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Fischer RSB, Vilchez S, Ronca SE, Kairis R, Lino A, Maliga A, Gunter SM, Murray KO. Persistence of dengue serotype 2 viral RNA in blood cells of a returned traveler with dengue fever. Travel Med Infect Dis 2024; 59:102699. [PMID: 38452991 DOI: 10.1016/j.tmaid.2024.102699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 03/09/2024]
Abstract
Dengue virus (DENV) is one of the most significant vector-borne pathogens worldwide. In this report, we describe clinical features and laboratory detection of dengue in a 45-year-old traveler to Nicaragua on return home to the United States in 2019. Clinical presentation was mild, with rash, headache, and fatigue, with only low-grade transient fever. Infection dynamics were documented by serology and PCR of serially collected body fluids. DENV serotype 2 was detected in whole blood 1 day after symptoms emerged, with viral RNA isolated to the red cell fraction, and remained detectable through day 89. DENV-2 RNA was detected in serum only on day 4, and IgM was undetectable on day 4 but evident by day 13. Viral RNA was also detected in urine. This report of DENV-2 RNA persistence in blood cells but only transient appearance in serum, supports the potential diagnostic value of whole blood over serum for PCR and opportunity of an expanded testing window. Informed testing approaches can improve diagnostic accuracy and inform strategies that preserve individual and public health.
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Affiliation(s)
- Rebecca S B Fischer
- School of Public Health, Texas A&M University Health Science Center, College Station, TX, USA; Section of Pediatric Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA; National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Samuel Vilchez
- Center of Infectious Diseases, Department of Microbiology and Parasitology, Faculty of Medical Sciences, National Autonomous University of Nicaragua, León (UNAN-León), León, Nicaragua
| | - Shannon E Ronca
- Section of Pediatric Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA; National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA; William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, TX, USA
| | - Rebecca Kairis
- Section of Pediatric Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA; William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, TX, USA
| | - Allison Lino
- Section of Pediatric Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA; William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, TX, USA
| | - Adrianna Maliga
- Section of Pediatric Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA; William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, TX, USA
| | - Sarah M Gunter
- Section of Pediatric Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA; National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA; William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, TX, USA
| | - Kristy O Murray
- Section of Pediatric Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA; National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA; William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, TX, USA
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2
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Gunter SM, Nelson A, Kneubehl AR, Justi SA, Manzanero R, Zielinski-Gutierrez E, Herrera C, Thompson J, Mandage R, Desale H, Maliga A, Bautista K, Ronca SE, Morey F, Fuentes RC, Lopez B, Dumonteil E, Morazan GH, Murray KO. Novel species of Triatoma (Hemiptera: Reduviidae) identified in a case of vectorial transmission of Chagas disease in northern Belize. Sci Rep 2024; 14:1412. [PMID: 38228608 PMCID: PMC10792162 DOI: 10.1038/s41598-023-50109-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024] Open
Abstract
Chagas disease is a leading cause of non-ischemic cardiomyopathy in endemic regions of Central and South America. In Belize, Triatoma dimidiata sensu lato has been identified as the predominate taxon but vectorial transmission of Chagas disease is considered to be rare in the country. We recently identified an acute case of vector-borne Chagas disease in the northern region of Belize. Here we present a subsequent investigation of triatomines collected around the case-patient's home. We identified yet undescribed species, closely related to Triatoma huehuetenanguensis vector by molecular systematics methods occurring in the peridomestic environment. The identification of a T. cruzi-positive, novel species of Triatoma in Belize indicates an increased risk of transmission to humans in the region and warrants expanded surveillance and further investigation.
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Affiliation(s)
- Sarah M Gunter
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
- William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, TX, USA.
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Alisa Nelson
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, TX, USA
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Alexander R Kneubehl
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Silvia A Justi
- Walter Reed Biosystematics Unit, Smithsonian Institution, Museum Support Center, Suitland, MD, USA
- One Health Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Smithsonian Institution National Museum of Natural History, Washington, DC, USA
| | | | | | - Claudia Herrera
- Department of Tropical Medicine, Vector-Borne and Infectious Disease Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Julie Thompson
- Department of Tropical Medicine, Vector-Borne and Infectious Disease Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Department of Biomedical Science, School of Medicine, Tulane University, New Orleans, LA, USA
| | - Rajendra Mandage
- Department of Tropical Medicine, Vector-Borne and Infectious Disease Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Hans Desale
- Department of Tropical Medicine, Vector-Borne and Infectious Disease Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Adrianna Maliga
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, TX, USA
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Kim Bautista
- Belize Ministry of Health and Wellness, Belmopan, Belize
| | - Shannon E Ronca
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, TX, USA
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Francis Morey
- Belize Ministry of Health and Wellness, Belmopan, Belize
| | - Rafael Chacon Fuentes
- Centers for Disease Control and Prevention-Central America Region, Guatemala City, Guatemala
| | - Beatriz Lopez
- Centers for Disease Control and Prevention-Central America Region, Guatemala City, Guatemala
| | - Eric Dumonteil
- Department of Tropical Medicine, Vector-Borne and Infectious Disease Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | | | - Kristy O Murray
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, TX, USA
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
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3
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Fortini MB, Erickson TA, Leining L, Robinson K, Carey MN, Smith SJ, Sullivan B, Nelson A, Gunter SM, Weatherhead JE. Review of Toxocariasis at a Children's Hospital Prompting Need for Public Health Interventions. Pediatr Infect Dis J 2023; 42:862-866. [PMID: 37625080 PMCID: PMC10754417 DOI: 10.1097/inf.0000000000004042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
BACKGROUND Toxocariasis, caused the by dog and cat roundworm, is one of the most common zoonotic helminth infections in the United States and can lead to severe lifelong morbidity in children. Although historical seroprevalence studies have identified a high frequency of toxocariasis regionally in the United States, there are few studies linking epidemiology and clinical disease in children. The study objective was to examine the contemporary epidemiology of pediatric toxocariasis within an endemic US region. METHODS We conducted an epidemiologic study analyzing children diagnosed with toxocariasis presenting to a tertiary pediatric hospital in Texas from 2010 to 2021. We examined risk factors and performed a geospatial analysis, including a comparative analysis of human cases and locations of surrendered infected stray animals in the same region. RESULTS Children diagnosed with toxocariasis were most commonly of Hispanic/Latino ethnicity (30/46; 65%), white race (41/45; 91%) and receiving Medicaid (34/44, 77%). Many infected children had contact with dogs or cats. Ocular toxocariasis was associated with a lack of peripheral eosinophilia ( P < 0.001). No other Toxocara syndromes were associated with defined absolute eosinophil count levels. Post-treatment resolution of eosinophilia was variable, ranging from 1 to 172 weeks. A Toxocara hotspot was identified in northeast Houston, comprising one of the lowest median household incomes in the region. CONCLUSIONS Toxocariasis is a devastating zoonotic infection in children living in the US. As it is not a reportable disease, the true burden remains unknown. It is critical to increase awareness of toxocariasis to direct public health interventions and ultimately reduce Toxocara -induced morbidity in US children.
