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Asociación entre cognición y depresión en adultos mayores panameños con cognición normal y deterioro cognitivo leve
Full text linkDepression and mild cognitive impairment (MCI) in the elderly are related to the development of different types of dementia and decreased functionality. A descriptive cross-sectional study was carried out with a sample of 73 Panamanian older adults aged 65 years or older, from the cohort of the PanamaAgingResearch Initiative (PARI). Health status and functionality were measured in activities of daily living. Cognitive functioning was measured with neuropsychological tests whose scores were combined to form six domains: global cognition, memory, language, visuospatial skills, attention, and executive functions. To measure depressive symptoms, the Geriatric Depression Scale (GDS-30) was used. An analysis of covariance (ANCOVA) was performed comparing subjects with and without possible depression for each cognitive domain, in subjects with MCI and normal cognition (NC) and controlling for the variables of age and education. Significant differences were found between the groups, the group with possible depression and MCI had lower scores compared to the other groups in global cognition. Two linear regression analyzes were performed to determine the factors associated with cognitive performance in each diagnostic group individually. In the NC group, education was a significant predictor of performance in the cognitive domains, while in the MCI it was found that age, education, depression and body mass index (BMI) were related to lower cognitive performance. , depression predicted poor performance in the cognitive domains of executive functions and attention. These results could contribute to the development of health policies aimed at older adults, and to specialized prevention and intervention efforts focused on minimizing disability and its mediators.La depresión y el deterioro cognitivo leve (DCL)en el adulto mayorestánrelacionadoscon el desarrollo de distintos tipos de demencia y disminución en la funcionalidad. Se realizó un estudio descriptivo de corte transversal con una muestra de 73adultos mayores panameños de 65 años o más, de la cohorte del PanamaAgingResearchInitiative (PARI). Se midió estado de salud y funcionalidad en las actividades de la vida diaria. El funcionamiento cognitivo fue medido con pruebas neuropsicológicas cuyos puntajes se combinaron para formar seis dominios: cognición global, memoria, lenguaje, habilidades visuoespaciales, atención y funciones ejecutivas. Para medir síntomas depresivos se utilizó la Escala de Depresión Geriátrica (GDS-30). Se realizó un análisis de covarianza (ANCOVA) comparando sujetos con y sin posible depresión para cada dominio cognitivo, en sujetos con DCL y cognición normal (CN)y controlando por las variables de edad y escolaridad. Se encontraron diferencias significativas entre los grupos, el grupo con posible depresión y DCL tenía menores puntuaciones en comparación con los otros grupos en cognición global. Se realizaron dos análisis de regresión lineal para determinar los factores asociados con el desempeño cognitivo en cada grupo diagnóstico individualmente. En el grupo CN la escolaridad fue un predictor significativo del desempeño en los dominios cognitivos, mientras queen el DCL se encontróque la edad,la educación,la depresión y elíndice de masa corporal (IMC) estaban relacionados con menor desempeñocognitivo.En el grupo de DCL, depresión predijo bajo desempeño en los dominios cognitivos de funciones ejecutivas y atención. Estos resultados podrían aportar al desarrollo depolíticas de salud dirigidas a adultos mayores, y a esfuerzos especializados de prevención e intervención enfocados enminimizar la discapacidad y sus mediadores
Simplified Model to Survey Tuberculosis Transmission in Countries Without Systematic Molecular Epidemiology Programs
