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Molecular approaches applied to the epidemiology of leishmaniasis in Venezuela.

Leishmaniasis is on the increase in Venezuela (ca 30,000 new cases per year) due to deterioration in health management, increased risk groups among inmunosuppressed individuals and increased human penetration into the ecological habitats of sandfly vectors. An STD2-funded project (1989-1992) focused on the Andean state of Táchira, which showed the highest annual index of new cases (ca 200-250). The project aimed at contributing to vector/parasite identification through a combination of molecular and well established field techniques: Newly developed molecular methods distinguished among Lu. spinicrassa, Lu. youngi and Lu. townsendi. These three species of the Verrucarum group are sympatric in the Northeast of the state and could be successfully identified by CHA, DNA probes and RAPD. A Le. braziliensis specific KDNA probe used with squash blots indicated that Lu. spinicrassa is the main vector and that Le. braziliensis is the main parasite species in Táchira state, Venezuela. PCR and the Le. brasiliensis specific DNA probe, schizodemes, isoenzymes and polyclonal antibodies agreed as taxonomic criteria for classification of Leishmania isolated from parasitologically confirmed cases in Tachira. Considerable degree of antigen heterogeneity in Venezuelan Le. braziliensis complex and Le. mexicana complex isolates from Tachira suggests multiple candidate antigens for improving the specificity of immunological diagnosis. The methods developed and tested in Táchira state should be valuable in order to help solving other outstanding epidemiological problems such as following of the epidemiological impact of intervention and vector control measures in highly endemic areas. Future work (STD3 funded, 1993-1996) aims to apply these molecular techniques to a vector control pilot study in Lara state, an area showing the highest incidence of new cases in the country.

Animals↗

Teaching family and community dimensions of clinical family medicine in Venezuela.

BACKGROUND AND OBJECTIVES: In Venezuela, family medicine is taught and practiced almost exclusively in ambulatory care settings. This article describes the evolution of the educational strategies that emphasize family and community aspects of clinical practice within one residency program in the country of Venezuela. METHODS: Three distinct phases of development are depicted, beginning with a biomedical and individual-centered approach. Subsequent efforts to involve residents in the community provoked criticism. Resident-faculty dialogue led to modifications and to the success of the current program. Some of the specific educational strategies are: a structured weekly five-hour community afternoon, a 40-hour course titled "Family Dynamics and Counseling," use of the family-oriented home visit to introduce residents to the community aspects of health care, and completion of a community-based and health-related project. RESULTS: A sample of residents and graduates noted an improved doctor-patient relationship, improved ability to work with groups, and improved skills for incorporating preventive medicine with a community focus into their clinical practice. CONCLUSIONS: The community involvement is enthusiastically supported by the residents, as it is perceived as useful for clinical practice. The program prepares family physicians to become more responsive to the health needs and the reality of Venezuelan society.

Community Health Services↗

[Colonization by Streptococcus group B in full term pregnancy and newborns in a community in Venezuela].

BACKGROUND: The aim of this study was to define the incidence of cervico-vaginal colonization by group B Streptococcus (SGB) in full term pregnancy as well as vertical and horizontal transmission in newborns attended in two public hospitals in Valencia, Venezuela. METHODS: An study cervico-vaginal exudates from 171 full term pregnant women was performed together with general obstetric survey. Oropharyngeal and nasal exudate studies in 118 newborns of the mothers studied were carried out during the first 12 hours after birth as was a neonatologic survey. RESULTS: The global percentage of maternal colonization by SGB were 32.7% while in the NB it was 45.8%. Among the NB colonized by SGB 73.2% were considered to have acquired the bacteria from the mother (vertical) with no significant differences in the data found in the two hospitals. The rate of horizontal colonization of the newborns was 42.3% in one hospital and only 8% in the second. CONCLUSIONS: There were no significant statistical differences between the rate of cervico-vaginal colonization in women attended in two public hospitals in Venezuela. No differences were observed in the rate of vertical colonization of newborns but to the contrary, that of the horizontal (nosocomial) colonization was of 42.3% and 8% in the Charity and University Hospitals, respectively.

Cervix Mucus↗

[Changes in lipid availability in Venezuela, 1970-1992].

