Gena G. Lawrence

Genetic Differences in Pneumocystis Isolates Recovered from Immunocompetent Infants and from Adults with AIDS: Epidemiological Implications

Polymerase chain reaction analysis, direct DNA sequencing, and histological staining were used to determine whether Pneumocystis jirovecii was present in lung tissue specimens obtained, at autopsy, from 58 infants without identifiable immunodeficiency. The results of genotyping of these specimens were compared with the results of genotyping of specimens obtained from 384 human immunodeficiency virus (HIV)-infected adults with Pneumocystis pneumonia. P. jirovecii DNA was detected at the mitochondrial large subunit rRNA and dihydropteroate synthase loci in 100% and 53%, respectively, of the specimens obtained from infants. All specimens obtained from adults tested positive for P. jirovecii at both loci. Genotype distributions at both loci were significantly different in the 2 populations (P < .0001). The observation of different strains circulating in immunocompetent infants and HIV-infected adults suggests independent transmission cycles that warrant further study.

Infection of Kissing Bugs with Trypanosoma cruzi, Tucson, Arizona, USA

A survey of triatomine insects found that 41.5% were infected with the causative agent of Chagas disease.

Pneumocystis colonisation is common among hospitalised HIV infected patients with non-Pneumocystis pneumonia

Background: When Pneumocystis DNA is recovered from respiratory specimens of patients without Pneumocystis pneumonia (PCP), patients are said to be colonised with Pneumocystis, although the significance of this state is unknown. Understanding risk factors for and outcomes of colonisation may provide insights into the life cycle and transmission dynamics of Pneumocystis jirovecii. Methods: We performed a cross sectional study of the prevalence and clinical predictors of Pneumocystis colonisation in 172 HIV infected, PCP negative inpatients undergoing diagnostic evaluation of 183 episodes of pneumonia at either the Medical Center of Louisiana at New Orleans between 2003 and 2005 or San Francisco General Hospital between 2000 and 2005. DNA was extracted from sputum and bronchoalveolar lavage specimens and amplified using a nested PCR assay at the mitochondrial large subunit (18S) ribosomal RNA locus. Colonisation was deemed present if Pneumocystis DNA was identified by both gel electrophoresis and direct DNA sequencing. Results: 68% (117/172) of all patients were colonised with Pneumocystis. No strong associations with colonisation were identified for any demographic factors. Among clinical factors, having a CD4+ T cell count ⩽50 cells/μl (unadjusted OR 2.4, 95% CI 1.09 to 5.48; p = 0.031) and using PCP prophylaxis (unadjusted OR 0.55, 95% CI 0.29 to 1.07; p = 0.077) were associated with Pneumocystis colonisation, although the latter association may have been due to chance. After adjustment for CD4+ T cell count, use of PCP prophylaxis was associated with a decreased odds of colonisation (adjusted OR 0.45, 95% CI 0.21 to 0.98; p = 0.045). 11 patients who were colonised were subsequently readmitted for evaluation of a second episode of pneumonia; three were found to be colonised again, but none had PCP. Conclusions: The majority of hospitalised HIV infected patients with non-PCP pneumonia are colonised with Pneumocystis. Failure to use co-trimoxazole prophylaxis and severe immunosuppression are associated with an increase in the odds of colonisation. Pneumocystis colonisation among hospitalised patients does not commonly lead to PCP.

THE BIOLOGY OF THE TRIATOMINE BUGS NATIVE TO SOUTH CENTRAL TEXAS AND ASSESSMENT OF THE RISK THEY POSE FOR AUTOCHTHONOUS CHAGAS DISEASE EXPOSURE

Abstract:  Triatomine bugs are a group of hematophagous arthropods that can serve as biological vectors for Trypanosoma cruzi, the etiological agent of American trypanosomiasis (Chagas disease). Because of differences in the biology and feeding habits among triatomine species, some are more likely than others to be involved in zoonotic and/or human-to-human transmission cycles of T. cruzi. In an attempt to assess the risk for Chagas disease exposure in south-central Texas, human habitations across Texas Health Service Region 8 (HSR 8) and surrounding counties were surveyed for triatomines to characterize the geographic distribution, species-specific biology, and T. cruzi–infection prevalence better. Between May 2010 and August 2013, a total of 545 triatomines representing all 5 known indigenous species (Triatoma gerstaeckeri, Triatoma indictiva, Triatoma lecticularia, Triatoma sanguisuga, and Triatoma protracta woodi) were collected from 59 sites across the region. Triatoma gerstaeckeri was the species most commonly found in domestic and peridomestic ecotopes across Texas HSR 8, representing over 80% of the triatomines collected. Adult T. gerstaeckeri exhibited a seasonal dispersal pattern that began in late April, peaked in mid-May, and then continued into August. On homes with available crevices in the exterior walls, adult T. gerstaeckeri were observed emerging from or entering these protective microhabitats, suggesting possible opportunistic colonization of some exterior walls compartments. Laboratory testing of triatomine hindgut contents for T. cruzi by PCR demonstrated the adult T. gerstaeckeri–infection prevalence across Texas HSR 8 to be 64%. Monitoring peridomestic adult T. gerstaeckeri over the seasonal dispersal peak demonstrated statistically significant increases in both their T. cruzi–infection prevalence (P < 0.01) and tendency to invade human dwellings (P < 0.01) in the later aspect of the emergence peak. In addition to the adult insects, variably sized and staged nymphs were recovered from the inside of 6 separate homes across Texas HSR 8. The results of this study show that T. gerstaeckeri is a widespread and common triatomine species across Texas HSR 8 and documented it to have some notable synanthropic tendencies. The high prevalence of T. cruzi infection in native triatomines, and the high frequency with which T. gerstaeckeri is recovered from human habitations, suggests that there is a risk for human exposure to T. cruzi in Texas HSR 8. Because of this, Chagas disease should be considered on the list of differential diagnoses for cases of cardiac arrhythmia, dilated cardiomyopathy, or heart failure in south-central Texas.

