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Silva Pereira S, Mathenge K, Masiga D, Jackson A. Transcriptomic profiling of Trypanosoma congolense mouthpart parasites from naturally infected flies. Parasit Vectors 2022; 15:152. [PMID: 35501882 PMCID: PMC9063227 DOI: 10.1186/s13071-022-05258-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Animal African trypanosomiasis, or nagana, is a veterinary disease caused by African trypanosomes transmitted by tsetse flies. In Africa, Trypanosoma congolense is one of the most pathogenic and prevalent causes of nagana in livestock, resulting in high animal morbidity and mortality and extensive production losses. In the tsetse fly, parasites colonise the midgut and eventually reach the mouthparts, from where they can be transmitted as the fly feeds on vertebrate hosts such as cattle. Despite the extreme importance of mouthpart-form parasites for disease transmission, very few global expression profile studies have been conducted in these parasite forms. Methods Here, we collected tsetse flies from the Shimba Hills National Reserve, a wildlife area in southeast Kenya, diagnosed T. congolense infections, and sequenced the transcriptomes of the T. congolense parasites colonising the mouthparts of the flies. Results We found little correlation between mouthpart parasites from natural and experimental fly infections. Furthermore, we performed differential gene expression analysis between mouthpart and bloodstream parasite forms and identified several surface-expressed genes and 152 novel hypothetical proteins differentially expressed in mouthpart parasites. Finally, we profiled variant antigen expression and observed that a variant surface glycoprotein (VSG) transcript belonging to T. congolense phylotype 8 (i.e. TcIL3000.A.H_000381200), previously observed to be enriched in metacyclic transcriptomes, was present in all wild-caught mouthpart samples as well as bloodstream-form parasites, suggestive of constitutive expression. Conclusion Our study provides transcriptomes of trypanosome parasites from naturally infected tsetse flies and suggests that a phylotype 8 VSG gene is constitutively expressed in metacyclic- and bloodstream-form parasites at the population level. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-022-05258-y.
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Affiliation(s)
- Sara Silva Pereira
- Department of Infection Biology and Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, 146 Brownlow Hill, Liverpool, L3 5RF, UK. .,Faculdade de Medicina, Instituto de Medicina Molecular - João Lobo Antunes, Universidade de Lisboa, Lisbon, Portugal.
| | - Kawira Mathenge
- International Centre of Insect Physiology and Ecology, Nairobi, Kenya
| | - Daniel Masiga
- International Centre of Insect Physiology and Ecology, Nairobi, Kenya
| | - Andrew Jackson
- Department of Infection Biology and Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, 146 Brownlow Hill, Liverpool, L3 5RF, UK.
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Glossina palpalis gambiensis (Tsetse Fly). Trends Parasitol 2020; 36:864-865. [PMID: 32563703 DOI: 10.1016/j.pt.2020.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/01/2020] [Accepted: 05/20/2020] [Indexed: 11/21/2022]
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Guschinskaya N, Ressnikoff D, Arafah K, Voisin S, Bulet P, Uzest M, Rahbé Y. Insect Mouthpart Transcriptome Unveils Extension of Cuticular Protein Repertoire and Complex Organization. iScience 2020; 23:100828. [PMID: 32000126 PMCID: PMC7033635 DOI: 10.1016/j.isci.2020.100828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 11/03/2019] [Accepted: 01/06/2020] [Indexed: 12/27/2022] Open
Abstract
Insects have developed intriguing cuticles with very specific structures and functions, including microstructures governing their interactions with transmitted microbes, such as in aphid mouthparts harboring virus receptors within such microstructures. Here, we provide the first transcriptome analysis of an insect mouthpart cuticle (“retort organs” [ROs], the stylets' precursors). This analysis defined stylets as a complex composite material. The retort transcriptome also allowed us to propose an algorithmic definition of a new cuticular protein (CP) family with low complexity and biased amino acid composition. Finally, we identified a differentially expressed gene encoding a pyrokinin (PK) neuropeptide precursor and characterizing the mandibular glands. Injection of three predicted synthetic peptides PK1/2/3 into aphids prior to ecdysis caused a molt-specific phenotype with altered head formation. Our study provides the most complete description to date of the potential protein composition of aphid stylets, which should improve the understanding of the transmission of stylet-borne viruses. First transcriptome of aphid retort glands and stylet cuticular protein composition A pyrokinin transcript is mandibular gland specific at the onset of adult moult Stylet cuticle is of higher protein complexity than other insect cuticles A new class of low-complexity cuticular proteins is predicted
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Affiliation(s)
- Natalia Guschinskaya
- Insa de Lyon, UMR5240 MAP CNRS-UCBL, 69622 Villeurbanne, France; Université de Lyon
| | - Denis Ressnikoff
- CIQLE, Centre d'imagerie Quantitative Lyon-Est, UCB Lyon 1, Lyon, France; Université de Lyon
| | | | | | - Philippe Bulet
- Platform BioPark Archamps, Archamps, France; CR University of Grenoble Alpes, Institute for Advanced Biosciences, Inserm U1209, CNRS UMR 5309, La Tronche, France
| | - Marilyne Uzest
- BGPI, Univ Montpellier, INRA, CIRAD, Montpellier SupAgro, Montpellier, France
| | - Yvan Rahbé
- Insa de Lyon, UMR5240 MAP CNRS-UCBL, 69622 Villeurbanne, France; BGPI, Univ Montpellier, INRA, CIRAD, Montpellier SupAgro, Montpellier, France; Université de Lyon.
