Focus: Tuberculosis in Neglected Populations

Affiliation: Faculty of Health Sciences, Federal University of Grande Dourados (UFGD), Yale Schools of Public Health and Medicine

Contacts: Dr Julio Croda, MD, PhD, (Site PI); Dr. Mariana Garcia Croda, MD,; Dr. Albert Icksang Ko, MD, (US PI)

Projects: Federal University of Grande Dourados and Yale University have a long-standing research and training program in the city of Dourados which focuses on tuberculosis in neglected populations such as indigenous, drug users and prisoners.  The program focuses on epidemiology and social determinants of tuberculosis. The site also provides research-training opportunities in non-communicable diseases, which affect neglected populations such as sexual transmitted diseases, HIV/AIDS, suicide and violence.  Furthermore, UFGD has participated with Yale in a NIH-sponsored Global Infectious Disease Training Program (D43 TW00919) since 2008. Please contact the site PIs for more specific details.  On-going projects include:

1 ) Risk factors associated with latent tuberculosis , HIV , hepatitis B , C and syphilis in the prison population in the state of Mato Grosso do Sul (Mato Grosso do Sul State Research Foundation, FUNDECT 23/200.547/2013): The Project is a prospective cohort study that began in 2013 and involves 3,500 inmates of 12 prisons in the state of Mato Grosso do Sul.

2 ) Magnitude and severity of sequelae in tuberculosis ( TB ) residual (Brazilian National Research Council, CNPq 40/2012): is a longitudinal study of in indigenous and non- indigenous populations aimed at assessing the disease burden, risk factors and long-term impacts related to tuberculosis.

3 ) Transmission dynamics and determinants associated with the acquisition and development of tuberculosis in ethnically distinct populations (Brazilian National Research Council, CNPq 471429/2011): The study aims:

a) to identify the risk factors associated with recent transmission , determined by standard genotyping by IS6110 RFLP and MIRU – VNTR,

b) Identify outbreaks or clusters of spatiotemporal isolated cases with the same genotypic pattern,

c) Compare the traditional identification of contacts and social network analysis to identify genetically related outbreaks, d) Identify socioeconomic factors and immunological associated with the acquisition and development of tuberculosis in ethnically distinct populations residing in the city of Dourados, Brazil

4) Dynamics of recent transmission of tuberculosis and multidrug resistance on the borders of Brazil (Brazilian National Research Council, CNPq 404237/2012-6) .We will perform a multicenter study in four border regions of Brazil to establish an active surveillance of the disease with the implementation of universal culture in these locations and through a cross-sectional study to determine the variables associated with recent transmission in context of borders. We will also determine the prevalence of MDR and XDR strains in these regions as well as comparing the traditional identification of contacts and social network analysis to identify genetically related outbreaks

5 ) HIV / AIDS Depression and Cognitive Decline : Behavioral Model , Pilot Drug Discovery and Clinical Analysis (Brazilian National Research Council, CNPq 472044/2012-5): We will implement coordinated basic and clinical studies of depression and cognitive decline that arise in patients with HIV/AIDS. These pathologies seriously affect patient quality of life and result from the many effects of the virus on the central nervous system (CNS), including the pronounced CNS inflammatory response induced by HIV and the resulting elevation of inflammatory cytokines. The pathologies also arise from the neurotoxic effects of HIV proteins, including the ENV protein, which is expressed at high levels in the HIV/AIDS patient CNS.

6) Social Inequality and Tuberculosis : Spatial distribution , risk factors and pharmacogenetics in the perspective of ethnicity (National School of Public Health, INOVA - ENSP ) . The study aims 

a) To characterize the genetic risk factors related to greater adverse effects to drugs ,

b) determine the frequencies of variants of genes involved in metabolism of anti-tuberculosis drugs (NAT2, CYP2E1 and GSTs ) in patients diagnosed during the study period ;

c) Compare gene frequencies and genotype among individuals who developed adverse effects and those who did not develop.

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