The authors carry out a research focused on the quantification and analysis of the main changes in feeding and nutrition in Venezuela between 1970 and 1992. Such research started with the review and adjustment of the Food Balance Sheets (Hojas de Balance de Alimentos) elaborated by the Instituto Nacional de Nutrición (National Nutrition Institute) between 1970 and 1979 in order to homogenize them in a methodological way to make them similar to those elaborated by that institution and the Fundación Polar for the 1980-90 period. Estimates were made about the daily and per person availability of food for human consumption (DCH) for 1991 and 1992. This report, a partial product of that research, characterizes the evolution of the lipidic DCH in Venezuela for the 1970-1992 period. This period has been divided in seven stages of the evolution of the total energetic DCH, as this reflects well the course of the daily and per person Food Purchasing Power (PCA); there is a direct and strong functional relationship between these two variables. Along those stages the behaviour of the lipidic DCH is studied and we try to view possible relationships between the evolution of the Venezeluans economical situation and the absolute and relative variations observed in the level and the structure of the lipidic DCH. This structure is analyzed from several points of view: groups of food sources, origin, "visibility", and place of origin. One purpose is to determine also which food groups are mainly responsible for the venezuelan's external lipidic dependence. A general picture of the evolution of the DCH for saturated fatty acids and cholesterol is made, as well as of the variations experienced by the P/S and M/S relationships. It was found that the most dynamic elements, those that can explain a very high percentage of the variations observed in the level and the structure of the lipidic DCH were: the groups of foods of Visible Fats, Milk and dairy products, and Meats; vegetal lipids; vegetal-visible and animal-invisible lipidic fractions; imported lipids or lipids of food products which raw materials were imported (oily raw materials to make oils and edible solid fats, and raw materials to make food for poultry and hogs). The importance of the food groups Visible Fats, Milk and dairy products, and Meats, as sources or saturated fatty acids in the diet of the Venezuelans was made evident (89-91% of the respective total DCH), as well as the importance of the food groups Eggs, Meats, Fish and Seafood, and Milk and dairy products, as sources of cholesterol (82-89% of the available total). It was found that the lipid-originated calories account for less than 30% of the total energetic DCH; saturated fatty acids account for less than 10% of the available calories/person/day; the DCH for cholesterol did not reach the level of 300 mg/p/d; the P/S and M/S relationships remained close to 1. These last four facts are considered favorable for the health of the human being.

Cholesterol, Dietary↗

Some nematodes of freshwater fishes in Venezuela.

The present paper comprises a systematic survey of nematodes found in 88 specimens of 24 species of freshwater fishes in Venezuela in 1992 and 1994. The following 13 species of nematodes were recorded: Adults; Guyanema longispiculum Moravec, Prouza et Royero, 1996, Guyanema sp., Procamallanus (Spirocamallanus) inopinatus Travassos, Artigas et Pereira, 1928, P. (S.) krameri (Petter, 1974) comb. n., P.(S.) pintoi (Kohn et Fernandes, 1988) comb, n., Procamallanus (Spirocamallanus) sp., Raphidascaris (Sprentascaris) mahnerti (Petter et Cassone, 1984). Larvae: Anisakidae gen. sp., Brevimulticaecum sp., Contracaecum sp. Type 1, Contracaecum sp. Type 2, Contracaecum sp. Type 3, Eustrongylides sp. All these parasites are reported from Venezuela for the first time and all findings represent new host records. Brevimulticaecum larvae are reported from fishes for the first time. Almost all parasites are briefly described and illustrated and problems concerning their morphology, taxonomy, hosts and geographical distribution are discussed. A new name, Terranova diazungriai nom.nov. is proposed for T. caballeroi Díaz-Ungría, 1968 (a junior homonym of T. caballeroi Barus et Coy Otero, 1966).

Animals↗

[A clone of Neisseria meningitidis serogroup C was responsible in 1994 of an unusual high rate of strains with a moderate resistance to penicillin in Caracas (Venezuela)].

