Joel M. Montgomery

Aerobic salivary bacteria in wild and captive Komodo dragons.

During the months of November 1996, August 1997, and March 1998, saliva and plasma samples were collected for isolation of aerobic bacteria from 26 wild and 13 captive Komodo dragons (Varanus komodoensis). Twenty-eight Gram-negative and 29 Gram-positive species of bacteria were isolated from the saliva of the 39 Komodo dragons. A greater number of wild than captive dragons were positive for both Gram-negative and Gram-positive bacteria. The average number of bacterial species within the saliva of wild dragons was 46% greater than for captive dragons. While Escherichia coli was the most common bacterium isolated from the saliva of wild dragons, this species was not present in captive dragons. The most common bacteria isolated from the saliva of captive dragons were Staphylococcus capitis and Staphylococcus caseolyticus, neither of which were found in wild dragons. High mortality was seen among mice injected with saliva from wild dragons and the only bacterium isolated from the blood of dying mice was Pasteurella multocida. A competitive inhibition enzyme-linked immunosorbent assay revealed the presence of anti-Pasteurella antibody in the plasma of Komodo dragons. Four species of bacteria isolated from dragon saliva showed resistance to one or more of 16 antimicrobics tested. The wide variety of bacteria demonstrated in the saliva of the Komodo dragon in this study, at least one species of which was highly lethal in mice and 54 species of which are known pathogens, support the observation that wounds inflicted by this animal are often associated with sepsis and subsequent bacteremia in prey animals.

DETECTION OF CRYPTOSPORIDIUM ANTIBODIES IN SERA AND ORAL FLUIDS USING MULTIPLEX BEAD ASSAY

For the first time, a multiplex bead assay (MBA) was used to assay oral fluid and serum specimens for immunoglobulin G (IgG) antibodies to specific Cryptosporidium parvum antigens that were coupled to polystyrene beads. Recombinant C. parvum 17- and 27-kDa antigens (r17 and r27, respectively) both linked with glutathione-S-transferase (GST) fusion proteins, native 17-kDa antigen, and GST alone were each coupled to microspheres that could be differentiated based on variable amounts of internally incorporated red fluorescent dye. Initial and follow-up serum and oral fluid specimens from a 1997 cryptosporidiosis outbreak in Spokane, Washington, were incubated with the coupled beads. Antibodies bound to the coupled beads were detected using biotinylated monoclonal anti-human IgG antibody and streptavidin-labeled r-phycoerythrin. Fluorescence intensity was measured by flow cytometry. For the 3 C. parvum antigens, the median of the mean fluorescence intensity (MFI) was significantly higher (P < 0.03) in the initial specimens than in the follow-up specimens. No significant change in IgG responses to GST in oral fluids or serum specimens was observed. For all Cryptosporidium antigens, the MFI in the initial serum specimens correlated with the MFI in the initial oral fluid specimens (P < 0.001, r > 0.673). For the recombinant antigens used in the MBA, the MFI correlated with the response as measured by an enzyme-linked immunosorbent assay that used r17 and r27 expressed without the GST fusion partner (P < 0.001, r > 0.854). MBA using sera or more conveniently collected oral fluids, especially from children, may be an option for immunodiagnosis of C. parvum infection and for prospective epidemiological studies designed to monitor infection risk.

Avian Influenza infections in nonmigrant land birds in Andean Peru.

As part of ongoing surveillance for avian influenza viruses (AIV) in Peruvian birds, in June 2008, we sampled 600 land birds of 177 species, using real-time reverse-transcription PCR. We addressed the assumption that AIV prevalence is low or nil among land birds, a hypothesis that was not supported by the results—rather, we found AIV infections at relatively high prevalences in birds of the orders Apodiformes (hummingbirds) and Passeriformes (songbirds). Surveillance programs for monitoring spread and identification of AIV should thus not focus solely on water birds.

Etiology and Incidence of Viral Acute Respiratory Infections Among Refugees Aged 5 Years and Older in Hagadera Camp, Dadaab, Kenya.

We used the Centers for Disease Control and Prevention-Kenya Medical Research Institute Acute Respiratory Infection (ARI) Surveillance System data to estimate severe acute respiratory infection (SARI) hospitalization rates, viral etiology, and associated complaints of influenza-like illnesses (ILI) and SARI conditions among those aged 5 years and older in Hagadera, Dadaab refugee camp, Kenya, for 2010-2012. A total of 471 patients aged ≥ 5 years met the case definition for ILI or SARI. SARI hospitalization rates per 10,000 person-years were 14.7 (95% confidence interval [CI] = 9.1, 22.2) for those aged 5-14 years; 3.4 (95% CI = 1.6, 7.2) for those aged 15-24 year; and 3.8 (95% CI = 1.6, 7.2) for those aged ≥ 25 years. Persons between the ages of 5 and 14 years had 3.5 greater odds to have been hospitalized as a result of SARI than those aged ≥ 25 years (odds ratio [OR] = 3.5, P < 0.001). Among the 419 samples tested, 169 (40.3%) were positive for one or more virus. Of those samples having viruses, 36.9% had influenza A; 29.9% had adenovirus; 20.2% had influenza B; and 14.4% had parainfluenza 1, 2, or 3. Muscle/joint pain was associated with influenza A (P = 0.002), whereas headache was associated with influenza B (P = 0.019). ARIs were responsible for a substantial disease burden in Hagadera camp.

