Mycobacterium tuberculosis lineage 4 comprises globally distributed and geographically restricted sublineages

Generalist and specialist species differ in the breadth of their ecological niches. Little is known about the niche width of obligate human pathogens. Here we analyzed a global collection of Mycobacterium tuberculosis lineage 4 clinical isolates, the most geographically widespread cause of human tuberculosis. We show that lineage 4 comprises globally distributed and geographically restricted sublineages, suggesting a distinction between generalists and specialists. Population genomic analyses showed that, whereas the majority of human T cell epitopes were conserved in all sublineages, the proportion of variable epitopes was higher in generalists. Our data further support a European origin for the most common generalist sublineage. Hence, the global success of lineage 4 reflects distinct strategies adopted by different sublineages and the influence of human migration.We thank S. Lecher, S. Li and J. Zallet for technical support. Calculations were performed at the sciCORE scientific computing core facility at the University of Basel. This work was supported by the Swiss National Science Foundation (grants 310030_166687 (S.G.) and 320030_153442 (M.E.) and Swiss HIV Cohort Study grant 740 to L.F.), the European Research Council (309540-EVODRTB to S.G.), TB-PAN-NET (FP7-223681 to S.N.), PathoNgenTrace projects (FP7-278864-2 to S.N.), SystemsX.ch (S.G.), the German Center for Infection Research (DZIF; S.N.), the Novartis Foundation (S.G.), the Natural Science Foundation of China (91631301 to Q.G.), and the National Institute of Allergy and Infectious Diseases (5U01-AI069924-05) of the US National Institutes of Health (M.E.)

Abdominal Leiomyoma in an Adult Transgender with Adrenogenital Syndrome: A Rare Case Report

Leiomyomas of the abdomen are rare intra-abdominal tumors, particularly in male patients with adrenal hyperplasia. We report the case of a 50-year-old considers himself a with a man, who was born as a female, and has several surgeries related to transitioning from intersex to male gender. These procedures include bilateral oophorectomy with silicone testicular implantation, bilateral mastectomy with closure of the labial cleft, reconstruction of the urethral canal, and placement of testicular implants. He has a wife and two adopted children. The patient presented to the emergency department suffering from lower abdominal pain and vomiting. On examination, the abdomen appeared distended and soft. In addition to positive bowel sounds, there is a palpable large, firm, slightly tender mass occupying the lower abdomen and extending above the umbilicus, a small penis, and bilateral suspected testes in the proximal inguinal region. Abdominal radiographs, abdominal ultrasounds, and computer tomography (CT) of the abdomen and pelvis with intravenous contrast revealed a large pelvic-abdominal mass, bilaterally enlarged adrenal glands, and bilaterally implanted tests seen in the inguinal region. An ultrasound-guided tissue biopsy and an exploratory laparotomy were performed, and the tumor was completely resected. A rounded, firm mass arises from the pelvis, with histopathology revealing its origin from the remnants of the uterus and vaginal adhesions adherent to the mesentery. A tissue biopsy confirmed the leiomyom

Mycobacterium tuberculosis lineage 4 comprises globally distributed and geographically restricted sublineages

Generalist and specialist species differ in the breadth of their ecological niches. Little is known about the niche width of obligate human pathogens. Here we analyzed a global collection of Mycobacterium tuberculosis lineage 4 clinical isolates, the most geographically widespread cause of human tuberculosis. We show that lineage 4 comprises globally distributed and geographically restricted sublineages, suggesting a distinction between generalists and specialists. Population genomic analyses showed that, whereas the majority of human T cell epitopes were conserved in all sublineages, the proportion of variable epitopes was higher in generalists. Our data further support a European origin for the most common generalist sublineage. Hence, the global success of lineage 4 reflects distinct strategies adopted by different sublineages and the influence of human migration