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Affiliation(s)
- Mary B. Fortini
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Baylor College of Medicine Houston, TX
- Department of Pediatrics, Division of Pediatric Tropical Medicine, Baylor College of Medicine Houston, TX
| | - Timothy A. Erickson
- Department of Pediatrics, Division of Pediatric Tropical Medicine, Baylor College of Medicine Houston, TX
| | - Lauren Leining
- Department of Pediatrics, Division of Pediatric Tropical Medicine, Baylor College of Medicine Houston, TX
| | - Karina Robinson
- Department of Pediatrics, Baylor College of Medicine Houston, TX
| | - Megan N. Carey
- Department of Pediatrics, Baylor College of Medicine Houston, TX
| | - Sarah J. Smith
- Veterinary Public Health, Harris County Public Health, Houston, TX
| | - Brendan Sullivan
- Veterinary Public Health, Harris County Public Health, Houston, TX
| | - Alisa Nelson
- Department of Pediatrics, Division of Pediatric Tropical Medicine, Baylor College of Medicine Houston, TX
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX
| | - Sarah M. Gunter
- Department of Pediatrics, Division of Pediatric Tropical Medicine, Baylor College of Medicine Houston, TX
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX
| | - Jill E. Weatherhead
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Baylor College of Medicine Houston, TX
- Department of Pediatrics, Division of Pediatric Tropical Medicine, Baylor College of Medicine Houston, TX
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine Houston, TX
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4
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Nilles EJ, de St Aubin M, Dumas D, Duke W, Etienne MC, Abdalla G, Jarolim P, Oasan T, Garnier S, Iihoshi N, Lopez B, de la Cruz L, Puello YC, Baldwin M, Roberts KW, Peña F, Durski K, Sanchez IM, Gunter SM, Kneubehl AR, Murray KO, Lino A, Strobel S, Baez AA, Lau CL, Kucharski A, Gutiérrez EZ, Skewes-Ramm R, Vasquez M, Paulino CT. Monitoring Temporal Changes in SARS-CoV-2 Spike Antibody Levels and Variant-Specific Risk for Infection, Dominican Republic, March 2021-August 2022. Emerg Infect Dis 2023; 29:723-733. [PMID: 36848869 PMCID: PMC10045678 DOI: 10.3201/eid2904.221628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
To assess changes in SARS-CoV-2 spike binding antibody prevalence in the Dominican Republic and implications for immunologic protection against variants of concern, we prospectively enrolled 2,300 patients with undifferentiated febrile illnesses in a study during March 2021-August 2022. We tested serum samples for spike antibodies and tested nasopharyngeal samples for acute SARS-CoV-2 infection using a reverse transcription PCR nucleic acid amplification test. Geometric mean spike antibody titers increased from 6.6 (95% CI 5.1-8.7) binding antibody units (BAU)/mL during March-June 2021 to 1,332 (95% CI 1,055-1,682) BAU/mL during May-August 2022. Multivariable binomial odds ratios for acute infection were 0.55 (95% CI 0.40-0.74), 0.38 (95% CI 0.27-0.55), and 0.27 (95% CI 0.18-0.40) for the second, third, and fourth versus the first anti-spike quartile; findings were similar by viral strain. Combining serologic and virologic screening might enable monitoring of discrete population immunologic markers and their implications for emergent variant transmission.
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5
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Shih DC, Silver R, Henao OL, Alemu A, Audi A, Bigogo G, Colston JM, Edu-Quansah EP, Erickson TA, Gashu A, Gbelee GB, Gunter SM, Kosek MN, Logan GG, Mackey JM, Maliga A, Manzanero R, Morazan G, Morey F, Munoz FM, Murray KO, Nelson TV, Olortegui MP, Yori PP, Ronca SE, Schiaffino F, Tayachew A, Tedasse M, Wossen M, Allen DR, Angra P, Balish A, Farron M, Guerra M, Herman-Roloff A, Hicks VJ, Hunsperger E, Kazazian L, Mikoleit M, Munyua P, Munywoki PK, Namwase AS, Onyango CO, Park M, Peruski LF, Sugerman DE, Gutierrez EZ, Cohen AL. Incorporating COVID-19 into Acute Febrile Illness Surveillance Systems, Belize, Kenya, Ethiopia, Peru, and Liberia, 2020-2021. Emerg Infect Dis 2022; 28:S34-S41. [PMID: 36502419 DOI: 10.3201/eid2813.220898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Existing acute febrile illness (AFI) surveillance systems can be leveraged to identify and characterize emerging pathogens, such as SARS-CoV-2, which causes COVID-19. The US Centers for Disease Control and Prevention collaborated with ministries of health and implementing partners in Belize, Ethiopia, Kenya, Liberia, and Peru to adapt AFI surveillance systems to generate COVID-19 response information. Staff at sentinel sites collected epidemiologic data from persons meeting AFI criteria and specimens for SARS-CoV-2 testing. A total of 5,501 patients with AFI were enrolled during March 2020-October 2021; >69% underwent SARS-CoV-2 testing. Percentage positivity for SARS-CoV-2 ranged from 4% (87/2,151, Kenya) to 19% (22/115, Ethiopia). We show SARS-CoV-2 testing was successfully integrated into AFI surveillance in 5 low- to middle-income countries to detect COVID-19 within AFI care-seeking populations. AFI surveillance systems can be used to build capacity to detect and respond to both emerging and endemic infectious disease threats.
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6
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Murray KO, Saldaña MA, Gunter SM, Manzanero R, Zielinski-Gutierrez E, Herrera C, Thompson JM, Maliga A, Bautista K, Lino A, Hawes E, Ronca SE, Morey F, Fuentes RC, Lopez B, Dumonteil E, Morazan GH. Diagnosis of Acute Chagas Disease in a Belizean Child with Evidence of a Multiclonal Trypanosoma cruzi Infection. Am J Trop Med Hyg 2022; 107:992-995. [PMID: 36395748 PMCID: PMC9709023 DOI: 10.4269/ajtmh.22-0338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/30/2022] [Indexed: 09/06/2023] Open
Abstract
In January 2020, we instituted acute febrile illness surveillance in 11 hospitals and clinics across Belize. Within 3 months, we diagnosed an acute case of Chagas disease by polymerase chain reaction in a 7-year-old child in the northern part of the country. Phylogenetic analyses of the parasite from the acute blood specimen revealed a multiclonal Trypanosoma cruzi infection, including parasites from the TcII (25.0% of haplotypes), TcIV (2.5% of haplotypes), and TcV (72.5% of haplotypes) discrete typing units. The family reported no history of travel, and three Triatoma species vectors were found within the home. The child's mother was seronegative for antibodies to T. cruzi, ruling out congenital transmission. Convalescent blood samples documented seroconversion and confirmed acute infection. The child was successfully treated with nifurtimox. This is the first known diagnosed case of acute Chagas infection in Belize, highlighting the need for further investigation and public health prevention measures.
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Affiliation(s)
- Kristy O Murray
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
- William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, Texas
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Miguel A Saldaña
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
- William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, Texas
| | - Sarah M Gunter
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
- William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, Texas
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | | | | | - Claudia Herrera
- Department of Tropical Medicine, Vector-Borne and Infectious Disease Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Julie M Thompson
- Department of Tropical Medicine, Vector-Borne and Infectious Disease Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
- Department of Biomedical Science, School of Medicine, Tulane University, New Orleans, Louisiana
| | - Adrianna Maliga
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Kim Bautista
- Belize Ministry of Health and Wellness, Belmopan, Belize
| | - Allison Lino
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
- William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, Texas
| | - Ella Hawes
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
- William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, Texas
| | - Shannon E Ronca
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
- William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, Texas
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Francis Morey
- Belize Ministry of Health and Wellness, Belmopan, Belize
| | - Rafael Chacon Fuentes
- U.S. Centers for Disease Control and Prevention-Central America Region, Guatemala City, Guatemala
| | - Beatriz Lopez
- U.S. Centers for Disease Control and Prevention-Central America Region, Guatemala City, Guatemala
| | - Eric Dumonteil
- Department of Tropical Medicine, Vector-Borne and Infectious Disease Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Gerhaldine H Morazan
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
- Belize Ministry of Health and Wellness, Belmopan, Belize
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Ronca SE, Gunter SM, Kairis RB, Lino A, Romero J, Pautler RG, Nimmo A, Murray KO. A Potential Role for Substance P in West Nile Virus Neuropathogenesis. Viruses 2022; 14:v14091961. [PMID: 36146768 PMCID: PMC9503494 DOI: 10.3390/v14091961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Of individuals who develop West Nile neuroinvasive disease (WNND), ~10% will die and >40% will develop long-term complications. Current treatment recommendations solely focus on supportive care; therefore, we urgently need to identify novel and effective therapeutic options. We observed a correlation between substance P (SP), a key player in neuroinflammation, and its receptor Neurokinin-1 (NK1R). Our study in a wild-type BL6 mouse model found that SP is upregulated in the brain during infection, which correlated with neuroinvasion and damage to the blood−brain barrier. Blocking the SP/NK1R interaction beginning at disease onset modestly improved survival and prolonged time to death in a small pilot study. Although SP is significantly increased in the brain of untreated WNND mice when compared to mock-infected animals, levels of WNV are unchanged, indicating that SP likely does not play a role in viral replication but may mediate the immune response to infection. Additional studies are necessary to define if SP plays a mechanistic role or if it represents other mechanistic pathways.