Detection of Broadly Distributed Sodium Channel Alleles Characteristic of Insect Pyrethroid Resistance in West Nile Virus Vector Culex pipiens Complex Mosquitoes in the United States

ABSTRACT West Nile virus (WNV) has emerged as a health threat to the North American population since its initial outbreak in New York City in 1999. Culex (Culex) pipiens complex mosquitoes have been considered to play the primary role in the enzootic maintenance and transmission of WNV in North America. The voltage-gated sodium channel (NaCh) gene contains pyrethroid resistance-associated mutations in the coding region in many insect species. However, the knowledge of potential NaCh mutations was minimal in Culex. Seeking pyrethroid resistance alleles in Culex, we evaluated a transect along the east coast of the United States with an NaCh-based genotyping tool that amplified a portion of the transcribed sequence containing kdr mutations and the intron immediately downstream of the mutation site. Three genotypes that are typically associated with pyrethroid resistance in insects have been identified in Culex pipiens complex mosquitoes in this study: susceptible wild type kds, the classical knock-down resistance Leu → Phe mutation (Phe/kdr), and a second resistance mechanism, a Leu → Ser mutation (Ser/kdr). Moreover, we observed heterozygotic individual mosquitoes possessing both kdr alleles. Results of this study advance our knowledge of the potential for pyrethroid insecticide resistance among the populations of Cx. pipiens complex in the United States.

Dihydropteroate synthase mutations in Pneumocystis pneumonia: Impact of applying different definitions of prophylaxis, mortality endpoints and mutant in a single cohort

Pneumocystis jirovecii dihydropteroate synthase (DHPS) gene mutations are well-reported. Although sulfa prophylaxis generally is associated with DHPS mutant infection, whether mutant infection is associated with poorer clinical outcomes is less clear. The differing definitions of sulfa prophylaxis and the different mortality endpoints used in these studies may be one explanation for the conflicting study results. Applying different definitions of prophylaxis, mortality endpoints and DHPS mutant to 301 HIV-infected patients with Pneumocystis pneumonia, we demonstrate that prophylaxis, irrespective of definition, increased the risk of infection with pure mutant (any prophylaxis: AOR 4.00, 95% CI: 1.83-8.76, P < 0.001) but not mixed genotypes (any prophylaxis: AOR 0.78, 95% CI: 0.26-2.36, P = 0.65). However, infection with mutant DHPS, irrespective of definition, was not associated with increased mortality (all-cause or PCP death) at the three time-intervals examined (all P > 0.05). Future studies should standardize key variables associated with DHPS mutant infection as well as examine DHPS mutant subtypes (pure mutant vs. mixed infections) - perhaps even individual DHPS mutant genotypes - so that data can be pooled to better address this issue.

A nuclear single-nucleotide polymorphism (SNP) potentially useful for the separation of Rhodnius prolixus from members of the Rhodnius robustus cryptic species complex (Hemiptera: Reduviidae)

The design and application of rational strategies that rely on accurate species identification are pivotal for effective vector control. When morphological identification of the target vector species is impractical, the use of molecular markers is required. Here we describe a non-coding, single-copy nuclear DNA fragment that contains a single-nucleotide polymorphism (SNP) with the potential to distinguish the important domestic Chagas disease vector, Rhodnius prolixus, from members of the four sylvatic Rhodnius robustus cryptic species complex. A total of 96 primer pairs obtained from whole genome shotgun sequencing of the R. prolixus genome (12,626 random reads) were tested on 43 R. prolixus and R. robustus s.l. samples. One of the seven amplicons selected (AmpG) presented a SNP, potentially diagnostic for R. prolixus, on the 280th site. The diagnostic nature of this SNP was then confirmed based on the analysis of 154 R. prolixus and R. robustus s.l. samples representing the widest possible geographic coverage. The results of a 60% majority-rule Bayesian consensus tree and a median-joining network constructed based on the genetic variability observed reveal the paraphyletic nature of the R. robustus species complex, with respect to R. prolixus. The AmpG region is located in the fourth intron of the Transmembrane protein 165 gene, which seems to be in the R. prolixus X chromosome. Other possible chromosomal locations of the AmpG region in the R. prolixus genome are also presented and discussed.

