Browsing by Author "Boom, Henry"

Now showing 1 - 7 of 7
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    CD81 T Cells Provide an Immunologic Signature of Tuberculosis in Young Children
    (American Thoracic Society, 2011) Lancioni, Christina; Nyendak, Mellisa; Sarah Zalwango, Sarah Kiguli; Mori, Tomi; Mayanja-Kizza, Harriet; Balyejusa, Stephen; Null, Megan; Baseke, Joy; Mulindwa, Deo; Byrd, Laura; Swarbrick, Gwendolyn; Scott, Christine; Johnson, Denise F.; Malone, LaShaunda; Mudido-Musoke, Philipa; Boom, Henry; Lewinsohn, David M.; Lewinsohn, Deborah A.
    Mycobacterium tuberculosis (Mtb), the etiology of tuberculosis (TB), causes over 9 million cases of disease and 1.7 million deaths annually (1). The only available vaccine to prevent TB, bacillus Calmette-Gue´ rin, offers little protection against the most common disease manifestations (2) and efforts to develop an improved vaccine are hampered by poor understanding of immunologic events that occur after Mtb exposure. Scientific studies of immunologic responses to initial Mtb infection are difficult because most individuals living in TB-endemic settings have experienced multiple Mtb exposures. Young children, however, suffer disproportionately after exposure to Mtb, because they are at substantial risk for developing TB after primary infection (3–5). Therefore, young children with TB offer a valuable window into the human immune response to primary Mtb infection.
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    Clinical and epidemiological characteristics of individuals resistant to M. tuberculosis infection in a longitudinal TB household contact study in Kampala, Uganda
    (BioMed Central, 2014) Ma, Ningning; Zalwango, Sarah; Malone, LaShaunda L; Nsereko, Mary; Wampande, Eddie M; Thiel, Bonnie A; Okware, Brenda; Igo Jr., Robert P; Joloba3, Moses L.; Mupere, Ezekiel; Mayanja-Kizza, Harriet; Boom, Henry; Stein, Catherine M
    Background: Despite sustained exposure to a person with pulmonary tuberculosis (TB), some M. tuberculosis (Mtb) exposed individuals maintain a negative tuberculin skin test (TST). Our objective was to characterize these persistently negative TST (PTST-) individuals and compare them to TST converters (TSTC) and individuals who are TST positive at study enrollment. Methods: During a TB household contact study in Kampala, Uganda, PTST-, TSTC, and TST + individuals were identified. PTST- individuals maintained a negative TST over a 2 year observation period despite prolonged exposure to an infectious tuberculosis (TB) case. Epidemiological and clinical characteristics were compared, a risk score developed by another group to capture risk for Mtb infection was computed, and an ordinal regression was performed. Results: When analyzed independently, epidemiological risk factors increased in prevalence from PTST- to TSTC to TST+. An ordinal regression model suggested age (p < 0.01), number of windows (p < 0.01) and people (p = 0.07) in the home, and sleeping in the same room (p < 0.01) were associated with PTST- and TSTC. As these factors do not exist in isolation, we examined a risk score, which reflects an accumulation of risk factors. This compound exposure score did not differ significantly between PTST-, TSTC, and TST+, except for the 5–15 age group (p = 0.009). Conclusions: Though many individual factors differed across all three groups, an exposure risk score reflecting a collection of risk factors did not differ for PTST-, TSTC and TST + young children and adults. This is the first study to rigorously characterize the epidemiologic risk profile of individuals with persistently negative TSTs despite close exposure to a person with TB. Additional studies are needed to characterize possible epidemiologic and host factors associated with this phenotype.
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    Comparison of MGIT and Myco/F Lytic Liquid-Based Blood Culture Systems for Recovery of Mycobacterium tuberculosis from Pleural Fluid
    (Journal of clinical microbiology, 2015) Harausz, Elizabeth; Kafuluma Lusiba, John; Nsereko, Mary; Johnson, John L.; Toossi, Zahra; Ogwang, Sam; Boom, Henry; Joloba, Moses L.
    Tuberculosis (TB) is the most frequent cause of exudative pleural effusions in areas of high TB incidence. Studies have shown that Mycobacterium tuberculosis is the causative agent in up to 44% of HIV-seronegative people hospitalized with a pleural effusion (1–3), and the percentage is higher in HIV-seropositive people (4). Pleural TB is a paucibacillary disease. The pathogenesis of a tuberculous pleural effusion is likely due to a delayed hypersensitivity reaction to M. tuberculosis proteins (for a review, see reference 5) and not to a large burden of organisms. The scarcity of organisms makes it difficult to isolate M. tuberculosis from pleural fluid samples, leading to low rates of culture confirmation. Rich culture media are generally more sensitive in detecting M. tuberculosis in sputum and other clinical samples (6). Few studies have compared different liquid media and examined their potential role in combination with solid media for the diagnosis of tuberculous pleurisy. In this study, we compared the Bactec 9120 Myco/F lytic blood culture system (Myco/F lytic) to the Bactec mycobacterial growth indicator tube (MGIT) 960 system (Becton Dickinson, Sparks, MD) (with each liquid system used in conjunction with locally prepared Middlebrook 7H11 solid medium) with respect to time to positivity (TTP), sensitivity, specificity, and percent culture yield of M. tuberculosis isolates from pleural fluid.
