diagnosis to obit (p = 0.05). TCD4+ levels and a diffuse chest X-ray finding were associated to Mycobacterium tuberculosis (MT) isolation (p = 0.014 and 0.000, respectively). Approximately eleven percent of all MT strains showed resistance to at least one drug while 3.1% were multidrug resistant. Non-tuberculous mycobacteria (NTM) totalized 35.19% of all species and the most frequently isolated ones were Mycobacterium avium complex (MAC; 22.3%), M. fortuitum (5.2%) and M. gordonae (3.1%). We conclude that the HIV-infected population studied has a high prevalence of NTM colonization. In a wide country like Brazil, regional differences on NTM distribution in HIV-infected individuals must be further evaluated in order to improve control and treatment of these opportunistic infections.

Orientador: Andréa Baptista Rossit / Banca: Daisy Nakamura Sato / Banca: Silvia Helena Vendramine / Resumo: São José do Rio Preto (SJRP), localizada na região Noroeste do Estado de São Paulo, Sudeste do Brasil, é considerada Município prioritário pelo Programa Nacional de Controle da Tuberculose e da AIDS. O objetivo deste trabalho foi avaliar retrospectivamente pacientes infectados pelo HIV com pelo menos um isolamento de Mycobacterium sp., atendidos em unidades de saúde de referência de SJRP e região, bem como descrever seus aspectos clínicos e sócio-demográficos. Foram avaliados no período de janeiro de 2000 a dezembro de 2006, 198 indivíduos soropositivos para o HIV com culturas positivas no Instituto Adolfo Lutz de SJRP. Houve uma correlação positiva entre a tuberculose e o registro de detenção (p=0.021). O uso do tabaco reduziu o tempo de vida entre o diagnóstico e o óbito (p=0.05). Houve associação entre o isolamento de M. tuberculosis (MT) e os níveis de linfócitos TCD4+ bem como o achado difuso para RX de tórax (p=0.014 e 0.000, respectivamente). Aproximadamente 11% de todas as cepas de MT mostraram resistência a pelo menos uma droga, enquanto 3.1% foram multiresistentes. Micobactérias não tuberculosas (MNT) totalizaram 35.19% de todos os isolamentos e a maioria das espécies pertence ao complexo Mycobacterium avium (MAC; 22.3%), seguido por M. fortuitum (5.2%) e M.gordonae (3.1%). Conclui-se que a população HIV estudada tem alta prevalência de colonização por MNT. Em um país com extensão continental como o Brasil, o conhecimento das diferenças regionais na distribuição de MNT em populações infectadas pelo HIV pode contribuir para o controle e tratamento dessas infecções oportunistas. / Abstract: São José do Rio Preto city (SJRP), Northwestern São Paulo State, Southeast Brazil, is considered "priority" by the National Programs of Tuberculosis and AIDS Control. Our purpose was to retrospectively evaluate Mycobacterium sp. isolated from HIV-infected patients attending the HIV/TB reference health care units from SJRP and region, as well as to describe their clinical and socio-demographic aspects. One hundred and ninetyeigth HIV-seropositive individuals provided 287 positives cultures from January 2000 to December 2006. There was a positive correlation between tuberculosis and prison record (p=0.021) and tobacco use reduced the mean lifetime from tuberculosis diagnosis to obit (p = 0.05). TCD4+ levels and a diffuse chest X-ray finding were associated to Mycobacterium tuberculosis (MT) isolation (p = 0.014 and 0.000, respectively). Approximately eleven percent of all MT strains showed resistance to at least one drug while 3.1% were multidrug resistant. Non-tuberculous mycobacteria (NTM) totalized 35.19% of all species and the most frequently isolated ones were Mycobacterium avium complex (MAC; 22.3%), M. fortuitum (5.2%) and M. gordonae (3.1%). We conclude that the HIV-infected population studied has a high prevalence of NTM colonization. In a wide country like Brazil, regional differences on NTM distribution in HIV-infected individuals must be further evaluated in order to improve control and treatment of these opportunistic infections. / Mestre