BACKGROUND: The aim of the study was to analyse meningococcal strains isolated from patients in Caracas (Venezuela) with epidemiological markers and to determine their susceptibility to antimicrobial agents. METHODS: We analyzed 29 meningococcal clinical strains isolated during 1994 in Caracas by serogrouping, serotyping and subserotyping, multilocus enzyme analysis (MEE), ribotyping and pulse field electrophoresis (PFGE) profile. We also determined the Minimal Inhibitory Concentration (MIC) to 5 antimicrobial agents. RESULTS: Twenty four (82.7%) were group C meningococcal strains. All group C meningococci were characterized as C: 2b: P1.5, belonging to the same electrophoretic type (ET) by MEE and showing the same profile by PFGE by using Bg/II endonuclease restriction enzyme. These group C meningococci showed two different patterns by ribotyping, with only one band difference. All Group C and one group B N. meningitidis isolates were moderately resistant to penicillin (MIC > or = 0.12 mg/l). CONCLUSIONS: During 1994 an unusual high incidence of meningococcal strains moderately resistant to penicillin (PenMR) was detected in Caracas (Venezuela). A clone of C: 2b: P1.5 meningococci seem to be responsable for this high incidence of PenMR isolates.

Cross Infection↗

[Nutritional status and body composition of a group of non-institutionalized elderly in the State of Zulia, Venezuela].

To assess the nutritional status and body composition of an elderly free-living population from the State of Zulia, Venezuela, ninety-four persons (47 male and 47 female), ages ranging from 60 to 88 years (mean age 69.55 +/- 6.60) (X +/- SD) were studied. Anthropometric measurements, and a dietary study by means of 24-hour recall and a Food Frequency were performed. Significant statistical differences (p < 0.001, and p < 0.05) were observed among female and male groups in all measures and indices except weight, waist, arm area, and arm muscle area. Significant differences (p < 0.05) were also observed among age groups in weight, Quetelet index, percentage ideal weight (% IW), and triceps skinfold thickness. The means of anthropometric measures and nutritional indicators were higher than the results obtained in other studies. The percentage of elderly obese with Quetelet greater than 30 kg/m < or = was 42.6% (females) and 6.4% (males). In contrast, when utilizing % IW it was observed that 4.3% of the men and 48.9% of the women were obese. Body fat distribution index (waist/hip) shows abdominal fat distribution in 21.3% males and 68.1% females. We found sex-based significant differences in dietary intake of energy, total fat, carbohydrates, iron, vitamin A, and thiamin. The results indicate that the intake of protein, total fat, calcium, phosphorus, iron, thiamin, and niacin is high among males y females, when compared with the present Recommended Dietary Allowance (RDA) values of Venezuela. The intake of carbohydrate, fiber, vitamin A, riboflavin, zinc, and copper is low among males and females according RDA values, as well as the intake of riboflavin in males. The study indicates a high frequency of men and women obese, and with overweight among females as a consequence of the inadequacy of dietary intake. The present findings emphasizes the need to study in depth the different factors that affect nutritional status of elderly individuals in our country.

Aged↗

[Application of the polymerase chain reaction to the diagnosis of sickle cell anemia in Venezuela].

Application of polymerase chain reaction technology to detect sickle cell patients and heterozygous carriers in a group of patients suspect for sickle cell disease was carried out. The sample was composed of 102 normal individuals, and 102 unrelated out patients who were attending in the Hematology Service at the Maracay Central Hospital in the State of Aragua in Venezuela. All patients were interviewed. Results of their medical histories and the physical examination, made during the clinical visit, were recorded. The blood samples were collected in EDTA by venopuncture and genomic DNA was extracted from leucocytes. An amplified 536 base pairs fragment of the beta-globin gene containing codon 6, was digested with an isoschizomer of Mst II, Bsu36 I and electrophoresed in 3% agarose. We have established the technical conditions in our laboratory for the detection of sickle cell disease using a PCR assay. 32 patients having haemoglobin SS (HbSS) and 70 patients in the heterozygous state (HbAS) were identified. We confirm that the normal controls have the HbAA genotype. The standardization of a highly sensitive and specific diagnostic test for sickle cell disease permited us to identify the normal controls, the homozygotes and heterozygotes. This methodology is one of the fundamental technical bases for establishing a newborn screening programme in the Central Region of Venezuela and also has application in research related with other genetic diseases that affect the Venezuelan people.

Anemia, Sickle Cell↗

The prevalence of hypertension and the state of cardiovascular health in Venezuela and surrounding nations.

