Improved Alere Determine Lipoarabinomannan Antigen Detection Test for the Diagnosis of Human and Bovine Tuberculosis by Manipulating Urine and Milk

Tuberculosis (TB) disease still kills 1-person every 21-seconds. Few TB diagnostic tests are considered truly appropriate for point of care settings. The WHO-endorsed immunodiagnostic Alere Determine Lipoarabinomannan Ag-test (LAM-test) detects Mycobacterium tuberculosis complex LAM in urine, and its use is recommended for TB diagnosis among HIV co-infected individuals with low CD4 T-cell counts. Here we found that a simple 15-minute enzymatic treatment at room temperature of LAM-spiked urine with \xCE\xB1-mannosidase (for human TB), and LAM-spiked milk with combined lactase and caseinase (for bovine TB), enhanced 10-fold the detection levels of the LAM-test and thus, improved the detection of LAM by the LAM-test in urine and milk that otherwise could be missed in the field. Future separate clinical research studies specifically designed to address the potential of these findings are required

Evolutionary history and spatiotemporal dynamics of the HIV-1 subtype B epidemic in Guatemala.

Different explanations exist on how HIV-1 subtype B spread in Central America, but the role of Guatemala, the Central American country with the highest number of people living with the virus, in this scenario is unknown. We investigated the evolutionary history and spatiotemporal dynamics of HIV-1 subtype B in Guatemala. A total of 1,047 HIV-1 subtype B pol sequences, from newly diagnosed ART-naïve, HIV-infected Guatemalan subjects enrolled between 2011 and 2013 were combined with published subtype B sequences from other Central American countries (n = 2,101) and with reference sequences representative of the BPANDEMIC and BCAR lineages from the United States (n = 465), France (n = 344) and the Caribbean (n = 238). Estimates of evolutionary, demographic, and phylogeographic parameters were obtained from sequence data using maximum likelihood and Bayesian coalescent-based methods. The majority of Guatemalan sequences (98.9%) belonged to the BPANDEMIC clade, and 75.2% of these sequences branched within 10 monophyletic clades: four also included sequences from other Central American countries (BCAM-I to BCAM-IV) and six were mostly (>99%) composed by Guatemalan sequences (BGU clades). Most clades mainly comprised sequences from heterosexual individuals. Bayesian coalescent-based analyses suggested that BGU clades originated during the 1990s and 2000s, whereas BCAM clades originated between the late 1970s and mid 1980s. The major hub of dissemination of all BGU, and of BCAM-II, and BCAM-IV clades was traced to the Department of Guatemala, while the root location of BCAM-I and BCAM-III was traced to Honduras. Most Guatemalan clades experienced initial phases of exponential growth (0.23 and 3.6 year-1), followed by recent growth declines. Our observations suggest that the Guatemalan HIV-1 subtype B epidemic is driven by dissemination of multiple BPANDEMIC founder viral strains, some restricted to Guatemala and others widely disseminated in the Central American region, with Guatemala City identified as a major hub of viral dissemination. Our results also suggest the existence of different sub-epidemics within Guatemala for which different targeted prevention efforts might be needed

Staphylococcus aureus bloodstream infections in Latin America: results of a multinational prospective cohort study

Background:Substantial heterogeneity in the epidemiology and management ofStaphylococcus aureusbacter-aemia (SAB) occurs in Latin America. We conducted a prospective cohort study in 24 hospitals from nine LatinAmerican countries.Objectives:To assess the clinical impact of SAB in Latin America.Patients and methods:We evaluated differences in the 30 day attributable mortality among patients with SABdue to MRSA compared with MSSA involving 84 days of follow-up. Adjusted relative risks were calculated using ageneralized linear model.Results:A total of 1030 patients were included. MRSA accounted for 44.7% of cases with a heterogeneous geo-graphical distribution. MRSA infection was associated with higher 30 day attributable mortality [25% (78 of 312)versus 13.2% (48 of 363), adjusted RR: 1.94, 95% CI: 1.38–2.73,P,0.001] compared with MSSA in the multivari-able analysis based on investigators’ assessment, but not in a per-protocol analysis [13% (35 of 270) versus8.1% (28 of 347), adjusted RR: 1.10, 95% CI: 0.75–1.60,P"0.616] or in a sensitivity analysis using 30 day all-cause mortality [36% (132 of 367) versus 27.8% (123 of 442), adjusted RR: 1.09, 95% CI: 0.96–1.23,P"0.179].MRSA infection was not associated with increased length of hospital stay. Only 49% of MSSA bloodstream infec-tions (BSI) received treatment withb-lactams, but appropriate definitive treatment was not associated withlower mortality (adjusted RR: 0.93, 95% CI: 0.70–1.23,P"0.602).Conclusions:MRSA-BSIs in Latin America are not associated with higher 30 day mortality or longer length ofstay compared with MSSA. Management of MSSA-BSIs was not optimal, but appropriate definitive therapy didnot appear to influence mortalit