Den mest välkända arten i släktet Mycobacterium som kan orsaka sjukdom hos människan är Mycobacterium tuberculosis (MTB). Infektioner av andra mykobakterier ökar världen över. Dessa benämns icke-tuberkulösa mykobakterier (NTM) och orsakar ofta liknande symtom som de vid MTB-infektion. Vanligtvis krävs dock olika behandlingar beroende på om infektionen är orsakad av MTB eller av NTM. Nuvarande diagnostik bygger på odling och mikroskopi, men analyser som innefattar molekylärbiologiska metoder för undersökning av mykobakteriers DNA blir allt vanligare. I denna studie jämfördes olika PCR-metoder för identifiering av NTM, där metoderna baserades på två tidigare publicerade artiklar. Tester gjordes på DNA från sex NTM-stammar med MTB-DNA som referens. För påvisning av hela släktet Mycobacterium användes primers riktade mot hsp65 och 16S, och för att kunna urskilja MTB från NTM användes primers riktade mot IS6110, IS1081 och ITS-MTC. Undersökningarna visade lägre Ct-värden och högre PCR-effektivitet för hsp65 än för 16S men tester med avseende på MTB-specifika primers visade samtliga amplifiering även för NTM. / The most well-known species of the genus Mycobacterium that can cause human disease is Mycobacterium tuberculosis (MTB). Infections caused by other mycobacteria is an increasing problem worldwide. These mycobacteria are known as non-tuberculous mycobacteria (NTM) and they often cause similar symptoms as those in MTB-caused infections. Usually different treatments are required depending on if the infection is caused by NTM or MTB. Current diagnostic methods are based on culture and microscopy, though molecular methods are becoming more common. In this study different PCR-methods for identification of NTM’s were compared. The different methods were based on two earlier published articles. Experiments were made with DNA from six NTM-species and with DNA from MTB as reference. To detect all mycobacteria primers targeting hsp65 and 16S were used, and primers targeting IS6110, IS1081 and ITS-MTC were used to separate MTB from NTM. This study showed lower Ct-values and higher PCR-efficiency for hsp65 than for 16S, but comparative tests regarding MTB-specific primers showed, with all three primer pairs, amplification of NTM as well.

The aim of this study was to investigate the diversity and prevalence of non-tuberculous mycobacteria (NTM) in cattle, African buffaloes and their environments in South Africa and the potential of these NTM to elicit cross- reactive immune responses in these animal species which may in turn lead to false diagnosis of bovine tuberculosis. A total of 40 NTM species were identified during a countrywide survey. Mycobacterium terrae, Mycobacterium nonchromogenicum, Mycobacterium vaccae/ Mycobacterium vanbaalenii and a group of isolates closely related to Mycobacterium moriokaense (M. moriokaense-like isolates) were the four most frequently isolated species. Further characterization of M. moriokaense- like isolates revealed two novel NTM species which were named Mycobacterium malmesburii sp.nov. and Mycobacterium komanii sp.nov. respectively. Genomes of M. nonchromogenicum, M. malmesburii sp. nov., M. komanii sp. nov., and M. fortuitum ATCC 6841 were elucidated and investigated for genes encoding homologues of M. bovis predominant immunogenic proteins. These included genes encoding for the Esx family proteins (esx genes), mpb70, mpb63, mpb64, hspX, tpx, Rv1120c, canA and dnaK. The esx gene orthologs encoded in ESX-1 (esxA and esxB), ESX-3 (esxH and esxG), esxR, and ESX-4 (esxT and esxU) loci were identified in the NTM genomes while those encoded in ESX-2 locus were absent in all the four NTM genomes and only esxN (encoded in the ESX-5 locus) and its homologue, esxK were present in M. nonchromogenicum. Gene orthologs encoding for MPB70 (M. malmesburii sp.nov. and M. komanii sp.nov.), DnaK (all four NTM species), CanA (all four NTM species), MPB64 (all four NTM species), Rv1120c (in all four NTM species), TpX, MBP63 and HspX (all in M. nonchromogenicum and M. fortuitum), were found in the NTM genomes. In contrast orthologs of mpb83 and espC were not detected in any of the four NTM. We could not judge just based on the overall protein sequence homologies of the antigens whether the NTM homologues will give rise to cross-reactive immune responses. We consequently checked the existence in NTM of epitopes shown to be immunogenic in M. bovis and M. tuberculosis. Amino acid sequence alignment of the EsxA and EsxB of the NTM sequenced in this study as well as M. smegmatis, M. bovis and M. tuberculosis respectively was done to investigate their similarities at “immunogenic” epitope level. In this analysis, we found that the six bovine T-cell recognized epitopes of M. bovis ESAT-6 described by Vordermeier et al., 2003 and 2007 had similarities to those of M. fortuitum and M. nonchromogenicum (showing sequence similarity of as high as 81.28% and as low as 52.9% ). Likewise a certain degree of sequence similarity between the six M. bovis CFP 10 immunogenic epitopes and those of the NTM species (highest similarity of 75% observed between all NTM and M. bovis and lowest similarity of 50% between M. komanii sp.nov, M. malmesburii sp.nov and M. bovis.) was observed. Still, with sequence homologies of less than 100% between the M. bovis immunogenic epitopes and those of the NTM, it was difficult to unambiguously predict T-cell cross-recognition. Comparison of the EsxR and EsxH amino acid sequences at immunogenic epitope level, revealed higher sequence similarities in the epitopes of NTM and those of M. bovis than the predicted protein sequences of EsxA and EsxB. A sequence similarity of 100% was observed between two of the five M. bovis immunogenic epitopes of EsxR and those of M. fortuitum, M. malmesburii sp. nov. and M. komanii sp.nov. Full cross- recognition of these NTM EsxR epitopes is therefore highly likely, and may lead to misdiagnosis of bovine Tuberculosis (BTB). The other three EsxR/EsxH epitopes shown to be immunogenic in M. bovis also exist in the three NTM showing similarity of as low as 77.7%. / Thesis (PhD)--University of Pretoria, 2015. / WOTRO Science for Global Development / Genomics Research Institute (GRI) / Veterinary Tropical Diseases / PhD / Unrestricted