Native rodent species are unlikely sources of infection for Leishmania (Viannia) braziliensis along the Transoceanic Highway in Madre de Dios, Peru.

An estimated 2.3 million disability-adjusted life years are lost globally from leishmaniasis. In Perus Amazon region, the department of Madre de Dios (MDD) rises above the rest of the country in terms of the annual incidence rates of human leishmaniasis. Leishmania (Viannia) braziliensis is the species most frequently responsible for the form of disease that results in tissue destruction of the nose and mouth. However, essentially nothing is known regarding the reservoirs of this vector-borne, zoonotic parasite in MDD. Wild rodents have been suspected, or proven, to be reservoirs of several Leishmania spp. in various ecosystems and countries. Additionally, people who live or work in forested terrain, especially those who are not regionally local and whose immune systems are thus naïve to the parasite, are at most risk for contracting L. (V.) braziliensis. Hence, the objective of this study was to collect tissues from wild rodents captured at several study sites along the Amazonian segment of the newly constructed Transoceanic Highway and to use molecular laboratory techniques to analyze samples for the presence of Leishmania parasites. Liver tissues were tested via polymerase chain reaction from a total of 217 rodents; bone marrow and skin biopsies (ear and tail) were also tested from a subset of these same animals. The most numerous rodent species captured and tested were Oligoryzomys microtis (40.7%), Hylaeamys perenensis (15.7%), and Proechimys spp. (12%). All samples were negative for Leishmania, implying that although incidental infections may occur, these abundant rodent species are unlikely to serve as primary reservoirs of L. (V.) braziliensis along the Transoceanic Highway in MDD. Therefore, although these rodent species may persist and even thrive in moderately altered landscapes, we did not find any evidence to suggest they pose a risk for L. (V.) braziliensis transmission to human inhabitants in this highly prevalent region.

Glucose uptake and metabolism in the Trichinella spiralis nurse cell

Isolated Trichinella spiralis nurse cells transport a significantly greater amount of glucose/mg of protein than the normal skeletal muscle cell line (L6). V(max) and K(m) estimations revealed that nurse cells have a much higher saturation point than L6 cells for glucose. The effects of numerous physiological conditions (Na(+) concentration, pH, and temperature) on nurse cell glucose uptake were investigated. It was determined that sodium concentration had no effect on glucose uptake. Low (<6.5) and high (>7.3) pH and low (5 degrees C) temperatures significantly effected glucose uptake. The two hormones, insulin and epinephrine, appeared to have little, if any, influence on the rate of glucose uptake by nurse cells. Glucose uptake was inhibited in the presence of 6-carbon carbohydrates. The H(+)/glucose symport inhibitors, dicyclohexylcarbodiimide (DCCD) and Carbonyl cyanide 4-trifluoromethoxyphenlhydrazone (FCCP), and the facilitated diffusion inhibitor phloretin also inhibited glucose uptake. Oubain, a Na(+)/glucose symport inhibitor, did not inhibit glucose uptake. These data, in conjunction with Western blot analyses, revealed that the transport of glucose occurs via H(+)/glucose symport and facilitated diffusion, perhaps through the glucose transport proteins GLUT 1 and/or 4. It was also demonstrated that nurse cells are capable of synthesising glycogen. It appears that glycogen is in a constant state of flux and physiological conditions, such as glucose concentration, significantly influence the synthesis of this macromolecule. We conclude that these results are consistent with the hypothesis that nurse cells, at least maintained in vitro, are metabolically highly active but show significant divergence from normal muscle cells in several fundamental aspects of sugar metabolism.

Serologic Evidence of the Geographic Distribution of Bacterial Zoonotic Agents in Kenya, 2007.