Full text linkSystematic molecular/genomic epidemiology studies for tuberculosis surveillance cannot be implemented in many countries. We selected Panama as a model for an alternative strategy. Mycobacterial interspersed repetitive unit–variable-number tandem-repeat (MIRU-VNTR) analysis revealed a high proportion (50%) of Mycobacterium tuberculosis isolates included in 6 clusters (A–F) in 2 provinces (Panama and Colon). Cluster A corresponded to the Beijing sublineage. Whole-genome sequencing (WGS) differentiated clusters due to active recent transmission, with low single-nucleotide polymorphism–based diversity (cluster C), from clusters involving long-term prevalent strains with higher diversity (clusters A, B). Prospective application in Panama of 3 tailored strain–specific PCRs targeting marker single-nucleotide polymorphisms identified from WGS data revealed that 31.4% of incident cases involved strains A–C and that the Beijing strain was highly represented and restricted mainly to Colon. Rational integration of MIRU-VNTR, WGS, and tailored strain–specific PCRs could be a new model for tuberculosis surveillance in countries without molecular/genomic epidemiology programsSystematic molecular/genomic epidemiology studies for tuberculosis surveillance cannot be implemented in many countries. We selected Panama as a model for an alternative strategy. Mycobacterial interspersed repetitive unit–variable-number tandem-repeat (MIRU-VNTR) analysis revealed a high proportion (50%) of Mycobacterium tuberculosis isolates included in 6 clusters (A–F) in 2 provinces (Panama and Colon). Cluster A corresponded to the Beijing sublineage. Whole-genome sequencing (WGS) differentiated clusters due to active recent transmission, with low single-nucleotide polymorphism–based diversity (cluster C), from clusters involving long-term prevalent strains with higher diversity (clusters A, B). Prospective application in Panama of 3 tailored strain–specific PCRs targeting marker single-nucleotide polymorphisms identified from WGS data revealed that 31.4% of incident cases involved strains A–C and that the Beijing strain was highly represented and restricted mainly to Colon. Rational integration of MIRU-VNTR, WGS, and tailored strain–specific PCRs could be a new model for tuberculosis surveillance in countries without molecular/genomic epidemiology program
Motor neuron disease-associated loss of nuclear TDP-43 is linked to DNA double-strand break repair defects
Full text linkGenome damage and their defective repair have been etiologically linked to degenerating neurons in many subtypes of amyotrophic lateral sclerosis (ALS) patients; however, the specific mechanisms remain enigmatic. The majority of sporadic ALS patients feature abnormalities in the transactivation response DNA-binding protein of 43 kDa (TDP-43), whose nucleo-cytoplasmic mislocalization is characteristically observed in spinal motor neurons. While emerging evidence suggests involvement of other RNA/DNA binding proteins, like FUS in DNA damage response (DDR), the role of TDP-43 in DDR has not been investigated. Here, we report that TDP-43 is a critical component of the nonhomologous end joining (NHEJ)-mediated DNA double-strand break (DSB) repair pathway. TDP-43 is rapidly recruited at DSB sites to stably interact with DDR and NHEJ factors, specifically acting as a scaffold for the recruitment of break-sealing XRCC4-DNA ligase 4 complex at DSB sites in induced pluripotent stem cell-derived motor neurons. shRNA or CRISPR/Cas9-mediated conditional depletion of TDP-43 markedly increases accumulation of genomic DSBs by impairing NHEJ repair, and thereby, sensitizing neurons to DSB stress. Finally, TDP-43 pathology strongly correlates with DSB repair defects, and damage accumulation in the neuronal genomes of sporadic ALS patients and in Caenorhabditis elegans mutant with TDP-1 loss-of-function. Our findings thus link TDP-43 pathology to impaired DSB repair and persistent DDR signaling in motor neuron disease, and suggest that DSB repair-targeted therapies may ameliorate TDP-43 toxicity-induced genome instability in motor neuron disease.Genome damage and their defective repair have been etiologically linked to degenerating neurons in many subtypes of amyotrophic lateral sclerosis (ALS) patients; however, the specific mechanisms remain enigmatic. The majority of sporadic ALS patients feature abnormalities in the transactivation response DNA-binding protein of 43 kDa (TDP-43), whose nucleo-cytoplasmic mislocalization is characteristically observed in spinal motor neurons. While emerging evidence suggests involvement of other RNA/DNA binding proteins, like FUS in DNA damage response (DDR), the role of TDP-43 in DDR has not been investigated. Here, we report that TDP-43 is a critical component of the nonhomologous end joining (NHEJ)-mediated DNA double-strand break (DSB) repair pathway. TDP-43 is rapidly recruited at DSB sites to stably interact with DDR and NHEJ factors, specifically acting as a scaffold for the recruitment of break-sealing XRCC4-DNA ligase 4 complex at DSB sites in induced pluripotent stem cell-derived motor neurons. shRNA or CRISPR/Cas9-mediated conditional depletion of TDP-43 markedly increases accumulation of genomic DSBs by impairing NHEJ repair, and thereby, sensitizing neurons to DSB stress. Finally, TDP-43 pathology strongly correlates with DSB repair defects, and damage accumulation in the neuronal genomes of sporadic ALS patients and in Caenorhabditis elegans mutant with TDP-1 loss-of-function. Our findings thus link TDP-43 pathology to impaired DSB repair and persistent DDR signaling in motor neuron disease, and suggest that DSB repair-targeted therapies may ameliorate TDP-43 toxicity-induced genome instability in motor neuron disease