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    Contact Investigation for Active Tuberculosis Among Child Contacts in Uganda
    (Oxford University Press, 2013) Jaganath, Devan; Zalwango, Sarah; Okware, Brenda; Nsereko, Mary; Kisingo, Hussein; Malone, LaShaunda; Lancioni, Christina; Okwera, Alphonse; Joloba, Moses; Mayanja-Kizza, Harriet; Boom, Henry; Stein, Catherine; Mupere, Ezekiel
    Background. Tuberculosis is a large source of morbidity and mortality among children. However, limited studies characterize childhood tuberculosis disease, and contact investigation is rarely implemented in high-burden settings. In one of the largest pediatric tuberculosis contact investigation studies in a resource-limited setting, we assessed the yield of contact tracing on childhood tuberculosis and indicators for disease progression in Uganda. Methods. Child contacts aged <15 years in Kampala, Uganda, were enrolled from July 2002 to June 2009 and evaluated for tuberculosis disease via clinical, radiographic, and laboratory methods for up to 24 months. Results. Seven hundred sixty-one child contacts were included in the analysis. Prevalence of tuberculosis in our child population was 10%, of which 71% were culture-confirmed positive. There were no cases of disseminated tuberculosis, and 483 of 490 children (99%) started on isoniazid preventative therapy did not develop disease. Multivariable testing suggested risk factors including human immunodeficiency virus (HIV) status (odds ratio [OR], 7.90; P < .001), and baseline positive tuberculin skin test (OR, 2.21; P = .03); BCG vaccination was particularly protective, especially among children aged ≤5 years (OR, 0.23; P < .001). Adult index characteristics such as sex, HIV status, and extent or severity of disease were not associated with childhood disease. Conclusions. Contact tracing for children in high-burden settings is able to identify a large percentage of culture-confirmed positive tuberculosis cases before dissemination of disease, while suggesting factors for disease progression to identify who may benefit from targeted screening.
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    Effectiveness of WHO’s pragmatic screening algorithm for child contacts of tuberculosis cases in resource-constrained settings: a prospective cohort study in Uganda
    (Lancet Respir Med, 2017) Martinez, Leonardo; Shen, Ye; Handel, Andreas; Chakraburty, Srijita; Stein, Catherine M; Malone, LaShaunda L; Boom, Henry; Quinn, Frederick D; Joloba, Moses L; Whalen, Christopher C; Zalwango, Sarah
    Background Tuberculosis is a leading cause of global childhood mortality; however, interventions to detect undiagnosed tuberculosis in children are underused. Child contact tracing has been widely recommended but poorly implemented in resource-constrained settings. WHO has proposed a pragmatic screening approach for managing child contacts. We assessed the effectiveness of this screening approach and alternative symptom-based algorithms in identifying secondary tuberculosis in a prospectively followed cohort of Ugandan child contacts. Methods We identified index patients aged at least 18 years with microbiologically confirmed pulmonary tuberculosis at Old Mulago Hospital (Kampala, Uganda) between Oct 1, 1995, and Dec 31, 2008. Households of index patients were visited by fieldworkers within 2 weeks of diagnosis. Coprevalent and incident tuberculosis were assessed in household contacts through clinical, radiographical, and microbiological examinations for 2 years. Disease rates were compared among children younger than 16 years with and without symptoms included in the WHO pragmatic guideline (presence of haemoptysis, fever, chronic cough, weight loss, night sweats, and poor appetite). Symptoms could be of any duration, except cough (>21 days) and fever (>14 days). A modified WHO decision-tree designed to detect high-risk asymptomatic child contacts was also assessed, in which all asymptomatic contacts were classified as high risk (children younger than 3 years or immunocompromised [HIV-infected]) or low risk (aged 3 years or older and immunocompetent [HIV-negative]). We also assessed a more restrictive algorithm (ie, assessing only children with presence of chronic cough and one other tuberculosis-related symptom). Findings Of 1718 household child contacts, 126 (7%) had coprevalent tuberculosis and 24 (1%) developed incident tuberculosis, diagnosed over the 2-year study period. Of these 150 cases of tuberculosis, 95 (63%) were microbiologically confirmed with a positive sputum culture. Using the WHO approach, 364 (21%) of 1718 child contacts had at least one tuberculosis-related symptom and 85 (23%) were identified as having coprevalent tuberculosis, 67% of all coprevalent cases detected (diagnostic odds ratio 9·8, 95% CI 6·8–14·5; p<0·0001). 1354 (79%) of 1718 child contacts had no symptoms, of whom 41 (3%) had coprevalent tuberculosis. The WHO approach was effective in contacts younger than 5 years: 70 (33%) of 211 symptomatic contacts had coprevalent disease compared with 23 (6%) of 367 asymptomatic contacts (p<0·0001). This approach was also effective in contacts aged 5 years and older: 15 (10%) of 153 symptomatic contacts had coprevalent disease compared with 18 (2%) of 987 asymptomatic contacts (p<0·0001). More coprevalent disease was detected in child contacts recommended for screening when the study population was restricted by HIV-serostatus (11 [48%] of 23 symptomatic HIV-seropositive child contacts vs two [7%] of 31 asymptomatic HIV-seropositive child contacts) or to only cultureconfirmed cases (47 [13%] culture confirmed cases of 364 symptomatic child contacts vs 29 [2%] culture confirmed cases of 1354 asymptomatic child contacts). In the modified algorithm, high-risk asymptomatic child contacts were at increased risk for coprevalent disease versus low-risk asymptomatic contacts (14 [6%] of 224 vs 27 [2%] of 1130; p=0·0021). The presence of tuberculosis infection did not predict incident disease in either symptomatic or asymptomatic child contacts: in symptomatic contacts, eight (5%) of 169 infected contacts and six (5%) of 111 uninfected contacts developed incident tuberculosis (p=0·80).