This review summarizes the prevalence of hypertension and the state of cardiovascular health in Venezuela and surrounding nations. First, the review discusses the fact that cardiovascular disease (CVD) is the main cause of death in Venezuela, Colombia, Brazil, and Trinidad and Tobago, accounting for 20% to 35% of all deaths. These data are similar to data from the developed world. Second, prevalence of hypertension in this region varies from 8% to 40% in the adult population, and, on average, 22% of the adult population of this region has an elevated blood pressure. However, prevalence rates vary considerably from country to country and within regions of the same country. Although mortality from hypertension as the main cause of death accounts for 1% to 4% of all deaths, mortality from stroke, mainly caused by hypertension, accounts for 10% of all deaths, indicating a failure in the treatment of hypertension. In most Latin American countries, the degree of awareness, treatment and control of hypertension is low, necessitating the establishment of programs to prevent, detect and effectively treat hypertension and decrease CVD risk factors.

Adolescent↗

Surname frequency and the isonymy structure of Venezuela.

Isonymy in Venezuela was studied analyzing the surnames of 3.9 million adults 40 years and older, selected from the register of electors updated in 1991. The electors were not differentiated by sex and represented all 22 states of Venezuela and its Federal District. The states of Nueva Esparta, an island, and Mérida, in the Venezuelan Andes, have the highest coefficients of microdifferentiation (R(ST)) and of inbreeding due to random isonymy. The states of Miranda, Aragua, Carabobo, and the Federal District, which includes the capital, Caracas, or are very close to it, had the lowest R(ST) values. The weighted averages of Fisher's alpha, a measure of surname abundance, varied by state from 43 in Nueva Esparta to 226 in Miranda, with a value of 210 for the entire country, much smaller than those observed in Switzerland, Germany, or Italy (2,396, 2,855, and 5,855, respectively). The fact that 32% of the total Venezuelan sample has only 40 surnames easily accounts for this small alpha. The correlation between the Euclidean distance and the log of geographic distance between the capital cities of states in km is high and significant (r = 0.78). The dendrogram built with the Euclidean distance matrix indicates the presence of three main clusters. One is formed by 10 states located in the western-central part of the country. The states of Zulia and Falcón join this cluster at a distance of 0.54 Euclidean units. A second cluster is formed by Barinas and the three Andean states. After combining these two, a third cluster joins them, formed by six Eastern states. Finally, the state of Amazonas enters the dendrogram at a distance of 0.66 units. Am. J. Hum. Biol. 12:352-362, 2000. Copyright 2000 Wiley-Liss, Inc.

Journal Article↗

Biosynthesis and combinatorial biosynthesis of pikromycin-related macrolides in Streptomyces venezuelae.

Pikromycin-related macrolides have recently attracted significant research interest because they are structurally related to the semisynthetic ketolide antibiotics that have demonstrated promising potential in combating multi-drug-resistant respiratory pathogens. Cloning and in-depth studies of the pikromycin biosynthetic gene cluster from Streptomyces venezuelae have led to new avenues in modular polyketide synthases, deoxysugar biosynthesis, cytochrome P450 hydroxylase, secondary metabolite gene regulation, and antibiotic resistance. Moreover, the knowledge and tools used for these studies are proving to be valuable in the development of advanced technologies for combinatorial biosynthesis of new macrolide antibiotics. This review summarizes these new developments and introduces S. venezuelae as a powerful new system for secondary metabolite pathway engineering from bench-top genetic manipulation to product fermentation.

Anti-Bacterial Agents↗

Conditions for the production of jadomycin B by Streptomyces venezuelae ISP5230: effects of heat shock, ethanol treatment and phage infection.

The novel benzoxazolophenanthridine antibiotic, jadomycin B, is produced by Streptomyces venezuelae ISP5230 following a 42 degrees C heat shock or exposure to ethanol. To further characterize these unusual culture conditions, studies were carried out using different media, varying nutrient content and concentrations, initial pH, and time of application of heat or ethanol stress. Highest titers of jadomycin B accumulated 48 h after S. venezuelae ISP5230 was inoculated into a D-galactose-L-isoleucine production medium (pH 7.5) which was supplemented with ethanol (6%, v/v) between 6 and 13 h. Cultures supplemented with ethanol later than 17 h post inoculation into the production medium produced little or no jadomycin B. Among other heat-shock inducing treatments examined, infection with phage SV1 was associated with increased jadomycin B production. Although jadomycin B titers showed little change with variations in the concentration of phosphate in the production medium, the nature of the nitrogen source was found to be important. Different colored pigments, presumed to be jadomycin B analogs, were formed when other amino acids replaced L-isoleucine in the medium as the sole nitrogen source. Increased jadomycin B titers accompanied increased L-isoleucine and D-galactose concentrations in the production medium.