Reduced Food Intake Among Tuberculosis Patients Within an Urban Setting in Panama (P10-023-19)
Full text linkObjectives The aim of our study is to characterize the dietary factors and food items intake of people living with pulmonary tuberculosis in an urban and high disease incidence city in Panama. Methods We recruited 41 participants newly diagnosed with pulmonary tuberculosis. We applied a culturally adapted version of the NHANES Food Screener to estimate dietary median intakes and to evaluate daily and weekly frequencies of consumption. All frequencies reported were converted to daily frequency to describe the dietary patterns and make estimations. Direct observed anti-tuberculosis therapy was provided to all participants. Results Among the participants, 20% were female, the average age was 38.9 years old, the average body mass index was 20.4 and 16% were patients living with HIV. When comparing the consumption frequency reported by the TB patients with the Panamanian Dietary recommendations, these patients did not meet the minimal frequency intake of fruit and whole grain. Only 30% of participants achieved the recommended fruit frequency intake. We also found that only 37% of participants meet the recommended consumption of at least 3 times a week of beans and legumes. In contrast, a high number of these TB patients (34/41) reported a daily vegetable intake frequency and a mean of 25 teaspoons of added sugar daily intake. For sugar-sweetened beverages intake, we found a mean frequency intake of twice a day and 73% of our participants had a daily consumption of any dairy product. A total of 63% of our participants reported consumption of processed meat more than twice a week. Conclusions The food intake pattern in patients suffering tuberculosis includes daily consumption of vegetables, frequent consumption of dairy products and sport or fruit drinks, but a low frequency of fruits, beans, and legumes. These findings suggest that the protective dietary factors including fruits and whole grain are not consumed at the minimum requirement intake to improve general health in our patient group. We recommend decreasing processed meat intake among patients suffering tuberculosis. Also, we recommend the use of diet supplementation programs to improve anti-tuberculosis treatment success rates. Food security investigations to determine the extent of limitations to access healthy food remain key for improving disease control.Objectives The aim of our study is to characterize the dietary factors and food items intake of people living with pulmonary tuberculosis in an urban and high disease incidence city in Panama. Methods We recruited 41 participants newly diagnosed with pulmonary tuberculosis. We applied a culturally adapted version of the NHANES Food Screener to estimate dietary median intakes and to evaluate daily and weekly frequencies of consumption. All frequencies reported were converted to daily frequency to describe the dietary patterns and make estimations. Direct observed anti-tuberculosis therapy was provided to all participants. Results Among the participants, 20% were female, the average age was 38.9 years old, the average body mass index was 20.4 and 16% were patients living with HIV. When comparing the consumption frequency reported by the TB patients with the Panamanian Dietary recommendations, these patients did not meet the minimal frequency intake of fruit and whole grain. Only 30% of participants achieved the recommended fruit frequency intake. We also found that only 37% of participants meet the recommended consumption of at least 3 times a week of beans and legumes. In contrast, a high number of these TB patients (34/41) reported a daily vegetable intake frequency and a mean of 25 teaspoons of added sugar daily intake. For sugar-sweetened beverages intake, we found a mean frequency intake of twice a day and 73% of our participants had a daily consumption of any dairy product. A total of 63% of our participants reported consumption of processed meat more than twice a week. Conclusions The food intake pattern in patients suffering tuberculosis includes daily consumption of vegetables, frequent consumption of dairy products and sport or fruit drinks, but a low frequency of fruits, beans, and legumes. These findings suggest that the protective dietary factors including fruits and whole grain are not consumed at the minimum requirement intake to improve general health in our patient group. We recommend decreasing processed meat intake among patients suffering tuberculosis. Also, we recommend the use of diet supplementation programs to improve anti-tuberculosis treatment success rates. Food security investigations to determine the extent of limitations to access healthy food remain key for improving disease control
