Paradoxical tuberculosis immune reconstitution inflammatory syndrome (TB-IRIS) in HIV patients with culture confirmed pulmonary tuberculosis in India and the potential role of IL-6 in prediction

Background: The incidence, manifestations, outcome and clinical predictors of paradoxical TB-IRIS in patients with HIV and culture confirmed pulmonary tuberculosis (PTB) in India have not been studied prospectively. Methods: HIV+ patients with culture confirmed PTB started on anti-tuberculosis therapy (ATT) were followed prospectively after anti-retroviral therapy (ART) initiation. Established criteria for IRIS diagnosis were used including decline in plasma HIV RNA at IRIS event. Pre-ART plasma levels of interleukin (IL)-6 and C-reactive protein (CRP) were measured. Univariate and multivariate logistic regression models were used to evaluate associations between baseline variables and IRIS. Results: Of 57 patients enrolled, 48 had complete follow up data. Median ATT-ART interval was 28 days (interquartile range, IQR 14–47). IRIS events occurred in 26 patients (54.2%) at a median of 11 days (IQR: 7–16) after ART initiation. Corticosteroids were required for treatment of most IRIS events that resolved within a median of 13 days (IQR: 9–23). Two patients died due to CNS TB-IRIS. Lower CD4+ T-cell counts, higher plasma HIV RNA levels, lower CD4/CD8 ratio, lower hemoglobin, shorter ATT to ART interval, extra-pulmonary or miliary TB and higher plasma IL-6 and CRP levels at baseline were associated with paradoxical TB-IRIS in the univariate analysis. Shorter ATT to ART interval, lower hemoglobin and higher IL-6 and CRP levels remained significant in the multivariate analysis. Conclusion: Paradoxical TB–IRIS frequently complicates HIV-TB therapy in India. IL-6 and CRP may assist in predicting IRIS events and serve as potential targets for immune interventions

Multiple Wolbachia strains in Apis mellifera capensis from South Africa

Eggs of the honeybee Apis mellifera capensis from South Africa were screened for Wolbachia using degenerate primers designed to amplify a segment of the wsp A gene sequences. This strategy resulted in the identification of two new strains ($w$Cap-B2, and -A1) in addition to the one ($w$Cap-B1) characterized earlier from A. m. capensis and A. m. scutellata. Strain-specific primers were designed and used to assay eggs from both A. m. capensis and A. m. scutellata. The $w$Cap-B1 sequence was amplified consistently from both A. m. capensis and A. m. scutellata, but the $w$Cap-B2 and -A1 sequences were amplified sporadically only from A. m. capensis. This indicates that the $w$Cap-B1 strain could be present at a higher titer or that $w$Cap-B2 and -A1 are present only in some individuals in the wider A. m. capensis population. The detection of these new Wolbachia strains suggests that additional investigations are required to determine the role of Wolbachia in the biology of A. m. capensis workers

Cutaneous manifestations of internal malignancy

Background: Many malignancies affecting the internal organs display cutaneous manifestations which may be either specific (tumor metastases) or nonspecific lesions. Aims: The study is aimed at determining the frequency and significance of cutaneous manifestations among patients with internal malignancy. Materials and Methods: 750 cases of proven internal malignancy, who attended a cancer chemotherapy center in South India, were studied. Specific infiltrates were confirmed by histopathology, fine needle aspiration cytology (FNAC) and marker studies. Results: Out of the 750 patients with internal malignancy, skin changes were seen in a total of 52 (6.93%) patients. Conclusion: Cutaneous metastases (specific lesions) were seen in 20 patients (2.66%): contiguous in 6 (0.8%), and non-contiguous in 14 (1.86%). Nonspecific skin changes were seen in 32 patients (4.26%). None of our patients presented with more than one type of skin lesions. Herpes zoster was the most common nonspecific lesion noticed in our patients, followed by generalized pruritus, multiple eruptive seborrheic keratoses, bullous disorder, erythroderma, flushing, purpura, pyoderma gangrenosum, insect bite allergy and lichenoid dermatitis

Wolbachia is present in Apis mellifera capensis, A. m. scutellata, and their hybrid in Southern Africa

Apis mellifera capensis, A. m. scutellata and their hybrids were screened by a sensitive Long PCR protocol for Wolbachia because this endosymbiont has been implicated in causing thelytoky in other Hymenoptera. Wolbachia was found in all workers of A. m. capensis examined, and in workers and drones of A. m. scutellata and in hybrid workers of these two subspecies. Cloning and sequencing indicated that all contained the same unique Wolbachia strain, named $w$Cap-B1, which belongs to the Con Group because it displayed less than 2.5% sequence divergence from the reference strain from Tribolium confusum. $w$Cap-B1 is closely related to Wolbachia from Diaphorina citri, Solenopsis invicta, Coleomegilla maculata lengi, Plutella xylostella, and Bemisia tabaci. Because no sequence differences were found among these bee populations, infection with this Wolbachia strain is unlikely to be associated with thelytoky in A. m. capensis

Genomic Analyses of Two Populations of Ageniaspis citricola (Hymenoptera: Encyrtidae) Suggest That a Cryptic Species May Exist

Slight differences in the life cycle and behavior of two colonies of the encyrtid endoparasitoid Ageniaspis citricola Logvinovskaya (obtained from Australia and Taiwan) were observed in quarantine facilities in Florida and led to a survey of genetic markers to determine the degree of genetic differences between them. Individuals of A. citricola from each colony were reared from the citrus leafminer, Phyllocnistis citrella Stainton, and compared by random amplified polymorphic DNA (RAPD) polymerase chain reaction (PCR). The results indicated that the colonies from Taiwan and Australia are genetically distinct, with no banding patterns shared between them. Such differences typically are not found unless the populations are isolated reproductively. Because the Australian colony was originally collected from Thailand and could have undergone genetic bottlenecks during importation into Australia and Florida, specimens obtained directly from Thailand were also included in the RAPD-PCR assay. RAPD banding patterns of individuals from Thailand were identical to those of the Australian colony and distinctly different from those produced by the colony derived from Taiwan. A 400-bp region of two highly conserved Actin genes was amplified from individuals of the Australian and Taiwan colonies by the PCR using degenerate primers. The two Actin sequences of individuals from Taiwan and Australia exhibited differences equivalent to those found in different arthropod species or genera. The combined molecular data suggest that one species of Ageniaspis may be parasitizing the citrus leafminer in Thailand and another may occur in Taiwan. The difficulties in resolving the “species problem” are discussed