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Tsagmo Ngoune JM, Reveillaud J, Sempere G, Njiokou F, Melachio TT, Abate L, Tchioffo MT, Geiger A. The composition and abundance of bacterial communities residing in the gut of Glossina palpalis palpalis captured in two sites of southern Cameroon. Parasit Vectors 2019; 12:151. [PMID: 30940213 PMCID: PMC6444424 DOI: 10.1186/s13071-019-3402-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 03/20/2019] [Indexed: 01/10/2023] Open
Abstract
Background A number of reports have demonstrated the role of insect bacterial flora on their host’s physiology and metabolism. The tsetse host and vector of trypanosomes responsible for human sleeping sickness (human African trypanosomiasis, HAT) and nagana in animals (African animal trypanosomiasis, AAT) carry bacteria that influence its diet and immune processes. However, the mechanisms involved in these processes remain poorly documented. This underscores the need for increased research into the bacterial flora composition and structure of tsetse flies. The aim of this study was to identify the diversity and relative abundance of bacterial genera in Glossina palpalis palpalis flies collected in two trypanosomiasis foci in Cameroon. Methods Samples of G. p. palpalis which were either negative or naturally trypanosome-positive were collected in two foci located in southern Cameroon (Campo and Bipindi). Using the V3V4 and V4 variable regions of the small subunit of the 16S ribosomal RNA gene, we analyzed the respective bacteriome of the flies’ midguts. Results We identified ten bacterial genera. In addition, we observed that the relative abundance of the obligate endosymbiont Wigglesworthia was highly prominent (around 99%), regardless of the analyzed region. The remaining genera represented approximately 1% of the bacterial flora, and were composed of Salmonella, Spiroplasma, Sphingomonas, Methylobacterium, Acidibacter, Tsukamurella, Serratia, Kluyvera and an unidentified bacterium. The genus Sodalis was present but with a very low abundance. Globally, no statistically significant difference was found between the bacterial compositions of flies from the two foci, and between positive and trypanosome-negative flies. However, Salmonella and Serratia were only described in trypanosome-negative flies, suggesting a potential role for these two bacteria in fly refractoriness to trypanosome infection. In addition, our study showed the V4 region of the small subunit of the 16S ribosomal RNA gene was more efficient than the V3V4 region at describing the totality of the bacterial diversity. Conclusions A very large diversity of bacteria was identified with the discovering of species reported to secrete anti-parasitic compounds or to modulate vector competence in other insects. For future studies, the analyses should be enlarged with larger sampling including foci from several countries. Electronic supplementary material The online version of this article (10.1186/s13071-019-3402-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jean Marc Tsagmo Ngoune
- INTERTRYP, Institut de Recherche pour le Développement, University of Montpellier, Montpellier, France.,Faculty of Science, University of Yaoundé I, P.O. Box 812, Yaoundé, Cameroon
| | - Julie Reveillaud
- ASTRE, INRA, CIRAD, University of Montpellier, Montpellier, France
| | - Guilhem Sempere
- INTERTRYP, Institut de Recherche pour le Développement, University of Montpellier, Montpellier, France
| | - Flobert Njiokou
- Faculty of Science, University of Yaoundé I, P.O. Box 812, Yaoundé, Cameroon
| | - Trésor T Melachio
- Faculty of Science, University of Yaoundé I, P.O. Box 812, Yaoundé, Cameroon
| | - Luc Abate
- UMR Maladies Infectieuses Et Vecteurs Écologie, Génétique, Évolution Et Contrôle, IRD 224-Centre National de la Recherche Scientifique, 5290-UM1-UM2, Montpellier, France
| | - Majoline T Tchioffo
- UMR Maladies Infectieuses Et Vecteurs Écologie, Génétique, Évolution Et Contrôle, IRD 224-Centre National de la Recherche Scientifique, 5290-UM1-UM2, Montpellier, France
| | - Anne Geiger
- INTERTRYP, Institut de Recherche pour le Développement, University of Montpellier, Montpellier, France. .,Center for Research on Filariasis and other Tropical Diseases (CRFilMT), P.O. Box 5797, Yaoundé, Cameroon. .,Faculty of Science, University of Yaoundé I, P.O. Box 812, Yaoundé, Cameroon.