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Affiliation(s)
- Shannon E. Ronca
- Division of Tropical Medicine, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA
- Correspondence: (S.E.R.); (K.O.M.)
| | - Sarah M. Gunter
- Division of Tropical Medicine, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA
| | - Rebecca Berry Kairis
- Division of Tropical Medicine, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA
| | - Allison Lino
- Division of Tropical Medicine, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA
| | - Jonathan Romero
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Robia G. Pautler
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Alan Nimmo
- Centre for Molecular Therapeutics and College of Medicine and Dentistry, James Cook University, Cairns, QLD 4878, Australia
| | - Kristy O. Murray
- Division of Tropical Medicine, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA
- Correspondence: (S.E.R.); (K.O.M.)
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8
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Erickson TA, Ronca SE, Gunter SM, Brown EL, Hasbun R, Murray KO. Zoonotic Disease Testing Practices in Pediatric Patients with Meningitis and Encephalitis in a Subtropical Region. Pathogens 2022; 11:pathogens11050501. [PMID: 35631022 PMCID: PMC9145480 DOI: 10.3390/pathogens11050501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022] Open
Abstract
Emerging vector-borne and zoonotic pathogens can cause neuroinvasive disease in children; utilization of appropriate diagnostic testing can be low, hindering diagnosis and clinical management of these cases. We must understand factors that influence healthcare providers’ decisions to order diagnostic testing. We reviewed medical charts for pediatric meningitis and encephalitis patients (90 days–18 years) between 2010 and 2017 and analyzed variables associated with testing for known neuroinvasive zoonotic pathogens in the southern United States: West Nile virus (WNV), Bartonella spp., and Rickettsia spp. Among 620 cases of meningitis and encephalitis, ~1/3 (n = 209, 34%) were tested for WNV. Fewer cases were tested for Bartonella (n = 77, 12%) and Rickettsia (n = 47, 8%). Among those tested, 14 (7%) WNV, 7 (9%) Bartonella, and 6 (13%) Rickettsia cases were identified. Factors predicting testing were similar between all agents: clinical presentation of encephalitis, focal neurologic symptoms, new onset seizure, and decreased Glasgow Coma Scale on admission. Cases with a history of arthropod contact were more likely to be tested; however, we did not see an increase in testing during the summer season, when vector exposure typically increases. While our test utilization was higher than that reported in other studies, improvement is needed to identify zoonotic causes of neuroinvasive diseases.
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Affiliation(s)
- Timothy A. Erickson
- Department of Pediatrics, Section of Pediatric Tropical Medicine, Center for Human Immunobiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA; (T.A.E.); (S.M.G.)
- School of Public Health, University of Texas Health Science Center, Houston, TX 77030, USA;
| | - Shannon E. Ronca
- Department of Pediatrics, Section of Pediatric Tropical Medicine, Center for Human Immunobiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA; (T.A.E.); (S.M.G.)
- Correspondence: (S.E.R.); (K.O.M.); Tel.: +1-832-824-7595 (S.E.R.)
| | - Sarah M. Gunter
- Department of Pediatrics, Section of Pediatric Tropical Medicine, Center for Human Immunobiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA; (T.A.E.); (S.M.G.)
| | - Eric L. Brown
- School of Public Health, University of Texas Health Science Center, Houston, TX 77030, USA;
| | - Rodrigo Hasbun
- McGovern Medical School, University of Texas, Houston, TX 77030, USA;
| | - Kristy O. Murray
- Department of Pediatrics, Section of Pediatric Tropical Medicine, Center for Human Immunobiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA; (T.A.E.); (S.M.G.)
- Correspondence: (S.E.R.); (K.O.M.); Tel.: +1-832-824-7595 (S.E.R.)
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9
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Krishnavajhala A, Armstrong BA, Kneubehl AR, Gunter SM, Piccione J, Kim HJ, Ramirez R, Castro-Arellano I, Roachell W, Teel PD, Lopez JE. Diversity and distribution of the tick-borne relapsing fever spirochete Borrelia turicatae. PLoS Negl Trop Dis 2021; 15:e0009868. [PMID: 34813588 PMCID: PMC8651100 DOI: 10.1371/journal.pntd.0009868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 12/07/2021] [Accepted: 10/01/2021] [Indexed: 11/26/2022] Open
Abstract
Borrelia turicatae is a causative agent of tick-borne relapsing fever (TBRF) in the subtropics and tropics of the United States and Latin America. Historically, B. turicatae was thought to be maintained in enzootic cycles in rural areas. However, there is growing evidence that suggests the pathogen has established endemic foci in densely populated regions of Texas. With the growth of homelessness in the state and human activity in city parks, it was important to implement field collection efforts to identify areas where B. turicatae and its vector circulate. Between 2017 and 2020 we collected Ornithodoros turicata ticks in suburban and urban areas including public and private parks and recreational spaces. Ticks were fed on naïve mice and spirochetes were isolated from the blood. Multilocus sequence typing (MLST) was performed on eight newly obtained isolates and included previously reported sequences. The four chromosomal loci targeted for MLST were 16S ribosomal RNA (rrs), flagellin B (flaB), DNA gyrase B (gyrB), and the intergenic spacer (IGS). Given the complexity of Borrelia genomes, plasmid diversity was also evaluated. These studies indicate that the IGS locus segregates B. turicatae into four genomic types and plasmid diversity is extensive between isolates. Furthermore, B. turicatae and its vector have established endemic foci in parks and recreational areas in densely populated settings of Texas.
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Affiliation(s)
- Aparna Krishnavajhala
- Department of Pediatrics and the National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Brittany A. Armstrong
- Department of Pediatrics and the National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Alexander R. Kneubehl
- Department of Pediatrics and the National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Sarah M. Gunter
- Department of Pediatrics and the National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Julie Piccione
- Texas A&M Veterinary Medical Diagnostic Laboratory, College Station, Texas, United States of America
| | - Hee J. Kim
- Department of Entomology, Texas A&M AgriLife Research, College Station, Texas, United States of America
| | - Rosa Ramirez
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
| | - Ivan Castro-Arellano
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
| | - Walter Roachell
- Public Health Command-Central, Fort Sam Houston, Texas, United States of America
| | - Pete D. Teel
- Department of Entomology, Texas A&M AgriLife Research, College Station, Texas, United States of America
| | - Job E. Lopez
- Department of Pediatrics and the National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
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10
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Abstract
Neuroborreliosis initially misdiagnosed as Lyme disease was discovered to be caused by the relapsing fever spirochete Borrelia turicatae. Tickborne relapsing fever spirochetes are an overlooked cause of disease around the globe. We report a case of tickborne relapsing fever in a patient in Texas, USA, who had a single febrile episode and gastrointestinal and neurologic symptoms. Immunoblot analysis using recombinant Borrelia immunogenic protein A implicated Borrelia turicatae as the causative agent.