Anti-Bacterial Agents↗

Influence of charge variation in the Streptomyces venezuelae alpha-amylase signal peptide on heterologous protein production by Streptomyces lividans.

With the aim of investigating determining factors for secretion of heterologous proteins by streptomycetes, we analysed the effect of charge variation in the Streptomyces venezuelae ATCC15068 alpha-amylase signal peptide on expression and secretion of mouse tumour necrosis factor alpha (mTNF) by Streptomyces lividans. To this end, the mTNF cDNA was fused to the wild-type alpha-amylase (aml) signal sequence and the fusion gene was expressed under the control of the S. venezuelae CBS762.70 subtilisin inhibitor gene (vsi) promoter, which has been shown to be very effective in initiating transcription. In addition, the number of positive charges in the N region of the alpha-amylase signal peptide was altered by in vitro mutagenesis. Secreted and intracellular mTNF levels were determined by sodium dodecyl sulphate/polyacrylamide gel electrophoresis and biological activity measurements. This revealed moderate amounts of secreted mTNF compared to the levels obtained in previous experiments using the vsi promoter in combination with the Vsi signal peptide. Levels of secreted mTNF could be increased sevenfold by introducing one extra positive charge in the N region of the signal peptide.

Animals↗

Molecular cloning of the genes for anthranilate synthetase from Streptomyces venezuelae ISP 5230.

Fragments of genomic DNA from Streptomyces venezuelae ISP5230 were cloned in the Escherichia coli expression vector pTZ18R and the plasmids were used to transform E. coli JA194 (trpE). The transformants included a prototrophic strain containing a recombinant plasmid, pDQ181, with an approximately 6.8-kb insert. Subcloning located the trpE-complementing DNA in a 2.4-kb segment. Transformation of E. coli ED23 (lacking both trpE and trpG functions) with plasmids containing the 2.4-kb DNA segment gave prototrophic strains exhibiting both the ASI and ASII activities of anthranilate synthetase. The results indicated that trpE and trpG are clustered in S. venezuelae. Regions hybridizing to the pDQ181 insert were present in the genomic DNA of other streptomycetes.

Anthranilate Synthase↗

Cloning, characterisation and regulation of an alpha-amylase gene from Streptomyces venezuelae.

The alpha-amylase gene (aml) of Streptomyces venezuelae ATCC15068 was cloned in Streptomyces lividans TK24 using the plasmid vector pIJ702. Sub-cloning and exonuclease III deletion experiments localised the sequences required for alpha-amylase production to a segment of 2.05 kb. Low-resolution nuclease S1 mapping revealed a aml transcript of approx. 1.7 kb, and the extracellular form of alpha-amylase was estimated by SDS-polyacrylamide gel electrophoresis to be 59 kDa, suggesting that aml mRNA is monocistronic. The nucleotide sequence of aml was determined and high-resolution nuclease S1 mapping experiments identified transcripts that appeared to initiate at a promoter identical to that of the alpha-amylase gene of Streptomyces limosus [Long et al., J. Bacteriol. 169 (1987) 5745-5754]. Transcription of aml in S. venezuelae, and of the cloned gene in Streptomyces coelicolor A3(2), was induced by maltose and repressed by glucose. Glucose repression in S. coelicolor A3(2) depended on a functional glucose kinase gene. The predicted amino acid sequence of the extracellular enzyme was very similar (75% identity) to the alpha-amylase of S. limosus and shared with this enzyme a strong susceptibility to tendamistat, a potent inhibitor of mammalian alpha-amylases. Sequence inspection revealed a putative signal sequence of 28 amino acids that preceded the probable signal peptidase cleavage site.

Amino Acid Sequence↗

The Streptomyces venezuelae pikAV gene contains a transcription unit essential for expression of enzymes involved in glycosylation of narbonolide and 10-deoxymethynolide.