The efficacy of Bacille-Calmette Guerin (BCG) vaccination in protection against pulmonary tuberculosis (TB) is highly variable between populations. One possible explanation is increased exposure of certain populations to non-tuberculous mycobacteria (NTM). Given the variable efficacy of BCG an improved vaccine against TB is required. The novel TB vaccine MVA85A has shown promising results, however, the immunogenicity of the vaccine is reduced when it is administered in the Expanded Programme on Immunisation (EPI) schedule. This thesis aims to explore: (A) the effect of exposure to NTM on the level of protection afforded by BCG vaccination against Mycobacterium tuberculosis (M. tb) and (B) the immunological mechanisms behind EPI interference with MVA85A. The effect of M. avium (MA) exposure via systemic and oral routes on the efficacy of BCG was tested using M. tb aerosol infection in a mouse model. The adaptive immune response was profiled in BCG vaccinated mice with and without exposure to MA pre- and post- M. tb infection. The results showed BCG efficacy could be enhanced by exposure to dead MA by a systemic route; T helper 1 and T helper 17 responses were associated with increased protection. In contrast, BCG efficacy may have been reduced by exposure to live MA by the oral route; T helper 2 and regulatory T cells were associated with reduced protection. To answer the second aim MVA85A was co-administered to mice with aluminium adjuvants or aluminium-containing vaccines to replicate the effect of co-administration in the EPI schedule; the adaptive immune response was profiled. T helper 2 and regulatory T cell responses induced by aluminium-containing vaccines were associated with a reduction in the immunogenicity of MVA85A.

Recent years have seen the emergence of Mycobacterium abscessus, a highly drug-resistant non-tuberculous mycobacterium, which causes life-threatening infections in people with chronic lung conditions like cystic fibrosis. This opportunistic pathogen is refractory to treatment with standard anti-tuberculosis drugs and most currently available antibiotics, often resulting in accelerated lung function decline. This project aims to use a structure-guided fragment-based drug discovery approach to develop effective drugs to treat M. abscessus infections. During the early stage of the project, three bacterial targets were identified, based on analysis of the structural proteome of M. abscessus and prior knowledge of M. tuberculosis drug targets, followed by gene knockout studies to determine target essentiality for bacterial survival. The three targets from M. abscessus were then cloned, expressed and purified and suitable crystallization conditions were identified leading to the determination of high resolution structures. Further, a large number of starting fragments that hit the three target proteins were determined, using a combination of biophysical screening methods and by defining crystal structures of the complexes. For target 3, PPAT (Phosphopantethiene adenylyl transferase), a chemical linking of two fragments followed by iterative fragment elaboration was carried out to obtain two compounds with low micromolar affinities in vitro. However, these compounds afforded only low inhibitory activity on M. abscessus whole cell. All starting fragments of target 2, PurC (SAICAR synthase), occupied the ATP indole pocket. Efforts were then made to identify further fragment hits by screening diverse libraries. Sub-structure searches of these initial fragment hits and virtual screening helped to identify potential analogues amenable to further medicinal chemistry intervention. While fragment hits of target 1, TrmD (tRNA-(N1G37) methyl transferase), were prioritized, whereby two chemical series were developed using fragment growing and merging approaches. Iterative fragment elaboration cycle, aided by crystallography, biophysical and biochemical assays led to the development of several potential lead candidates having low nano-molar range of in vitro affinities. Two such compounds afforded moderate inhibition of M. abscessus and stronger inhibition of M. tuberculosis and S. aureus cultures. Further chemical modifications of these compounds as well as others are now being done, to optimize cellular and in vivo activities, to be ultimately presented as early stage clinical candidates.