Habitat disturbance and the organization of bacterial communities in Neotropical hematophagous arthropods
Full text linkThe microbiome plays a key role in the biology, ecology and evolution of arthropod vectors of human pathogens. Vector-bacterial interactions could alter disease transmission dynamics through modulating pathogen replication and/or vector fitness. Nonetheless, our understanding of the factors shaping the bacterial community in arthropod vectors is incomplete. Using large-scale 16S amplicon sequencing, we examine how habitat disturbance structures the bacterial assemblages of field-collected whole-body hematophagous arthropods that vector human pathogens including mosquitoes (Culicidae), sand flies (Psychodidae), biting midges (Ceratopogonidae) and hard ticks (Ixodidae). We found that all comparisons of the bacterial community among species yielded statistically significant differences, but a difference was not observed between adults and nymphs of the hard tick, Haemaphysalis juxtakochi. While Culicoides species had the most distinct bacterial community among dipterans, tick species were composed of entirely different bacterial OTU’s. We observed differences in the proportions of some bacterial types between pristine and disturbed habitats for Coquillettidia mosquitoes, Culex mosquitoes, and Lutzomyia sand flies, but their associations differed within and among arthropod assemblages. In contrast, habitat quality was a poor predictor of differences in bacterial classes for Culicoides biting midges and hard tick species. In general, similarities in the bacterial communities among hematophagous arthropods could be explained by their phylogenetic relatedness, although intraspecific variation seems influenced by habitat disturbance.The microbiome plays a key role in the biology, ecology and evolution of arthropod vectors of human pathogens. Vector-bacterial interactions could alter disease transmission dynamics through modulating pathogen replication and/or vector fitness. Nonetheless, our understanding of the factors shaping the bacterial community in arthropod vectors is incomplete. Using large-scale 16S amplicon sequencing, we examine how habitat disturbance structures the bacterial assemblages of field-collected whole-body hematophagous arthropods that vector human pathogens including mosquitoes (Culicidae), sand flies (Psychodidae), biting midges (Ceratopogonidae) and hard ticks (Ixodidae). We found that all comparisons of the bacterial community among species yielded statistically significant differences, but a difference was not observed between adults and nymphs of the hard tick, Haemaphysalis juxtakochi. While Culicoides species had the most distinct bacterial community among dipterans, tick species were composed of entirely different bacterial OTU’s. We observed differences in the proportions of some bacterial types between pristine and disturbed habitats for Coquillettidia mosquitoes, Culex mosquitoes, and Lutzomyia sand flies, but their associations differed within and among arthropod assemblages. In contrast, habitat quality was a poor predictor of differences in bacterial classes for Culicoides biting midges and hard tick species. In general, similarities in the bacterial communities among hematophagous arthropods could be explained by their phylogenetic relatedness, although intraspecific variation seems influenced by habitat disturbance
Application of matrix-assisted laser desorption/ionization mass spectrometry to identify species of Neotropical Anopheles vectors of malaria
Full text linkBackground: Malaria control in Panama is problematic due to the high diversity of morphologically similar Anopheles mosquito species, which makes identifcation of vectors of human Plasmodium challenging. Strategies by Panama‑ nian health authorities to bring malaria under control targeting Anopheles vectors could be inefective if they tackle a misidentifed species.