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11
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Bermúdez SE, Armstrong BA, Domínguez L, Krishnavajhala A, Kneubehl AR, Gunter SM, Replogle A, Petersen JM, Lopez JE. Isolation and genetic characterization of a relapsing fever spirochete isolated from Ornithodoros puertoricensis collected in central Panama. PLoS Negl Trop Dis 2021; 15:e0009642. [PMID: 34398885 PMCID: PMC8389842 DOI: 10.1371/journal.pntd.0009642] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/26/2021] [Accepted: 07/10/2021] [Indexed: 11/18/2022] Open
Abstract
Tick-borne relapsing fever (TBRF) spirochetes are likely an overlooked cause of disease in Latin America. In Panama, the pathogens were first reported to cause human disease in the early 1900s. Recent collections of Ornithodoros puertoricensis from human dwellings in Panama prompted our interest to determine whether spirochetes still circulate in the country. Ornithodoros puertoricensis ticks were collected at field sites around the City of Panama. In the laboratory, the ticks were determined to be infected with TBRF spirochetes by transmission to mice, and we report the laboratory isolation and genetic characterization of a species of TBRF spirochete from Panama. Since this was the first isolation of a species of TBRF spirochete from Central America, we propose to designate the bacteria as Borrelia puertoricensis sp. nov. This is consistent with TBRF spirochete species nomenclature from North America that are designated after their tick vector. These findings warrant further investigations to assess the threat B. puertoricensis sp. nov. may impose on human health. Tick-borne relapsing fever (TBRF) is an often misdiagnosed neglected tropical disease primarily impacting those in resource limited settings. Most species are transmitted by argasid ticks, but ixodid ticks and the human body louse are also competent vectors. Infection of TBRF spirochetes is challenging to diagnose because argasid ticks are rapid feeders and rarely spotted on the patient. Moreover, given the nonspecific manifestation of disease and poor clinical awareness, TBRF is overlooked. In Central America, TBRF was studied in the Canal Zone of Panama until the 1930s. Over the last 10 years argasid ticks have been reported to colonize human dwellings in the country but it has remained vague if the disease persists. In this study, we demonstrate the transmission of TBRF spirochetes from field collected ticks and the laboratory isolation and genetic characterization of the species. These findings suggest that TBRF spirochetes continue to circulate in Panama and should prompt health care providers to consider this disease when patients present with a fever of unknown origin. Furthermore, with the laboratory isolation of this bacteria, molecular diagnostic tools can be developed to improve epidemiological studies of TBRF spirochetes in Central America.
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Affiliation(s)
- Sergio E Bermúdez
- Departamento de Investigación en Entomología Médica, Instituto Commemorativo Gorgas de Estudios de la Salud, Ciudad de Panama Panama
| | - Brittany A Armstrong
- Department of Pediatrics, The National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America.,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Lillian Domínguez
- Departamento de Investigación en Entomología Médica, Instituto Commemorativo Gorgas de Estudios de la Salud, Ciudad de Panama Panama
| | - Aparna Krishnavajhala
- Department of Pediatrics, The National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Alexander R Kneubehl
- Department of Pediatrics, The National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America.,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Sarah M Gunter
- Department of Pediatrics, The National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Adam Replogle
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Bacterial Diseases Branch, Fort Collins, Colorado, United States of America
| | - Jeannine M Petersen
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Bacterial Diseases Branch, Fort Collins, Colorado, United States of America
| | - Job E Lopez
- Department of Pediatrics, The National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America.,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States of America
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12
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Erickson TA, Mayes B, Murray KO, Gunter SM. The epidemiology of human ehrlichiosis in Texas, 2008-2017. Ticks Tick Borne Dis 2021; 12:101788. [PMID: 34325087 DOI: 10.1016/j.ttbdis.2021.101788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 01/10/2023]
Abstract
Tick-borne diseases in the United States, including ehrlichiosis, represent a growing public health problem. The purpose of this study was to examine the contemporary epidemiology of human ehrlichiosis in Texas by analyzing cases reported to the Texas Department of State Health Services. In Texas, 101 cases of ehrlichiosis were reported during 2008-2017. We observed geographic grouping of cases as well as an increasing trend of reported cases occurring annually from 2009 to 2017. Notably, 27 cases occurred in 2008 in south Texas with unique patient characteristics in that they were younger, less likely to be hospitalized, and presented with disease earlier in the year than typically seen. Our findings highlight the importance of disease awareness and prevention of tick bites as well as further investigation into transmission risk and future disease patterns.
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Affiliation(s)
- Timothy A Erickson
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States; National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States; William T. Shearer Center for Human Immunobiology, Baylor College of Medicine, Houston, TX, United States
| | - Bonny Mayes
- Texas Department of State Health Services, Austin, TX, United States
| | - Kristy O Murray
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States; National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States; William T. Shearer Center for Human Immunobiology, Baylor College of Medicine, Houston, TX, United States
| | - Sarah M Gunter
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States; National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States; William T. Shearer Center for Human Immunobiology, Baylor College of Medicine, Houston, TX, United States.
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13
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Nolan MS, Aguilar D, Misra A, Gunter SM, Erickson T, Gorchakov R, Rivera H, Montgomery SP, Murray KO. Trypanosoma cruzi in Nonischemic Cardiomyopathy Patients, Houston, Texas, USA. Emerg Infect Dis 2021; 27:1958-1960. [PMID: 34152952 PMCID: PMC8237890 DOI: 10.3201/eid2707.203244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
To investigate possible cardiac manifestations of Chagas disease, we tested 97 Latinx patients with nonischemic cardiomyopathy in Houston, Texas, USA, for Trypanosoma cruzi infection. We noted a high prevalence of underdiagnosed infection and discrepant results in clinical diagnostic assays. Latinx cardiac patients in the United States would benefit from laboratory screening for T. cruzi infection.
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14
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Oluyomi AO, Gunter SM, Leining LM, Murray KO, Amos C. COVID-19 Community Incidence and Associated Neighborhood-Level Characteristics in Houston, Texas, USA. Int J Environ Res Public Health 2021; 18:ijerph18041495. [PMID: 33557439 PMCID: PMC7915818 DOI: 10.3390/ijerph18041495] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/21/2021] [Accepted: 01/30/2021] [Indexed: 12/27/2022]
Abstract
Central to developing effective control measures for the COVID-19 pandemic is understanding the epidemiology of transmission in the community. Geospatial analysis of neighborhood-level data could provide insight into drivers of infection. In the current analysis of Harris County, Texas, we used custom interpolation tools in GIS to disaggregate COVID-19 incidence estimates from the zip code to census tract estimates—a better representation of neighborhood-level estimates. We assessed the associations between 29 neighborhood-level characteristics and COVID-19 incidence using a series of aspatial and spatial models. The variables that maintained significant and positive associations with COVID-19 incidence in our final aspatial model and later represented in a geographically weighted regression model were the percentage of the Black/African American population, percentage of the foreign-born population, area derivation index (ADI), percentage of households with no vehicle, and percentage of people over 65 years old inside each census tract. Conversely, we observed negative and significant association with the percentage employed in education. Notably, the spatial models indicated that the impact of ADI was homogeneous across the study area, but other risk factors varied by neighborhood. The current findings could enhance decision making by local public health officials in responding to the COVID-19 pandemic. By understanding factors that drive community transmission, we can better target disease control measures.
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Affiliation(s)
- Abiodun O. Oluyomi
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA;
- Environmental Health Service, Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Gulf Coast Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence:
| | - Sarah M. Gunter
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX 77030, USA; (S.M.G.); (L.M.L.); (K.O.M.)
- Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
- William T. Shearer Center for Human Immunobiology, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Lauren M. Leining
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX 77030, USA; (S.M.G.); (L.M.L.); (K.O.M.)
- Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
- William T. Shearer Center for Human Immunobiology, Texas Children’s Hospital, Houston, TX 77030, USA
- Division of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Kristy O. Murray
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX 77030, USA; (S.M.G.); (L.M.L.); (K.O.M.)
- Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
- William T. Shearer Center for Human Immunobiology, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Chris Amos
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA;
- Gulf Coast Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX 77030, USA
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX 77030, USA
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15
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Gatchalian SR, Agathis NT, Castillo-Carandang NT, Gunter SM, Murray KO, Mandalakas AM. Design and Evaluation of Risk Assessment Tools to Identify Pediatric Tuberculosis Infection in Bohol, the Philippines, a Low-HIV- and High-TB-Burden Setting. Am J Trop Med Hyg 2020; 103:1818-1826. [PMID: 32975174 PMCID: PMC7646812 DOI: 10.4269/ajtmh.20-0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Identifying children with, or at substantial risk of, Mycobacterium tuberculosis infection (TBI) and providing TB preventive therapy (TPT) represent an important, yet challenging, strategy in curbing the global burden of childhood TB. Risk assessment scoring tools, which quantify risks associated with unique factors characterizing an individual, could act as a surrogate measure of TBI risk and guide effective and efficient TPT delivery. We assessed important risk factors of childhood TBI and created risk assessment tools through secondary analysis of data from a large, community-based childhood TB prevalence study in the island province of Bohol in the Philippines, a low–HIV- and high–TB-burden, post-disaster setting. We identified four factors that were statistically associated with acquiring TBI—being 5 years or older, having a known TB contact, having a known TB contact who was either the mother or another primary caregiver, and living in a high–TB-burden municipality. We created 2-item, 4-item, and 9-item scores intended to identify child TBI in this low-resource, low–HIV-, and high–TB-burden setting. In addition to the design, evaluation, and impact analysis of these generalizable and valuable risk assessment tools, our study findings emphasize the necessity of targeting both household and community-associated transmissions of childhood TBI to achieve the global goal to end TB.
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Affiliation(s)
- Salvacion R Gatchalian
- Department of Pediatrics, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Nickolas T Agathis
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Nina T Castillo-Carandang
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Philippines.,Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Sarah M Gunter
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Kristy O Murray
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Anna M Mandalakas
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
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16
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Dye-Braumuller KC, Lynn MK, Gorchakov R, Gunter SM, Berry RM, Murray KO, Nolan MS. Low Trypanosoma cruzi transmission risk to humans in the Trans-Pecos region of Texas. Parasite Epidemiol Control 2020; 11:e00180. [PMID: 33005772 PMCID: PMC7511731 DOI: 10.1016/j.parepi.2020.e00180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/12/2020] [Accepted: 09/04/2020] [Indexed: 01/24/2023] Open
Abstract
In the Trans-Pecos region of Texas, reports of domestic triatomine bites were common (67%), with 36% of residentially collected triatomines positive for Trypanosoma cruzi. Despite the transmission potential, no human infections were detected. Collected Triatoma rubida species were themselves frequently parasitized with mites.
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Affiliation(s)
| | | | - Rodion Gorchakov
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Sarah M Gunter
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Rebecca M Berry
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Kristy O Murray
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Melissa S Nolan
- University of South Carolina, Columbia, SC, USA.,Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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17
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Gunter SM, Ronca SE, Sandoval M, Coffman K, Leining L, Gorchakov R, Murray KO, Nolan MS. Chagas Disease Infection Prevalence and Vector Exposure in a High-Risk Population of Texas Hunters. Am J Trop Med Hyg 2020; 102:294-297. [PMID: 31872798 DOI: 10.4269/ajtmh.19-0310] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Chagas disease, caused by the vector-borne parasite Trypanosoma cruzi, remains one of the most significant neglected tropical diseases affecting the Americas. Identifying high-risk populations is important for understanding Chagas disease transmission and directing public health resources. We recently hypothesized that Texas hunters may be at an elevated risk for contracting Chagas disease because of opportunities for vector exposure and contact with blood of infected reservoirs. To assess their unique exposure risks, we conducted a statewide screening program of Texas hunters. A total of 885 study participants were interviewed and tested for T. cruzi infection; 18 screened positive on a rapid, point-of-care test; however, none were found positive through confirmatory testing. We did find a high prevalence of reported direct contact with wildlife blood as well as triatomine and other arthropod disease vectors. This large-scale screening program represents a novel approach to better understand the vector-borne disease risk in this unique population.
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Affiliation(s)
- Sarah M Gunter
- Section of Pediatric Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Shannon E Ronca
- Section of Pediatric Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Micaela Sandoval
- The University of Texas Health Science Center, School of Public Health, Houston, Texas
| | - Kimberly Coffman
- The University of Texas Health Science Center, School of Public Health, Houston, Texas
| | - Lauren Leining
- The University of Texas Health Science Center, School of Public Health, Houston, Texas.,Section of Pediatric Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Rodion Gorchakov
- Section of Pediatric Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Kristy O Murray
- Section of Pediatric Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Melissa S Nolan
- The University of South Carolina, Arnold School of Public Health, Greenville, South Carolina.,Section of Pediatric Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
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18
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Gorchakov R, Gulas-Wroblewski BE, Ronca SE, Ruff JC, Nolan MS, Berry R, Alvarado RE, Gunter SM, Murray KO. Optimizing PCR Detection of West Nile Virus from Body Fluid Specimens to Delineate Natural History in an Infected Human Cohort. Int J Mol Sci 2019; 20:ijms20081934. [PMID: 31010160 PMCID: PMC6514913 DOI: 10.3390/ijms20081934] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022] Open
Abstract
West Nile virus (WNV), a mosquito-borne arbovirus, remains a major global health concern. In this study, we optimized PCR methods then assessed serially-collected whole blood (WB), urine (UR), saliva, and semen specimens from a large cohort of WNV-positive participants to evaluate the natural history of infection and persistent shedding of WNV RNA. Viral RNA extraction protocols for frozen WB and UR specimens were optimized and validated through spiking experiments to maximize recovery of viral RNA from archived specimens and to assess the degradation of WNV RNA in stored UR specimens. The resultant procedures were used in conjunction with PCR detection to identify WNV-positive specimens and to quantify their viral loads. A total of 59 of 352 WB, 10 of 38 UR, and 2 of 34 saliva specimens tested positive for WNV RNA. Although a single semen specimen was positive 22 days post onset, we could not definitively confirm the presence of WNV RNA in the remaining specimens. WNV RNA-positive UR specimens exhibited profound loss of viral RNA during storage, highlighting the need for optimal preservation pre-storage. This study provides optimized methods for WNV RNA detection among different fluid types and offers alternative options for diagnostic testing during the acute stages of WNV.
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Affiliation(s)
- Rodion Gorchakov
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA.
| | - Bonnie E Gulas-Wroblewski
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA.
- Department of Wildlife and Fisheries Sciences, Texas A&M University, College Station, TX 77843, USA.
| | - Shannon E Ronca
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA.
| | - Jeanne C Ruff
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA.
| | - Melissa S Nolan
- University of South Carolina, Arnold School of Public Health, Columbia, SC 29208, USA.
| | - Rebecca Berry
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA.
| | - R Elias Alvarado
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA.
| | - Sarah M Gunter
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA.
| | - Kristy O Murray
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA.
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19
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Dye-Braumuller KC, Gorchakov R, Gunter SM, Nielsen DH, Roachell WD, Wheless A, Debboun M, Murray KO, Nolan MS. Identification of Triatomines and Their Habitats in a Highly Developed Urban Environment. Vector Borne Zoonotic Dis 2019; 19:265-273. [PMID: 30571182 PMCID: PMC6459272 DOI: 10.1089/vbz.2018.2352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Eleven triatomine species, the vector for Chagas disease, are endemic in the southern U.S. While traditionally thought to only occur in rural habitats and sylvatic transmission cycles, recent studies provide compounding evidence that triatomines could exist in urban habitats and domestic transmission cycles in Texas. We conducted a study of active and passive surveillance techniques over 3 years (2016-2018) in the City of Houston, Harris County, Texas to determine the presence of triatomines in this metroplex. Active surveillance methods uncovered Triatoma sanguisuga nymphs from two locations in downtown Houston city parks. We also documented the first Trypanosoma cruzi positive kissing bug collected in an urban environment of Harris County, Texas. Our findings provide evidence that triatomines can be found in heavily populated U.S. urban environments, and warrant public health support for expanded triatomine and Chagas disease surveillance in city settings.