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Zhou Y, Badgett MJ, Orlando R, Willis JH. Proteomics reveals localization of cuticular proteins in Anopheles gambiae. INSECT BIOCHEMISTRY AND MOLECULAR BIOLOGY 2019; 104:91-105. [PMID: 30278207 PMCID: PMC6370036 DOI: 10.1016/j.ibmb.2018.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/14/2018] [Accepted: 09/27/2018] [Indexed: 05/02/2023]
Abstract
Anopheles gambiae devotes over 2% of its protein coding genes to its 298 structural cuticular proteins (CPs). This paper provides new LC-MS/MS data on two adult structures, proboscises and palps, as well as three larval samples - 4th instar larvae, just their terminal segment, and a preparation enriched in their tracheae. These data were combined with our previously published results of proteins from five other adult structures, whole adults, and two preparations chosen for their relatively clean cuticle, the larval head capsules left behind after ecdysis and the pupal cuticles left behind after adult eclosion. Peptides from 28 CPs were recovered in all adult structures; 24 CPs were identified for the first time, 6 of these were members of the TWDL family. Most newly identified proteins came from the larval sources. Based solely on peptide recovery, from our data and from other investigators, most available on VectorBase, there were only 4 CPs that were restricted to a single adult structure. More were restricted to a single metamorphic stage, 14 in larvae, 0 in pupae and 32 in adults. Expression data from our earlier RT-qPCR studies reduces these numbers. Charting restriction of CPs to stage or structure is a step forward in establishing their specific roles.
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Affiliation(s)
- Yihong Zhou
- Department of Cellular Biology, University of Georgia, Athens, GA, 30602, USA
| | - Majors J Badgett
- Complex Carbohydrate Research Center, University of Georgia, Athens, GA, 30602, USA
| | - Ron Orlando
- Complex Carbohydrate Research Center, University of Georgia, Athens, GA, 30602, USA
| | - Judith H Willis
- Department of Cellular Biology, University of Georgia, Athens, GA, 30602, USA.
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Kariithi HM, Meki IK, Schneider DI, De Vooght L, Khamis FM, Geiger A, Demirbaş-Uzel G, Vlak JM, iNCE IA, Kelm S, Njiokou F, Wamwiri FN, Malele II, Weiss BL, Abd-Alla AMM. Enhancing vector refractoriness to trypanosome infection: achievements, challenges and perspectives. BMC Microbiol 2018; 18:179. [PMID: 30470182 PMCID: PMC6251094 DOI: 10.1186/s12866-018-1280-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
With the absence of effective prophylactic vaccines and drugs against African trypanosomosis, control of this group of zoonotic neglected tropical diseases depends the control of the tsetse fly vector. When applied in an area-wide insect pest management approach, the sterile insect technique (SIT) is effective in eliminating single tsetse species from isolated populations. The need to enhance the effectiveness of SIT led to the concept of investigating tsetse-trypanosome interactions by a consortium of researchers in a five-year (2013-2018) Coordinated Research Project (CRP) organized by the Joint Division of FAO/IAEA. The goal of this CRP was to elucidate tsetse-symbiome-pathogen molecular interactions to improve SIT and SIT-compatible interventions for trypanosomoses control by enhancing vector refractoriness. This would allow extension of SIT into areas with potential disease transmission. This paper highlights the CRP's major achievements and discusses the science-based perspectives for successful mitigation or eradication of African trypanosomosis.