Diseases of zoonotic origin contribute to the burden of febrile illnesses in developing countries. We evaluated serologic evidence of exposure to Bacillus anthracis, Brucella spp., spotted fever group rickettsioses (SFGR), and typhus group rickettsioses (TGR) from samples of persons aged 15–64 years collected during a nationwide human immunodeficiency virus (HIV) serosurvey conducted in 2007 in Kenya. The seropositivity observed for pathogens was B. anthracis 11.3%, Brucella spp. 3.0%, SFGR 23.3%, and TGR 0.6%. On univariate analysis, seropositivity for each pathogen was significantly associated with the following risk factors: B. anthracis with province of residence; Brucella spp. with sex, education level, and wealth; SFGR with age, education level, wealth, and province of residence; and TGR with province of residence. On multivariate analysis, seropositivity remained significantly associated with wealth and province for B. anthracis; with sex and age for Brucella spp; and with sex, education level, and province of residence for SFGR whereas TGR had no significance. High IgG seropositivity to these zoonotic pathogens (especially, B. anthracis and SFGR) suggests substantial exposure. These pathogens should be considered in the differential diagnosis of febrile illness in Kenya.

Malaria Parasitemia among Febrile Patients Seeking Clinical Care at an Outpatient Health Facility in an Urban Informal Settlement Area in Nairobi, Kenya

Nairobi is considered a low-risk area for malaria transmission, but travel can influence transmission of malaria. We investigated the demographic characteristics and travel history of patients with documented fever and malaria in a study clinic in a population-based surveillance system over a 5-year period, January 1, 2007 to December 31, 2011. During the study period, 11,480 (68%) febrile patients had a microscopy test performed for malaria, of which 2,553 (22%) were positive. Malaria was detected year-round with peaks in January, May, and September. Children aged 5–14 years had the highest proportion (28%) of positive results followed by children aged 1–4 years (23%). Almost two-thirds of patients with malaria reported traveling outside Nairobi; 79% of these traveled to three counties in western Kenya. History of recent travel (i.e., in past month) was associated with malaria parasitemia (odds ratio: 10.0, 95% confidence interval: 9.0–11.0). Malaria parasitemia was frequently observed among febrile patients at a health facility in the urban slum of Kibera, Nairobi. The majority of patients had traveled to western Kenya. However, 34% reported no travel history, which raises the possibility of local malaria transmission in this densely populated, urban setting. These findings have important implications for malaria control in large Nairobi settlements.

Evaluation of the Field Performance of ImmunoCard STAT!® Rapid Diagnostic Test for Rotavirus in Dadaab Refugee Camp and at the Kenya–Somalia Border

Rotavirus commonly causes diarrhea in children, leading to hospitalization and even death. Rapid diagnostic tests are feasible alternatives for determining rotavirus outbreaks in refugee camps that have inadequate laboratory capacity. We evaluated the field performance of ImmunoCard STAT!® Rotavirus (ICS-RV) in Dadaab Refugee Camp and at the Kenya–Somalia border. From May to December 2014, we prospectively enrolled children aged < 5 years hospitalized with acute diarrhea, defined as ≥ 3 episodes of loose stool in 24 hours for < 7 days. Stool samples were collected and tested by trained surveillance clerks using ICS-RV per manufacturers instructions. The field performance characteristics of ICS-RV were evaluated against the gold standard test, Premier™ Rotaclone® enzyme immunoassay. The operational characteristics were evaluated using World Health Organization (WHO) ASSURED criteria to determine whether ICS-RV is appropriate as a point-of-care test by administering a standard questionnaire and observing surveillance clerks performing the test. We enrolled 213 patients with a median age of 10 months (range = 1–48); 58.2% were male. A total of 71 (33.3%) and 60 (28.2%) patients tested positive for rotavirus infection by immunoassay and ICS-RV, respectively. The sensitivity, specificity, and positive and negative predictive values of ICS-RV compared with the immunoassay were 83.1% (95% confidence interval [CI] = 72.3–91.0), 99.3% (95% CI = 96.1–100), 98.3% (95% CI = 91.1–100), and 92.1% (95% CI = 86.6–95.5), respectively. The ICS-RV fulfilled the WHO ASSURED criteria for point-of-care testing. ICS-RV is a field-ready point-of-care test with good field performance and operational characteristics. It can be useful in determining rotavirus outbreaks in resource-limited settings.

Improving Capture of Vaccine History: Case Study from an Evaluation of 10-Valent Pneumococcal Conjugate Vaccine Introduction in Kenya

With the accelerated introduction of new vaccines in low-income settings, understanding immunization program performance is critical. We sought to improve immunization history acquisition from Ministry of Health vaccination cards during a vaccine impact study of 10-valent pneumococcal conjugate vaccine on pneumococcal carriage among young children in Kenya in 2012 and 2013. We captured immunization history in a low proportion of study participants in 2012 using vaccination cards. To overcome this challenge, we implemented a household-based reminder system in 2013 using community health workers (CHWs), and increased the retrieval of vaccine cards from 62% in 2012 to 89% in 2013 (P < 0.001). The home-based reminder system using CHWs is an example of an approach that improved immunization history data quality in a resource-poor setting.