Methods: A rapid mass spectrometry identifcation procedure was developed to accurately and timely sort out feld-collected Neotropical Anopheles mosquitoes into vector and non-vector species. Matrix-assisted laser desorp‑ tion/ionization (MALDI) mass spectra of highly-abundant proteins were generated from laboratory-reared mosquitoes using diferent extraction protocols, body parts, and sexes to minimize the amount of material from specimen vouch‑ ers needed and optimize the protocol for taxonomic identifcation. Subsequently, the mass spectra of feld-collected Neotropical Anopheles mosquito species were classifed using a combination of custom-made unsupervised (i.e., Principal component analysis—PCA) and supervised (i.e., Linear discriminant analysis—LDA) classifcation algorithms. Results: Regardless of the protocol used or the mosquito species and sex, the legs contained the least intra-specifc variability with enough well-preserved proteins to diferentiate among distinct biological species, consistent with pre‑ vious literature. After minimizing the amount of material needed from the voucher, one leg was enough to produce reliable spectra between specimens. Further, both PCA and LDA were able to classify up to 12 mosquito species, from diferent subgenera and seven geographically spread localities across Panama using mass spectra from one leg pair. LDA demonstrated high discriminatory power and consistency, with validation and cross-validation positive identif‑ cation rates above 93% at the species level.
Conclusion: The selected sample processing procedure can be used to identify feld-collected Anopheles species, including vectors of Plasmodium, in a short period of time, with a minimal amount of tissue and without the need of an expert mosquito taxonomist. This strategy to analyse protein spectra overcomes the drawbacks of working with‑ out a reference library to classify unknown samples. Finally, this MALDI approach can aid ongoing malaria eradicationBackground: Malaria control in Panama is problematic due to the high diversity of morphologically similar Anopheles mosquito species, which makes identifcation of vectors of human Plasmodium challenging. Strategies by Panama‑ nian health authorities to bring malaria under control targeting Anopheles vectors could be inefective if they tackle a misidentifed species.
Methods: A rapid mass spectrometry identifcation procedure was developed to accurately and timely sort out feld-collected Neotropical Anopheles mosquitoes into vector and non-vector species. Matrix-assisted laser desorp‑ tion/ionization (MALDI) mass spectra of highly-abundant proteins were generated from laboratory-reared mosquitoes using diferent extraction protocols, body parts, and sexes to minimize the amount of material from specimen vouch‑ ers needed and optimize the protocol for taxonomic identifcation. Subsequently, the mass spectra of feld-collected Neotropical Anopheles mosquito species were classifed using a combination of custom-made unsupervised (i.e., Principal component analysis—PCA) and supervised (i.e., Linear discriminant analysis—LDA) classifcation algorithms. Results: Regardless of the protocol used or the mosquito species and sex, the legs contained the least intra-specifc variability with enough well-preserved proteins to diferentiate among distinct biological species, consistent with pre‑ vious literature. After minimizing the amount of material needed from the voucher, one leg was enough to produce reliable spectra between specimens. Further, both PCA and LDA were able to classify up to 12 mosquito species, from diferent subgenera and seven geographically spread localities across Panama using mass spectra from one leg pair. LDA demonstrated high discriminatory power and consistency, with validation and cross-validation positive identif‑ cation rates above 93% at the species level.