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    Genetic and Shared Environmental Influences on Interferon-g Production in Response to Mycobacterium tuberculosis Antigens in a Ugandan Population
    (The American Society of Tropical Medicine and Hygiene, 2010) Tao, Li; Zalwango, Sarah; Chervenak, Keith; Thiel, Bonnie; Malone, LaShaunda L.; Feiyou, Qiu; Mayanja-Kizza, Harriet; Boom, Henry; Stein, Catherine M.
    Interferon-g (IFN-g) is a key cytokine in the immune response to Mycobacterium tuberculosis (Mtb). Many studies established IFN-g responses are influenced by host genetics, however differed widely by the study design and heritability estimation method. We estimated heritability of IFN-g responses to Mtb culture filtrate (CF), ESAT-6, and Antigen 85B (Ag85B) in 1,104 Ugandans from a household contact study. Our method separately evaluates shared environmental and genetic variance, therefore heritability estimates were not upwardly biased, ranging from 11.6% for Ag85B to 22.9% for CF. Subset analyses of individuals with latent Mtb infection or without human immunodeficiency virus infection yielded higher heritability estimates, suggesting 10–30% of variation in IFN-g is caused by a shared environment. Immunosuppression does not negate the role of genetics on IFN-g response. These estimates are remarkably close to those reported for components of the innate immune response. These findings have implications for the interpretation of IFN-g response assays and vaccine studies.
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    Genome Scan of M. tuberculosis Infection and Disease in Ugandans
    (PLoS ONE, 2018) Stein, Catherine M.; Zalwango, Sarah; Malone, LaShaunda L.; Won1, Sungho; Mayanja- Kizza, Harriet; Mugerwa, Roy D.; Leontiev, Dmitry V.; Thompson, Cheryl L.; Cartier, Kevin C.; Elston, Robert C.; Iyengar, Sudha K.; Boom, Henry; Whalen, Christopher C.
    Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), is an enduring public health problem globally, particularly in sub-Saharan Africa. Several studies have suggested a role for host genetic susceptibility in increased risk for TB but results across studies have been equivocal. As part of a household contact study of Mtb infection and disease in Kampala, Uganda, we have taken a unique approach to the study of genetic susceptibility to TB, by studying three phenotypes. First, we analyzed culture confirmed TB disease compared to latent Mtb infection (LTBI) or lack of Mtb infection. Second, we analyzed resistance to Mtb infection in the face of continuous exposure, defined by a persistently negative tuberculin skin test (PTST-); this outcome was contrasted to LTBI. Third, we analyzed an intermediate phenotype, tumor necrosis factor-alpha (TNFa) expression in response to soluble Mtb ligands enriched with molecules secreted from Mtb (culture filtrate). We conducted a full microsatellite genome scan, using genotypes generated by the Center for Medical Genetics at Marshfield. Multipoint model-free linkage analysis was conducted using an extension of the Haseman-Elston regression model that includes half sibling pairs, and HIV status was included as a covariate in the model. The analysis included 803 individuals from 193 pedigrees, comprising 258 full sibling pairs and 175 half sibling pairs. Suggestive linkage (p,1023) was observed on chromosomes 2q21-2q24 and 5p13-5q22 for PTST-, and on chromosome 7p22-7p21 for TB; these findings for PTST- are novel and the chromosome 7 region contains the IL6 gene. In addition, we replicated recent linkage findings on chromosome 20q13 for TB (p = 0.002). We also observed linkage at the nominal a = 0.05 threshold to a number of promising candidate genes, SLC11A1 (PTST- p = 0.02), IL-1 complex (TB p = 0.01), IL12BR2 (TNFa p = 0.006), IL12A (TB p = 0.02) and IFNGR2 (TNFa p = 0.002). These results confirm not only that genetic factors influence the interaction between humans and Mtb but more importantly that they differ according to the outcome of that interaction: exposure but no infection, infection without progression to disease, or progression of infection to disease. Many of the genetic factors for each of these stages are part of the innate immune system.