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Affiliation(s)
- Henry M Kariithi
- Biotechnology Research Institute, Kenya Agricultural & Livestock Research Organization, P.O Box 57811, 00200, Kaptagat Rd, Loresho, Nairobi, Kenya
| | - Irene K Meki
- Insect Pest Control Laboratory, FAO/IAEA Agriculture & Biotechnology Laboratory, IAEA Laboratories Seibersdorf, A-2444 Seibersdorf, Austria
- Laboratory of Virology, Wageningen University and Research, Wageningen, 6708 PB The Netherlands
| | - Daniela I Schneider
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, New Haven, CT 06510 USA
| | - Linda De Vooght
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Fathiya M Khamis
- International Centre of Insect Physiology and Ecology, P.O. Box 30772, 00100, Nairobi, Kenya
| | - Anne Geiger
- INTERTRYP, Institut de Recherche pour le Développement, University of Montpellier, Montpellier, France
| | - Guler Demirbaş-Uzel
- Insect Pest Control Laboratory, FAO/IAEA Agriculture & Biotechnology Laboratory, IAEA Laboratories Seibersdorf, A-2444 Seibersdorf, Austria
| | - Just M Vlak
- Laboratory of Virology, Wageningen University and Research, Wageningen, 6708 PB The Netherlands
| | - ikbal Agah iNCE
- Institute of Chemical, Environmental & Biological Engineering, Research Area Biochemical Technology, Vienna University of Technology, Gumpendorfer Straße 1a, 1060 Vienna, Austria
| | - Sorge Kelm
- Department of Medical Microbiology, Acıbadem Mehmet Ali Aydınlar University, School of Medicine, 34752, Ataşehir, Istanbul, Turkey
| | - Flobert Njiokou
- Centre for Biomolecular Interactions Bremen, Faculty for Biology & Chemistry, Universität Bremen, Bibliothekstraße 1, 28359 Bremen, Germany
| | - Florence N Wamwiri
- Laboratory of Parasitology and Ecology, Faculty of Sciences, Department of Animal Biology and Physiology, University of Yaoundé 1, Yaoundé, BP 812 Cameroon
| | - Imna I Malele
- Trypanosomiasis Research Centre, Kenya Agricultural & Livestock Research Organization, P.O. Box 362-00902, Kikuyu, Kenya
| | - Brian L Weiss
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, New Haven, CT 06510 USA
| | - Adly M M Abd-Alla
- Molecular Department, Vector and Vector Borne Diseases Institute, Tanzania Veterinary Laboratory Agency, Majani Mapana, Off Korogwe Road, Box, 1026 Tanga, Tanzania
- Insect Pest Control Laboratory, FAO/IAEA Agriculture & Biotechnology Laboratory, IAEA Laboratories Seibersdorf, A-2444 Seibersdorf, Austria
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Geiger A, Malele I, Abd-Alla AM, Njiokou F. Blood feeding tsetse flies as hosts and vectors of mammals-pre-adapted African Trypanosoma: current and expected research directions. BMC Microbiol 2018; 18:162. [PMID: 30470183 PMCID: PMC6251083 DOI: 10.1186/s12866-018-1281-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Research on the zoo-anthropophilic blood feeding tsetse flies' biology conducted, by different teams, in laboratory settings and at the level of the ecosystems- where also co-perpetuate African Trypanosoma- has allowed to unveil and characterize key features of tsetse flies' bacterial symbionts on which rely both (a) the perpetuation of the tsetse fly populations and (b) the completion of the developmental program of the African Trypanosoma. Transcriptomic analyses have already provided much information on tsetse fly genes as well as on genes of the fly symbiotic partners Sodalis glossinidius and Wigglesworthia, which account for the successful onset or not of the African Trypanosoma developmental program. In parallel, identification of the non- symbiotic bacterial communities hosted in the tsetse fly gut has recently been initiated: are briefly introduced those bacteria genera and species common to tsetse flies collected from distinct ecosystems, that could be further studied as potential biologicals preventing the onset of the African Trypanosoma developmental program. Finally, future work will need to concentrate on how to render tsetse flies refractory, and the best means to disseminate them in the field in order to establish an overall refractory fly population.