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Affiliation(s)
| | - Rodion Gorchakov
- Section of Pediatric Tropical Medicine, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Sarah M. Gunter
- Section of Pediatric Tropical Medicine, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - David H. Nielsen
- Public Health Command Central, JBSA-Fort Sam Houston, San Antonio, Texas
| | - Walter D. Roachell
- Public Health Command Central, JBSA-Fort Sam Houston, San Antonio, Texas
| | - Anna Wheless
- Section of Pediatric Tropical Medicine, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Mustapha Debboun
- Mosquito and Vector Control Division, Harris County Public Health, Houston, Texas
| | - Kristy O. Murray
- Section of Pediatric Tropical Medicine, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Melissa S. Nolan
- Section of Pediatric Tropical Medicine, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
- Department of Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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20
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Nolan MS, Aguilar D, Brown EL, Gunter SM, Ronca SE, Hanis CL, Murray KO. Continuing evidence of Chagas disease along the Texas-Mexico border. PLoS Negl Trop Dis 2018; 12:e0006899. [PMID: 30427833 PMCID: PMC6261633 DOI: 10.1371/journal.pntd.0006899] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 11/28/2018] [Accepted: 10/04/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Chagas disease is a chronic parasitic infection that progresses to dilated cardiomyopathy in 30% of human cases. Public health efforts target diagnosing asymptomatic cases, as therapeutic efficacy diminishes as irreversible tissue damage progresses. Physician diagnosis of Chagas disease cases in the United States is low, partially due to lack of awareness of the potential burden in the United States. METHODOLOGY/PRINCIPAL FINDINGS The current study tested a patient cohort of 1,196 Starr County, Texas residents using the Hemagen Chagas ELISA Kit as a preliminary screening assay. Samples testing positive using the Hemagen test were subjected to additional confirmatory tests. Two patients (0.17%) without previous Chagas disease diagnosis were identified; both had evidence of acquiring disease in the United States or along the Texas-Mexico border. CONCLUSIONS/SIGNIFICANCE The Texas-Mexico border is a foci of Chagas disease human cases, with a local disease burden potentially twice the national estimate of Hispanic populations. It is imperative that physicians consider persons with residential histories along the Texas-Mexico border for Chagas disease testing.
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Affiliation(s)
- Melissa S. Nolan
- Department of Pediatric Tropical Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - David Aguilar
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, TX, United States of America
- Department of Cardiology, Baylor College of Medicine, Houston, TX, United States of America
| | - Eric L. Brown
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Sarah M. Gunter
- Department of Pediatric Tropical Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Shannon E. Ronca
- Department of Pediatric Tropical Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Craig L. Hanis
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Kristy O. Murray
- Department of Pediatric Tropical Medicine, Baylor College of Medicine, Houston, TX, United States of America
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21
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Gunter SM, Versteeg L, Jones KM, Keegan BP, Strych U, Bottazzi ME, Hotez PJ, Brown EL. Cover Image. Parasite Immunol 2018. [DOI: 10.1111/pim.12484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Gunter SM, Versteeg L, Jones KM, Keegan BP, Strych U, Bottazzi ME, Hotez PJ, Brown EL. Covalent vaccination with Trypanosoma cruzi Tc24 induces catalytic antibody production. Parasite Immunol 2018; 40:e12585. [PMID: 30132929 DOI: 10.1111/pim.12585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/13/2018] [Accepted: 08/16/2018] [Indexed: 11/28/2022]
Abstract
Trypanosoma cruzi 24 (Tc24) is a recently described B-cell superantigen (BC-SAg) expressed by all developmental stages of T. cruzi, the causative agent of Chagas disease. BC-SAgs are immunoevasins that interfere with the catalytic response available to a subset of natural antibodies comprising the preimmune (innate) repertoire. Electrophilic modifications of BC-SAgs facilitate the formation of highly energetic covalent reactions favouring B-cell differentiation instead of B-cell downregulation. Therefore, the aim of this study was to convert the inhibitory signals delivered to B-cells with specificity for Tc24 into activating signals after conjugating electrophilic phosphonate groups to recombinant Tc24 (eTc24). Covalent immunization with eTc24 increased the binding affinity between eTc24 and naturally nucleophilic immunoglobulins with specificity for this BC-SAg. Flow cytometric analyses demonstrated that eTc24 but not Tc24 or other electrophilically modified control proteins bound Tc24-specific IgM+ B-cells covalently. In addition, immunization of mice with eTc24 adjuvanted with ISA720 induced the production of catalytic responses specific for Tc24 compared to the abrogation of this response in mice immunized with Tc24/ISA720. eTc24-immunized mice also produced IgMs that bound recombinant Tc24 compared to the binding observed for IgMs purified from non eTc24-immunized controls. These data suggest that eTc24 immunization overrides the immunosuppressive properties of this BC-SAg.
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Affiliation(s)
- Sarah M Gunter
- Texas Children's Hospital Center for Vaccine Development, Pediatric Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Leroy Versteeg
- Texas Children's Hospital Center for Vaccine Development, Pediatric Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Kathryn M Jones
- Texas Children's Hospital Center for Vaccine Development, Pediatric Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Brian P Keegan
- Texas Children's Hospital Center for Vaccine Development, Pediatric Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Ulrich Strych
- Texas Children's Hospital Center for Vaccine Development, Pediatric Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Maria Elena Bottazzi
- Texas Children's Hospital Center for Vaccine Development, Pediatric Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas.,Department of Biology, Baylor University, Waco, Texas
| | - Peter J Hotez
- Texas Children's Hospital Center for Vaccine Development, Pediatric Tropical Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Eric L Brown
- Center for Infectious Disease, The University of Texas School of Public Health, Houston, Texas
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23
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Erickson T, Gunter SM, Starke J, Murray KO. Evidence of locally acquired spotted fever group rickettsioses in Southeast Texas, 2008-2016. Zoonoses Public Health 2018; 65:897-901. [PMID: 30152119 DOI: 10.1111/zph.12518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/26/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Abstract
We identified six paediatric case-patients from southeast Texas diagnosed with confirmed or probable Spotted Fever Group Rickettsiosis (SFGR) between 2008 and 2016. Only one case had a history of travel to an endemic area. Clinical and laboratory findings strongly suggest locally acquired Rocky Mountain Spotted Fever in one Houston patient. Public health reporting of SFGR is critical for monitoring emergence in nonendemic regions.
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Affiliation(s)
- Timothy Erickson
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas.,Section of Pediatric Tropical Medicine, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Sarah M Gunter
- Section of Pediatric Tropical Medicine, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Jeffrey Starke
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Kristy O Murray
- Section of Pediatric Tropical Medicine, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
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24
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Gunter SM, Murray KO, Gorchakov R, Beddard R, Rossmann SN, Montgomery SP, Rivera H, Brown EL, Aguilar D, Widman LE, Garcia MN. Likely Autochthonous Transmission of Trypanosoma cruzi to Humans, South Central Texas, USA. Emerg Infect Dis 2018; 23:500-503. [PMID: 28221110 PMCID: PMC5382766 DOI: 10.3201/eid2303.161157] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Chagas disease, caused by Trypanosoma cruzi, is a major neglected tropical disease affecting the Americas. The epidemiology of this disease in the United States is incomplete. We report evidence of likely autochthonous vectorborne transmission of T. cruzi and health outcomes in T. cruzi–seropositive blood donors in south central Texas, USA.