Pneumocystis jirovecii Dihydropteroate Synthase Gene Mutations and Human Immunodeficiency Virus‐Associated Pneumocystis Pneumonia

LAURENCE HUANG, DAVID A. WELSH, ROBERT F. MILLER, C. BEN BEARD, GENA G. LAWRENCE, MELISSA FOX, ALEXANDRA SWARTZMAN, MATTHEW R. BENSLEY, DENISE CARBONNET, J. LUCIAN DAVIS, AMY CHI, BECKY J. YOO and JEFFREY L. JONES HIV/AIDS Division, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California 94110, and Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California 94110, and Pulmonary and Critical Care Medicine, Medical Center of Louisiana at New Orleans, Louisiana State University Health Sciences Center, New Orleans, Los Angeles, and Department of Population Sciences and Primary Care, Centre for Sexual Health and HIV Research, Royal Free and University College Medical School, University College London, London, United Kingdom, and Division of Vector-Borne Infectious Diseases, Bacterial Diseases Branch, U.S. Centers for Disease Control and Prevention, Fort Collins, Colorado, and Division of Parasitic Diseases, National Center for Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia

Phenotypic variability confirmed by nuclear ribosomal DNA suggests a possible natural hybrid zone of Triatoma brasiliensis species complex

Triatoma brasiliensis macromelasoma occurs in Pernambuco state, Brazil, which is situated between the distribution areas of Triatoma brasiliensis brasiliensis (north) and Triatoma juazeirensis (south). T. b. macromelasoma displays greater variations in its chromatic phenotype than either T. b. brasiliensis or T. juazeirensis, and patterns reminiscent of one or the other. Experimental crosses from each of these members of the T. brasiliensis species complex generated fertile offspring suggesting that viable hybrids could be present in nature, despite their significant genetic distances. Considering the geographical position of occurrence of the T. b. macromelasoma (in Pernambuco) it was proposed to be an area capable of supporting natural hybridization between T. b. brasiliensis and T. juazeirensis. Since phenotypic variability is expected, this study investigated the existence of intermediate chromatic phenotypes for T. b. macromelasoma in various locations in areas between the T. b. brasiliensis and T. juazeirensis occurrences. Thirteen different color patterns were for the first time characterized and nine of those displayed intermediate phenotypes. Molecular analysis performed using ribosomal DNA intergenic region, grouped all within the T. brasiliensis complex. The intermediate chromatic phenotypes, molecular analysis and experimental crosses all support the distinction of a zone of hybridization that gave rise to the T. b. macromelasoma through homoploidal evolution.

The Chagas disease domestic transmission cycle in Guatemala: Parasite-vector switches and lack of mitochondrial co-diversification between Triatoma dimidiata and Trypanosoma cruzi subpopulations suggest non-vectorial parasite dispersal across the Motagua valley

Parasites transmitted by insects must adapt to their vectors and reservoirs. Chagas disease, an American zoonosis caused by Trypanosoma cruzi, is transmitted by several species of triatomines. In Central America, Triatoma dimidiata is a widely dispersed vector found in sylvatic and domestic habitats, with distinct populations across the endemic region of Guatemala. Our aim was to test the strength of association between vector and parasite genetic divergence in domestic environments. Microsatellite (MS) loci were used to characterize parasites isolated from T. dimidiata (n=112) collected in domestic environments. Moderate genetic differentiation was observed between parasites north and south of the Motagua Valley, an ancient biogeographic barrier (FST 0.138, p=0.009). Slightly reduced genotypic diversity and increased heterozygosity in the north (Allelic richness (Ar)=1.00-6.05, FIS -0.03) compared to the south (Ar=1.47-6.30, FIS 0.022) suggest either a selective or demographic process during parasite dispersal. Based on parasite genotypes and geographic distribution, 15 vector specimens and their parasite isolates were selected for mitochondrial co-diversification analysis. Genetic variability and phylogenetic congruence were determined with mitochondrial DNA sequences (10 parasite maxicircle gene fragments and triatomine ND4+CYT b). A Mantel test as well as phylogenetic, network and principal coordinates analyses supported at least three T. dimidiata haplogroups separated by geographic distance across the Motagua Valley. Maxicircle sequences showed low T. cruzi genetic variability (π nucleotide diversity 0.00098) with no evidence of co-diversification with the vector, having multiple host switches across the valley. Sylvatic Didelphis marsupialis captured across the Motagua Valley were found to be infected with T. cruzi strains sharing MS genotypes with parasites isolated from domiciliated triatomines. The current parasite distribution in domestic environments can be explained by multiple parasite-host switches between vector populations and selection or bottleneck processes across the Motagua Valley, with a possible role for didelphids in domestic transmission.