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Affiliation(s)
- Anne Geiger
- INTERTRYP, Institut de Recherche pour le Développement, University of Montpellier, Montpellier, France
| | - Imna Malele
- Vector and Vector Borne Diseases Institute, Majani Mapana, Off Korogwe Road, Box, 1026 Tanga, Tanzania
| | - Adly M Abd-Alla
- Insect Pest Control Laboratory, Joint FAO/IAEA Division of Nuclear Techniques in Food and Agriculture, Vienna, Austria
| | - Flobert Njiokou
- Faculty of Science, University of Yaoundé I, P.O. Box 812, Yaoundé, Cameroon
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Awuoche EO, Weiss BL, Mireji PO, Vigneron A, Nyambega B, Murilla G, Aksoy S. Expression profiling of Trypanosoma congolense genes during development in the tsetse fly vector Glossina morsitans morsitans. Parasit Vectors 2018; 11:380. [PMID: 29970164 PMCID: PMC6029126 DOI: 10.1186/s13071-018-2964-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/20/2018] [Indexed: 02/07/2023] Open
Abstract
Background The tsetse transmitted parasitic flagellate Trypanosoma congolense causes animal African trypanosomosis (AAT) across sub-Saharan Africa. AAT negatively impacts agricultural, economic, nutritional and subsequently, health status of the affected populace. The molecular mechanisms that underlie T. congolense’s developmental program within tsetse are largely unknown due to considerable challenges with obtaining sufficient parasite cells to perform molecular studies. Methods In this study, we used RNA-seq to profile T. congolense gene expression during development in two distinct tsetse tissues, the cardia and proboscis. Indirect immunofluorescent antibody test (IFA) and confocal laser scanning microscope was used to localize the expression of a putative protein encoded by the hypothetical protein (TcIL3000_0_02370). Results Consistent with current knowledge, genes coding several variant surface glycoproteins (including metacyclic specific VSGs), and the surface coat protein, congolense epimastigote specific protein, were upregulated in parasites in the proboscis (PB-parasites). Additionally, our results indicate that parasites in tsetse’s cardia (C-parasites) and PB employ oxidative phosphorylation and amino acid metabolism for energy. Several genes upregulated in C-parasites encoded receptor-type adenylate cyclases, surface carboxylate transporter family proteins (or PADs), transport proteins, RNA-binding proteins and procyclin isoforms. Gene ontology analysis of products of genes upregulated in C-parasites showed enrichment of terms broadly associated with nucleotides, microtubules, cell membrane and its components, cell signaling, quorum sensing and several transport activities, suggesting that the parasites colonizing the cardia may monitor their environment and regulate their density and movement in this tissue. Additionally, cell surface protein (CSP) encoding genes associated with the Fam50 ‘GARP’, ‘iii’ and ‘i’ subfamilies were also significantly upregulated in C-parasites, suggesting that they are important for the long non-dividing trypomastigotes to colonize tsetse’s cardia. The putative products of genes that were upregulated in PB-parasites were linked to nucleosomes, cytoplasm and membrane-bound organelles, which suggest that parasites in this niche undergo cell division in line with prior findings. Most of the CSPs upregulated in PB-parasites were hypothetical, thus requiring further functional characterization. Expression of one such hypothetical protein (TcIL3000_0_02370) was analyzed using immunofluorescence and confocal laser scanning microscopy, which together revealed preferential expression of this protein on the entire surface coat of T. congolense parasite stages that colonize G. m. morsitans’ proboscis. Conclusion Collectively, our results provide insight into T. congolense gene expression profiles in distinct niches within the tsetse vector. Our results show that the hypothetical protein TcIL3000_0_02370, is expressed on the entire surface of the trypanosomes inhabiting tsetse’s proboscis. We discuss our results in terms of their relevance to disease transmission processes. Electronic supplementary material The online version of this article (10.1186/s13071-018-2964-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Erick O Awuoche
- Department of Biochemistry, Biotechnology Research Institute, Kenya Agricultural and Livestock Research Organization, Kikuyu, Kenya. .,Department of Biomedical Science and Technology, School of Public Health and Community Development, Maseno University, Private Bag, Maseno, Kenya. .,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA. .,Department of Agriculture, School of Agriculture and Food Science, Meru University of Science and Technology, Meru, Kenya.
| | - Brian L Weiss
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Paul O Mireji
- Department of Biochemistry, Biotechnology Research Institute, Kenya Agricultural and Livestock Research Organization, Kikuyu, Kenya.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.,Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute, Kilifi, Kenya
| | - Aurélien Vigneron
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Benson Nyambega
- Department of Medical Biochemistry, School of Medicine, Maseno University, Private Bag, Maseno, Kenya
| | - Grace Murilla
- Department of Biochemistry, Biotechnology Research Institute, Kenya Agricultural and Livestock Research Organization, Kikuyu, Kenya
| | - Serap Aksoy
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
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