In Streptomyces venezuelae, four polyketide synthase (PKS) polypeptides encoded by pikAI-pikAIV are used to generate 10 and 12-membered macrocyclic structures, narbonolide and 10-deoxymethynolide. Sequence analysis suggests these genes are translationally coupled with downstream genes, pikAV (encoding a type II thioesterase), desVIII-desVI (encoding enzymes responsible for production of the final glycosylated products pikromycin, narbomycin, methymycin and neomethymycin) and desR (a resistance gene). Type II thioesterases have been suggested to have an editing function in polyketide biosynthesis and deletion of the corresponding genes often leads to decreased levels of polyketide production. Surprisingly an in-frame deletion of 687 bp of the 843 bp pikAV ORF led to a strain SC1022 that produced normal yields of polyketide products, but only in the aglycone form. Plasmid-based expression of the desVIII-VI and desR in the SC1022 strain completely restored production of glycosylated products, despite the absence of a functional pikAV gene product. Under these conditions the PikAV TEII therefore does not play an important role in polyketide biosynthesis, and its function remains an enigma. These observations also demonstrate that the region of pikAV DNA deleted in strain SC1022 contains a transcription unit essential for expression of the des genes. A sequence alignment of PikAV with members of the highly conserved type II thioesterases revealed a short divergent region at the carboxy terminus, suggesting a region of pikAV that might contain such a transcription unit. DNA containing this region of pikAV was shown to be able to increase plasmid-based expression of both crotonyl CoA reductase gene (ccr) and the erythromycin resistance gene (ermE) in S. venezuelae.

Acyl-CoA Dehydrogenases↗

A repressor-response regulator gene pair controlling jadomycin B production in Streptomyces venezuelae ISP5230.

A second regulatory gene (jadR(1)) is located immediately upstream of the putative repressor gene (jadR(2)) in the jad cluster for biosynthesis of the antibiotic jadomycin B in Streptomyces venezuelae ISP5230. It encodes a 234-amino acid polypeptide with a sequence resembling those of response regulator proteins in two-component control systems. Features in the conserved C-terminal domain of JadR(1) place the protein in the OmpR-PhoB subfamily of response regulators. In mutants where jadR(1) was deleted or disrupted, jadomycin B was not produced, implying that the gene has an essential role in biosynthesis of the antibiotic. Cloning jadR(1) from S. venezuelae in pJV73A, and introducing additional copies of the gene into the wild-type parent by plasmid transformation gave unstable strains with pJV73A integrated into the chromosome. The transformants initially showed increased production of jadomycin B but gave lower titers as excess copies of jadR(1) were lost; mature cultures stabilized with a wild-type level of antibiotic production. The mutant from which jadR(1) had been deleted could not be transformed with pJV73A. Altering the composition of jadR genes in the chromosome by integration of vectors carrying intact and disrupted copies of jadR(1) and jadR(2) provided evidence that the two genes form a regulatory pair different in function from previously reported two-component systems controlling antibiotic biosynthesis in streptomycetes.

Alleles↗

Use of degenerate primers and touchdown PCR to amplify a halogenase gene fragment from Streptomyces venezuelae ISP5230.

Consensus amino acid sequences of FADH(2)-dependent bacterial halogenases were used to design PCR primers amplifying a halogenase gene fragment from the chloramphenicol producer Streptomyces venezuelae ISP5230. The sequence-specific degenerate primers (MPF1 and MPR2) were used with a touchdown PCR procedure in the first PCR-assisted cloning of a halogenase gene fragment. In the region of the 290-bp PCR product containing the reverse primer, the deduced amino acid sequence exhibited characteristics of a beta-alpha-beta fold present in FAD-binding sites of certain monooxygenases. When used to probe Southern blots of restriction-enzyme-digested DNA, the [alpha-(32)P]dCTP-labeled PCR product hybridized specifically with DNA fragments from genomic DNA of S. venezuelae ISP5230. Primers MPF1 and MPR2 also allowed amplification by PCR of approximately 290-bp DNA fragments from several other streptomycetes. The fragments from Streptomyces aureofaciens NRRL2209 and Streptomyces coelicolor A3(2) showed sequence identity with halogenase genes from these species. Thus, the PCR primers are of potential value for amplification and subsequent isolation of actinomycete halogenase genes.

Amino Acid Sequence↗