Conclusion: The selected sample processing procedure can be used to identify feld-collected Anopheles species, including vectors of Plasmodium, in a short period of time, with a minimal amount of tissue and without the need of an expert mosquito taxonomist. This strategy to analyse protein spectra overcomes the drawbacks of working with‑ out a reference library to classify unknown samples. Finally, this MALDI approach can aid ongoing malaria eradicatio
Overweight, Obesity, and Older Age Favor Latent Tuberculosis Infection among Household Contacts in Low Tuberculosis-Incidence Settings within Panama
Full text linkLatent tuberculosis infection (LTBI) remains the main source of new active tuberculosis (TB) cases worldwide. Household close contacts (HCCs) are at high risk of acquiring LTBI and subsequent development of TB. In this study, we aim to identify risk factors associated with LTBI in HCCs of TB patients living in a low TB-incidence setting. Our results revealed that HCCs who are aged more than 50 years (OR = 4.05) and overweight (OR = 15.3) are at higher risk of acquiring LTBI. None of these LTBI household contacts progressed to active TB. These findings suggest that HCCs who are young adults and children with normal and low body mass index are less likely to acquire LTBI after exposure to TB patients, even in low TB-incidence settings.Latent tuberculosis infection (LTBI) remains the main source of new active tuberculosis (TB) cases worldwide. Household close contacts (HCCs) are at high risk of acquiring LTBI and subsequent development of TB. In this study, we aim to identify risk factors associated with LTBI in HCCs of TB patients living in a low TB-incidence setting. Our results revealed that HCCs who are aged more than 50 years (OR = 4.05) and overweight (OR = 15.3) are at higher risk of acquiring LTBI. None of these LTBI household contacts progressed to active TB. These findings suggest that HCCs who are young adults and children with normal and low body mass index are less likely to acquire LTBI after exposure to TB patients, even in low TB-incidence settings
Avian Mycobacteriosis in a Rescued Harpy Eagle from Darien Forest, Panama
Full text linkThe Harpy eagle (Harpia harpyia) is the largest raptor in the Neotropical region, distributed in low densities within primary forest habitats from southern Mexico to east-central Brazil, including Central America and Panama.
Although locally extinct due to habitat degradation, human poaching and reduction of tropical forests in recent decades, some remnant populations are known to be small and isolated. Thus, information on its ecology, including infectious diseases, is critical for conservation efforts and management of populations of this emblematic species in the wild. Avian Mycobacteriosis (AM) is a chronic disease affecting a wide range of birds and mammals and clinical cases have been sporadically reported, although in harpy eagles, has not been documented. In addition, scant information exists on pathologies affecting raptors, therefore, this report expands the knowledge on infectious diseases affecting wild birds. This study describes the first case of AM in an immature harpy eagle rescued from Darien gap and presents details of the clinical manifestation of the disease and its histological findings.The Harpy eagle (Harpia harpyia) is the largest raptor in the Neotropical region, distributed in low densities within primary forest habitats from southern Mexico to east-central Brazil, including Central America and Panama.
Although locally extinct due to habitat degradation, human poaching and reduction of tropical forests in recent decades, some remnant populations are known to be small and isolated. Thus, information on its ecology, including infectious diseases, is critical for conservation efforts and management of populations of this emblematic species in the wild. Avian Mycobacteriosis (AM) is a chronic disease affecting a wide range of birds and mammals and clinical cases have been sporadically reported, although in harpy eagles, has not been documented. In addition, scant information exists on pathologies affecting raptors, therefore, this report expands the knowledge on infectious diseases affecting wild birds. This study describes the first case of AM in an immature harpy eagle rescued from Darien gap and presents details of the clinical manifestation of the disease and its histological findings
Control of paratuberculosis: who, why and how. A review of 48 countries
Full text linkParatuberculosis, a chronic disease affecting ruminant livestock, is caused by Mycobacterium avium subsp. paratuberculosis (MAP). It has direct and indirect economic costs, impacts animal welfare and arouses public health concerns. In a survey of 48 countries we found paratuberculosis to be very common in livestock. In about half the countries more than 20% of herds and flocks were infected with MAP. Most countries had large ruminant populations (millions), several types of farmed ruminants, multiple husbandry systems and tens of thousands of individual farms, creating challenges for disease control. In addition, numerous species of free-living wildlife were infected. Paratuberculosis was notifiable in most countries, but formal control programs were present in only 22 countries. Generally, these were the more highly developed countries with advanced veterinary