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25
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Gunter SM, Jones KM, Seid CA, Essigmann HT, Zhan B, Strych U, Bottazzi ME, Hotez PJ, Brown EL. Mutations to Cysteine Residues in the Trypanosoma cruzi B-Cell Superantigen Tc24 Diminish Susceptibility to IgM-Mediated Hydrolysis. J Parasitol 2017; 103:579-583. [PMID: 28581897 DOI: 10.1645/17-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
B-cell superantigens (BC-SAgs) are immunoevasins that have evolved in response to innate catalytic IgM antibodies; germ-line encoded immunoglobulins present in the preimmune repertoire independent of prior antigen exposure. Catalysis is the result of a 2-step process that involves first the formation of a non-covalent bond between the BC-SAg and the immunoglobulin followed by covalent bond formation at the catalytic site resulting in target hydrolysis. Tc24 is a recently described Trypanosoma cruzi BC-SAg hypothesized to play a role in evading the humoral response early in the infection period. We previously demonstrated that exposure to Tc24 following immunization or infection resulted in the depletion of the catalytic IgM response, leaving a gap in the catalytic IgM repertoire. The present report compares the BC-SAg properties of wild-type Tc24 (Tc24-WT) to that of 2 recombinant Tc24 isoforms: Tc24-C2 (Cys to Ser mutations in the 2 most-proximal Cys residues) and Tc24-C4 (Cys to Ser mutations in all 4 Cys residues present). BC-SAg activity was assessed by immunizing mice with the respective isoforms and examining the ability of IgM purified from the respective groups to hydrolyze the 3 Tc24 isoforms. In addition, the ability of IgM purified from naive mice to hydrolyze the Tc24 isoforms was also assessed. Immunization with Tc24-WT, Tc24-C2, or Tc24-C4 resulted in loss of IgM-mediated hydrolysis of Tc24-WT. However, the ability of IgM purified from naive mice (previously shown to hydrolyze Tc24-WT) was less effective in hydrolyzing the 2 Tc24 isoforms. These data demonstrate that although the BC-SAg site in the mutants remained intact, their reduced susceptibility to IgM-mediated hydrolysis suggested that structural changes resulting from the Cys to Ser mutations altered accessibility to the catalytic site in the 2 isoforms.
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Affiliation(s)
- Sarah M Gunter
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas 77030
| | - Kathryn M Jones
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas 77030
| | - Christopher A Seid
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas 77030
| | - Heather T Essigmann
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas 77030
| | - Bin Zhan
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas 77030
| | - Ulrich Strych
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas 77030
| | - Maria Elena Bottazzi
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas 77030
| | - Peter J Hotez
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas 77030
| | - Eric L Brown
- Baylor College of Medicine, National School of Tropical Medicine, Section of Tropical Medicine, Houston, Texas 77030
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26
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Hanis CL, Garrett KE, Essigmann HT, Robinson DA, Gunter SM, Nyitray AG, Brown EL. Household aggregation of Staphylococcus aureus by clonal complex and methicillin resistance profiles in Starr County, Texas. Eur J Clin Microbiol Infect Dis 2017; 36:1787-1793. [PMID: 28474178 DOI: 10.1007/s10096-017-2992-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/17/2017] [Indexed: 02/08/2023]
Abstract
Staphylococcus aureus is one of the most common causes of skin and soft tissue infections in health-care and community settings, but transmission of S. aureus in community-based populations is incompletely understood. S. aureus carriage phenotypes (persistent, intermittent, and non-carriers) were determined for households from Starr County, TX. Nasal swabs were collected from a cohort of 901 residents and screened for the presence of S. aureus. Isolated strains were spa-typed and assigned to clonal complexes. Of the 901 participants there were 134 pairs, 28 trios, 11 quartets, 3 quintets and 1 septet residing in the same household. There was a significant increase in "ever" carriers (persistent and intermittent carriers combined) in these households over that expected based on population frequencies (p = 0.029). There were 42 ever carrier pairs of individuals with 21 concordant for clonal complex type whereas only 4.7 were expected to be so (p = 6.9E-11). These results demonstrated clear aggregation of S. aureus carriage and concordance for strain types within households. As antibiotic-resistant S. aureus strains increase in community settings, it is important to better understand risk factors for colonization, mechanisms of transmission, clonal complexes present, and the role of household concordance/transmission.
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Affiliation(s)
- C L Hanis
- Human Genetics Center, Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - K E Garrett
- Center for Infectious Disease, Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, Houston, TX, USA
| | - H T Essigmann
- Center for Infectious Disease, Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, Houston, TX, USA
| | - D A Robinson
- Department of Microbiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - S M Gunter
- Center for Infectious Disease, Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, Houston, TX, USA.,National School of Tropical Medicine, Section of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - A G Nyitray
- Center for Infectious Disease, Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, Houston, TX, USA
| | - E L Brown
- Center for Infectious Disease, Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, Houston, TX, USA.
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27
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Harris N, Woc-Colburn L, Gunter SM, Gorchakov R, Murray KO, Rossmann S, Garcia MN. Autochthonous Chagas disease in the southern United States: A case report of suspected residential and military exposures. Zoonoses Public Health 2017; 64:491-493. [PMID: 28418113 DOI: 10.1111/zph.12360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Indexed: 11/28/2022]
Abstract
Chagas disease is a parasitic infection that can result in a progressive dilated cardiomyopathy. Here, we present the epidemiologic details of a suspected locally acquired transmission case originating from the southern United States. This is the first published report of Chagas disease in a young, healthy United States veteran with repeat triatomine exposures in Arizona. Military personnel and Arizona residents should be aware of their Chagas disease transmission risks.
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Affiliation(s)
- N Harris
- Baylor College of Medicine, Michael E. Debakey Veterans Affairs Medical Center, Houston, TX, USA
| | - L Woc-Colburn
- Baylor College of Medicine, Michael E. Debakey Veterans Affairs Medical Center, Houston, TX, USA.,Baylor College of Medicine, National School of Tropical Medicine, Houston, TX, USA
| | - S M Gunter
- Baylor College of Medicine, National School of Tropical Medicine, Houston, TX, USA
| | - R Gorchakov
- Baylor College of Medicine, National School of Tropical Medicine, Houston, TX, USA
| | - K O Murray
- Baylor College of Medicine, National School of Tropical Medicine, Houston, TX, USA
| | - S Rossmann
- Gulf Coast Regional Blood Center, Houston, TX, USA
| | - M N Garcia
- Baylor College of Medicine, Michael E. Debakey Veterans Affairs Medical Center, Houston, TX, USA.,Baylor College of Medicine, National School of Tropical Medicine, Houston, TX, USA
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28
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Garcia MN, Burroughs H, Gorchakov R, Gunter SM, Dumonteil E, Murray KO, Herrera CP. Molecular identification and genotyping of Trypanosoma cruzi DNA in autochthonous Chagas disease patients from Texas, USA. Infect Genet Evol 2017; 49:151-156. [PMID: 28095298 DOI: 10.1016/j.meegid.2017.01.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/12/2017] [Accepted: 01/14/2017] [Indexed: 12/27/2022]
Abstract
The parasitic protozoan Trypanosoma cruzi, the causative agent of Chagas disease, is widely distributed throughout the Americas, from the southern United States (US) to northern Argentina, and infects at least 6 million people in endemic areas. Much remains unknown about the dynamics of T. cruzi transmission among mammals and triatomine vectors in sylvatic and peridomestic eco-epidemiological cycles, as well as of the risk of transmission to humans in the US. Identification of T. cruzi DTUs among locally-acquired cases is necessary for enhancing our diagnostic and clinical prognostic capacities, as well as to understand parasite transmission cycles. Blood samples from a cohort of 15 confirmed locally-acquired Chagas disease patients from Texas were used for genotyping T. cruzi. Conventional PCR using primers specific for the minicircle variable region of the kinetoplastid DNA (kDNA) and the highly repetitive genomic satellite DNA (satDNA) confirmed the presence of T. cruzi in 12/15 patients. Genotyping was based on the amplification of the intergenic region of the miniexon gene of T. cruzi and sequencing. Sequences were analyzed by BLAST and phylogenetic analysis by Maximum Likelihood method allowed the identification of non-TcI DTUs infection in six patients, which corresponded to DTUs TcII, TcV or TcVI, but not to TcIII or TcIV. Two of these six patients were also infected with a TcI DTU, indicating mixed infections in those individuals. Electrocardiographic abnormalities were seen among patients with single non-TcI and mixed infections of non-TcI and TcI DTUs. Our results indicate a greater diversity of T. cruzi DTUs circulating among autochthonous human Chagas disease cases in the southern US, including for the first time DTUs from the TcII-TcV-TcVI group. Furthermore, the DTUs infecting human patients in the US are capable of causing Chagasic cardiac disease, highlighting the importance of parasite detection in the population.