services. Of the countries without a formal control program for paratuberculosis, 76% were in South and Central America, Asia and Africa while 20% were in Europe. Control programs were justified most commonly on animal health grounds, but protecting market access and public health were other factors. Prevalence reduction was the major objective in most countries, but Norway and Sweden aimed to eradicate the disease, so surveillance and response were their major objectives. Government funding was involved in about two thirds of countries, but operations tended to be funded by farmers and their organizations and not by government alone. The majority of countries (60%) had voluntary control programs. Generally, programs were supported by incentives for joining, financial compensation and/or penalties for non-participation. Performance indicators, structure, leadership, practices and tools used in control programs are also presented. Securing funding for long-term control activities was a widespread problem.Paratuberculosis, a chronic disease affecting ruminant livestock, is caused by Mycobacterium avium subsp. paratuberculosis (MAP). It has direct and indirect economic costs, impacts animal welfare and arouses public health concerns. In a survey of 48 countries we found paratuberculosis to be very common in livestock. In about half the countries more than 20% of herds and flocks were infected with MAP. Most countries had large ruminant populations (millions), several types of farmed ruminants, multiple husbandry systems and tens of thousands of individual farms, creating challenges for disease control. In addition, numerous species of free-living wildlife were infected. Paratuberculosis was notifiable in most countries, but formal control programs were present in only 22 countries. Generally, these were the more highly developed countries with advanced veterinary services. Of the countries without a formal control program for paratuberculosis, 76% were in South and Central America, Asia and Africa while 20% were in Europe. Control programs were justified most commonly on animal health grounds, but protecting market access and public health were other factors. Prevalence reduction was the major objective in most countries, but Norway and Sweden aimed to eradicate the disease, so surveillance and response were their major objectives. Government funding was involved in about two thirds of countries, but operations tended to be funded by farmers and their organizations and not by government alone. The majority of countries (60%) had voluntary control programs. Generally, programs were supported by incentives for joining, financial compensation and/or penalties for non-participation. Performance indicators, structure, leadership, practices and tools used in control programs are also presented. Securing funding for long-term control activities was a widespread problem
Simplified Model to Survey Tuberculosis Transmission in Countries Without Systematic Molecular Epidemiology Programs
Full text linkSystematic molecular/genomic epidemiology studies for tuberculosis surveillance cannot be implemented in many countries. We selected Panama as a model for an alternative strategy. Mycobacterial interspersed repetitive unit–variable-number tandem-repeat (MIRU-VNTR) analysis revealed a high proportion (50%) of Mycobacterium tuberculosis isolates included in 6 clusters (A–F) in 2 provinces (Panama and Colon). Cluster A corresponded to the Beijing sublineage. Whole-genome sequencing (WGS) differentiated clusters due to active recent transmission, with low single-nucleotide polymorphism–based diversity (cluster C), from clusters involving long-term prevalent strains with higher diversity (clusters A, B). Prospective application in Panama of 3 tailored strain–specific PCRs targeting marker single-nucleotide polymorphisms identified from WGS data revealed that 31.4% of incident cases involved strains A–C and that the Beijing strain was highly represented and restricted mainly to Colon. Rational integration of MIRU-VNTR, WGS, and tailored strain–specific PCRs could be a new model for tuberculosis surveillance in countries without molecular/genomic epidemiology programs.Systematic molecular/genomic epidemiology studies for tuberculosis surveillance cannot be implemented in many countries. We selected Panama as a model for an alternative strategy. Mycobacterial interspersed repetitive unit–variable-number tandem-repeat (MIRU-VNTR) analysis revealed a high proportion (50%) of Mycobacterium tuberculosis isolates included in 6 clusters (A–F) in 2 provinces (Panama and Colon). Cluster A corresponded to the Beijing sublineage. Whole-genome sequencing (WGS) differentiated clusters due to active recent transmission, with low single-nucleotide polymorphism–based diversity (cluster C), from clusters involving long-term prevalent strains with higher diversity (clusters A, B). Prospective application in Panama of 3 tailored strain–specific PCRs targeting marker single-nucleotide polymorphisms identified from WGS data revealed that 31.4% of incident cases involved strains A–C and that the Beijing strain was highly represented and restricted mainly to Colon. Rational integration of MIRU-VNTR, WGS, and tailored strain–specific PCRs could be a new model for tuberculosis surveillance in countries without molecular/genomic epidemiology programs