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Affiliation(s)
- Melissa N Garcia
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Hadley Burroughs
- Department of Tropical Medicine, Vector-Borne Infectious Disease Research Center, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Rodion Gorchakov
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Sarah M Gunter
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Eric Dumonteil
- Department of Tropical Medicine, Vector-Borne Infectious Disease Research Center, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA; Centro de Investigaciones Regionales "Dr. Hideyo Noguchi", Autonomous University of Yucatan (UADY), Merida, Yucatan, Mexico
| | - Kristy O Murray
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Claudia P Herrera
- Department of Tropical Medicine, Vector-Borne Infectious Disease Research Center, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA.
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Garcia MN, Cropper TL, Gunter SM, Kramm MM, Pawlak MT, Roachell W, Ronca SE, Stidham RA, Webber BJ, Yun HC. Vector-borne diseases of public health importance for personnel on military installations in the United States. US Army Med Dep J 2017:90-101. [PMID: 28511278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Melissa N Garcia
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
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30
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Gunter SM, Brown EL, Gorchakov R, Murray KO, Garcia MN. Sylvatic Transmission of Trypanosoma cruzi Among Domestic and Wildlife Reservoirs in Texas, USA: A Review of the Historical Literature. Zoonoses Public Health 2016; 64:313-327. [PMID: 27911051 DOI: 10.1111/zph.12330] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Indexed: 11/29/2022]
Abstract
Chagas disease (Trypanosoma cruzi infection) is one of the most important neglected tropical diseases affecting the Americas. The transmission dynamic of this parasite is a complicated process that involves three genera of Triatominae subfamily and over 100 known mammalian reservoirs composed of domestic, peridomestic and wildlife species. Understanding the complex relationship between vector species and mammalian hosts is important for preventing transmission to humans. We performed a historical literature review to assess the disease burden in the Texas wildlife and domestic animal population. Reports of sylvatic transmission in Texas date back to the 1940s. We found that up to 23 species can serve as reservoirs for T. cruzi in the state with wood rats, raccoons, and wild and domestic canine species most frequently reported as positive for the parasite. We finish with a discussion of the current research gaps, implications for high-risk populations and future directions for research.
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Affiliation(s)
- S M Gunter
- Center for Infectious Diseases, University of Texas School of Public Health, Houston, TX, USA.,National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - E L Brown
- Center for Infectious Diseases, University of Texas School of Public Health, Houston, TX, USA
| | - R Gorchakov
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - K O Murray
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - M N Garcia
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
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31
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Gorchakov R, Trosclair LP, Wozniak EJ, Feria PT, Garcia MN, Gunter SM, Murray KO. Trypanosoma cruzi Infection Prevalence and Bloodmeal Analysis in Triatomine Vectors of Chagas Disease From Rural Peridomestic Locations in Texas, 2013-2014. J Med Entomol 2016; 53:911-918. [PMID: 27106934 DOI: 10.1093/jme/tjw040] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/14/2016] [Indexed: 06/05/2023]
Abstract
Protozoan pathogen Trypanosoma cruzi (Chagas, 1909) is the etiologic agent of Chagas disease, which affects millions of people in Latin America. Recently, the disease has been gaining attention in Texas and the southern United States. Transmission cycle of the parasite involves alternating infection between insect vectors and vertebrate hosts (including humans, wildlife, and domestic animals). To evaluate vector T. cruzi parasite burden and feeding patterns, we tested triatomine vectors from 23 central, southern, and northeastern counties of Texas. Out of the 68 submitted specimens, the majority were genetically identified as Triatoma gerstaeckeri (Stal, 1859), with a few samples of Triatoma sanguisuga (LeConte, 1855), Triatoma lecticularia (Stal, 1859), Triatoma rubida (Uhler, 1894), and Triatoma protracta woodi (Usinger, 1939). We found almost two-thirds of the submitted insects were polymerase chain reaction-positive for T. cruzi Bloodmeal sources were determined for most of the insects, and 16 different species of mammals were identified as hosts. The most prevalent type of bloodmeal was human, with over half of these insects found to be positive for T. cruzi High infection rate of the triatomine vectors combined with high incidence of feeding on humans highlight the importance of Chagas disease surveillance in Texas. With our previous findings of autochthonous transmission of Chagas disease, urgent measures are needed to increase public awareness, vector control in and around homes, and Chagas screening of residents who present with a history of a triatomine exposure.
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Affiliation(s)
- Rodion Gorchakov
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, BCM320, Houston, TX 77030 (; ; ; )
| | - Lillian P Trosclair
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, BCM320, Houston, TX 77030 (; ; ; )
| | - Edward J Wozniak
- Zoonosis Control Unit, Health Service Region 8, Texas Department of State Health Services, 112 Joe Carper Drive, Uvalde, TX 78801
| | - Patricia T Feria
- Department of Biology, University of Texas Rio Grande Valley, 1201 West University Dr., Edinburg, TX 78539
| | - Melissa N Garcia
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, BCM320, Houston, TX 77030 (; ; ; )
| | - Sarah M Gunter
- Center for Infectious Diseases, University of Texas School of Public Health, 1200 Pressler Street, Houston, TX 77030 , and
| | - Kristy O Murray
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, BCM320, Houston, TX 77030 (; ; ; ),
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32
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Gunter SM, Jones KM, Zhan B, Essigmann HT, Murray KO, Garcia MN, Gorchakov R, Bottazzi ME, Hotez PJ, Brown EL. Identification and Characterization of the Trypanosoma cruzi B-cell Superantigen Tc24. Am J Trop Med Hyg 2015; 94:114-121. [PMID: 26598565 PMCID: PMC4710414 DOI: 10.4269/ajtmh.15-0438] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/09/2015] [Indexed: 12/22/2022] Open
Abstract
Trypanosoma cruzi causes life-long disease after infection and leads to cardiac disease in 30% of infected individuals. After infection, the parasites are readily detectable in the blood during the first few days before disseminating to infect numerous cell types. Preliminary data suggested that the Tc24 protein that localizes to the T. cruzi membrane during all life stages possesses B-cell superantigenic properties. These antigens facilitate immune escape by interfering with antibody-mediated responses, particularly the avoidance of catalytic antibodies. These antibodies are an innate host defense mechanism present in the naive repertoire, and catalytic antibody–antigen binding results in hydrolysis of the target. We tested the B-cell superantigenic properties of Tc24 by comparing the degree of Tc24 hydrolysis by IgM purified from either Tc24 unexposed or exposed mice and humans. Respective samples were subjected to sodium dodecyl sulfate polyacrylamide gel electrophoresis, silver stained, and the degree of hydrolysis was measured. Data presented in this report suggest that the T. cruzi Tc24 is a B-cell superantigen based on the observations that 1) Tc24 was hydrolyzed by IgM present in serum of unexposed mice and humans and 2) exposure to Tc24 eliminated catalytic activity as early as 4 days after T. cruzi infection.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Eric L. Brown
- *Address correspondence to Eric L. Brown, Center for Infectious Diseases, University of Texas School of Public Health, 1200 Pressler St. Houston, TX 77030. E-mail:
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